OBJECTIVES: This study aims to explore the clinical and pathological characteristics of congenital granular cell tumors and provide some references for clinical diagnosis, differential diagnosis, and treatment. METHODS: Nine ca-ses of congenital granular cell tumors who visited the Children's Hospital of Zhejiang University School of Medicine from February 2008 to March 2022 were retrospectively analyzed. Herein, its clinical characteristics, pathological characteristics, treatment, and prognosis were summarized and analyzed. RESULTS: We found that nine patients were all female, aged 1‑38 days when they saw the doctor. Three of them were attached in maxillary and the other six were attached in mandible. Meanwhile, six tumors were found during the mother's pregnancy at 28-39 weeks and three tumors were found at the baby's birth. One case was excised surgically under local anesthesia, and the other cases were excised surgically under general anesthesia. After 1 month to 12 years of follow-up, patients have no recurrence, however, two cases emerged new teeth from the tumor resection site. Histopathology of all excised lesions was congenital granular cell lesion. CONCLUSIONS Congenital granular cell tumor is a benign tumor and the prognosis is good. Therefore, surgical resection of the tumor can be done without extensive resection, and it generally does not relapse. Thus, ultrasonography during pregnancy is an important method for the early detection of congenital granular cell epulis.
Infant ; Child ; Pregnancy ; Humans ; Female ; Granular Cell Tumor/surgery* ; Retrospective Studies ; Neoplasm Recurrence, Local ; Anesthesia, General ; Diagnosis, Differential

Objective: To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones. Methods: Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group(38 cases) underwent laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE), and B group(49 cases) underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). The curative effect of the two groups was observed.The operation time, the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery, and the complications of the two groups were recorded. Results: In A group, the average diameter of common bile duct stones was (1.02±0.25)cm, the average diameter of common bile duct diameter was (1.15±0.25)cm.In B group, the mean diameter of common bile duct stones was (0.99±0.26)cm, and the average diameter of common bile duct was (1.13±0.26) cm.The differences between the two groups were not statistically significant (t=0.513, 0.437, 0.367, P=2.083, 1.533, 1.095). The successful operation rate of A group was 92.11%(35/38), which in B group was 91.84%(45/49), the difference was not statistically significant between the two groups(χ²=0.006, P=0.974). The incidence rate of complications in B group was 20.41%, which was significantly higher than that in A group, the difference was statistically significant(χ²=3.654, P=0.019). The hospitalization time, hospitalization expenses in A group were (10.6±2.6)d, (26 649.8±3 478.6)CNY, respectively, which were significantly better than those in B group (t=21.971, 17.168, all P<0.05). Conclusion The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery, and the safety of the former is higher than the latter.

This was a case of 32-year-old HAN woman admitted to psychiatric hospital presenting for social withdraw,deluded ideas,unexplained runaways and suicide behaviors.She was diagnosed as schizophrenia and brought to the psychiatrist for unbearable behavior problems by her family.When admitted to hospital the patient showed significant depressive symptoms and delusions with influent speech,hypotonia,involuntary movements of distal limb and ataxia.Cognitive tests revealed multiple deficits.Consulted with the neurologist,a diagnosis of organic mental disorder was suggested.Magnetic resonance imaging showed slight widen of lateral ventricles and mild atrophy of caudate nucleus and cortex of frontal lobe.The family history was re-collected and found three family members shared the influent speech and ataxia.Then the clinical diagnose of Huntingdon Disease was made and validated with gene tests.

Objective: To investigate the computer-aided design(CAD) of enblock porous silicone prosthesis for forehead and temporal augmentation with endoscope technique. Methods: The 3-dimensional image of the enblock porous silicone prosthesis for forehead and temporal augmentation was designed with the aid of computer based on the 3-D images, the metal model and silicone prosthesis were made for surgery guided by endoscope technique. Results: 20 cases underwent frontal and temporal augmentation with enblock protheis with primary healing. No complication, like infection, effusion, nerve injury, prothesis displacement, happened. The patients were followed up for half a year with satisfactory result . Conclusions CAD for enblock porous silicone prosthesis for forehead and temporal augmentation has the advantages of individual design and good adaptation. Endoscope technique can be effective for reduction of the complication, like bleeding and protheis displacement.

