Objective To analyze the causes and results of treatment of periprosthetic femoral frac-tures after total hip arthroplasty and to explore the best operative methods for fractures. Methods 11 cases treated for periprosthetic femoral fracture after total hip arthroplasty were subjected to a retrospective fol-low-up study from December 1998 to March 2003. There were 8 men and 3 women, the mean age was 56 years (range, 43 to 75 years). There were 2 Vancouver A type fractures, 7 B2 type, 1 B3 type, 1 C type. 5 fractures were treated by nonoperative methods and other 6 by operative methods, including one fracture malunion treated initially by skin traction. There were 5 revisions using long stem supplemented with cortical allograft strut, including 4 uncemented stems with distal fixation and one cemented stem; the remaining one fracture treated by open reduction and internal fixation. Results None was lost for follow-up. The mean follow-up period was 25.6 months (range, 7 to 50 months). 9 fractures united at a mean of 4 months (range, 3 to 6 months). Nonunion was found in 2 fractures, both were treated nonoperatively. All the 6 fractures treated by operative methods united. Up to now, 7 stems were well-fixed, continuous radiolucent line was seen in one revision case, 3 stems were loosened. The function of the patients with well-fixed stems was bet-ter than those with loosened stems, the mean Harris score of the former was 91. All the cortical allograft struts were incorporated with host bone within one year. No strut fracture happened. Conclusion Type A fractures with well-fixed stems can be treated by nonoperative methods, while type B1 and type C fractures should be treated by open reduction and internal fixation, on condition there is no surgical contraindication. For fractures with loosened stems, use of an uncemented long stem with distal fixation supplemented with cortical allograft strut is the best choice.

Objective To explore the effect and utilization of comprehensive treatment on intrahepatic recurrence after hepatic resection for hepatocellular carcinoma.Methods One and two year recurrent rate of 60 patients with hepatocellular carcinoma who underwent hepatic resection in a two-year follow up were analyzed retrospectively,control group 30 cases,comprehensive treatment group 30 cases.Results One and two year intrahepatic recurrent rate of comprehensive treatment is 13％(4/30)and 40％(12/30)respectively.The difference was statistically singnificant(x2=4.176,4.310,all P＜0.05).Conclusion The effect of comprehensive treatment on postponing intrahepatic recurrence after hepatic resection for hepatocellular carcinoma is obvious.

Objective To observe the preventive effect of alprostadil on contrast-induced nephropathy (CIN) in patients undergoing coronary intervention.Methods Two hundred and fifteen patients undergoing coronary intervention were divided into treatment group (112 cases) and control group (103 cases) by random digits table method.Patients in treatment group were treated routinely with addition of alprostadil (10 μ g intravenous injection every 12 h once for 7-10 days,given before surgery).Patients in control group were given routine therapy only.Complications of the two groups and CIN occurrence were observed.Results The occurrence rate of CIN in treatment group was lower than that in control group[7.1％ (8/112) vs.18.4％ (19/103),P ＜ 0.05].The occurrence rate of CIN in patients with renal insufficiency was higher than that in patients with normal renal function [51.6％ (16/31) vs.6.0％ (11/184),P ＜ 0.01].The occurrence rate of CIN in patients with diabetes was higher than that in patients without diabetes [22.1％(15/68) vs.8.2％ (12/147),P ＜ 0.01].Conclusions Alprostadil in coronary intervention before treatment can obviously reduce the incidence of CIN.CIN is more likely to occur in patients with renal insufficiency or with diabetes.

