OBJECTIVETo compare the clinical curative effect of thoracolumbar burst fracture treated by the posterior unilateral approach corpectomy fusion screw-rod fixation and anterior corpectomy bone fusion screw plate fixation.

METHODSFrom January 2008 to May 2014,36 cases of thoracolumbar burst fracture underwent operation of decompression, fusion, and internal fixation was retrospective analyzed. Among them, 16 patients were treated through posterior approach as posterior group, including 13 males and 3 females aged from 37 to 62 years old; 9 cases caused by falling injury, 3 cases by traffic accident injury,4 cases by heavy aboved;the injury segment was on T₁₂ in 2 cases, L₁ in 5 cases, L₂ in 7 cases, L₃ in 2 cases; according ASIA grade, 3 cases were grade A, 2 cases were grade B, 2 cases were grade C, 5 cases were grade D, 4 cases were grade E; the time between injury and operation ranged from 5 to 15 days. Other 20 patients were treated through anterior-lateral approach as anterior-lateral group, including 15 males and 5 females with age from 27 to 62 years old; 12 cases caused by falling injury, 4 cases by traffic accident injury, 4 cases by heavy aboved; the injury segment was on T₁₂ in 2 cases, L₁, in 7 cases, L₂ in 9 cases, L₃ in 2 cases; for ASIA grade: 4 cases were grade A, 2 cases were grade B, 4 cases were grade C, 6 cases were grade D, 4 cases were grade E; the time between injury and operation ranged from 4 to 12 days. The operation time, bleeding during operation and postoperative drainage volume were observed in two groups,and the changes of nerve function of ASIA grade, clinical efficacy,improved degree of thoracic and lumbar lordosis,and bony fusion were compared between two groups.

RESULTSAll patients were followed up from 12 to 24 months with an average of (15.8 ± 3.3) months. The operation time, bleeding during operation, and postoperative drainage volume had no significant different between two groups (P > 0.05). As compared with preoperative, ASIA grade of two groups at last follow-up had statistically significantly different (P < 0.01), the neural function of two groups after operation was recovered for different extent. The JOA score of two groups was compared between last follow-up and preoperative, the difference had statistically significant (P < 0.01), the two groups showed good clinical effect. The clinical results of ASIA grade, JOA score and RIS had no significant differences between two groups. All patients of two groups were obtained fusion. Thoracic and lumbar lordosis angle improvement degree had no significant difference between two groups ,it bad significant difference had statistical significance compared with preoperative, the two approaches could effectively restore the spinal sequence.

CONCLUSIONFor patients with thoracolumbar burst fracture just treated by anterior decompression and reconstruction of anterior column, according to the degree of operation performer' skill proficiency and the patient' condition to choose, but for patients must performed the spinal canal decompression anterior and posterior, the three column-reconstruction to required anterior-posterior approach, the posterior unilateral approach corpectomy fusion screw-rod fixation obviously shorten operation time, reduce the operation wound, it is worth the clinical promotion.

Adult ; Decompression, Surgical ; methods ; Female ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Pedicle Screws ; Reconstructive Surgical Procedures ; Retrospective Studies ; Spinal Fractures ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; injuries ; surgery

Objective To evaluate the value of differential diagnosis on congenital biliary atresia(BA) and infantile hepatitis syndrome(IHS) by technetium-99m-diethyl-iminodiacetic acid(99Tcm-EHIDA)hepatobiliary scintigraphy with phenobarbitol sodium.Methods Fifty-eight infants with persistent jaundice were taken phenobarbitol sodium[5 mg/(kg?d)] ,bid ?7 d).Those who had not bowel and gallbladders radioactivity within 24 hours were diagnosed as the diagnostic criterion of BA.Those with bowel and gallbladders radioactivity within 24 hours were diagnosed as the diagnostic criterion of IHS,who then received 99Tcm-EHIDA hepatobiliary scintigraphy with single photon emission computed tomography(SPECT) instrument.The results of all children were analyzed and compared with pathology and clinical follow up results.Results 99Tcm-EHIDA hepatobiliary scintigraphy correctly diagnosed 24 infants with last diagnosis BA and 29 infants with last diagnosis IHS,5 neonates false positive in all 34 IHS patients.The sensitivity in the diagnosis of BA was 100%,the specificity and accuracy were 85.3% and 91.4%,restectively.The sensitivity was 85.3% in the diagnosis of IHS;the specificity and accuracy were 100% and 91.4%,respectively.Conclusions 99Tcm-EHIDA hepatobiliary scintigraphy with phenobarbitol sodium can accurately differentiate BA and HIS at early stage.

OBJECTIVETo investigate the effect of c-kit mutation on the prognosis of gastrointestinal stromal tumors.

METHODSA search of studies in PubMed and MedLine (from 1999 to 2008) was performed to assess the effect of c-kit mutation on the prognosis of gastrointestinal stromal tumors. The articles were retrieved with the entries of "gastrointestinal stromal tumors", "imatinib", "c-kit" and "mutation". A meta-analysis was performed to assess the data included.

