A 49-year-old woman was admitted to hospital with intermittent dizziness and fatigue for 7 years. The symptoms were aggravated and accompanied by bone pain for more than 4 months. She was referred to our hospital. Laboratory tests and imaging findings suggested that acquired Fanconi Syndrome (FS) was associated with smoldering multiple myeloma (MM). Renal biopsy and electron microscopy confirmed the diagnosis of proximal light chain tubular disease (LCPT). LCPT causes proximal tubular dysfunction, which is characterized by the cytoplasmic crystal deposition usually kappa monoclonal light chain in the proximal tubule. MM with FS and LCPT is less common in clinical practice because it is difficult to diagnose. This is a typical case focusing on the differential diagnosis of monoclonal gammopathy of renal significance(MGRS) such as LCPT and plasma cells diseases.

Objective To evaluate the efficacy and safety of endoscopic balloon dilation (EBD) on treatment of benign colorectal anastomotic stenosis.Methods Data of 36 patients with benign colorectal anastomotic stenosis undergoing EBD at Zhongshan Hospital from 2011 to 2015 were reviewed retrospectively.The number of dilation,complications rate,short-term effects and recurrence rate of stenosis were analyzed.Results Thirty-six patients had post-surgery anastomotic stenosis within 2-49 months (median 6 months),including 10 (27.8％) patients of grade 1 stenosis,15 (41.7％) of grade 2 stenosis,and 11 (30.5％) of grade 3 stenosis.The anastomotic distance from anus was 3-24 cm (median 6 cm).The 36 patients underwent 80 times of EBD with mean time of 2.22.Among them,69.4％ (25/36) cases received 1-2 times and 30.6％ (11/36) received 3 times or more.During the EBD operation,14 (17.5％) patients had minor bleeding,and intraoperative or postoperative perforation did not appeared.Postoperative obstructive symptoms were relieved in all patients.The anastomotic diameter was greater than 20 mm and EBD treatment was successful.Postoperative follow-up was 22-76 months (median 44 months).Four (11.1％) patients had recurrence of anastomotic benign stenosis at 7,11,18,and 63 months after the last time of EBD,respectively,and the symptoms were improved after the second treatment.Conclusion EBD is safe and effective in treating benign colorectal anastomotic stenosis,with better short-term and long-term outcomes.

Objective: To evaluate the possibility of transverse sacroiliac screw placement in different segments of the sacrum. Methods: Data of 80 pelvic CT scans (slice thickness ≤1.0 mm) archived in CT department of the Third Hospital of Hebei Medical University from September 2016 to October 2017 were retrospectively collected. Mimics software was used to rebuild the pelvis three-dimensional model. According to whether the sacral 1(S₁) segment could place the transverse sacroiliac screws or not, all the sacrums were divided into normal group (n=55) and dysmorphic group (n=25). Simulation the S₁, sacral 2(S₂) transverse sacroiliac screw placement in 3-Matic software. Analysis whether there was any difference in maximum diameter and length of S₂ transverse sacroiliac screw between the normal group and the dysmorphic group. The pelvic CT data of the dysmorphic group were measured, and the optimal tilt angle and length of the oblique S₁ screw were obtained. The feasibility of transverse sacroiliac screw insertion in sacral 3(S₃) segment was evaluated.t-test, rank sum test, and χ² test was used to analyze data, respectively. Results: In the dysmorphic group, the largest diameter of the S₁ transverse screw was (4.9±1.6)mm, and the normal group was (13.6±3.6)mm (t=-15.07, P=0.00). In the dysmorphic group, the largest diameter of S₂ transverse screw was (13.8±3.0)mm, and was (12.4±2.2)mm in the normal group(t=2.11, P=0.04). There was no significant difference in the length of S₂ transverse sacroiliac screw between the two groups (t=0.47, P=0.64). In the dysmorphic group, the anterior vertebral height of S₁ was (23.1±4.0)mm, which was significantly higher than that of the normal group ((14.1±4.2)mm)(t=9.01, P=0.00). The angle of S₁S₂ in the dysmorphic group was 10.9°(3.8°, 17.6°), which was significantly larger than that of the normal group (2.0°(1.0°, 2.0°) (Z=-4.03, P=0.00). In the dysmorphic group, the incline angle of the oblique S₁ sacroiliac screw was (35.6±6.2)°, the anteversion angle was (37.2±4.4)°, and the mean screw length was (90.2±4.7)mm. In the dysmorphic group, the placement rate of S₃ transverse sacroiliac screw was 48.0%, and that of the normal sacral group was 9.1%. Conclusions There is often dysmorphic in the sacrum in patients with large S₁ anterior vertebral height and S₁S₂ angle. Sacral dysmorphic patients with posterior pelvic ring injury may be treated with S₁ pedicle oblique sacroiliac screws. S₃ transverse sacroiliac screws should be carefully placed, especially for the absence of sacral dysmorphic in patients.