Objective To investigate the effect of preoperative preplacement of nasobiliary drainage in radiofrequency ablation of small hepatocellular carcinoma at hepatic portal. Methods 7 patients with small hepatocellular carcinoma who were admitted to our hospital from June 2014 to June 2017 were selected. All patients were the cases who were prone to injure the bile duct at hepatic portal upon the radiofrequency electrode needle entering liver cancer in the small hepatocellular carcinoma at hepatic portal. The nasal bile duct was pre-placed preoperatively, and infusion of water into nasobiliary bile duct was conducted to expand the bile duct for intraoperative identification and avoiding false puncture. In some cases, after intraoperative bile duct injury, postoperative nasobiliary drainage was given to avoid obstructive jaundice or the occurrence of bile tumor at hepatic portal. Results The treatment effective rate in the patients was 100％ (7/7). Blood biochemistry, routine blood test, liver function were re-examined after surgery. Liver CT or MRI was reexamined 30 to 60 d after surgery. After the preplacement of nasal biliary, there was one case of pancreatitis, with the incidence rate of complications of 14. 3％. The long-term treatment effect was favorable, without tumor recur-rence. Conclusion For small hepatocellular carcinoma at hepatic portal, preoperative preplacment of nasobiliary drainage is used, and the direction of the bile duct during radiofrequency ablation can be clearly observed, so as to effectively avoid the bile duct injury.

Objective To evaluate the clinical outcomes of internal fixation with extra-articular distal humerus locking compression plate (LCP) for the treatment of mid-distal humerus diaphyseal fracture.Methods From December 2012 to December 2016,a cohort of 22 patients with mid-distal humerus shaft fracture were treated by open reduction and internal fixation using extra-articular distal humerus LCP.They were 14 males and 8 females with an average age of 42.7 years (range,from 18 to 86 years).According to AO classification,there were 13 cases of type 12-A,7 cases of type 12-B,and 2 cases of type 12-C.The surgical time,intra-operative blood loss and hospital stay were recorded.The clinical outcomes were evaluated by the Mayo elbow performance score (MEPS) at the last follow-ups.Results Surgical time ranged from 46 to 95 minutes with an average of 57 minutes.The average blood loss was 220 mL (range,from 150 to 400 mL).The average hospital stay was 10.5 days (range,from 9 to 13 days).The mean follow-up was 23.8 months (range,from 6 to 48 months).Bone union was achieved in 21 cases after an average of 4.6 months (range,from 3 to 9 months),and one patient experienced bone non-union which was uneventfully healed after secondary auto platelet rich plasma (PRP) graft management.The average MEPS elbow performance score was 88.2,resulting in 16 excellent,4 fine and 2 fair cases (excellent and fine rate:90.9％).Conclusions Since extra-articular distal humerus LCP can provide stable internal fixation,facilitating early postoperative rehabilitation,it may be considered an effective alternative osteosynthesis for mid-distal comminuted humeral diaphyseal fractures.

Objective To evaluate the causes of local masses found after periocular fat grafting,and the way of treatment in order to avoid the medical dispute.Methods In 37 patients with local mass being repaired,15 patients with superficial bulges were treated through surgical removal and as piration;10 patients with focal masses were treated with aspiration;12 patients with bulges close to eyelid margin and failure after the first two treatment methods were treated through incision.Results Histopathologic findings showed the characteristic features of lipogranuloma.Chronic inflammatory cells were infiltrated.Numerous,variable-sized lipid vacuoles were surrounded by histiocytes and for eign body-type giant cells.There were areas of fibrosis and fat necrosis.35 cases were followed-up for 3 months to 1 years.Both doctors and patients were satisfied with results in 27 cases,basically satisfied in 6 cases,but not satisfied in 2 cases.Two patients were lost to follow up.Conclusions The special complication of masses in the periocular fat grafting operation can be greatly improved with the personalized therapy.