RESULTSA total of 15 articles were collected in this analysis. No significant differences was found in incidence of mitoses (> 5/50 HPF) between the patients with wild type c-kit (wild type group) and the ones with mutated c-kit (mutation group) (P = 0.710); tumor recurrence and metastasis rate after surgery was significant higher in the mutation group than that in wild type group (P = 0.010); as for imatinib response with different c-kit mutation types, the results showed the incidence of clinical response (complete response + partial response) was significantly higher in mutation group than that in wild type group (P = 0.009), but the imatinib resistance rate was lower in mutation group (P = 0.000); three studies provided data for imatinib resistance with c-kit second mutations, the results showed the second mutations mainly focus on exon 13, 14, 17.

CONCLUSIONSC-kit mutation is related closely with the incidence of recurrence and metastasis in GIST after surgery. The mutations of c-kit influences the therapeutic effects of imatinib.

Antineoplastic Agents ; therapeutic use ; Benzamides ; Case-Control Studies ; Gastrointestinal Stromal Tumors ; drug therapy ; genetics ; Humans ; Imatinib Mesylate ; Mutation ; Piperazines ; therapeutic use ; Prognosis ; Proto-Oncogene Proteins c-kit ; genetics ; Pyrimidines ; therapeutic use

OBJECTIVETo analyze the relationship between invasive pituitary adenomas and cavernus sinus and cariod artery and to predict their surgical outcomes.

METHODSTotally 270 patients with pituitary tumors were investigated in this retrospective study, including 113 men and 157 women, with a mean age of 40.8 years. The mean disease history was 3.6 years. Pituitary microadenomas were diagnosed in 56 cases, macroadenomas in 118 cases, and hugeadenomas in 96 cases. Adrenocorticotropic hormone-releasing adenomas (Cushing's diseases) were diagnosed in 40 cases, growth hormone-releasing adenomas in 58 cases, prolactinomas in 57 cases, and non-functional pituitary adenomas in 115 cases. Transsphenoidal microsurgery were performed on 260 patients, while transcranial microsurgery on 6 patients.

RESULTSThe percentage of invasive pituitary adenomas was about 3.6% in microadenomas, 20.4% in macroadenomas, and 61.4% in hugeadenomas. Rate of total removal was 94.1% in non-invasive pituitary adenomas, and was 58.8% in invasive pituitary adenomas.

CONCLUSIONSIt is important to analyze the grade of invasive pituitary adenomas to improve the removal of pituitary adenomas, avoid injuring cariod artery, and increase the rate of total removal.

Adenoma ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Carotid Arteries ; pathology ; surgery ; Cavernous Sinus ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hypophysectomy ; methods ; Magnetic Resonance Imaging ; Male ; Microsurgery ; Middle Aged ; Neoplasm Invasiveness ; Pituitary ACTH Hypersecretion ; pathology ; surgery ; Pituitary Neoplasms ; pathology ; surgery ; Radiotherapy, Adjuvant ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the value of transforaminal approach single interbody fusion cage combining with fixation with pedicle screws in treating lumbar instability.

METHODSFrom 2006 to 2009, 36 patients (39 interspaces) with lumbar instability were retrospectively analyzed, included 14 males and 22 females; aged from 45 to 68 years with an average of 54 years; course of disease was from 6 months to 12 years with an average of 4 years. Of them, instability in lumbar disc herniation had 8 cases, lumbar spinal stenosis 5 cases, postoperative instability in lumbar disc herniation 3 cases, lumbar spondylolysis 20 cases; unstable segment in L3,4 had 2 cases, L4,5 18 cases, L5S1 13 cases, and double segment 3 cases (both L4,5 and L5S1). All patients underwent decompression, reduction, interbody fusion with single cage from transforaminal approach with pedicle screws and posterolateral fusion. The clinical effects were evaluated according to imaging results and JOA scoring system.

RESULTSAll the patients were followed up from 8 to 32 months with an average of 18 months. The results of 38 intervertebral fusion, suspicious fusion of a vertebral space, fusion rate was 97.4% (38/39). Segmental lordosis angle after operation was increased (4.09 +/- 0.13) degrees than before operation (P < 0.01), and final follow-up was reduced (3.83 +/- 0.17) degrees than after operation (P > 0.05). JOA scoring before operation and final follow-up were respectively 8.14 +/- 1.09 and 13.54 +/- 1.19, there was statistically significant between the two periods (P < 0.01); the JOA score improvement rate (RIS): 28 cases got excellent result, 6 good and 2 fair, the rate of excellent and good was 94.4%.

CONCLUSIONThe path through the transforaminal approach single-fusion cage, implantation of pedicle screw fixation fusion surgery can simplify operations, reduce complications, and can obtain satisfactory clinical efficacy, which is an effective method for the treatment of lumbar instability.

