OBJECTIVETo evaluate the clinical effects of iliolumbar fixation for the sacrum fractures of Denis type II.

METHODSThe clinical data of 86 patients with sacrum fracture of Denis type II treated by iliolumbar fixation from January 2008 to January 2012 were retrospectively analyzed. There were 55 males and 31 females, aged from 17 to 55 years old with an average of 39.1 years. Among them, 73 cases complicated with pelvis fracture and 13 cases with acetabular fracture; 37 cases with sacral neurological symptoms and 49 cases without sacral neurological symptoms. Fracture healing time, nerve function, clinical function and complications were observed in the patients.

RESULTSIn 86 cases, 6 cases were out of followed-up and 80 cases were followed up from 24 to 71 months with an average of 36 months. The mean fracture healing time was 13 weeks (ranged, 10 to 38 weeks). According to Gibbons scoring to evaluate the neurological function, preoperative nerve rehabilitation, lower limbs feeling, lower limbs activity,bladder and rectum function,total score respectively were 0.62 +/- 0.04, 1.54 +/- 0.35, 1.12 +/- 0.18, 0.23 +/- 0.01, 3.46 +/- 0.47 and postoperative respectively were 0.82 +/- 0.12, 0.36 +/- 0.04, 0.05 +/- 0.01, 0.03 +/- 0.01, 1.25 +/- 0.22, there were statistically significant differences between preoperative and postoperative (P < 0.05). According to Majeed scoring to evaluate the clinical function, postoperative pain, standing, sitting, sexual life, work ability, total score respectively were 22.54 +/- 4.02, 27.93 +/- 5.46, 8.47 +/- 3.61, 2.54 +/- 1.33, 16.46 +/- 4.34, 81.32 +/- 8.73, 60 cases got excellent results, 17 good, 3 fair. The main complications including fracture nonunion of 5 cases,deep incision infection of 1 case, and screw prominence resulting uncomfortable of 8 cases.

CONCLUSIONIliolumbar fixation has the advantages of stable fixation, satisfactory functional rehabilitation, less complications, and is a good method in treating sacrum fracture of Denis type II.

Adolescent ; Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sacrum ; injuries ; surgery ; Spinal Fractures ; surgery ; Treatment Outcome ; Young Adult

Objective To discuss the feasibility and accuracy of left atrial appendage (LAA)ejection fraction by real-time 3 dimensional imaging (3D-EF),and tissue velocity of the LAA wall by tissue Doppler imaging (TDI)via transesophageal echocardiography (TEE)in assessing LAA functions.Methods A total number of 76 patients with atrial fibrillation (AF)were included in the study consecutively and underwent TEE for LAA investigations.3D-EF,fractional area change by 2 dimensional imaging (2D-FAC),peak emptying velocity (PEV),LAA tissue velocity by TDI at the mid-portion of lateral wall (TDI-L),mid-portion of septal wall (TDI-S)and the apical tip (TDI-A)were calculated.Results Statistic analysis showed the following results:1 )2D-FAC,3D-EF,PEV,TDI-L,TDI-S and TDI-A were all significantly higher in patients with sinus rhythm than those with AF during the TEE examinations (all P <0.05),and significantly higher in patients without spontaneous echo contrast (SEC)than those who had SEC (all P <0.05);2)The results of 3D-EF showed a good correlation with 2D-FAC (r=0.727,P =0.000),and their correlations with PEV were similar (2D-FAC and PEV:r =0.685;3D-EF and PEV:r =0.632,both P =0.000);3)TDI-A [(14.95±4.63)cm/s]were significantly higher than TDI-L [(12.62±3.96)cm/s]and TDI-S [(12.68±3.59)cm/s](both P =0.000).The correlations of TDI-A with PEV,2D-FAC and 3D-EF were all marked higher than those of TDI-L and TDI-S (with PEV:r=0.840 vs r=0.564,r=0.524;with 2D-FAC:r=0.701 vs r=0.486,r=0.504;with 3D-EF:r=0.753 vs r=0.493,r=0.522,all P <0.05). Conclusions 3D TEE is feasible and reliable in assessing LAA emptying function.The best location for LAA tissue velocity evaluation is the apical tip.

