摘要:目的: 報道同卵雙生子間腎移植效果,探討免疫抑制劑及激素的使用、鑒定同卵雙生子的方法以及術后隨訪。 方法 :個案報道結合文獻綜述。 結果 :手術獲得成功。術后隨訪8月,患者恢復良好。 結論 :同卵雙生間的腎移植安全有效,術后不需要使用免疫抑制劑也能維持移植腎功能正常。Abstract: Objective: Reported the effects of renal transplantation between identical twins,explored the use of immunosuppressive drugs and glucocorticoid, identification method of the identical twins and postoperative followup . Methods :Combining case report and literature review. Results :The operation is success.Followup in 8 months,the patient recover well. Conclusion : The renal transplantation between identical twins is safe and effective,the immunosuppressant is not need for the postoperative patients to maintain the graft`s function.
Objective To investigate the effectiveness of cannulated lag screws combined with lateral supporting plates in the treatment of Hoffa fracture of Letenneur type I and type III. Methods Between May 2004 and April 2011, 11 patients with Hoffa fracture of Letenneur type I and type III were treated, including 6 males and 5 females with an average age of 36 years (range, 25-47 years). Factures were caused by traffic accident in 8 cases, by falling in 2 cases, and by the other in 1 case. Fracture involved the left knee in 7 patients and the right knee in 4 patients. According Letenneur’s classification criteria, there were 7 type I fractures (6 lateral condyle fractures and 1 medial condyle fracture) and 4 type III fractures (3 lateral condyle fractures and 1 medial condyle fracture). Of 11 fractures, 9 were fresh fractures and 2 were old fractures. Two 6.5 mm cannulated lag screws combined with lateral supporting plates were used to fix fractures by anterolateral or anteromedial incision. Results All incisions achieved primary healing with no early complication. All patients were followed up 12-26 months (mean, 15 months). X-ray films showed bone healing with an average healing time of 15 weeks (range, 10-18 weeks). No loosening or breaking of internal fixator was observed; the removal time of internal fixation was 9-15 months (mean, 12 months). Accoding to Letenneur’s functional assessment system, the results were excellent in 7 cases, good in 3 cases, and poor in 1 case at last follow-up. Conclusion Cannulated lag screws combined with lateral supporting plates fixation is effective in treatment of Hoffa fracture of Letenneur type I and type III with a high union rate; anterolateral or anteromedial approach is the first choice for Hoffa fracture of type I and type III, especially for complicating by tibial plateau fracture or patella fracture.
ObjectiveTo compare the outcomes of kidney transplantation (KT) between Tibetan and Han recipients.MethodsPatients greater than 18 years old, who had received the first ABO-compatible KT between April 2006 and March 2017, were retrospectively included. A propensity score matching (PSM) of Tibetans to Hans was performed by 1∶3 ratio. Survival, renal function and adverse events of the two groups were compared.ResultsOf the 1 820 patients who fit the screening criteria, 123 Tibetans and 357 Hans were included after PSM. The median follow-up time was 48 months. There was no statistically significant difference in death-censored grafts survival (P=0.061) or patients survival (P=0.440) between the two groups. The serum creatinine was higher in Tibetans than that in Hans within one year after KT (P<0.05), and the estimated glomerular filtration rate was lower in Tibetans than that in Hans within 5 years after KT (P<0.05), but no difference thereafter (P>0.05). The incidence of delayed graft function in Tibetan patients after operation was higher than that in Han patients (4.9% vs. 1.4%, P=0.037), but there was no significant difference in the incidence of acute rejection, infection, reoperation, or cancer between the two groups (P>0.05).ConclusionTibetans receiving KT achieve excellent and comparable long-term graft and patient survival to Hans, with similar long-term graft function.
