[Objective]To discuss the postoperative effect of the posteromedial structure injury (medial collateral ligament,MCL,posterior oblique ligament,POL) of the knee.[Method]Fourteen cases of complex posteromedial structure injury were treated from January 2002 to October 2007,twelve of which combined with ACL injury and two combined with PCL injury.Classification of posteromedial structure injury:typeⅠ,8 cases,ruptured from the femur with small bone fragment;type Ⅱ,2 cases,ruptured from the femur without bone fragment;typeⅢ,2 cases,the structure were torn from the body area,and type Ⅳ,2 cases,ruptured from the tibia.The injury were repaired by different techniques according to the classification.Eight cases applied star-shaped steel plate,four with GⅡ anchor screws(2 attached to the femur and 2 to the tibia adhesion respectively),and 2 cases with end-to-end suture.The ruptured ACL and PCL were reconstructed by arthroscopy.Autologous semitendinosus and gracilis were used for 8 ACL reconstruction and B-T-B technique for the other two ACL reconstruction.Two ruptured PCL were reconstructed with allograft of Achilles tendon.[Result]All cases were followed up for twelve months at average(6-18 months) except two cases only for four months.The functional score of the knees were improved from 56.7(50-60) preoperatively to 81.2(74-94) postoperatively in average valued by Lysholm system.Ten cases received normal knee flexion and extension range after repair of the posteromedial structure while 2 cases with restricted 5 degree extension.Nine cases received excellent result in lateral stress test while 2 cases with "+" and 1 case with "++" at zero angle.[Conclusion]Early repaire for the posteromedial structure injury will deliver excellent knee stability.

Cardiac neurosis is a syndrome caused by dysfunction of CNS,which influences autonomic function and then disordered cardiac-vascular function.The author sums up a set of firm-soft differentiation treatment to the disease under his years of clinical experience,which has marked clinical cure effect.

The treatment of total avulsion of the hand is somewhat difficult and the result usually not satisfactory. Four cases of such patients were treated from 1983 to 1987. After routine debridement, digital nerves and its surrounding adipose tissue were preserved. An "S" shape skin flap was designed an raised in the contralateral upper abdominal quadrant to cover the injured hand like a bag, so that both sides of the hand were covered. The donor area (12cm2) was directly sutured. Nerve endings might grow into the flaps because of the preservation of digital nerves. Three patients were followed-up for 2 to 6 years, the injured hands regained good pain sensation as well as stereognostic and temperatuer sensations. The function of the hand is satisfactory, but the flap looked bulky and multiple plastic operations were necessary to seperate the fingers.

Objective To evaluate the efficacy of thoracic cavity perfusion with cisplatin combined with mannan peptide in nasopharyngeal carcinoma patients with malignant pleural effusion.Methods 47 cases of nasopharyngeal carcinoma patients with malignant pleural effusion with a median age of 50 years old (41-70 years old) were enrolled.Pleural effusion occurred at 38.5 months on average after diagnosis,unilateral effusion was seen in 45 patients (95.7 ％),bilateral effusion was seen in 2 patients (4.2 ％).Cisplatin combined with mannan peptide was administered through pleural puncture by PICC center vein pipe after drainage.Data of survival complications and response to the treatment were reviewed.Results 17 patients (36.1％) had a complete remission (CR),21 patients (44.6 ％) had partial remission (PR),and the total remission rate (CR+ PR) was 80.9 ％.The median survival time was 10.5 months.Patients with pleural fluid pH ≥ 7.2,glucose ≥ 60 mg/L,and lactic dehydrogenase (LDH) ＜ 600 U/L showed association with good efficacy,the efficacy rates were 85.0 ％ (34/40),86.5 ％ (32/37),89.5 ％ (34/38),the median survival time were 11.5,12.0,12.5 months.Pleural fluid pH ＜ 7.2,glucose ＜ 60 mg/L,and LDH ≥ 600 U/L showed association with poor efficacy,the efficacy rates were 42.8 ％ (3/7),50.0 ％ (5/10),44.4 ％ (4/9),the median survival time were 6.5,6.5,6.0 months (P ＜ 0.05).The curative effect of the patients with bone metastasis and (or) pulmonary metastasis without liver metastasis was more similar with that of the patients with liver metastases [(47.0 ％ (16/34) vs 57.1％ (4/7),x2 =0.01,P =0.29].But median survival time had significant difference (11.0 vs 6.0 months,P =0.02).The Cox multi-factor analysis confirmed that the LDH value of effusion was an independent factor as prognosis evaluation.Major side effects of the treatment included fever,chest pain,nausea and vomiting.Conclusion Thoracic cavity perfusion using cisplatin combined with mannan peptide is effective in the treatment of malignant pleural effusion in nasopharyngeal carcinoma patients with pleural effusion,with relatively low toxicity.LDH value is a predictive factor for survival.The patients with liver metastases appeare poor median survival time.