Objective To evaluate the efficacy of mitomycin (MMC) intravesical chemotherapy for superficial bladder carcinoma by in vitro chemosensitivity using histoculture drug response assay (HDRA).Methods Forty-one cases of superficial bladder transitional cell carcinoma(TCC) were obtained,including 30 males and 11 females with mean age of 55 years.Of them,10 cases were Ta and 31 were T1 according to TNM stage system (UICC 2002) while 9 cases were G1,22 were G2 and 10 were G3 (WHO1973).All cases had no chemotherapy history before operation and were operated to retain bladder.Tumor specimens were cultured by three-dimensional histoculture.HDRA with im-proved MTT assay was utilized for chemosenstivity test of MMC with 1 g/L concentration and 2 hours exposure.Growth inhibition rate (GI) exceeding 70% was defined as high-sensitive while less than 50% GI was defined as insensitive,others were moderate-sensitive.All cases were performed standard intravesical chemotherapy with MMC 40 mg plus 40 mt saline.Every case was followed up every 3 months.The patients were followed up for 5 years or untill recurrence.Results The MMC chem-osensitivity was different among 41 patients.Thirteen cases were insensitive including 1 of Ta,12 of T1 (P=0.009) and 1 of G1,7 of G2,5 of G3(P=0.101).Total recurrence rate was 39%(16/41) af-ter 3 to 5 years follow-up.There were 1 of Ta,15 of T1 (P=0.059) and 10 of G2 6 of G3 (P=0.016).Insensitive group recurrence rate was 77% (10/13) while sensitive group was 21% (6/28,P= 0.004).Patients in sensitive group showed a longer median time(49.2 months) than patients in insen-sitive group (16.5 months,P<0.001) according to Kaplan-Meier analysis with Log-rank test.The MMC chemosensitivity was independent prognostic factor examed by Cox regression analysis (P= 0.008).There was a 78% correlation rate of chemosensitivity by HDRA to clinical effect of MMC in-travesical chemotherapy.Conclusion HDRA could evaluate MMC intravesical chemotherapy for su-perficial bladder TCC,improve therapeutic effect and lower tumor recurrence rate.

Objective To investigate the effect of dexmedetomidine combined with the preemptive analgesia with dezocine on the treatment of patients with prolapse and prolapse of hemorrhoids (PPH).Methods A total of 60 patients with PPH were randomly divided into dexmedetomidine + dezocine group (group A) and normal saline + dezocine group (group B).All patients received lowdose saddle anesthesia,and at the time points of saddle anesthesia fixed plane (T0),firing the stapler (T1) and at the end of operation (T2),systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),Ramsay sedation score,the incidence of postoperative analgesic effect and complications were compared between two groups.Results At T1 and T2,the SBP,DBP and HR of group A were significantly lower than those of group B (P ＜ 0.05),and the score of Ramsay sedation was significantly higher than that of group B (P ＜ 0.05).The analgesic effect VAS scores of group A at 4,8,12,24 and 48 h after operation were significantly lower than those in group B (P ＜0.05).There was no significant difference in anal distention and discomfort between the two groups (P ＞ 0.05).There were significant differences in the incidence of urinary retention,nausea and vomiting,and nocturnal sleep disorders between the two groups (P ＜ 0.01).Conclusion Dexmedetomidine combined with preemptive analgesia with dezocine is effective in treatment of patients with PPH surgery.

