The Mycoplasma hominis infection is a rare postoperative complication after joint replacement. Based on our knowledge, there were only two cases reported by Korea all over the world currently. A case of postoperative Mycoplasma hominis infection after total knee replacement in our hospital was reported in this article. It was confirmed through mass spectrometer and Mycoplasma cultivation and treated by the first stage debridement, polyethylene insert replacement, and then drainage and irrigation combined with sensitive antibiotics after the operation. We observed that the C reactive protein (CRP) level correlates with the development of disease, while the erythrocyte sedimentation rate (ESR) remains at a high level, indicating the relevance between the Mycoplasma hominis infection caused by knee joint replacement and CRP. This study aims to report the case and review relevant literature.

BACKGROUNDAlthough thrombolytic therapy with rescue percutaneous coronary intervention (PCI) is a common treatment strategy for ST-segment elevation acute myocardial infarction (STEMI), scant data are available on its efficacy relative to primary PCI, and comparison was therefore the aim of this study.

METHODSThis multicenter, open-label, randomized, parallel trial was conducted in 12 hospitals on patients (age < or = 70 years) with STEMI who presented within 12 hours of symptom onset (mean interval > 3 hours). Patients were randomized to three groups: primary PCI group (n = 101); recombinant staphylokinase (r-Sak) group (n = 104); and recombinant tissue-type plasminogen activator (rt-PA) group (n = 106). For all patients allocated to the thrombolytic therapy arm, coronary angiography was performed at 90 minutes after drug therapy to confirm infarct-related artery (IRA) patency; rescue PCI was performed in cases with TIMI flow grade < or = 2. Bare-metal stent implantation was planned for all patients.

RESULTSAfter randomization it required an average of 113.4 minutes to start thrombolytic therapy (door-to-needle time) and 141.2 minutes to perform first balloon inflation in the IRA (door to balloon time). Rates of IRA patency (TIMI flow grade 2 or 3) and TIMI flow grade 3 were significantly lower in the thrombolysis group at 90 minutes after drug therapy than in the primary PCI group at the end of the procedure (70.5% vs. 98.0%, P < 0.0001, and 53.0% vs. 85.9%, P < 0.0001, respectively). Rescue PCI with stenting was performed in 117 patients (55.7%) in the thrombolytic therapy arm. Rates of patency and TIMI flow grade 3 were still significantly lower in the rescue PCI than in the primary PCI group (88.9% vs. 97.9%, P = 0.0222, and 68.4% vs. 85.0%, P = 0.0190, respectively). At 30 days post-therapy, mortality rate was significantly higher in the thrombolysis combined with rescue PCI group than in primary PCI group (7.1% vs. 0, P = 0.0034). Rates of death/MI and bleeding complications were significantly higher in the thrombolysis with rescue PCI group than in the primary PCI group (10.0% vs. 1.0%, P = 0.0380, and 28.10% vs. 8.91%, P = 0.0001, respectively).

CONCLUSIONSThrombolytic therapy with rescue PCI was associated with significantly lower rates of coronary patency and TIMI flow grade 3, but with significantly higher rates of mortality, death/MI and hemorrhagic complications at 30 days, as compared with primary PCI in this group of Chinese STEMI patients with late presentation and delayed treatments.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Female ; Fibrinolytic Agents ; therapeutic use ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; therapy ; Thrombolytic Therapy

OBJECTIVETo discuss damage control orthopaedics in 53 cases of severe polytrauma who have mainly sustained orthopaedic trauma.

METHODSThe data of 53 cases of severe polytrauma who had mainly sustained orthopaedic trauma were retrospectively analyzed. And the methods and timing of damage control orthopaedics were discussed in this study.

RESULTSWe succeeded in rescuing the lives of all the 53 patients, and 38 patients returned to their former work.

CONCLUSIONSInjury Severity Score (ISS(90)) should be 17 in severe polytrauma patients, but in severe polytrauma patients who have mainly sustained orthopaedic trauma, the ISS(90) of bone and joint injuries should be 16. We recommend that primary minimally-invasive external fracture stabilization should be made for extremities and pelvis in these patients to avoid additional surgical trauma and that definitive secondary fracture care should be performed after medical stabilization for these patients in intensive care unit (ICU).

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Orthopedic Procedures ; Retrospective Studies

OBJECTIVETo explore the strategy of damage control in clinical treatment of multiple injuries headed by cervical spinal cord injury.

METHODSA retrospective analysis was performed in 32 patients. Cervical fractures associated with tetraplegia occurred in 18 patients, traumatic intervertebral disk hernia associated with tetraplegia in 2 patients, and cervical fractures and dislocation associated with tetraplegia in 12 patients. Seventeen cases were combined with craniocerebral injury, 7 combined with pulmonary contusion, multi-fractures of rib or hemopneumothorax, 2 combined with pelvic fracture and other 8 combined with fracture of limbs. The neural function was assessed by the American Spinal Injury Association (ASIA) scale.

RESULTSThirty-one patients were followed up for an average of 14 months. Of them, 10 got complete recovery, 13 obtained improvement of more than one ASIA grade, 8 did not improve, and 1 died.

CONCLUSIONSFor the emergency treatment of multiple injuries headed by cervical spinal cord injury, the damage control strategy is the principle to follow. The final operations are preferably performed within 5 to 10 days after injury so as to raise the successful rate of remedy.

