Objective To investigate the effect of Fillet flap and postoperative pressure combined with magnet pieces and triamcinolone acetonide injection therapy for keloid in aural region.Methods From January 2009 to January 2011,87 patients (102 side ears) with keloid at the aural region were treated.Fillet flap repaired for keloid in aural region,pressure treating by magnet pieces began at 14 days after operation,and continued for more than one year.Triamcinolone acetonide injection therapy began 1 months after operation if keloid recurrence tendency.Results After operation,80 patients (94 lateral ears) healed by first intention.Hematoma under flap appeared in 7 patients (8lateral ears),and healed by changing dressings.And 87 cases (102 lateral ears) were followed up for 1 year.The effect of operation and pressure therapy group and operation,pressure and injection therapy group was significantly higher than operation group,with statistically significant differences.Effect of operation,pressure and injection therapy group was higher than that of operation and pressure therapy group,but there was no significant difference.Conclusions Fillet flap and postoperative pressure combined with magnet pieces and triamcinolone acetonide injection therapy can effectively treat aural region keloids.

Although traditional Chinese medicine (TCM) shows its effectiveness undoubtedly in clinical practice, the deficiency in objective assessment methods is yet a bottleneck which has restricted its development of modernization and internationalization. On the basis of clinical experiences, the authors discussed the title cutting from current situation and tendency, and expanded gradually. It is concluded that by aiming directly at problems and referring to the principle and methods of evidence-based medicine (EBM), using rationally the design in clinical practice and combined with individualization and standardization should be a feasible way for TCM clinical therapeutic effect assessment.
Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Evidence-Based Medicine ; methods ; standards ; Humans ; Medicine, Chinese Traditional ; methods ; standards ; Phytotherapy ; Research Design

Biomedical Research ; trends ; Humans ; Medicine, Chinese Traditional

OBJECTIVETo investigate the way of diagnosis and therapy of parosteal osteosarcoma.

METHODSA retrospective review was conducted of 48 patients treated at our department between June 1964 and December 2001. The average age of patients in this study was 29.2 years (13 - 47 years). Thirty-two of the patients were female; sixteen were male. The single most common site is the posterior aspect of the distal femur (in 36 patients), followed by the femur shaft (in 6 patients), the proximal tibia (in 2 patients), etc. Nine patients had been operated on before referral to our department.

RESULTSThe average follow-up period from the first operation was 5.2 (0.25 - 24) years. In 36 of the 39 patients in whom a limb-salvage procedure was performed, a segment of the tumor-bearing bone was excised along with the tumor, whereas in 3 patients only the subadjacent cortex was excised with the tumor. In the limb-sparing group, the reconstruction was achieved by means of attenuated tumor bone or allograft in 23 cases, by endoprosthetic replacement in 9 cases, and by allograft replacement in 4 cases. The local resections were wide in 35 cases, and marginal in 13 cases. After marginal surgery, local recurrence occurred in 5/13 patients, whereas it occurred in 3/35 patients treated with wide resection. Pulmonary metastases developed in 6 patients, four patients died, and 2 patients are alive with disease. There were 4 cases of fractures of bone grafts. Four patients developed an infection. Long-term survival rate is 85.8%. For tumors that invaded the medullary canal there was no statistical association with local recurrence or metastasis. There is statistical significance between surgical margin and local recurrence.

CONCLUSIONSWide surgical excision alone is adequate treatment for patients with conventional parosteal osteosarcoma. A tumor-free margin remains the critical factor determining overall prognosis. When a marginal excision was knowingly done to preserve a major neurovascular bundle, the risk of recurrence was less than when it was done to shell-out a presumptively benign lesion. Repeated recurrence probably increases the risk of dedifferentiation and thereby worsens the prognosis. Recurrent lesions with multiple soft-tissue satellite nodules or involvement of the neurovascular structures may however require amputation to provide sufficient local control when a wide margin cannot be achieved. An individualized resection will be performed in the future probably under the help of the advanced technique of image to distinguish the reactive zone from the normal tissue precisely.

Adolescent ; Adult ; Bone Neoplasms ; diagnostic imaging ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Osteosarcoma, Juxtacortical ; diagnostic imaging ; surgery ; Prognosis ; Radiography

