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Objective:To investigate the feasibility and safety of a novel surgery, to restore irreducible atlantoaxial dislocation (IAAD) by atlantoaxial joint release through wedge-end-mini-channel (via conventional Smith-Robinson anterolateral approach) combined with posterior fixation.Methods:Five patients with IAAD from May 2013 to December 2021 were retrospectively analyzed, including 3 males and 2 females, aged 44.6±9.0 years (range, 38-61). All the patients received atlantoaxial joint release through wedge-end-mini-channel (via conventional Smith-Robinson anterolateral approach) combined with posterior fixation. The Japanese Orthopedic Association (JOA) score and improvement rate, American Spinal Injury Association (ASIA) grade, atlantodental interval (ADI) and reduction rate, space available for the cord (SAC) and fusion of bone graft were measured and recorded.Results:The follow-up time was 80.0±23.1 months (range, 34-96 months). The surgery time of anterior joint release was 105±23 min (range, 75-135 min), and the total surgery time was 234±42 min (range, 212-276 min). The blood loss of anterior joint release was 80±16 ml (range, 60-100 ml), and the total blood loss was 123±34 ml (range, 85-150 ml). JOA scores were 6.6±0.9 before surgery, 11.2±0.4 at post-operative 1 month, and 14.8±0.80 at the last follow-up ( F=97.28, P<0.001), and the improvement rate of the last follow-up JOA score was 79.1%±7.64%. The ASIA grade were three cases of 'C’ level and two cases of 'D’ level before surgery, and two cases of 'D’ level and three cases of 'E’ level at the last follow-up. The ADI before surgery, at post-operative 6 months and the last follow-up were 9.56±1.07 mm, 1.46±0.39 mm and 1.48±0.29 mm, respectively ( F=206.54, P<0.001). The reduction rate of last follow-up ADI was 84.6%±1.4%. The SAC before surgery, at post-operative 6 months and last follow-up were 10.3±1.83 mm, 20.12±1.19 mm and 20.06±1.25 mm, respectively ( F=44.47, P<0.001). Grafted bone fuse was seen in 3 cases at post-operative 6 months, and 5 cases at post-operative 12 months. The only complication was unexpected titanium rod fracture in 1 case at post-operative 14 months. Conclusion:For IAAD, the novel surgery of atlantoaxial joint release through wedge-end-mini-channel (via conventional Smith-Robinson anterolateral approach) combined with posterior fixation could achieve well joint restoration and neural function improvement, which was a safe and effective procedure.
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Objective@#To investigate the clinicopathological features, diagnosis and differential diagnosis of dedifferentiated liposarcoma (DDLPS) with inflammatory myofibroblastic tumor (IMT)-like features.@*Methods@#Five cases of DDLPS with IMT-like features were collected from the First Affiliated Hospital of Nanjing Medical University, the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine and the First People′s Hospital of Qinzhou between 2013 and 2018. EnVision method and fluorescence in situ hybridization (FISH) were used to detect the immunophenotype of the tumor cells and the profile of MDM2 gene amplification respectively.@*Results@#All five cases were male and the median age was 61 (range 53 to 65) years. The clinical symptoms were mainly related to the space-occupying lesions. The tumors were located in duodenal mesentery (two cases), intestinal wall (one case), retroperitoneum (one case), and spermatic cord (one case). Grossly, the tumors were not well encapsulated, ranging from 3 to 13 cm (median 6.7 cm) in diameter, with tan to gray and firm cut surface. Histologically, the dedifferentiated component closely resembled inflammatory myofibroblastic tumor (IMT), with spindle/polygonal/stellate-shaped cells arranged in storiform, sheet-like, or random pattern, with varying degrees of chronic inflammation and fibrosis. All three major patterns seen in IMT (myxoid, cellular and hypocellular fibrous) were observed, the hypocellular fibrous pattern was the most common. Well-differentiated liposarcomatous component was found in the peripheral areas of all the tumors. One case had high grade dedifferentiated component. Four cases were strongly positive for MDM2 and p16. Two cases were positive for SMA, and one case was focally positive for desmin and one for CD34. None of the cases stained for ALK-1. FISH demonstrated MDM2 gene amplification in all five cases. Clinical follow-ups were available in all five cases and the interval ranged from 3 to 66 months (median 23 months). Two patients developed recurrences and one patient had metastasis. The remaining two patients were alive with no evidence of tumor recurrence at 3 and 14 months after surgery respectively.@*Conclusions@#DDLPS with IMT-like features is a more aggressive neoplasm than its histological mimic (IMT), and should not be misdiagnosed as other intermediate or low-grade malignant tumors, such as IMT, sclerosing liposarcoma, inflammatory liposarcoma, aggressive fibromatosis, solitary fibrous tumors, low-grade myofibroblastic sarcoma, and low-grade fibrosarcoma.
