ObjectiveTo evaluate the instant response and side effects of hypofractionated high-dose 3-dimensional conformal radiotherapy (3-DCRT) for esophageal carcinoma treatment.MethodsSixty-nine patients with esophageal carcinoma were treated by 3-DCRT and 91 patients with routine radiotherapy.The prescribed dose was from 3000 to 4500 cGy in 3-DCRT group, with fractionated dose 300 cGy, one dose a day and five doses a week.The reference dose curve was the 90％ of the isodose curve.For the routine radiotherapy group,the prescribed dose was from 4000 to 6600 cGy,fractionated by 180 ～200 cGy a time,once a day and 5 times a week.Results At the end of the radiotherapy, 3-DCRT produced CR 42.0％ (29/69) , PR 49.3％ (34/69) and instant response rate 91.3％, while routine radiotherapy produced CR 35.2％ (32/91), PR 59.3％ (54/91) and instant response rate 94.5％, respectively.The difference was not significant between the two groups(P ＞ 0.05) .The survival rates one year after the treatment were 82.6.0％ (57/69)and 84.6％ (77/91) ,respectively.The acute radiation esophagitis rate was 66.7％ (46/69) in 3-DCRT group and was 64.8％ (59/91) in routine radiotherapy grouprespectively.ConclusionHypofractionated high-dose 3-DCRT is feasible for treatment of esophageal carcinoma.

To analyze congenital sensorineural hearing loss combined with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). For the case of cochlear implantation to child with congenital sensorineural deafness combined BPES, accomplish routine examination and assessment, combining with literature to analyze the clinical diagnosis of this disease and its significance. Sensorineural hearing loss is a common congenital diseases with neonatal incidence of 1 per thousand - 3 per thousand, 50%-70% of deafness is associated with genetic factors, the incidence of congenital sensorineural hearing loss combined with eye disease is about 40%-60%, mainly reflected in ametropia and retinopathy. BPES's main clinical manifestations is blepharophimosis, ptosis, epicanthus inversus, and telecanthus. BPES is a rare autosomal dominant disease caused by FOXL 2 gene mutation, sometimes associated with retarded growth, delayed development, congenital heart disease, and microcephaly. Suffering from both sensorineural hearing loss and BPES is rare in reported literature. This case is diagnosed by clinical examination, without visual impairment. Facial nerve dysplasia has been found during the surgery. For congenital deafness patients with eye disease or other diseases, timely and correct diagnosis has important clinical significance, which can improve the diagnostic rate and make it coming true to early intervention, and then, effectively improve the quality of the patients. There are few literature reports, of patients with two kinds of genetic diseases. Our inference is that the cases are rare or the patients has visited different departments and ignored the other systems' signs. Therefore, in such doubtful cases, we should do the professional comprehensive examination in daily clinical work in order to avoid missed diagnosis or delayed treatment and intervention. By analyzing this case, the patient may also suffer from facial nerve dysplasia. Preoperatively viewing CT scan and operatively facial nerve monitor being used can avoid the occurrence of surgical complications.
Blepharophimosis ; complications ; genetics ; Child ; Forkhead Transcription Factors ; Hearing Loss, Sensorineural ; congenital ; diagnosis ; Humans ; Mutation ; Skin Abnormalities ; complications ; genetics ; Urogenital Abnormalities ; complications ; genetics

Child ; Cochlear Implantation ; rehabilitation ; Hearing Loss ; rehabilitation ; surgery ; Hearing Tests ; Humans ; Surveys and Questionnaires