Objective To investigate the effect of dexmedetomidine combined with the preemptive analgesia with dezocine on the treatment of patients with prolapse and prolapse of hemorrhoids (PPH).Methods A total of 60 patients with PPH were randomly divided into dexmedetomidine + dezocine group (group A) and normal saline + dezocine group (group B).All patients received lowdose saddle anesthesia,and at the time points of saddle anesthesia fixed plane (T0),firing the stapler (T1) and at the end of operation (T2),systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),Ramsay sedation score,the incidence of postoperative analgesic effect and complications were compared between two groups.Results At T1 and T2,the SBP,DBP and HR of group A were significantly lower than those of group B (P ＜ 0.05),and the score of Ramsay sedation was significantly higher than that of group B (P ＜ 0.05).The analgesic effect VAS scores of group A at 4,8,12,24 and 48 h after operation were significantly lower than those in group B (P ＜0.05).There was no significant difference in anal distention and discomfort between the two groups (P ＞ 0.05).There were significant differences in the incidence of urinary retention,nausea and vomiting,and nocturnal sleep disorders between the two groups (P ＜ 0.01).Conclusion Dexmedetomidine combined with preemptive analgesia with dezocine is effective in treatment of patients with PPH surgery.

OBJECTIVETo study the usefulness of the intraoperative photodynamic diagnosis (PDD) and fluorescence-guided resection of malignant gliomas.

METHODSFifteen consecutive patients with malignant gliomas received doses of hematoporphyrin derivative (HPD, 2 mg/kg body weight) 48 hours before induction of anesthesia. After the tumors recognized by bare eyes they were removed routinely. The fluorescence around 690 nm excited by laser beam (wavelength 632.5 nm) was detected by laser electronic spectrum analyzer and then fluorescing tissue was removed whenever it was considered safel. Tissue samples derived from the walls of tumor cavities after resection and PDD were sent for histological examination. Compared with the result of the histological examination, the sensitivity and specificity of PDD were calculated and recorded. Early postoperative MRI or CT were done to determine the extend of the resection of the tumors. Surgical mortality and morbidity were also recorded.

RESULTSIntraoperatively, in all of 15 cases tumor areas with HPD fluorescence could be recognized by laser electronic spectrum analyzer. On the basis of 106 tissue samples derived from 15 tumors, a sensitivity of 90.6%, a specificity of 96.8% and an accuracy of 94.3% of PDD were achieved. In 2 cases the resection of residual tumor were performed after finding left tumors by PDD. Complete resection of contrast-enhancing tumor was accomplished in 9 patients (60%). Residual intraoperative tissue fluorescence left unresected for safety reasons predicted residual enhancement on MR images in 5 of the 6 remaining patients. No perioperative deaths and one case of morbidity were encountered.

CONCLUSIONSIntraoperative photodynamic diagnosis following resection of malignant gliomas can detect residual tumor tissue with high accuracy. Photodynamic diagnosis and fluorescence-guided resection of malignant gliomas have a positive role in improving the radicality of malignant glioma resection.

Adult ; Brain Neoplasms ; diagnosis ; surgery ; Female ; Glioma ; diagnosis ; surgery ; Hematoporphyrin Derivative ; Humans ; Male ; Middle Aged ; Photosensitizing Agents ; Retrospective Studies ; Spectrometry, Fluorescence ; Treatment Outcome