BACKGROUND: Dynamic glucose monitoring can reflect the fluctuation of blood glucose by successive examination at the interval of 5 minutes,which contributes to the overall and objective evaluation of glucose metabolism.OBJECTIVE: To investigate the tendency and characteritics of blood glucose fluctuation in type 2 diabetic and normal subjects. DESIGN: A case-controlled retrospective experiment based on patients and healthy controls.SETTING: Endocrine Metabolism Ward and Clinic of Sixth People's Hospital Affiliated to Shanghai Jiaotong University.PARTICIPANTS: Totally 47 patients were newly diagnosed as having type 2 diabetes mellitus at Endocrine Metabolism Ward and Clinic, Sixth People's Hospital Affiliated to Shanghai Jiaotong University, between December 2002 and July 2004. They had not received intervention (diet, exercise or medicine) before. Those with acute complications such as ketoacidosis and hyperosmolar coma were excluded. Meanwhile, 43 healthy controls were selected from those coming for routine health examinations, and they had no family history of diabetes, and impaired fasting glucose and impaired glucose tolerance were excluded. Their lipid and liver and kidney indexes as well as blood pressure were within normal range. They all signed informed consent.METHODS: Totally 43 normals and 47 patients with type 2 diabetes mellitus were subjected to dynamic glucose monitoring for consecutive (71±10) hours, and (846±122) results of glucose level were obtained.MAIN OUTCOME MEASURES: The average glucose level, diurnal maximum and minimum, fluctuation amplitude, the average preprandial and postprandial glucose values and the time percentage of diurnal glycemic fluctuations.RESULTS: According to the objective of this study, all subjects went through the experiment without loss. ① The fluctuation tendency of blood glucose in two groups: The average glucose, diurnal maximum and maximum fluctuation amplitude in type 2 diabetes mellitus group were [(12.2±2.6) mmol/L], [(18.5±2.7) mmol/L] and [(11.2±2.8) mmol/L,respectively], which were significantly higher than those in control group [(5.3±0.5), (7.8±1.4) and (3.9±1.6) mmol/L](t=16.68, 23.04, 15.14;P ＜ 0.001). ② The percentage of diurnal glycemic fluctuations time: The time percentage of glycemic fluctuations within 2.8-7.8 mmol/L was 99％ (87％-100％) in control group, 95％ (28％-100％) and 62％ (6％-100％) when blood glucose.was increased to ＞ 7.8 mmol/L or ＞ 11.1 mmol/L in type 2 diabetes mellitus group.CONCLUSION: Blood glucose in type 2 diabetes mellitus has been proved to fluctuate at a relatively higher level than that of normals, with greater fluctuation amplitude.Dynamic glucose monitoring is benefical to evaluating the tendency and characteritics of blood glucose fluctuations in type 2 diabetic and normal subjects.

Objective:To investigate the effect of Yiqi Huoxue Jiedu on diabetic peripheral neuropathy.Methods: 60 patients were randomly divided into treatment group receiving Yiqi Huoxue Jiedu treatment,control group receiving vitamin B and routine treatment to improve neural microcirculation.The conduction velocity of all patients’sensory and motor nerves and the scores of the symptoms had been observed.Results: Symptoms and nerve conduction velocity of treatment group and control group had been improved respectively,and the treatment group was superior to control group in clinic symptoms,clinical obvious effective rate and total effective rate.Conclusion: Yiqi Huoxue Jiedu method can improve conduction velocity of sensory and motor nerves,symptoms of anesthesia and pain of limbs of patients with diabetes peripheral neuropathy,and have good effect on diabetes peripheral neuropathy.

Objective To observe the sensitivity ofastrocytoma to chemotherapeutic drugs, in order to explore the drug selection using chemosensitivity testing in vitro on astrocytoma. Comparing different WHO grade astrocytoma to chemotherapeutic drugs sensitivity differences,providing the basis data for clinical treatment. Methods The astrocytoma cells were seperated and cultured in vitro from 142 tumor tissues by glioma resection, including 55 cases of low-grade astrocytoma (WHO grade Ⅰ , Ⅱ) and 87 cases of high-grade astrocytoma (WHO grade Ⅲ, Ⅳ). The proliferation inhibition and chemosensitivity of tumor cells to 11 drugs were investigated by using MTT method. Results There were 54.93% (78/142) patients recommended chemotherapeutic drug in 142 cases. The percentage was 41.82%(23/55) in the low-grade astrocytoma, and 63.22% (55/87) in the high-grade astrocytoma respectively. Teniposide,carboplatin,vincristine as the sensitive drugs were similar in different WHO grade astrocytoma. Conclusions The chemosensitivity testing could be used to filtrate sensitive drugs to clinical chemotherapy. The action is more prominent in high-grade astrocytoma than in low-grade astrocytoma. There is no difference in the choice of sensible drugs among different WHO grade astrocytoma.

