Objective:To explore the risk factors for duodenal papillary adenocarcinoma by comparing the differences in clinical and endoscopic features between patients with duodenal papillary adenomas and adenocarcinomas.Methods:This study retrospectively included patients diagnosed as having duodenal papillary adenocarcinoma and adenoma from January 1st 2018 to June 1st 2023 at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. Demographic, clinical manifestations, laboratory tests, imaging, endoscopic and pathological characteristics of patients with adenomas and adenocarcinomas were collected and compared. Multivariable logistic regression analysis was employed to identify high-risk factors for duodenal papillary adenocarcinoma.Results:A total of 119 cases of adenocarcinoma and 171 cases of adenoma were included. There were statistically significant differences between the two groups in terms of patient age, body mass index (BMI), clinical symptoms, family history of malignant tumors, bile duct dilation, pancreatic duct dilation, lesion size, adenoma site classification, stage assessed by EUS, and involvement of the bile and pancreatic ducts ( P<0.05). Univariate logistic regression analysis revealed that non-ampullary lesions, involvement not limited to the major duodenal papilla assessed by EUS, involvement of the bile and pancreatic ducts assessed by EUS, age ≥60 years, lesion size ≥1.5 cm, clinical symptoms, family history of malignant tumors, bile duct dilation, and pancreatic duct dilation were risk factors for duodenal papillary adenocarcinoma. Multivariate logistic regression analysis showed that non-ampullary lesions ( OR=7.00, 95% CI:1.44-34.15, P=0.016), involvement not limited to the major duodenal papilla assessed by EUS ( OR=13.77, 95% CI: 4.69-40.45, P<0.001), age ≥60 years ( OR=2.52, 95% CI: 1.23-5.18, P=0.011), bile duct dilation ( OR=2.58, 95% CI: 1.12-5.94, P=0.026), and lesion size ≥1.5 cm ( OR=2.76, 95% CI:1.36-5.59, P=0.005) were independent risk factors for duodenal papillary adenocarcinoma. Conclusion:This study shows the independent risk factors for duodenal papillary adenocarcinoma, which include non-ampullary lesions, involvement not limited to the major duodenal papilla assessed by EUS, age ≥60 years, bile duct dilation, and lesion size ≥1.5 cm.

Objective The application of metal augments in the revision of total hip arthroplasty(THA)has achieved re-markable results in the treatment of bone defects.However,there are limited studies compared this effective method with the traditional treatment.The purpose of this article is to investigate the curative effect of both metal augmentation and impacted bone grafting in the revision of acetabular bone defect. Methods We retrospectively analyzed 20 patients(20 hips)with bone defects after THA in Au-thority of Nanjing General Hospital of Nanjing Military Region from August 2010 to February 2017.These 20 patients were allocated into 2 groups:impacted bone grafting group(n=11,filling acetabular bone defect with autogenous iliac bone and artificial bone)and metal aug-mentation group(n=9,filling acetabular bone defect with metal aug-ment).The duration of surgery,blood loss and the hospital for special surgery knee score(HSS)were compared between these two groups and the Harris score was applied to evaluate the hip function and full weight bearing. Results The surgery duration and blood loss of impacted bone grafting group were significantly increased when compared with the metal augmentation group(44.5±7.82 min vs 36.22±5.19 min and 431.82±57.76 mL vs 333.33±72.80 mL respec-tively).there were 3 cases showed mild bone resorption in the I regions in the impacted bone grafting group, while only one case showed mild bone resorption in the II region in the metal augmentation group.The HSS scores in the metal augmentation group were higher than those in the impacted bone grafting group at the time of postoperative 2 weeks(43.89±2.76 vs 40.82±4.42), 3 months (49.89±2.03 vs 45.27±3.90)and 6 months(53.44±2.46 vs 50.55±3.67), the differences were statistically significant(P<0.001). The Harris scores in the metal augmentation group were higher than those in the impacted bone grafting group(P<0.01).The metal augmentation group had a shorter time of getting out of bed compared with the impacted bone grafting group(P<0.01). Conclusion For those patients with upper acetabular bone defect,revision surgery using metal augments can save the operation time.Meanwhile, it is also superior to the impacted bone grafting in the early prosthesis stability and bone ingrowth,and thus enables to shorten the time on getting out of bed and promote functional.

OBJECTIVETo investigate the application of the expanding forming under the plate through cervical spatium intermusculare approach to treat multi-segmental myelopathic cervical spondylosis.

METHODSFrom July 2005 to June 2013, 25 patients with multi-segmental myelopathic cervical spondylosis were treated by the expanding forming under the plate through cervical spatium intermusculare approach including 16 males and 9 females with an average age of 56.5 years old ranging from 35 to 78 years old. Among them, 10 cases were onset without causes slowly, 7 cases were onset without causes suddenly, 8 cases were onset after mild trauma or tired. JOA scoring, incidence of postoperative axial symptoms and imaging studies were used to evaluate the effect.