Objective To study the application of pediculated skin flaps in the treatment of com-plicated long urethratresia. Methods From March 1999 to May 2006, a total of 18 male patients with complicated long urethratresia were treated by using the pediculated skin flaps. The causes of urethratresia were 7 cases of postoperative pelvic fractures with posterior urethral stricture, 4 cases of transurethral intravesical chemotherapy, 3 cases of postoperative bulbar urethral stricture, 2 cases of gonorrhea, and 2 cases of long-time urethral catheter placement. Four cases were urethratresia nf cor-pus penis, 7 cases were anterior urethral obliteration, 7 cases were posterior urethral and anterior ure-thral obliteration. Urethro-perineal fistulas were found in 8 cases, posterior urethrorectal fistulas in 7 cases, false passage formations in 8 cases. The average length of urethratresia was 15.1 cm (range 8. 7 to 23. 0 cm). The urethral scar was rasected, the posterior urethrorectal fistula was repaired, and different kinds of pediculated skin flaps depending on the length of urethratreaia was used. Results All the patients were followed up for 12 to 18 months (mean 14 months). Fifteen patients voided well 3 months postoperatively, none of the urography showed stricture. The mean peak urinary flow rate was 16. 9 ml/s (range from 16. 5 to 21.7 ml/s). Of the other 3 cases, 1 case experienced difficult voi-ding due to the long and circuitous tabularized skin flap but recovered after proper shortening;1 case had restenosis for the infection of anastomosis but voided well after excision and reanastomnsis;1 casehad a urinary fistula resulting from hematoma and infection, but was successfully treated by the neo-plasty of the urinary fistula. The mean peak urinary flow rate was 17.0 ml/s (range 15.0 to 22.0 ml/s) for 17 patients 6 months postoperatively, except for one who experienced genuine urinary incon-tinence. At 9-18 months after operations, the mean peak urinary flow rate was 17.5 ml/s (range 15.8 to 22.5 ml/s) for 17 patients. Conclusion The single-stage urethroplasty based on pediculated skin flaps is a reliable and durable method for complicated long urethratresia.

OBJECTIVETo characterize the clinical features of Chinese HNPCC families and to screen the mutations of a poly-(A)8 tract in M3 cholinergic receptor gene in these families.

METHODSThe clinical features of 15 Chinese HNPCC families were characterized. Genomic DNAs from 15 probands were prepared. PCR and direct DNA sequencing analysis were employed to examine the mutations of a poly-(A)8 tract in exon 8 of M3 cholinergic receptor gene.

RESULTSTotal 55 cancer patients were found in 15 families including 41 cases of colorectal carcinoma with an average of 2.73 colorectal carcinomas developed per family. Thirty out of forty-one (73%) patients were diagnosed before age of 50 years. Proximal colon was involved in 51% of patients, while anus and rectum were 40 %. Synchronous and metachronous multiple colorectal cancers developed in 5 patients (12%). Two thirds of families belonged to Lynch II syndrome, and total 18 extracolonic malignancies in 14 patients were identified. Gastric carcinoma was the most common extracolonic types. In 15 HNPCC probands, no mutation was detected in the poly-(A)8 tract of exon 8 of M3 cholinergic receptor gene.

CONCLUSIONM3 cholinergic receptor gene might have little relation with HNPCC in Chinese population. The criteria for Chinese HNPCC are useful and practical in clinical application.

Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; genetics ; Colorectal Neoplasms, Hereditary Nonpolyposis ; genetics ; pathology ; Family Characteristics ; ethnology ; Family Health ; Female ; Gene Expression Regulation, Neoplastic ; genetics ; Humans ; Male ; Middle Aged ; Mutation ; Pedigree ; Phenotype ; Poly A ; Receptor, Muscarinic M3 ; genetics

OBJECTIVEExperiences and lessons of uvulopalatopharyngoplasty (UPPP ) perioperative management, especially causes of postoperative tracheotomy, were analyzed, and related strategy was raised to have a better perioperative management and to avoid tracheotomy.

METHODSTwo hundred and fifty eight cases of obstructive sleep apnea hypopnea syndromes (OSAHS) diagnosed with polysomnography (PSG) were treated with modified uvulopalatopharyngoplasty (UPPP). The perioperative management was summarized. Patients were divided into two groups according to the perioperative management: without or with perioperative comprehensive management. In group A, there were 32 patients, without comprehensive management, and in group B there were 226 cases with comprehensive management. Sixty eight cases in group B whose apnea hypopnea index over 50 times per hour and the lowest arterial oxygen saturation was less than 0.5 were treated with continuous positive airway pressure (CPAP) for 1 to 3 weeks. For all the 258 cases, perioperative management includes treatment of medical complications, treatment with antibiotics 2 or 3 days before the operation. None of these cases had tracheotomy before surgery.

