Objective To investigate the advance in surgical treatment of inferior pole fracture of patella and to explore the existing problems and further research directions. Methods Domestic and foreign l iterature in recent years on patella fracture was extensively reviewed, the surgical treatment of inferior pole fracture of patella was summarized by combining the research findings with cl inical experience. Results The surgical treatment of inferior pole of patella fractures included retaining the integrity of the patella and partial patellectomy of inferior pole of patella and extending knee installationreconstruction. There were kinds of ways to retain the integrity of the patella, such as circular wire fixation, tension bandfixation, NiTi-patella concentrotor fixation, basket plate fixation, reforming McLaughl in way and polydioxanone suture netfixation; the latter category is partial patellectomy and extensor device reconstruction. Every surgical way had its advantages and l imitations. Conclusion Most studies tend to retain the integrity of the patella, but some researches have shown that partial resection of inferior pole of patella had no significant effect on knee function. It is important to obtain the security excisional range and elongation range postoperative by experiment for regulating the treatment of comminuted fractures of inferior pole of patella.
ObjectiveTo explore the molecular characteristics of partial epilepsy with febrile seizures plus(PEFS+). MethodsWe systematically reviewed all SCN1A mutation-related publications that published between Jan.2000 and Dec.2014 on Pubmed and established a database of SCN1A mutations (http://www.gzneurosci.com/SCN1Adatabase/). The characteristics of mutations that cause PEFS+ were analyzed and compared with that of severe myoclonic epilepsy in infancy (SMEI). ResultsThe database included 1, 257 SCN1A mutations, which identified from 1, 727 unrelated cases. In which there were 30 mutations, from 32 unrelated cases, were associated with PEFS+. 76.7% (23/30) mutations were missense, of which 47.8% (11/23) were located on pore region. Significant difference in the percentage of truncation mutation was observed between PEFS+ and SMEI (P < 0.05). There was no significant difference in the percentage of missense mutation that located on the pore region between PEFS+ and SMEI; but the differ significantly in D-value of the missense mutations, which quantified the alteration of amino acid(P=0.042, rank sum test). ConclusionsPEFS+, which distinguishes from GEFS+ and SMEI in clinical and molecular characteristics, is a special phenotype of epilepsy that is associated with SCN1A mutations.
Objective To summarize experiences of surgical treatment and long-term results of myasthenia gravis (MG). Methods Two hundred thirty-six patients underwent thymectomy for MG in our department from Jan.1978 to Dec. 2002. The perioperative management, relative factors of postoperative crisis and long-term results were analysed. Results In 236 patients postoperative crisis took place in 44 cases accounted for 18.6%. The occurrence of postoperative crisis was related to preoperative management, modified Osserman clinical classification and combination with thymoma. Three cases died in the postoperative periods. Among them, one died of acute respiratory distress syndrome induced by aspiration and the other died of crisis. The effective rate in 1, 3, 5 years was 84.6%, 91.0% and 89.0% respectively. Conclusions Thymectomy for MG is safe and effective. Delayed extubation could decrease the needs of tracheotomy in patients with high risk factors for postoperative crisis. The partial sternotomy approach is less traumatic but the long-term effects of surgery are identical to those reported by the most authors.
Objective To analyze the clinical effect of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection. Methods From January 2010 to December 2015, 30 patients (25 males, 5 females) underwent partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection with involvement of aortic root. The range of age was from 27 to 72 years, and the mean age was 51.2±8.0 years. The proximal aortic dissection received partial aortic root remodeling, and the operation procedures included partial aortic root remodeling+ascending aortic replacement in 9 patients, partial aortic root remodeling+ascending aortic replacement+hemi-arch replacement in 6 patients, partial aortic root remodeling+ascending aortic replacement+Sun's procedure in 15 patients. The patients were followed up for 10 to 60 months with a mean of 37.9±3.2 months. Preoperative and postoperative degrees of aortic regurgitation were compared. Results All patients survived from the operation, and one patient died from severe pulmonary infection 15 days after operation. The overall survival rate was 96.7% (29/30). One patient died during the follow-up. Two patients underwent aortic valve replacement in the 12th and 15th postoperative month respectively because of severe aortic regurgitation (AI). Up to the last follow-up, trivial or no aortic regurgitation was demonstrated in 24 patients, but mild aortic regurgitation occurred in 2 patients. Conclusion The surgical treatment for aortic root pathology due to Stanford type A aortic dissection is challenging, and partial aortic root remodeling operations could restore valve durability and function, and obtains the early- and mid-term results.