Objective To explore the feasibility, safety and effectiveness of endoscopic submucosal dissection ( ESD) in the treatment of the synchronous multiple early cancer or precancerous lesions in esophageal and stomach. Methods A retrospective study was conducted on the data of 5 patients with synchronous multiple early cancer or precancerous lesions in esophageal and stomach who were treated by ESD in Endoscopy Center of Zhongshan Hospital from January 2008 to December 2013. The characteristics of lesions, and results of therapy and follow-up were analyzed. Results All 5 patients were male with mean age of 67. 8±13. 1 years. The mean size of esophageal lesions was 2. 1±0. 9 cm with 1 lesion located in the upper esophagus and 4 in the middle. The mean size of gastric lesions was 2. 5±1. 5 cm with 2 lesions in the antrum, 2 in the gastric angle and 1 in cardia. Lesions in 4 cases were removed at the same time and 1 at different times. All lesions achieved complete resection. Postoperative pathological results showed that there were 2 cases of esophageal precancerous lesions with gastric precancerous lesions, 2 cases of esophageal precancerous lesions with early gastric cancer, and 1 case of early esophageal cancer with early gastric cancer. The 5 patients with 10 lesions all achieved curative resection. Postoperative esophageal stricture occurred in 1 case, which was improved after dilation. Median follow-up time was 72 months, when 3 patients survived and 2 patients died. However, the cause of death was not associated with the treatment. Conclusion ESD is a minimally invasive endoscopic method for treating synchronous multiple primary early cancers in esophagus and stomach.

Objective To explore the clinical value of dental floss traction-assisted endoscopic full-thickness resection ( EFTR) for muscularis propria tumor in gastric fundus. Methods Twenty-four patients with muscularis propria tumor in gastric fundus and undergoing EFTR with traction of dental floss from January to December in 2016 in Endoscopy Center of Zhongshan Hospital were enrolled in the trial group. Another 24 patients undergoing traditional EFTR from January to December in 2015 were enrolled in the control group. The control group was paired with the trial group according to tumor size. The differences in tumor resection time, hospitalization time, and complication rate were compared between the two groups. Results There were no significant differences in the mean age and gender composition between the two groups ( both P>0. 05) . The tumor resection time of the trial group was shorter than that of the control group ( 10. 8 ± 2. 8 min VS 19. 0 ± 4. 7 min, t = 7. 298, P<0. 05 ) . There was no significant difference in postoperative hospital stay between the two groups ( 3. 2 ± 0. 5 days VS 3. 2 ± 0. 5 days, t=0. 291, P=0. 772) . No postoperative delayed bleeding or perforation and other complications occurred in the two groups. Conclusion Dental floss traction-assisted EFTR is safe and effective to treatment of muscularis propria tumors in gastric fundus, which can expose the tumor boundary, so that the surgical level may be clearer to simplify the operation and reduce the tumor resection time.