Objective To evaluate the Laparoscopic combined fiber choledochoscope common bile duct cho-lelithotomy for my own clinical experience in rencent five years.Methods Clinic data of 25 cases with choledocholi-thiasis undergoing laparoscopic common bile duct cholelithotomy from June 2010 to March 2014 were retrospectively analyzed.Results The operation was performed successfully in 24 cases,a case conversions to laparotomy,21 cases with T-tube drainage,3 cases with primary ductal submucosa closure.The operative time was 105 to 305min,mean (184.0 ±12.2 ) min, postoperative hospitalization time was 6 to 10 day, mean ( 7.7 ±0.2 ) day, a case residual stones,no bile leakage.Conclusion The beginning of Laparoscopic combined fiber choledochoscope common bile duct cholelithotomy,one-stage suture of common bile duct should be selected carefully, timely transfer laparotomy, should not aim for laparoscopic surgery success rate.

Acute Disease ; Coma ; chemically induced ; Female ; Humans ; Middle Aged ; Organophosphate Poisoning ; Pesticides ; poisoning

Aged ; Humans ; Lower Extremity ; Middle Aged ; Muscle, Skeletal/physiology* ; Vibration

OBJECTIVETo observe the efficacy of He-wei Jie-gu (Chinese characters) decoction on femoral intertrochanteric fractures after internal fixation in elderly.

METHODSFrom January 2010 to January 2012, 90 elderly patients with osteoporotic intertrochanteric fracture were randomly divided into two groups. The patients in experimental group were treated with open reduction and internal fixation, He-wei Jie-gu decoction and Caltrate D in oral, including 18 males and 27 females with an average age of (77.8±11.3) years old ranging from 65 to 89 years old;the time from injured to operation was 2 to 9 days with an average of (6.6±2.1) days; according to Evans-Jensen classification, 17 cases were in type I, 8 in type II, 15 in type III, 3 in type IV, 2 in type V. Meanwhile, the patients in control group were treated with open reduction and internal fixation, Caltrate D in oral, including 16 males and 29 females with an average age of (81.2±9.6) years old ranging from 67 to 91 years old; the time from injury to operation was 2 to 10 days with an average of (6.8±2.6) days; according to Evans-Jensen classification, 15 cases were in type I, 10 in type II, 14 in type III, 4 in type W, 2 in type V. The VAS score, hip BMD value before and after treatment, fracture healing and the Harris function score after operation were recorded and compared.

RESULTSAll patients were followed up from 3 to 9 months with an average of (5.6±2.8) months. Compared with the control group, the VAS score of the experimental group had an obviously reduction (F=98.138, P<0.01) after treatment; the hip BMD value at 3 months after treatment in the experimental group was higher than that of the control group (P<0.05); the fracture healing rate of the experimental group was higher than that of the control group (P<0.05); Harris score in 3 months of follow-up in the experimental group was higher than that of the control group (t=2.542, P<0.05); all the differences between two groups were statistically significant (P<0.05).

CONCLUSIONHe-wei Jie-gu decoction can reduce postoperative pain and increase bone mineral density after internal fixation of femoral intertrochanteric fracture in elderly, promote the fracture healing and functional recovery in the hip joint.

Aged ; Aged, 80 and over ; Bone Density ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Femur ; injuries ; surgery ; Fracture Fixation, Internal ; Hip Fractures ; surgery ; Humans ; Male ; Osteoporotic Fractures ; drug therapy ; physiopathology ; surgery ; Pain, Postoperative ; drug therapy ; physiopathology