Adolescent ; Adult ; Cervical Vertebrae ; injuries ; Emergency Treatment ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; etiology ; surgery ; Quadriplegia ; Retrospective Studies ; Spinal Cord Injuries ; surgery

OBJECTIVETo compare the outcome of damage control in patients with severe polytrauma in normal time and in the earthquake of 2008 Sichuan China.

METHODSIn the retrospective study, 26 cases with severity polytrauma in peacetime and 24 cases with severe polytrauma who have mainly sustained in the earthquake of 2008 Sichuan China were involovd. The patients' demographics, the methods and effects of damage control were evaluated.

RESULTSIn the earthquake group, 24 cases succeeded in the rescuing life; among whom, 3 patients needed the further debridement and dermoplasty. In the normal time group, 26 cases succeeded in the rescuing life; among whom, 19 patients had returned to their former work and 3 patients needed the further treatment. There was no difference between two groups in therapeutic effects (P > 0.05).

CONCLUSIONBoth in earthquake and in normal time, treating the severity polytrauma by damage control orthopedics can acquire satisfied effect.

Adolescent ; Adult ; Bone and Bones ; injuries ; surgery ; Child ; China ; Disasters ; Earthquakes ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; complications ; surgery ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the application of injury severity score ( ISS) to multiple injuries headed by spinal cord injury.

METHODSThe data of 55 cases (40 males and 15 females, aged 17-69 years, mean equal to 41 years) of multiple injuries headed by spinal cord injury treated in our hospital from January 2000 to December 2004 were reviewed and analyzed with ISS (Version of AIS-2005) to explore their relationship.

RESULTSThe ISS values increased with the number of injured regions, so did the complications. The recovery rate was negatively related to ISS values. During the period of immunity observation, the patients with ISS larger than 25 could undergo planned operations safely.

CONCLUSIONSTreatment for multiple injuries headed by spinal cord injury closely depends on the general and local conditions of the patients. ISS may provide useful data for the choice of treatment methods.

Adolescent ; Adult ; Aged ; Female ; Humans ; Injury Severity Score ; Length of Stay ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Retrospective Studies ; Spinal Cord Injuries ; surgery

OBJECTIVETo assess the clinical usefulness, accuracy, and safety of tele-manipulation for frameless stereotactic surgery using the CAS-R-5 robot system.

METHODSWe prospectively evaluated 32 patients underwent tele-manipulation of frameless stereotactic operations from Sep. 2005 to Sep. 2006. Tele-manipulations were performed via a digital data network by a neurosurgeon in Beijing while the patients were located in Yan'an. The distance is 1300 kilometers away. The accuracy of location and improvement of symptom were observed after operation. The period of follow-up was from 3 to 14 months (the average was 12 months).

RESULTSThe surgical operations in 32 cases were successful. Remote fiducial registration was performed with a mean accuracy of 1. 50 mm and the standard difference were 0.32 mm between the planned and actual target. There were no complications.

CONCLUSIONSDiagnosis and treatment for intracranial disease by tele-manipulation frameless stereotactic surgeries are reliable and safe.

Adolescent ; Adult ; Aged ; Brain ; pathology ; surgery ; Brain Diseases ; surgery ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Reproducibility of Results ; Retrospective Studies ; Robotics ; methods ; Stereotaxic Techniques ; Surgery, Computer-Assisted ; Treatment Outcome

OBJECTIVETo explore the operative indications and operative methods of primary total hip arthroplasty for acetabular fracture and to observe the clinical curative effect.

METHODSWe retrospectively summarized and analyzed the traumatic conditions, fracture types, complications, operative time, operative techniques, and short term curative effect of 11 patients (10 males and 1 female, with a mean age of 42.4 years) with acetabular fracture who underwent primary total hip arthroplasty.

RESULTSThe patients were followed up for 6-45 months (mean=28 months). Their average Harris score of postoperative hip joint was 78.

CONCLUSIONUnder strict mastery of indications, patients with acetabular fracture may undergo primary total hip arthroplasty, but stable acetabular components should be made.

Acetabulum ; diagnostic imaging ; injuries ; Arthroplasty, Replacement, Hip ; methods ; Female ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Radiography

Adolescent ; Adult ; Child ; Female ; Hemostasis, Surgical ; methods ; Humans ; Male ; Middle Aged ; Subclavian Artery ; injuries ; Subclavian Vein ; injuries ; Vascular Surgical Procedures ; methods ; Wounds and Injuries ; surgery

OBJECTIVETo analyze retrospectively the surgical treatment of 21 cases of infected arterial injuries of the major limb hospitalized from 1989 to 2003 in our department.

METHODSAfter a radical debridement and drainage, an autologous vessel bypass reconstruction, simple vessel ligation or amputation were carried out respectively according to each patient's condition. In order to make a better milieu for the grafts, local musculo-cutaneous flaps were translocated to cover the wounds in 9 cases.

RESULTS1 case (4.8%) died during the treatment. 5 cases (5/21, 23.8%) underwent amputations. Blood supply reconstruction was successful in 15 cases (15/21, 71.4%). 93.3% (14/15) of the cases were successful in getting an unobstructed vessel at early stage. Thrombosis occurred in 1 case (1/15, 6.7%) and a sound result was obtained after a second operation.

CONCLUSIONSRadical debridement combined with bypass vessel reconstruction with autologous vein and with musculo-cutaneous flap translocation is an effective treatment for infective limb vascular injuries.