Objective To compare and analyze the epidemiological features of adult pelvic fractures between West China and East China from 2010 to 2011.Methods The data of adult pelvic fractures treated from January 2010 to December 2011 in 63 hospitals in West China and East China were collected through the PACS system and case reports checking system.The data from the 35 hospitals in East China were assigned into group A and those from the 28 hospitals in West China into group B.The analytic items included gender,age,age distribution and type of AO classification.Results A total of 7,896 cases were collected.In group A of 5,683 cases,there were 2,829 males and 2,854 females,with a male to female ratio of 0.99∶1 and a median age of 42 years (interquartile range,from 30 to 55 years).In group B of 2,213 cases,there were 1,123 males and 1,090 females,with a male to female ratio of 1.03∶1 and a median age of 41 years (interquartile range,from 31 to 54 years).There was no significant difference in the male to female ratio between the 2 groups (x2 =0.594,P =0.441) but there was a significant difference in the median age (Z =-4.344,P =0.000).The age distribution showed that the peak range was from 31 to 40 years in group A (with a proportion of 21.50％) and from 41 to 50 years in group B (with a proportion of 23.41％),showing no significant difference between the 2 groups (P ＞ 0.05).In both groups,type 61-A was the high risk type of fracture (82.23％ in group A and 86.08％ in group B),and type 61-A2 the high risk subtype of fracture (41.47％ in group A and 54.36％ in group B),showing significant differences (P ＜ 0.05).Conclusions East China and West China had similar male to female ratios in pelvic fractures.Generally,the patients in West China were younger,for the most patients in East China were aged from 31 to 40 years and those in West China from 41 to 50 years.In both East China and West China,type 61-A2 and subtype 61-A2 were the most common,but the proportions of type 61-A2 and subtype 61-A2 were higher in West China than in East China.

Objective To compare and analyze the epidemiological features of adult patients with distal humerus fractures between the east and west China from 2010 to 2011.Methods The data of adult patients with distal humerus fracture treated from January 2010 to December 2011 in 63 hospitals in the east and west China were collected through the PACS system and case reports checking system.The data from 35 hospitals in the east China were classified as group A,and those from 28 hospitals in the west China as group B.The analytic items included gender,age and AO/OTA classification.Results A total of 2,668 cases were collected.The median age of the 1,852 cases in group A was 42 (IQR:33) years old.The high peak age ranged from 21 to 30 years old;the gender ratio of group A was 1.18:1.The median age of the 816 cases in group B was 37 (IQR:27) years old.The high peak age ranged from 31 to 40 years old;the gender ratio of group B was 1.80:1.Group A had a significantly lower gender ratio but a significantly higher median age than group B (P ＜ 0.05).The proportions of patients from 16 to 20 and from 31 to 40 years old in group A were significantly lower than those in group B but the proportion of patients aged above 61 years old in group A was significantly higher than that in group B (P ＜ 0.05).According to the AO/OTA classification,1,399 cases (52.44％) were type 13-A,682 ones (25.56％) type 13-B and 587 ones (22.00％) type 13-C.The proportions of type 13-A and type 13-A1 in group A were significantly lower than in group B (P ＜ 0.05).Conclusions Fractures of the distal humerus mostly occurred in the age range from 21 to 40 years old and in males.Type 13-A fractures were the most common.The east China had a significantly higher proportion of female patients,an older median age and a lower proportion of type 13-A1 fracture than the west China.

Objective To compare the epidemiological characteristics of scapular neck fracture between the east and west areas in China from 2010 through 2011.Methods Tbe data of scapular neck fractures treated between January 2010 and December 2011 at 35 east hospitals and 28 west ones were analyzed retrospectively.The patients' gender,age and Miller classification were documented.The data from the 35 east hospitals were classified as group A while the data from the 28 west ones as group B.Comparisons were made to find out the general epidemiological characteristics.Results A total of 584 scapular neck fractures were collected.The total male/female ratio was 3.46∶ 1.The scapular neck fractures predominated in an age range from 41 to 50 years (25.17％).According to the Miller classification,there were 150 cases (25.68％) of type Ⅰ,306 ones (52.40％) of type Ⅱ and 128 ones (21.92％) of type Ⅲ.426 cases (72.95％) were stable fractures and 158 ones (27.05％) unstable fractures.The male/female ratio was 3.64∶1 in group A of 427 patients and 3.03∶1 in group B of 157 patients.There were no significant differences between the 2 groups in male/female ratio (P ＞ 0.05).The median age of group A (44 years) was significantly older than that of group B (39 years).The fractures predominated in an age range from 41 to 50 years (24.36％) in group A and in the age range from 31 to 40 years (36.31％) in group B.The most frequent fracture type was type Ⅱ in both groups,accounting for 51.52％ and 54.78％ respectively.There were no significant differences between the 2 groups in distribution of Miller classification (P ＞ 0.05).Conclusions The peak age of scapular neck fractures was from 41 to 50 years,the high-risk type was Miller type Ⅱ and stable fractures were more common.There were more male patients than female ones.The median age in the east area was older than that in the west area.