Objective To study clinical feature of diagnosis of pancreatic cancer,in order to reach early diagnosis.Methods 70 cases of pancreatic cancer from ours in-patients 1990 to 2000 were reviewed and analyzed.Results The number of patients with stage Ⅰ～Ⅱ were only 8 cases(11 4%). 40 patients (57 1%) hospitalized within one month after they felt ill.19 cases(29 1%) were diagnosed as pancreatic cancer within one month,including 5 patients(26 3%) with stage Ⅰ or Ⅱ .Abdominal pain(73 4%),jaundice(10 1%) and discomfort of upper abdominal(5 8%) were the most common initial symptoms.misdiagnosis were 40(57 1%) cases .The most common misdiagnosis were chronic gastritis(21 4%),chromic cholecystitis(7 14%) and peptic ulcer(5 71%).The serum levels of CA199,CA125 were higher in 16/18 cases (88 9%) and 6/7 cases (85 7%) respectively. Three cases in stage I or II were found higher serum CA125 and other tumor marker normal.Five patients were diagnosed as diabetes within five months before the diagnosis of the cancer.Conclusions For most of the patients with pancreatic cancer ,usually they were definite diagnosis in moderate or advanced stage. So the status of the diagnosis of pancreatic cancer is disappointed . Hospitalizing late,being misdignosed and developing quickly were the main causes;The most common misdiagnosis are chronic gastritis, cholecystitis and peptic ulcer;elevation of serum CA199 and CA125 are sensitive to diagnose pancreatic cancer. Detections of CA125 and hyperglycemia may favour earlier diagnosis of pancreatic cancer.

Objective To estimate the application of ultrasound measurement of detrusor wall thickness (DWT) in the assessment of curative effect after operation. Methods Detrusor thickness was measured by linear ultrasound (7. 5 MHz) either at a filling volume of 50% of cystometric capacity or at 250 ml filling in 86 patients, who were diagnosed equivocal BOO, during a pressure-flow study. All patients accepted transurethral resection of the prostate. At 3 months post-surgery, the patients were divided into two groups according to curative effect after operation. The volume of the prostate, age and DWT were compared between the two groups. Results There was no difference in either age or volume of the prostate between the two groups. DWT was significantly higher (P＜0.01) in the more curative effect group (37 cases, DWT 2. 5±0.3 mm) compared to the less curative effect group (49 cases, 2.2±0. 3 mm). As a predictor of curative effect, DWT of 2. 8 mm or greater had a positive predictive value of 100%, a negative predictive value of 62%, specificity of 100% and sensitivity of 19%. Receiver operating characteristic analysis (ROC) revealed that DWT had a high predictive value for curative effect post-surgery with an AUC of 0. 84±0. 04. Conclusions In patients with equivocal BOO, ultrasonographically assessed detrusor thickness may have a predictive value for curative effect post-surgery. However, this cutoff value needs to be validated in a larger study population.

Objective To assess the environmental contact allergens in patients with allergic contact dermatitis (ACD).Methods Totally,167 patients with ACD were included in this study.All the patients underwent patch test.Results Of these patients,92 (55.1％) were diagnosed as facial ACD,and 148 showed positive patch test results (88.6％).The six most common allergens in a decreasing order were nickel sulfate,fragrance mix,paraphenylenediamine,thimerosal,octanoates and amerchol L 101.Conclusion Patch test may be an efficient way to confirm the cause of ACD.