Diabetes Mellitus ; Enterobacter cloacae ; Humans ; Maxilla ; Osteonecrosis

BACKGROUND: The cluster of multiple metabolic disorders, namely raised blood pressure, overweight or obesity, raised triglyceride level, reduced high density lipoprotein cholesterol (HDL-C) level were the predictor of type 2 diabetes mellitus (DM). However, similar data especially the old people's data is relatively rare in China.OBJECTIVE: To analyze the relationship between the components of metabolic syndrome (MetS), their clusters and the risk of diabetes among Chinese old population.DESIGN: Cross-sectional study.SETTING :Beijing Institute of Geriatrics, Beijing Hospital, Ministry of Public Health.PARTICIPANTS: The study was carried out from February 2001 until November 2001.4 499 volunteers aged 60 and over were recruited from the academic institutes in Beijing Xicheng, Haidian and Shijingshan districts through cluster sampling methods. They were selected after excluding those who did not have integral data.METHODS: Diabetes was considered when fasting glucose was ≥7.0 mmol/L and was treated for or diagnosed as DM. Chi-square tests were performed to compare the categorical data. Age and sex adjustment were taken in the comparison of the levels of blood pressure, waist circumference (WC), The body mass index (BMI), and lab variables, Multifactor stepwise (backward)Logistic regression analyses were used to select the factors which would have association with the risk of DM. When analyzing the relationship between number of clustering of the traits of MetS and DM, the group without any metabolic abnormalities was set as control group. The dummy variables were set for 1,2,3,4 clusters of metabolic abnormalities. The Logistic regression model was used again to test the relationship and adjusted by age and the family history of DM.MAIN OUTCOME MEASURES: The blood glucose, waist, BMI, blood pressure, triglyceride (TG), HDL-C, and family history of diabetes of subjects.RESULTS: 4 444 people in the mean age of 65±5 were retrieved. 556cases of DM were found in this survey. Age, family history of diabetes,systolic blood pressure, waist and TG were independently associated with the risk of DM, with OR (95%CI) being 1.02 (1.00-1.04), 3.48(2.76-4.39), 1.02 (1.01-1.02), 1.03 (1.00-1.03), 1.13 (1.05-1.21), respectively. When TG was not in the model, HDL-C was also inversely associated with DM (OR=0.67, 95%CI 0.49-0.91). The risk of DM increased with clustering of abdominal obesity, raised blood pressure, raised TG, and reduced HDL-C level in individuals.CONCLUSION: In addition to age and genetic factors, metabolic factors, especially their clusters are closely related to the risk of diabetes. Therefore, the features of MetS are important indicators for the risk of DM in aged people.

Objective :To study mutation of Ps3 gene and its relationship with histologic grade and Dukes' stage in colorectal cancer. Methods :PCR-SSCP was used to detect mutations of Ps3 in 30 colorectal cancer patients. Results: It was found that 6 mutations (20. 0%) in the coding region of P53 gene. One mutation was located in exon4; 5 mutations were located in exon 5; none of mutation was found in exon 2 and 3. According to the histologic grade of of colorectal cancer,the frequencies of P53 gene mutation were 1/8 (12. 5%) in the well differentiated and in the moderately differentiated as well,3/10 (30. 0%) in the poorly differenctiated and 1/4 (25.0%) in the undifferentiated. In clinic, the frequencies of P53 gene mutation were associated with Dukes stage: 1/10 (10. 0 % ) in B stage, 2/12 (16. 7%) in C Stage,3/8(37. 5%) in D stage. Conclusion:The mutation of P53 gene is related to Dukes＇ stage,and the P53 gene mutation hardly occurs in exon 2,3 in coloretal cancer.

Objective The analysis of correlation between the occurrence of tourette syndrome with one-child family environment. Methods The authors investigated home environment of two groups. One group included 200 patients with tourette syndrome and is the other group included healthy children of the same age in 3 different primary and secondary schools. By comparing with the home environmental factors, parenting styles and parent emotional factors between two groups. Results The instabilities of home environment included bad family relationship, separation between parents, divorce, scolding and even beating children. It showed that anxiety of the direct supervisors among the sickness group were higher than healthy control group as well. Among the ten factors of the Family Environments Scale, the significant differences showed in six factors of affection,cohesion,expressiveness, conflict, intellectual-culture orientation, active-recreational orientation, organization between the two groups. Conclusion So we concluded that ①There is a correlation between the parents relations,parenting styles and the incidence of tourette syndrome; ②An anxiety of the direct supervisor may initiate, even aggravate the incidence of tourette syndrome; ③It is important to convert the education mode and take family overall treatment in order to reduce the incidence and improve the effectiveness of tourette syndrome.

Objective To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) in intrathoracic tuberculosis(TB).Methods We retrospectively analyzed patients underwent EBUS-TBNA with a final diagnosis of intrathoracic TB at Shanghai Chest Hospital from October 2009 to March 2013 and observed that the diagnostic efficacy by pathology and microbiology and safety of EBUS-TBNA for intrathoracic TB.Results 75 patients were diagnosed with pulmonary TB or intrathoracic tuberculous lymphadenitis,and accuracy was 80％ (60/75) by EBUS TBNA.A total of 60 patients had pathology,acid-fast bacilli(AFB) staining and mycobacterial culture test results,of whom 52 (86.67％)were diagnosed.Pathological findings were consistent with TB in 77.33％ patients (58/75),in 20.31％ (13/64) the smear were positive for AFB and in 46.67％ (28/60) were positive for cuhure.One hundred and twenty-nine mediastinal or hilar lymph nodes and 10 intrapulmonary lesions were biopsied in 75 patients,the average target number of per patient were 1.85.Pathological findings were consistent with TB in 66.19％ samples(92/139),in 13.91％ (16/115) were positive for AFB and in 38.32％ (41/107) were positive for culture.Multivariate regression revealed that short-axis diameter was an independent risk factor associated with positive pathology,smear and euhure.Additionally,more aspiration times cause higher pathology positive rate,pathology showing necrosis and positive smear were independent risk factors associated with positive cuhure.There were two patients occurred complications during operation.Conclusion EBUS-TBNA was a safe and effective method for the diagnosis of intrathoracic tuberculosis.

Humans ; Male ; Middle Aged ; Paranasal Sinuses ; diagnostic imaging ; Sublingual Gland Neoplasms ; diagnosis