RESULTSIn group A, three of 32 patients had postoperative tracheotomy, two because of bleeding, and another one because of laryngeal spasm. In group B, none of 226 patients underwent tracheotomy, which owing to modified operative apparatus and effective perioperative and postoperative treatment (chi2 = 21.35, P < 0.001). In group A, 5 of 32 patients had oral pharynx bleeding after 24 hours of the operation. While 26 of 226 patients in group B did so (chi2 = 0.15, P > 0.05).

CONCLUSIONComprehensive perioperative management can effectively lower down the complication rate for patients receiving uvulopalatopharyngoplasty.

Adult ; Cleft Palate ; surgery ; Female ; Humans ; Male ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; adverse effects ; Palate ; surgery ; Pharynx ; surgery ; Postoperative Complications ; surgery ; Retrospective Studies ; Sleep Apnea, Obstructive ; surgery ; Tracheotomy ; adverse effects ; Treatment Outcome ; Uvula ; surgery

Objective To evaluate the therapeutic effect of hBNP on rats with chronic heart failure (CHF). Methods Thirty CHF rats defined by echocardiography at 12 weeks post abdominal aortic constriction were randomly divided into Ad-hBNP group (2. 5 × 1010 VP/ml NS Ad-hBNP 1 ml/week ×4,n = 14), Ad-Track group ( n = 8 ), placebo group ( NS, n = 8 ), 10 sham-operated rats served as control group. After 4 weeks treatment, cardiac function was evaluated by echocardiography and hemodynamic measurements. Heart weight (HW) and HW/body weight (BW) ratio were determined. Results IVS,LVPW, LVEDD and LVESD were significantly reduced in the Ad-hBNP group [(2. 34 ±0. 29)mm, (2. 28 ± 0. 18)mm, (6. 50 ±0. 42)mm, (3.54 ±0. 59) mm] than those in the Ad-Track group[(2. 71 ±0. 35) mm,(3.02 ±0.85)mm, (7.71 ±0.83)mm, (4.72 ±0.80)mm] and in the NS group [(2.78 ±0.23)mm,(2. 83 ± 0. 53 ) mm, (7. 34 ± 0. 97 ) mm, (4. 55 ± 0. 77 ) mm, all P ＜ 0. 05]. The LVEF and LVFS of the Ad-hBNP group [(79. 27 ±7.01 )%, (43.38 ±6. 73)%] were significantly higher than in the Ad-Track group[(70.85±4.81)%, (35.72 ±3.68)%] and in the NS group[(69.67 ±6.90)%, (34.91 ±5.10)%, all P ＜0. 01]. HR[(417.48 ±32. 57) beats/min, (446. 85 ±61.49) beats/min, P ＜0. 05;(440. 83 ±32. 18) beats/min , P ＜0. 05], LVEDP[( - 4. 24 ±4. 00) mm Hg( 1 mm Hg =0. 133 kPa);(21.99 ±6. 80) mm Hg, P ＜0. 01; ( 18.00 ± 12. 25)mm Hg, P＜0. 01] were significantly decreased and while LVSP[(131.79 ±15.76) mm Hg; (112.99 ±32.35) mm Hg, P＜0.05; (117.13 ±15.26)mmHg], +dP/dtmax[(5037.20 ±430.41) mm Hg/s; (4217.40 ± 1354. 15)mm Hg/s, P ＜0.05;(4310. 50 ± 1293.97 ) mm Hg/s, P ＜ 0. 05] and - dP/dtmax [( - 4382. 00 ± 1304. 79 ) mm Hg/s;(-3725.00±791.34) mm Hg/s, P ＜ 0.05; ( - 3890.00 ± 1043.73) mm Hg/s, P ＜ 0.05] were significantly increased in Ad-hBNP group than in Ad-Track group and NS group ( all P ＜ 0. 05 ). HW and HW/BW were also decreased in Ad-hBNP group than in the Ad-Track group and the NS group. Conclusion Exogenous hBNP improved the cardiac function and attenuated remodeling in CHF rats.