In the experiment, we designed and synthesized two siRNAs based on the sequence of nuclear receptor-related factor 1 (Nurr1) mRNA. They were separately subcloned into the plasmid of pSilenCircle (pSC) containing U6 promoter. The pSC-Nurr1 vectors (pSC-N1 and pSC-N2) specific to Nurr1 gene and the negative control vector of short-hairpin RNA (shRNA) eukaryotic expression vector were constructed. We cultured the dopaminergic cell line MN9D and the verified vectors were transfected with LipofectamineTM 2000 in vitro. The positive cell clones transfected with pSC were obtained after being screened with 500 mug/ml G418. After that, the silencing effects of Nurr1 and TH mRNA or protein were detected by real time RT-PCR and Western blot. The neurite extension of MN9D cells was observed and photographed by inverted microscope. The results showed that Nurr1 mRNA expression in MN9D cells was specifically down-regulated by the vectors of pSC-N1 and pSC-N2, and the silencing effects were 62.3% and 45.6%, respectively. The dopaminergic phenotype of TH mRNA was also suppressed significantly and the silencing effects were 76.3% and 62.6%, respectively. Meanwhile, the expressions of Nurr1 and TH proteins were also significantly suppressed, and the silencing effects of Nurr1 and TH protein were 57.4%, 72.0% and 79.1%, 70.1% respectively. The negative control and liposome groups had no effect on the two genes. In conclusion, Nurr1 shRNA expressing vectors can inhibit the expressions of Nurr1 and TH mRNA or protein in MN9D cells, and Nurr1 might play a role in neurite extension of MN9D cells. Nurr1 shRNA expressing vector may provide a novel applicable strategy for the study on the function of the genes associated with Parkinson disease and the development of dopaminergic neuron.
Cell Line ; Dopaminergic Neurons ; cytology ; metabolism ; Down-Regulation ; Fetus ; Humans ; Mesencephalon ; cytology ; Neurites ; physiology ; Nuclear Receptor Subfamily 4, Group A, Member 2 ; genetics ; metabolism ; RNA, Messenger ; genetics ; metabolism ; RNA, Small Interfering ; genetics ; Transfection ; Tyrosine 3-Monooxygenase ; genetics ; metabolism

OBJECTIVETo improve the life quality of cancer patients with metastasis to long bone and to select suitable surgical treatment.

METHODSFifty two patients with metastasis 27 men and 25 women, were treated from 1990 to 1999. Their average age was 56.8 years (33 - 74). In 16 patients with multiple lesions, underwent surgery at bone shaft (29 patients) and bone epiphysis (26). Thirty patients were treated for pathologic fracture and the rest for impending fracture. Operations included limb-salvage (51 patients) and amputation (4) Limb salvage consisted of intralesional curettage (3 patients), intramedullary nailing reconstruction (29), endoprosthesis (18), and temporary spacer (1). 21 patients accepted postoperative chemotherapy or radiotherapy.

RESULTSFollow-up of 52 patients for a mean of 28.2 months (2 - 122 months) showed pain relief (41 patients), (75%) and full or part weight-bearing stability (36) 69%. Local tumor recurrence occurred in 11 patients.

CONCLUSIONSSurgical treatment can effectively improve the life quality of patients with metastasis to long bone. The metastatic lesions should be resected with wide or radical margin for the patients with kidney, breast, prostate and thyroid cancer.

Adult ; Aged ; Bone Neoplasms ; pathology ; secondary ; surgery ; Female ; Follow-Up Studies ; Humans ; Limb Salvage ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo evaluate the differences in selecting patients who will undergo operation by comparing the evaluating systems and to discuss the indication of surgery performed on patients with spinal metastases.

METHODSOf the 113 patients presented at Jishuitan Hospital, Beijing, PRC. from February 1994 to February 2002, who were diagnosed as spinal metastases, the clinical, pathological and imaging records of 82 patients were reviewed. Harrington's classification system, Tokuhashi's scoring system, Tomita's scoring system, and Grubb's scoring system were used to evaluate each of these patients at the same time. The classification or score concerning each patient was recorded and compared. SPSS software was used for statistical analysis. McNemar Test was used to compare the proportion of surgery indicated by different evaluating systems.

RESULTS(1) Surgical treatment was indicated for 92.7% of patients by Tomita's scoring system and 69.5% by Harrington's classification system respectively. The difference was statistically significant at the level of P < 0.001. (2) Seventy-five cases with spinal cord palsy and progressive pain could be assessed by Tokuhashi's system. These patients were evaluated by Tomita's system at the same time. The type of surgery determined by Tokuhashi's score was excisional operation for 20% of the patients, palliative operation for 20%. As for the remaining 60%, either excisional or palliative operation might be chosen. The type of surgery determined by Tomita's score was excisional operation for 49.3% of the patients, palliative for 42.7%, and nonsurgical modality for the remaining 8.0%. (3) Twenty-five patients were classified as I, II or III, by Harrington's classification system. These patients were evaluated by the Grubb scoring system to predict the possibility of pathologic fracture and by Tomita's system at the same time to determine if an operation was necessary. By Grubb's system, prophylactic stabilization was necessary for twenty-two patients. By Tomita's system, surgery was chosen for 23 patients. But the treatment options were different in 5 patients assessed by the two systems.