RESULTSTwenty-five cases were followed up for 6 months to 7 years and 6 months with an average of 2 years and 9 months. There were no infection, cerebrospinal fluid leakage after the operation, and complications such as nerve damage were occurred. The operation time was 120 to 150 min, the bleeding was 300 to 500 ml. Imaging examination showed vertebral canal sagittal diameter increased, the vertebral canal increased significantly in the cross sectional area of the spinal cord, cervical curvature was straighten in 4 cases (2 cases of them became normal sequence). There were no more cases of cervical protruding and segmental instability increased. Postoperative walking ability enhanced, the finger activity of majority of patients improved on flexibility, grip strength, and accuracy of using chopsticks improved, numbness and chest waist band feeling had different degree of reduce, preoperative urine impairment were improved to varying degrees. Preoperative JOA scores were 3 to 13 points with an average of (8.86 ± 4.25) points; Postoperative 12 months' JOA scores were 7 to 17 points with an average of (13.76 ± 3.56) points, period was 60.19% in average, JOA score had statistically difference between before and after operation (P < 0.05). The result were excellent in 14 cases, good in 6 cases, and fair in 4 cases and poor in 1 case.

CONCLUSIONApplication of the expanding forming under the plate through cervical spatium intermusculare approach to treat multi-segmental myelopathic cervical spondylosis, through muscular clearance, can retain complete cervical back muscle, maintain stability of cervical spine, and vertebral canal can get effective decompression at the same time.

Adult ; Aged ; Bone Plates ; Cervical Vertebrae ; Female ; Humans ; Laminectomy ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Spondylosis ; surgery

OBJECTIVETo explore the surgical method and its effects of adjacent spinal segment degeneration after anterior cervical fusion.

METHODSFrom March 2000 to March 2011, 27 patients with spinal segment degeneration who had accepted the operation of anterior cervical fusion were treated with surgical treatment. There were 16 males and 11 females with an average age of 55.3 years (ranged from 48 to 72 years). JOA scores and image examination were used to evaluate the clinical effects.

RESULTSAll patients were followed up for 1.8 to 7.2 years with an average of 3.6 years. All pathological segments obtained fully decompression with good spinal bombe, no internal fixation loosening and cervical spine instability were found. Nerve root pain had disappeared and nerve function had significantly improved. Before operation, 3 days after operation and at last follow-up, JOA scores were 9.15 +/- 3.46, 13.96 +/- 2.79 and 13.52 +/- 2.91, respectively, and there was significant difference between preoperation and postoperation (P < 0.05). Intervertebral height and physiological curvature improved obviously than preoperation (P < 0.05).

CONCLUSIONIn order to relief spinal compression and rebuild spinal stability, a surgical treatment will be recommend to adjacent spinal segment degeneration combining spinal nerve symptoms and physical sign as soon as possible. Selecting an appropriate surgery to treat different compressed segment would receive satisfactory results.

Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Spinal Fusion ; adverse effects

OBJECTIVETo investigate the therapeutic effectes of vacuum sealing drainage (VSD) technique and reattachment of avulsed skin in treating avulsion injuries of limbs.

METHODSA retrospective analysis was done on 25 patients suffering from avulsion injuries of limbs, who were treated with vacuum sealing drainage and reattachment of the avulsed skin. Among the patients, 19 patients were male and 6 patients were female, ranging in age from 21 years to 57 years, with an average of 41 years. After debridement, the patients got reattachment of skin graft with subdermal vascular network or split-thickness skin graft, and the wound surface was covered with polyvinyl sponge. VSD was removed after 7 to 14 days. The color, survival rate and sensory function of the skin were observed after operation.

RESULTSAll the wounds infection was controlled with VSD. The skin survival rate was more than 96% in 16 cases, more than 90% in 7 cases, and skin edge of 2 cases had little necrosis but rehabilitated after dress-changing. The reattached skins had almost normal skin color, soft and abrasion resistant, satisfactory sensory function, and no compression ulcer was observed after 4 weeks.

CONCLUSIONVSD combined with graft with subdermal vascular network or split-thickness skin graft helps to promote wound drainage, reattachment of skin, and decrease infection. It is an effective method in treating avulsion injuries of limbs.

Adult ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Vacuum ; Young Adult

OBJECTIVETo explore the therapeutic effects of percutaneous vertebroplasty with Genex combined with pedical screw fixation in the treatment of thoracolumbar burst fractures.

METHODSFrom February 2007 to October 2009, 38 patients with thoracolumbar burst fractures were treated with percutaneous vertebroplasty with Genex and pedical screw fixation. There were 25 males and 13 females, with a mean age of 42 years old (ranged, 30 to 68 years). The cause of injuries included road accident of 9 cases,crush injury of 7 cases,crash of 21 cases and others of 1 case. The fractures were classified according to Denis classification: 6 cases of type A, 22 cases of type B, 7 cases of type C and 3 cases of type D. Functional assessment of nerves was assessed according to ASIA criteria: 4 cases of type A,7 cases of type B, 10 cases of type C, 6 cases of type D and 11 cases of type E. Therapeutic effects were assessed by imaging and ASIA standard.