Objective To compare the epidemiological characteristics of glenoid fractures between the east and west areas in China from 2010 through 2011.Methods The data of glenoid fractures treated between January 2010 and December 2011 at 35 east hospitals and 28 west ones in China were analyzed retrospectively.The patients' gender,age and type of Ideberg classification were documented.The data from the 35 east hospitals were classified as group A while those from the 28 west ones as group B.Comparisons were made to find out the general epidemiological characteristics.Results A total of 347 glenoid fractures were collected.The total male/female ratio was 2.69∶ 1.The glenoid fractures predominated in 2 age ranges from 41 to 50 years and from 51 to 60 years (19.60％).According to the Ideberg classification,there were 75 cases (21.61％) of type Ⅰ,152 ones (43.80％) of type Ⅱ,27 ones (7.78％) of type Ⅲ,20 ones (5.76％) of type Ⅳ,46 ones (13.26％) of type Ⅴ and 27 ones (7.78％) of type Ⅵ.The male/female ratio was 2.80∶1 in group A of 228 patients and 2.50∶1 in group B of 119 patients.The median age of group A was 47 years old and that of group B 44 years old.The differences were not statistically significant in male/female ratio,median age or distribution of age between the 2 groups (P ＞ 0.05).The fractures predominated in the age range from 51 to 60 years old (23.68％) in group A and in the age range from 31 to 40 years old (21.85％) in group B.The most frequent fracture type was type Ⅱin both groups,accounting for 41.23％ and 48.74％ respectively.There was a significant difference between the 2 groups in distribution of Ideberg classification (P ＜ 0.05).Conclusions The peak age of glenoid fractures was from 41 to 60 years,the high-risk type was Ideberg type Ⅱ and there were more male patients than female ones.The proportion of Ideberg type Ⅴ in the east area was higher than that in the west area.

Objective To compare and analyze the epidemiological features of adult tibial plateau fractures from 2010 to 2011 between West China and East China.Methods The data of adult patients with tibial plateau fracture treated from January 2010 to December 2011 in 63 hospitals from West China and East China were collected through the PACS system and case reports checking system.The data of 28 hospitals from West China were classified as West group while the data of 35 hospitals from East China as East group.The analytic items included gender,age,age distribution and type of Schaztker classification.Results A total of 4,603 adult tibial plateau fractures were collected.The largest age proportion was from 41 to 50 years,with 41 to 50 years in males and 51 to 60 years in females.The highest age proportion in group A was from 51 to 60 years,and that in group B was from 41 to 50 years,showing significant differences between the 2 groups in age distribution (P ＜ 0.05).There were 3,346 cases in group A,including 2,438 males and 998 females with a male to female ratio of 2.35:1;there were 1,257 cases in group A,including 821 males and 436 females with a male to female ratio of 1.88:1.There were significant differences between the 2 groups in gender distribution (P ＜ 0.05).The high-risk fracture type was Schaztker type Ⅵ in both groups,with 898 cases in group A and 411 ones in group B;the lowest fracture type was Schaztker type Ⅴ in both groups,with 214 cases in group A and 149 ones in group B.There were significant differences between the 2 groups in fracture type ratios (P ＜ 0.05).Conclusions Adult tibial plateau fractures predominated in males in both East and West China.The average age of the patients from East China was higher than that from West China.The high-risk type was Schaztker type Ⅵ in both areas.