Aged ; Bone Screws ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; pathology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Diseases ; diagnostic imaging ; surgery ; therapy ; Spinal Fusion ; methods ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo study the combination of Mandibular distraction and orthognathic techniques for the reconstruction of adult hemifacial microsomia.

METHODSThe three-dimensional CT reconstruction data was used with Mimics for preoperation design. The osteotomy location, distraction vector, distraction distance were decided before operation with a surgical guider. At the first stage, internal distractor was implanted after ostetomy through an extra-oral approach. The distraction begun 5-7 days after operation with a frequency of 1 mm/day. After distraction, the distractor was maintained for 3-6 months. At the second stage, the distractor was removed. Le Fort I osteotomy was performed in order to correct the cross-bite and improve the facial contour. Usually, bone graft was inserted into the gap after Le Fort I osteotomy. The genioplasty was also performed if necessary.

RESULTS9 cases of adult hemifacial microsomia with severe mandibular deviation were treated. The facial asymmetry were improved greatly. 1 patient suffered an wound infection in the maxillary region after Le Fort I osteotomy and healed uneventfully with wound irrigation.

CONCLUSIONSMandibular distraction combined with orthognathic surgery is an effective procedure for adult hemifacial microsomia with complicated mandibular hypoplasia.

Adult ; Aged ; Bone Transplantation ; Facial Asymmetry ; surgery ; Goldenhar Syndrome ; surgery ; Humans ; Mandible ; surgery ; Osteogenesis, Distraction ; methods ; Osteotomy, Le Fort ; methods

OBJECTIVETo evaluate the effectiveness and safety to treat Chiari malformation with the surgical decompression of the foramen magnum under endoscope.

METHODSIn 1 patient with Chiari malformation with syringomyelia, we made a 2.5 cm incision under the endoscope for the surgical decompression of the foramen magnum.

RESULTSAll the symptoms and signs were remarkably relieved, and the patient could walk the next day and was discharged 3 days after the operation.

CONCLUSIONThe endoscope-assisted decompression of the foramen magnum is a safe and effective surgical method to treat Chiari malformation.

Adult ; Arnold-Chiari Malformation ; complications ; surgery ; Decompression, Surgical ; methods ; Female ; Foramen Magnum ; surgery ; Humans ; Syringomyelia ; etiology ; surgery ; Treatment Outcome

Colorectal Neoplasms ; complications ; Humans ; Male ; Middle Aged ; Neck ; pathology ; Rectal Neoplasms ; complications ; Skin Neoplasms ; diagnosis ; pathology ; secondary ; Thorax ; pathology

Along with the rapid development of molecular biology, cell biology, genetics, and immunology, there is a new understanding on the pathogenesis of pituitary adenomas. The pathogenesis of pituitary adenomas is considered to be related with gene mutation, growth factors, cell receptors, transcription factors, and cellular signaling pathways.
Adenoma ; genetics ; metabolism ; Humans ; Mutation ; Pituitary Neoplasms ; genetics ; metabolism ; Signal Transduction

OBJECTIVETo have a retrospective review of the patients undergoing anterior lumbar interbody fusion (ALIF) with clinical and radiological assessment, and observe changing of graft after procedure and assess correlation between graft collapse and recurrence of radiculopathy.

METHODSSixty-seven consecutive patients undergoing ALIF only at L(4 - 5) with autologous iliac crest graft for intervertebral disc prolapse were followed-up for an average of 14 (2.5 - 32) years. The effect of the fusion was examined by the existence of radiolucent lines and bony continuity on plain radiographs and tomographs, or mobility on flexion-extension radiographs. The disc height was also measured. Lower limb radiculopathy was assessed based on the symptom and examination. Paired samples t-test was used for statistical analysis.

RESULTSSixty-four patients with successful fusion were analyzed (fusion rate: 96%). All measurements in this study were completed by the same author, and the measurement error of more than 2 mm was statistically significant. According to this, graft collapse occurred in 55 patients (86%) and 9 patients (14%) had no graft collapse. In these 55 cases, the original disc height was (12.1 +/- 2.9) mm, increased immediately after the surgery to (16.2 +/- 1.9) mm, however re-narrowed to (12.9 +/- 2.7) mm at the first observation of solid fusion (a mean of 9 months, ranging from 5 to 14 months), which was not significant different compared to the original. There was no significant change in disc height after solid fusion and the disc space at the final follow-up was (12.6 +/- 2.3) mm. There was no radiculopathy observed in 52 cases (95%) during the follow-up.

CONCLUSIONDisc space re-narrowing was observed in most cases after single level ALIF of L(4 - 5), however it was rarely less than the initial and unlikely to result in recurrence of radiculopathy.

Adult ; Equipment and Supplies ; Female ; Follow-Up Studies ; Humans ; Low Back Pain ; surgery ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; surgery ; Lumbosacral Region ; diagnostic imaging ; Male ; Middle Aged ; Radiography ; Recurrence ; Spinal Fusion ; methods ; Spinal Osteophytosis ; surgery ; Time Factors ; Transplantation, Autologous ; methods ; Treatment Outcome