Objective To evaluate the effect of composite (bFGF/PDPB) of basic fibroblast growth factor（bFGF） and partially deproteinized bone (PDPB) on the repair of femoral head defect. Methods Forty-eight femoral heads with defect derived from 24 New Zealand rabbits were divided into 3 groups at random, which were implanted with bFGF/PDPB(group A), PDPB(group B) and nothing(group C) respectively.The rabbits were sacrificed at 2,4,and8 weeks after operation, and then the femoral heads were obtained. The specimens injected with Chinese ink were created. Then X-ray examination, histopathological and morphological examination of blood vessel, and image analysis were made. Results The bone defects healed completely 8 weeks after operation in group A. The implants in the repaired tissue were not substituted completely in group B. The bone defects did not heal completely in group C. Two weeks after operation, affluent newly formed vessels were seen in repaired areas in groupA. No significant difference between group A and group B was observed 8 weeks after operation. In group C, newly formed vessels were scarce 2, 4, and 8 weeks after operation. There were 3 sides rated excellent, 2 good and 1 fair in group A; 1 excellent, 2 good, 2 fair and 1 poor in group B; and 1 fair and 5 poor in group C according to the X-ray evaluation 8 weeks after operation. Eight weeks after operation, the volume fraction of bone trabecula in repaired tissue was higher in group A than that in group B (Plt;0.05), and the fraction in group C was thelowest among the 3 groups (Plt;0.05). Conclusion The composite ofbFGF and PDPB can effectively promote the repair of femoral head defect of rabbit.
ObjectiveTo investigate the etiology, clinical features, treatment, and prognosis of Partial status epilepticus (PSE). MethodsSeventeen PSE patients were hospitalized in the Department of Neurology at the First Hospital of Jilin University from April 2013 to June 2015. Clinical data were retrospectively analyzed. ResultsA total of 17 patients, 8 male and 9 female, 18~91years old, at mean age (48.90±21.17) years were included. About 12 cases (70.59%) had acute symptomatic status epilepticus, the etiologies including central nervous system inflammation (5 cases), cortical infarction (3 cases), metabolic disorder (1 case), hypoxic-ischemic encephalopathy (1 case), space-occupying lesions(1 case) and degeneration (1 case); four cases (23.53%) were diagnosed with epilepsy, one case (5.88%) had no definite pathogenesis. The seizure types included complex partial status epilepticus (8 cases, 47.06%), complex part of the secondary comprehensive status epilepticus (3 cases, 17.65%), supplementary motor area (SMA) status epilepticus (4 cases, 23.53%), epilepsia partialis continua (EPC) (1case, 5.88%)and complex partial status epilepticus & aura continua (1case, 5.88%). Nine cases (52.94%) were effective after one hour treament, eight cases (47.06%) were negative. 17 cases are followed-up and 4 cases lost, the average follow-up time is (10.89±8.64) months. 8 cases are completely seizure free, and 3 cases have experience less seizures or the symptom is relived; the other 2 cases die from Creutzfeldt-Jacob desease(case No.10) and Respiratory failure(case No.12). ConclusionsThe inpatients of partial status epilepticus are mostly "situation related". Patients with clinical suspect should be administrated with long term video-Electroencephalogram(EEG) monitoring timely. Early diagnosis, treatment and the aggressive treatment can help to improve the prognosis. Patients of encephalitis usually progress into refractory status epilepticus, the anesthetic drugs should be used as soon as possible.
【摘要】 目的 評價聚四氟乙烯人工聽骨在慢性中耳炎聽力重建中的應用效果。 方法 回顧性分析2008年8月〖CD3/5〗2009年12月慢性中耳炎手術中接受聚四氟乙烯部分/全人工聽骨贗復物(Partial/Total ossicular replacement prostheses,PORP/TORP,美國美敦力公司)行聽骨鏈重建的50例患者50只耳的臨床資料及隨訪結果。比較聽力學資料完整的39例39只耳手術前及手術后3～6個月語言頻率(05、1.0、2.0 kHz)氣導平均聽力及氣骨導差(airbonecap,ABG)。 結果 隨訪3～16個月,50只耳手術后1～3個月均干耳,手術后1個月鼓膜愈合良好。9只耳手術中人工聽骨表面未置入耳屏軟骨,其中1只耳手術后3個月人工聽骨脫出,1只耳手術后2個月鼓膜內陷,人工聽骨外端盤面外突。39只耳手術前氣導聽力為3667～9500 dB,平均為(5970±1433) dB;骨導聽力為330～5170 dB,平均為(2278±1161) dB;手術后氣導聽力平均為(4660±1703) dB,與手術前比較,差異有統計學意義(Plt;001)。手術前ABG為10～60 dB,平均為(3700±1212) dB。手術后ABG平均為(2620±1156) dB,與手術前比較,差異有統計學意義(Plt;001)。手術后氣導聽力提高1000～3000 dB者(手術后聽力提高有效)共24只耳,有效率為615%(24/39)。 結論 聚四氟乙烯人工聽骨是慢性中耳炎體重建聽骨的理想材料,手術后取得良好的聽力結果,遠期療效需進一步觀察。【Abstract】 Objective To evaluate the effects of hearing reconstruction in chronic otitis meadia with prothesis. Methods Retrospective reviews were performed in 50 patients(50 ears)who had undergone Teflon Partial/Total ossicular replacement prostheses (PORP/TORP) implants from August 2008 to December 2009. Audiometric measurements (the average hearing threshold at 05, 10, 20 kHz) were taken in 39 patients (39 ears) preoperatively and postoperatively. Comparisons of preoperative and postoperative mean air condition and air bone gap (ABG) were performed. Results All patients were followed up for three to 16 months, and the surgery resulted in a dry ear and a healing drum without perforation in all 50 patients. Of the nine patients without tragus cartilage interposed between the drum and the prosthesis, one patient occured prothesis extrusion, and one patient had retraction of the eardrum. The mean air conduction of the 39 patients before and after surgery were (5970±1433) dB and (4660±1703) dB. The mean air bone gap (ABG) was (3700±1212) dB before operation, while it was elevated to (2620±1156) dB when followed up (Plt;001). The surgical treatments were found to be successful (postoperative mean air condition improved 10.0030.00 dB) in 24 ears (615%). The effectiveness was 615%. Conclution Teflon could be an ideal material for ossicular reconstruction in chronic otitis media, and the hearing improvement is obtained after operation, but the problem of extrusion has not been solved at present, and the longterm effects should be surveyed.