CONCLUSIONSThere was a great difference in the selection of treatment modality for patients with spinal metastases by different evaluating systems. That no systems have incorporated the evaluation of life expectancy and the local lesion causes differences. The patients should be evaluated individually by more factors than those proposed by the established systems.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Preoperative Care ; methods ; Prognosis ; Proportional Hazards Models ; Spinal Neoplasms ; diagnosis ; secondary ; Survival Analysis ; Young Adult

BACKGROUNDCraniopharyngioma of the third ventricle is difficult to treat and its therapeutic regimens and operative approaches have been controversial. This study was undertaken to probe indications for microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach, its surgical procedures and therapeutic effects, and prevention of postoperative complications.

METHODSFifty-one patients with craniopharyngioma of the third ventricle were treated from January 2000 to October 2004 by an improved transventricular approach for removing the tumor via the interventricular foramen, the intermedius of the septum pellucidum or choroid fissure. Symptoms and signs of the patients, and results of imaging, operation, and follow-up were analyzed.

RESULTSOf the 51 patients who had received the improved transventricular resection, 4 underwent a combined approach with an entrance of the pterion. Forty patients (78.43%) underwent total resection and others subtotal resection, without an operative death. Epileptic seizures were found in 3 patients (5.88%) and subdural effusion in the operative field in 4 (7.84%). All patients showed good general conditions after operation, and follow-up for an average of 27.52 months showed relapse of the tumour in 8 patients (15.69%).

CONCLUSIONSMicrosurgical resection of craniopharyngioma of the third ventricle by an improved transventricular approach has advantages of operative safety and efficacy, lower mortality and disability, and less complications.

Adolescent ; Adult ; Aged ; Cerebral Ventricle Neoplasms ; diagnosis ; pathology ; surgery ; Child ; Child, Preschool ; Craniopharyngioma ; diagnosis ; pathology ; surgery ; Female ; Humans ; Infant ; Male ; Microsurgery ; Middle Aged ; Pituitary Neoplasms ; diagnosis ; pathology ; surgery ; Third Ventricle

OBJECTIVETo investigate the administration of far-lateral approach in lesions located anterior or anterolateral to brain stem and upper cervical spinal cord.

METHODSTwenty-three patients underwent far lateral approach, including 12 retrocondylar approach, 5 partial transcondylar approach, 3 transfacetal and partial transcondylar approach, 2 transtubercular approach and 1 complete transcondylar approach.

RESULTSTotal tumor removal was achieved in 15 patients, subtotal removal in 5 patients, 3 vertibral artery aneurysms were clipped successfully, 3 patients were given occipitalcervical fusion. There was no operative mortality. The most frequent complications were lower cranial nerve deficit, CSF leakage, injury to vertibral artery, and ischemia of brain stem, cerebellum or spinal cord. No patient presented clinical instability of the occipitocervical junction after surgery.

CONCLUSIONSThe far-lateral approach is an ideal approach to structures located ventral to cranial-cervicle junction. But some of the surgical steps are technically difficult and carry some degree of risk. The choice of approach depends on the pathological feature and degree of exposure required for effective surgical treatment. Bone removal should be quantified for individual lesion. The approach may be limited to less aggressive steps, while still achieving significant exposure and surgical space.

Adolescent ; Adult ; Aneurysm ; surgery ; Basilar Artery ; surgery ; Brain Neoplasms ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Microsurgery ; Middle Aged ; Neurosurgical Procedures ; methods ; Treatment Outcome ; Vertebral Artery ; surgery

OBJECTIVETo evaluate the effect of importing triamcinolone acetonide into hypertrophic scars with skin roller needles.

METHODSThirty-two cases with burn hypertrophic scar were treated. The skin roller needles were moved back and forth on the hypertrophic scars with triamcinolone acetonide dropping on the scar surface at the same time. So the triamcinolone acetonide could be imported into the scar through needles and needle holes. The effect was evaluated as cured, effective, and no effect. The Vancouver scaring criteria and visual analogue scale was used to assess the scar color, thickness, texture and feeling before and after treatment, as well as at the untreated scar area (control).

RESULTSThirty-two cases were treated 1-3 times, including 28 cases with cured result and 4 cases with effective result. The total effective rate was 100%. The scar color, thickness, texture and feeling was significantly different between the scar before and after treatment, or between the treated and untreated scar (P < 0.05).

CONCLUSIONSImporting triamcinolone acetonide into hypertrophic scars with skin roller needles is effective. It is a new method for the treatment of large hypertrophic scar with medicine.

Burns ; complications ; Cicatrix, Hypertrophic ; drug therapy ; etiology ; Humans ; Injections, Intralesional ; instrumentation ; Needles ; Treatment Outcome ; Triamcinolone Acetonide ; administration & dosage