【摘要】 目的 探討腎移植術后藥物（環孢素A和鈣離子拮抗劑）、口腔衛生與牙齦增生的關系。 方法 隨訪2003年1月—2010年3月間321例腎移植患者，記錄患者術后藥物使用和口腔衛生情況，觀察牙齦增生程度。結果 〖HTSS〗口腔衛生水平與牙齦增生程度之間存在統計學相關性（rs=0.344，P=0.000），口腔衛生水平越差，牙齦增生越嚴重。服用環孢素A和鈣離子拮抗劑患者（A組）牙齦增生發生率為62.15%，高于單純服用環孢素A患者（B組）23.40%，二者比較，差異有統計學意義（χ2=39.220，P=0.000）。結論 〖HTSS〗腎移植術后環孢素A和鈣離子拮抗劑聯合應用明顯增加了牙齦增生的發病率。口腔衛生水平與牙齦增生程度之間存在重要關聯，口腔衛生差是牙齦增生的危險因素。【Abstract】 Objective To investigate the correlation between drugs (cyclosporine A and calcium channel blocker), oral hygiene and gingival hyperplasia in patients after renal transplantation. Methods We continuously followed up 321 patients undergoing renal transplantation from January 2003 to July 2009 in our hospital. The levels of oral hygiene, medication and gingival hyperplasia were recorded. Results There was a close relationship between the level of oral hygiene and the degree of gingival hyperplasia (rs=0.344, P=0.000). Higher grades of gingival hyperplasia (grades Ⅱ and Ⅲ) were found exclusively in patients who did not have good oral hygiene. There was a higher tendency of developing gingival hyperplasia among patients who received cyclosporine A and calcium channel blocker than those who only received cyclosporine A (62.15% vs. 23.40%; χ2=39.220, P=0.000). Conclusion The prevalence of gingival hyperplasia is higher in renal transplant recipients taking cyclosporine A and calcium channel blockers. There is a significant relationship between the level of oral hygiene and the development of gingival hyperplasia. Poor oral hygiene is a risk factor of gingival hyperplasia.
This paper proposes a novel metal artifact reduction (MAR) algorithm for dental implants in kilovoltage computed tomography (kVCT) using megavoltage cone-beam computer tomography (MVCBCT). Firstly, two CT images were derived by scanning patient with dental implants using kVCT and MVCBCT. Metal image was derived by thresholding segmentation in kVCT. MVCBCT and kVCT images were fused to generate prior image which was forward projected to get surrogate sinogram of metal trace. The corrected image was generated by filtered backprojection (FBP) reconstruction in corrected sinogram. The results of proposed algorithm were compared with other frequently-used metal artifact reduction algorithm, such as normalized MAR (NMAR), normalized MAR using MVCBCT prior images (NMAR-MV), and linear interpolation MAR (LIMAR). The normalized root mean square deviation (NRMSD) and mean absolute deviation (MAD) were computed. The experiment showed that the proposed method removed serious metal artifacts without introducing new artifacts. The values of NRMSD and MAD for proposed method were the minimum in all methods. The values of NRMSD for NMAR, NMAR-MV, LIMAR and the proposed method were 21.0%, 22.1%, 41.9% and 17.0% respectively. And MAD values of them were 232, 235, 553, 205 HU, respectively. In conclusion, the proposed metal artifact reduction algorithm can successfully suppress metal artifacts for dental implants, and greatly improve the quality of CT image.
目的 探討鹽酸氨基葡萄糖膠囊聯合透明質酸鈉注射液治療髖骨關節炎的臨床療效。 方法 納入疼痛門診2010年7月－2011年7月收治的髖骨關節炎患者60例，隨機分為透明質酸鈉關節腔內注射聯合口服鹽酸氨基葡萄糖膠囊組（A組）和單獨透明質酸鈉關節腔內注射組（B組），每組30例。透明質酸鈉關節腔內注射均為2.5 mL/次，每周1次，連續5周為1療程。鹽酸氨基葡萄糖膠囊口服，0.75 g/次，2次/d，6周為1個療程。評估兩組患者治療后6周后髖關節疼痛視覺模擬評分（VAS評分）及Lequesne指數評定髖關節休息痛、運動痛、局部壓痛、關節活動度、晨僵及行走能力，并觀察兩組不良反應發生情況。 結果 治療6周后A組Lequesne功能指數及VAS評分較B組顯著降低（P＜0.05），兩組不良反應比較差異無統計學意義（P＞0.05）。 結論 治療髖骨關節炎患者時，聯合應用透明質酸鈉及鹽酸氨基葡萄糖膠囊療效優于單獨應用透明質酸鈉者，且并未增加不良反應的發生。
Objective To explore the clinical value of pleura biopsy and partial pleura cryobiopsy via electronic bronchoscope in diagnosis of unknown exudative pleural effusion. Methods Diagnostic results of 563 patients with unknown exudative pleural effusion were analyzed retrospectively. Bronchoscope and routine pleura biopsy were performed in 187 patients. Bronchoscope and routine pleura biopsy plus partial pleura cryobiopsy were performed in 376 patients. Pathological positive rates of the two groups were compared. Results In the 187 patients examined by bronchoscope and routine pleura biopsy from 2006 to 2008, 161 patients obtained pathological positive results ( 86.1% ) . In the 376 patients examined by bronchoscope and routine pleura biopsy plus partial pleura cryobiopsy from 2009 to 2012, 354 patients acquired pathological diagnosis ( 94.1% ) . There was significant difference between the two groups ( P lt; 0.05) . The main complications were bleeding and local chest pain, and they can be controlled easily. Conclusions Electronic bronchoscope and pleura biopsy can obtain high detection rate of nearly 90% in diagnosis of unknown exudative pleural effusion especially when combined with cryobiopsy of partial pleura. Electronic bronchoscope combined with pleura biopsy or cryobiopsy is an alternative in clinical settings when thoracoscope is unavailable.