RESULTSAll the patients were followed up, and the duration ranged from 6 months to 34 months,with a mean period of 16.5 months. The results were observed after 1 week by X-ray inspection that vertebrate column array of all patients were restored to normal, anterior height of centrum restored to (98.50 +/- 2.17)%, posterior height of centrum for (98.87 +/- 1.82)%; and Cobb angle of injured vertebra decreased to average of (1.63 +/- 2.15) degree; the stenosis rate restored to (1.45 +/- 3.47)%. By X-ray inspection, it was observed that the vertebral height kept good at 6 months after operation, and the bone density almostly normal. By CT scanning, it was observed that bone defects of vertebrae disappeared, and restored to normal bony tissue. The nerve function restored 1 to 2 grades 6 months after operation.

CONCLUSIONArtificial bone of Genex applied in vertebral body-plasty has good biocompatibility, strong bone inducibility, no complications, little loss of vertebrae height and Cobb angle, and satisfactory results in the near future.

Adult ; Aged ; Female ; Follow-Up Studies ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Lumbosacral Region ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Male ; Middle Aged ; Skin ; Thoracic Injuries ; diagnostic imaging ; physiopathology ; surgery ; Tomography, X-Ray Computed ; Vertebroplasty ; instrumentation

OBJECTIVETo explore the therapeutic effectiveness of vacuum sealing drainage (VSD) technique and mesh grafting in treating defects of skin and soft tissues in foot.

METHODSA retrospective analysis was done on 17 cases (11 male and 6 female) suffering from defects of skin and soft tissues in foot, which were treated by vacuum sealing drainage and mesh grafting. The age of patients was from 18 to 67 years with an average of 43 years. The wound surface was filled with polyvinyl alcohol gelatin sponge after debridement and continuous negative pressure drainage was taken for 24 h. After 7 days, granulation tissue growing mesh grafting was performed and to observe the skin colour, survival rate and feet function.

RESULTSAll the infection of wounds was controlled with VSD for 1 to 3 times. Skin survival rate of 14 cases more than 98%, 2 cases more than 95%; skin edge of 1 case had little necrosis, but foot function obtained rehabilitation after dress-changing.

CONCLUSIONVacuum sealing drainage (VSD) technique and mesh grafting is effective methods for the treatment of defects of skin and soft tissues in foot and is worthy generalization and application.

Adolescent ; Adult ; Aged ; Drainage ; Female ; Foot Deformities, Congenital ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skin Abnormalities ; physiopathology ; surgery ; Soft Tissue Injuries ; physiopathology ; surgery ; Treatment Outcome ; Vacuum ; Young Adult

OBJECTIVETo explore operative method and clinical effect of selective fenestration of cervical vertebral lamina to excise ligamentum flavum for treating hypertrophic ligamentum flavum (HLF).

METHODSFrom March 1998 to May 2007, 21 patients (14 males and 7 females) with HLF were reviewed retrospectirely, whose age was from 37 to 76 years with an average of 52.2 years. The history of HLF was from 5 h to 25 years with an average of 3 years and 10 months. Reason of onset: 4 cases were no inducement, 10 cases were slow-moving,and 7 cases caused by injury. The operative effect was assessed according to JOA scores and radiologic results.

RESULTSAll patients were followed up with an average of 2.5 years(ranging from 3 months to 7.5 years). Radiologic results: sagittal diameter of vertebral canal and trans.sec.area increased and spinal cord were well than preoperative status. The majority of cases got stronger in the walking, improvement in the fingers mobility and holding power and using chopsticks, abatement in the limbs numb and thoracic waist zonesthesia, amelioration in the urination and defecation functional disturbance than preoperative symptom. The JOA scoring was 5-16 scores with an average of 11.48 +/- 2.94 before operation,and 7-17 scores with an average of 13.81 +/- 2.98 after operation. That results had statistical significance between before and after operation (t = 3.51, P < 0.05). There were 13 cases excellent (improvement rate more than 75%), 5 cases good (improvement rate in 50%-74%), 2 cases fair (improvement rate in 25%-49%), 1 case poor (improvement rate less than or equal to 24%) with an average improvement rate of 85.2%.

CONCLUSIONIt is simple in the operative procedure and tiny in trauma in treatment for hypertrophic ligamentum flavum with selective fenestration of cervical vertebral lamina to excise ligamentum flavum. The method can obtain effective decompression for vertebral canal but choice of indication must be reasonable.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Female ; Humans ; Hypertrophy ; surgery ; Ligamentum Flavum ; pathology ; surgery ; Male ; Middle Aged ; Spinal Diseases ; surgery ; Treatment Outcome

Adolescent ; Bone Screws ; Child ; Epiphyses ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Tibia ; injuries ; surgery ; Tibial Fractures ; surgery

Absorbable Implants ; Adult ; Bone Screws ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Joint Dislocations ; diagnostic imaging ; physiopathology ; surgery ; Male ; Middle Aged ; Recovery of Function ; Talus ; injuries ; Tomography, X-Ray Computed