To evaluate the biological tolerance of the human liver to prolonged warm ischemia, 20 patients who underwent liver resections with hepatic inflow occlusion are reported. Biopsy of liver were performed during and after consecutive periods of hepatic ischemia, and speciments were observed under light and electron microscope. The results showed that hepatic vascular occlusion for ＜30 min, resulted in atotissular temporary but reversible pathologic and ultrastructural changes in liver, even patients with liver cirrhosis had better recovery from the operation when the hepatic ischemia was lengthen up to 40 min.
ObjectiveTo investigate the therapeutic effect of modified tricuspid valvuloplasty using anterior leaflet in patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia. MethodsNinety-five patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia underwent surgical treatment in our hospital from June 2002 to March 2014. There were 39 males and 56 females with an average age of 3.2±6.6 years (range 3 months to 46 years). Preoperative echocardiography prompted all patients had varying degrees of tricuspid valve dysplasia and tricuspid regurgitation (mild in 14 cases, moderate in 49 cases, and severe in 32 cases). According to the different development of anterior and septal leaflet, we used different techniques to repair the tricuspid problems. If the residual septal leaflet was larger than one third of the normal septal leaflet, we continuously stitched the half of the septal side of anterior leaflet to the two third of the left side of residual septal leaflet. If the residual septal leaflet was less than one third of the normal septal leaflet, we reserved part of pericardial patch at right side of septal crest at repairing the atrial septal defect, and continuously stitched the left two third of the patch edge to the half of septal side of anterior leaflet. All patients received transesophageal echocardiography (TEE) to evaluate the intraoperative effect of valvuloplasty. The patients were followed up with echocardiography after 3 to 6 months to evaluate the condition of tricuspid. ResultsThere was no perioperative death or Ⅲ degree atrioventricular block. Intraoperative TEE showed that the effect of tricuspid valvuloplasty was good with 3 cases of mild regurgitation and 2 cases of moderate regurgitation. Other 90 cases had no significant regurgitation. The aortic cross-clamping time was 35.2±11.2 min and cardiopulmonary bypass time was 64.9±16.6 min. In the followed-up between 3 to 6 months, tricuspid regurgitation situation improved significantly than that in preoperative period with mild regurgitation or no reflux in 89 cases and moderate regurgitation in 6 cases. There was no severe regurgitation occurred. ConclusionThe therapeutic effect is satisfactory by using anterior leaflet to repair the regurgitation of tricuspid in patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia.
Objective To study the short-term effectiveness of absorbable anchor in repairing of partial anterior cruciate ligament (ACL) rupture. Methods Between December 2013 and February 2015, 22 patients with partial ACL rupture were repaired with absorbable anchor under arthroscopy. There were 12 males and 10 females with an average age of 27.5 years (range, 20-44 years). The injury located at left knee in 8 cases and at right knee in 14 cases. The time from injury to admission ranged from 2 to 13 days (mean, 9.8 days). Sixteen partial ACL ruptures combined with meniscus injury. The effectiveness was assessed by Tegner score, Lysholm score, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, and MRI, as well as knee laxity was evaluated by KT-1000. Results All incisions healed at stage Ⅰ without any complication. All patients were followed up 12 months. ACL rerupture did not occurred during follow-up. There was no significant difference in Tegner score, Lysholm score, and IKDC score between before injury and at 12 months after operation (P>0.05). And the median satisfaction VAS score was 9.5 (range, 9-10). The tibial anterior translation difference was 0.5 mm (range, 0-6 mm). MRI showed that the scarring and continuity of the ligament were rated as grade 1 in all patients. Conclusion Arthroscopic repairing by absorbable anchor is a feasible method for partial ACL rupture, with ideal knee function, good satisfaction, and satisfactory short-term effectiveness.