ObjectiveTo summarize the perioperative management experience and the treatment strategy of hyperkalemia after simultaneous pancreas and kidney transplantation (SPK).MethodThe clinical data of patients with diabetes combined with end-stage renal disease who accepted SPK in the Organ Transplantation Center of West China Hospital of Sichuan University from November 2017 to November 2019 were retrospectively analyzed.ResultsA total of 6 patients accepted SPK totally. The cold ischemia time of all allografts was less than 8 h. The levels of fasting blood glucose and serum creatinine were normal in the 5 surviving patients, and the diabetic complications were relieved or improved, except for 1 patient who died of cardiac arrest due to acute left heart failure. There were 1 case of delayed primary renal function recovery, 2 cases of bleeding in the surgical area of pancreas transplantation, 1 case of gastrointestinal bleeding, 3 cases of microthrombosis in the blood vessels of pancreas transplantation, 2 cases of perirenal effusion infection, 2 cases of pulmonary infection, and 1 case of ureterobladder anastomotic leakage, all of which were cured after symptomatic treatment. Only 2 patients occurred hyperkalemia after SPK (the highest level was 6.49 mmol/L and 6.67 mmol/L respectively), and transfusion of 10% glucose injection contain insulin, emergency dialysis and oral fludrocortisone were successively performed on them to restore the potassium density in 1 month and 2 months after surgery. There were no complications of perioperative surgical technical hemorrhage, intestinal leakage, large arteriovenous thrombosis, necrotizing pancreatitis, etc.ConclusionsSPK is the most effective treatment for patients with diabetes combined with end-stage renal disease. Transfusion of 10% glucose injection contain insulin, emergency dialysis, and oral fludrocortisone are effective strategies in treating hyperkalemia after SPK.
ObjectiveTo evaluate the health economics indexes of day surgery mode and traditional specialist hospitalization mode, and to provide reference for the selection of different hospitalization mode of inguinal-type cryptorchidism in children.MethodsThe patients with unilateral cryptorchidism under 5 years old between January 2017 and January 2018 in Chongqing Children’s Hospital were selected in this study. According to different inpatient surgery modes, the included children were divided into day surgery group (day group) and special in-hospital surgery group (specialty group). The general data of patients, treatment indicators, incidence of complications, postoperative testicular atrophy rate, recurrence, nosocomial infection, hospitalization time, hospitalization cost, satisfaction of patients, and other health effect indicators between the two operation modes were compared. The treatment effect indexes and cost-effect ratio of the two modes were statistically analyzed.ResultsA total of 198 children were included, including 83 in the day group and 115 in the specialty group. The patients in both groups underwent orchiopexy by small inguinal dermatoglyph and scrotal incision. There was no statistically significant difference in the affected side, source area, postoperative complications, or nosocomial infection between the two groups (P>0.05). The patients in the specialty group were older than those in the day group [(27.60±11.04) vs. (20.88±9.48) months old; t=4.586, P<0.001]; the bed occupancy time [(118.60±10.80) vs. (23.95±5.90) h; t=72.353, P<0.001] and operation time [(0.45±0.15) vs. (0.38±0.12) h; t=2.946, P=0.004] in the specialty group were longer than those in the day group. The difference was statistically significant in hospitalization expenses between the two groups (χ2=155.374, P<0.001); 92.8% of the children in the day group spent less than 5 000 yuan, while 95.7% of the children in the specialty group spent more than 5 000 yuan. The American Society of Anesthesiologists scores in the specialty group were higher than those in the day group (χ2=44.870, P<0.001). The treatment effect indexes in the day group and the specialty group were 0.99 and 1.01, respectively, and the cost-effect ratios were 3 850 and 6 657, respectively. The economic benefit of the day group was better.ConclusionsThe cost-effectiveness of day surgery is better than that of specialized inpatient surgery. Therefore, this model can be recommended for children who meet the indications of day surgery.