Objective To summarize the clinical experience of surgical intervention for cardiac neoplasm in a fetus . Methods A 32-year-old pregnant woman was admitted to our hospital for complaint of fetal cardiac neoplasm .A separated het-erogenic cardiac occupying lesion was identigied at right atrium of the fetus by echocardiography , whose size is 2.85 cm ×2.25 cm, but the pathogenic origin still remained uncertain, maybe originate from ether pericardium or atrium.The annulus of tri-cuspid valve was compressed nearly 50% with the presence of amount of pericardial effusion.The fetal heart rate decreased at some fetal position resulting in the compression to the heart.So an Ex-utero Intrapartum Therapy(EXIT) procedure was per-formed under the supply of placenta at the 32 weeks of pregnancy.Cesarean section was performed with intact umbilicus and fe-tal circulation by obstetricians.Consequently, the median sternotomy of this fetus and pericardiotomy were performed , with 30 ml clear pericardial effusion drained .The tumor was confirmed to be giant right atrial neoplasm after the intraoperative explora-tion.Considering on the high risk of the cardiopulmonary bypass and limited time for EXIT , the giant atrial neoplasm was left alone with delayed sternum closure after the effectively decompression of the heart .The omphalotomy was successfully per-formed after the EXIT surgery.The neoplasm resection and the repair for its defect on right atrium were performed with cardiop-ulmonary bypass 2 days later.Results Convalesce of this mother was quite good after cesarean resetion .Hemodynamics of the premature baby was satisfatory after the resection of right atrial neoplasm which pathological report was benign hemangioma . Conclusion Via multiple disciplines collaboration , EXIT intervention for fetus is feasible and safe under adequate prepara-tion.

Objective To investigate the therapeutic effect of quercetin on acute gouty arthritis and its influence in re-nal function in rats. Methods Seventy male Sprague-Dawley rats were randomly divided into normal control group, model group, colchicine group (0.5 mg/kg), allopurinol group (20 mg/kg), quercetin 100, 200 and 400 mg/kg groups (n=10 for each group). Rats were administered various drugs by oral gavage once a day for seven consecutive days throughout the experi-ment. On the fifth day, the animal model of acute arthritis was set up by giving monosodium urate crystal combined with hypo-xanthine. The inflammatory reaction was detected by measuring the circumference of right hind leg anklejoint with a tie line method at 0, 2, 6, 12, 24 and 48 h. The swelling ratio was calculated. The serum levels of uric acid (UA),β2-microglobulin (β2-MG), cystatin C (Cys-C), urea nitrogen (Urea) and creatinine (Cr) were detected by colorimetry and enzyme-linked im-munosorbent assay.Rats were sacrificed at the end of experiment, and the kidney was weighed and the renal index was calcu-lated. Results Treatment with quercetin, colchicine or allopurinol can significantly attenuate swelling rate in rats of acute gouty arthritis. The serum levels of UA were significantly higher in colchicine group and quercetin group than those of nor-mal control group and allopurinol group. The serum levels of UA was significantly lower in allopurinol group than that of nor-mal control group. After 48-h modeling, there was no significant difference in serum UA level between seven groups except allopurinol group. The levels ofβ2-MG and Cys-C were the lowest in normal control group than those of other groups. The se-rum levels of Urea and Cr and renal index were the highest in allopurinol group compared with those of other groups ( P<0.05). Conclusion Quercetin shows a significant effect of anti-inflammatory on acute gouty arthritis in rats. The model es-tablishment may lead to different degrees of renal damage. Quercetin has no protective effect against renal injury, and allopu-rinol aggravates kidney injury.

Objective To evaluate the clinical effect and experience of correcting tear trough by transconjunctival fat reposition.Methods The study was performed in 60 patients with lower eyelid fat prolapse and tear trough deformity,in whom eyelid skin tightening was deemed unnecessary.All patients were divided into observation group and control group according to their desire.The observation group received the orbital fat release through the conjunctiva.The control group corrected eyelid bag without releasing orbital fat.The control group received filler treatment 2 months after operation.Postoperative complications were recorded,and the degree of outcome satisfaction was obtained at the 6-month postoperative follow-up.Results Of the 30 patients in the observation group,excellent result was achieved in 25 cases,basically satisfactory in 2 cases,unsatisfactory in 3 cases.Of the 30 patients in the control group,excellent result was achieved in 16 cases,basically satisfactory in 8 cases,unsatisfactory in 6 cases.Conclusions Transconjunctival fat repositioning is a better procedure for patients with lower eyelid fat prolapse,tear trough deformity and eyelid skin tightening.