Objective To explore the mechanisms of posterior pilon fractures and evaluate the curative effects of different types of fixation on the treatment of posterior pilon fractures.Methods We included in this retrospective study 20 patients with posterior pilon fracture who had been treated from January 2012 to January 2015 at our department.They were 10 men and 10 women,from 23 to 77 years of age (average,50.6 years).According to the classification by Yu Guangrong,5 cases belonged to type Ⅰ,3 to type Ⅱa,4 to type Ⅱb,and 7 to type Ⅲ.One was not indentified because of lacking CT examination.The mechanisms included ground level fall in 2 cases,motor vehicle accident in 7,fall off stairs in 5,sport injury in 2,fall from a bike in one and fall from a height in 3.More than 25％ of the articular surface was involved in 13 patients.Syndesmosis injury was identified in 6 patients by Cotton test during operation.Internal fixation varied accordingly.We recorded the mechanism,classification,proportion of the articular surface involved (more or less than 25％),and syndesmosis injury to figure out the characteristics of posterior pilon fractures.We used the Burwell-Charnley radiographic criteria to assess the postoperative reduction of the articular surface,and the Olerud-Molander scoring scale and visual analogue scale (VAS) to assess the ankle function.The curative effects of different types of fixation on the treatment of posterior pilon fractures were compared.Results Of the 20 patients,17 were available for follow-up for 6 to 36 months (average,17.8 months).Two patients received reoperation because of implant failure after cannulated screw fixation from anterior to posterior.The Burwell-Charnley radiographic evaluation revealed 12 anatoinical reducations and 8 fair reductions.The mean Olerud-Molander score for the 17 patients at the final follow-ups was 81.5 (range,from 35 to 100) and the mean walking VAS was 1 (from 0 to 3).Conclusions Posterior pilon fractures are mostly caused by medium to high energy violence,resulting from a combination of rotational and vertical forces.Since there is a high risk of implant failure,the cannulated screw fixation from anterior to posterior is not recommended.Good clinical outcomes are observed in the cannulated screw fixation from posterior to anterior and the plate/cannulated screw fixation for posterior pilon fractures.

Objective To compare the effect of thoracoscopic and laparoscopic surgery with conventional thoracic surgery on esophageal cancer and its influence on pulmonary function. Methods Ninety?four patients with esophageal cancer treated in the Second Affiliated Hospital of Chengdu Medical College from March 2010 to March 2016 were selected and were divided into the control group ( 54 cases) and the study group ( 40 cases) according to operation methods. The control group received traditional thoracotomy. The study group received thoracoscopic and laparoscopic surgery. The operation and pulmonary function indexes were compared. Results The operation time of the patients in the study group was significantly longer than that in the control group ( (218. 1±35. 8) min vs. (192. 3±40. 1) min,t=3. 23,P<0. 05). Intraoperative blood loss of the patients in the study group was significantly less than that in the control group ( (286. 4±83. 5) ml vs. (343. 7 ±96. 7) ml,t=3. 01,P<0. 05) . The number of lymph nodes cleared of the patients was significantly higher in the study group ( (18.0±5.4) node vs. (15.5±4.6) node,t=2.42,P<0.05).Thoracic drainage of the patients in the study group was significantly less than that in the control group ( (650. 3±61. 3) ml vs. (1153. 5 ±133. 7) ml,t=22. 12,P<0. 05). Chest tube pull out time in the study group was significantly earlier than that in the control group ( (5. 1±1. 3) d vs. (8. 0±1. 8) d,t=8. 65,P<0. 05). First exhaust time in the study group was significantly earlier than that in the control group ( (33. 2±6. 7) h vs. (40. 7±7. 3) h,t=5. 10,P<0. 05). Hospital stay in the study group was significantly shorter than that in the control group ( ( 13. 8 ± 2. 8 ) d vs. (18. 2± 3. 6) d, t=6. 42, P<0. 05) . Postoperative complications occurred in 4 cases in the study group, accounting for 10%, significantly lower than that in the control group, 15 cases, 27. 8%, the difference was statistically significant (χ2=4. 50,P<0. 05) . VC,FEV1 and MVV in the study group were significantly higher than those in the control group ( VC:( 81. 5 ± 15. 6 )% vs. ( 42. 3 ± 8. 1 )%;FEV1: ( 85. 7 ± 9. 1 )% vs. ( 43. 6 ±6. 8)%;MVV:(76. 0±8. 9)% vs. (48. 3±7. 6)%,t=15. 83,25. 68,16. 24,P<0. 05). 3?year survival rate of the study group and the control group were 45. 0% (18/40) and 44. 4% (24/54),respectively. There was no significant difference between the two groups (χ2 = 0. 01, P> 0. 05 ) . Conclusion Thoracoscopic and laparoscopic surgery for esophageal cancer has the advantages of small trauma,rapid recovery and low incidence of complications and obvious protective effect on pulmonary function. It is safe and feasible.