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Objective To assess the influence of different interventional injection routes of raltitrexed on the liver function, histology and pharmacokinetics in experimental rabbits, and to discuss the feasibility, safety and advantages of local application of raltitrexed. Methods A total of 25 New Zealand white rabbits were randomly and equally divided into 5 groups with 5 rabbits in each group: group A (using peripheral intravenous injection), group B (employing hepatic arterial infusion), group C (adopting hepatic artery embolization with Lipiodol), group D (hepatic artery embolization with gelfoam particles), and group E (direct puncture of liver and injection). Clinical equivalent dose (0. 17 mg/kg) raltitrexed injection was given to each experimental rabbit. At 5, 15, 30, 60, 120 and 180 min after the treatment, venous blood sample was collected for pharmacokinetic analysis. At 6 h and one week after administration of drug, liver functions were tested, and histological specimens of liver tissues were made at the same time. Results The peripheral blood drug concentrations at 5 and 60 min in group A were 0. 91 μg/mL and 0 μg/mL respectively, at 5 and 180 min in group B were 1. 73 μg/mL and 0. 37 μg/mL respectively, at 5 and 180 min in group C were 0. 82 μg/mL and 0. 08 μg/mL respectively, at 5 and 180 min in group D were 0. 94 μg/mL and 0. 08 μg/mL, and at 5 and 60 min in group E were 0. 39 μg/mL and 0. 13 μg/mL respectively. Six hours after administration of drug, the serum levels of AST, ALT in group C, group D and group E were significantly increased (P＜0. 0l), which returned to normal levels in one week after the treatment. The severity of liver tissue degeneration and necrosis detected in each group varied, in a severity - decreasing order, from group E, group C, group D, group B and group A. In group E, the surrounding normal liver tissue had no obvious necrosis. Conclusion The rabbit' s liver has no significant first pass elimination effect to raltitrexed. The equivalent dose of raltitrexed administered through the hepatic artery can cause obvious hepatocellular injury. Direct puncture and injection produce limited liver injury. Clinically, the dose of raltitrexed can be adjusted based on the degree of super selective catheterization condition and tumor size. (J Intervent Radiol, 2018, 27:247-251)
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Objective To investigate clinical and histopathological manifestations of cutaneous plasmacytosis.Methods The clinical and histopathological data were collected from 7 cases of cutaneous plasmacytosis and analyzed retrospectively.Results Of the 7 patients,2 were female,and 5 were male.The average age was 42.4 years,and the duration of disease ranged from 2 to 10 years.All the 7 patients presented with multiple slow progressive brown patches and plaques.No abnormality was observed in routine examinations of blood,urine and faeces,electrocardiogram and abdominal ultrasonography in the 7 patients.Three patients underwent serum IgG detection,and their serum levels of IgG were all higher than reference values.Two patients were subjected to cytological examination of bone marrow,which showed the percentage of plasma cells (mainly mature plasma cells) was up to 5％.Histopathological examination of 7 cases showed pigmentation in the basal layer of the epidermis,and infiltration mainly consisting of lymphocytes and mature plasma cells around the blood vessels in the dermis.Immunohistochemical study revealed that the ratio of κ to λ light chain was approximately 1∶ 1,and the plasma cells were strongly positive for IgG.IgG4 was positive in very few plasma cells in 1 case,and negative in the other 6 cases.Conclusion The etiology of cutaneous plasmacytosis is still unclear,but it has characteristic clinical and histopathological manifestations.
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<p><b>OBJECTIVE</b>To evaluate the clinical and radiological efficacy of paraspinal muscle approach with winglike working channel in the treatment of thoracic and lumbar spine fracture.</p><p><b>METHODS</b>From October 2010 to August 2012, a total of 51 patients with thoracic and lumbar spine fractures without neurological symptoms were enrolled in the study, including 32 males and 19 females. All patients were divided into two groups: 26 patients were treated through posterior paraspinal muscle approach with winglike working channel, and 25 patients were treated through traditional posterior approach. In all patients, the interval between injury and operation was less than two weeks; the vertebral canal blocked area was less than 1/3 in sagittal diameter; the compression of the fractured vertebra height was less than 2/3. And the patients with pathological fracture and severe osteoporosis were excluded. The perioperative index including operative blood loss, draining loss, operative time, postoperative bed time were recorded. The clinical results were evaluated by visual analogue scale (VAS) for back pain preoperatively, at 3 days, 3 months, the last follow-up postoperatively and modified Macnab criteria at the last follow-up. The radiological results were evaluated by sagittal Cobb angle and the anterior height of the fractured vertebra. The data of two groups were compared statistically with paired and independent t test, χ² test, Mann-Whitney U test and Wilcoxon test.</p><p><b>RESULTS</b>All patients were followed up with average of 16.6 months. In the two groups, the operative blood loss was respectively (91.5 ± 36.6) ml and (209.2 ± 38.3) ml (t=-11.216, P=0.000), draining loss was (13.7±4.4) ml and (162.3 ± 56.6) ml (t=-13.352, P=0.000), postoperative bed time was (87.3 ± 11.5) hours and (118.4 ± 20.4) hours (t=-6.727, P=0.000), VAS for back pain at 3 days postoperatively was 5.5 ± 1.0 and 6.4 ± 0.8 (t=-3.304, P=0.002), also VAS at the last follow-up was 1.0 (1.0) and 2.0 (1.0) (U=191.0, P=0.008). Data above showed significant differences between the two groups.No significant differences were found in operative time, (109.0 ± 29.7) min vs. (119.2 ± 26.8) min (t=-1.283, P=0.206), and modified Macnab criteria (χ²=0.513, P=0.774) between the two groups. The anterior height of the fractured vertebra preoperatively, at 1 week and the last follow-up postoperatively of the two groups were respectively (57.2 ± 11.8)% and (55.2 ± 10.9)% (t=0.685, P=0.496), (95.2 ± 8.3)% and (95.3 ± 5.8%) (t=-0.068, P=0.946), (92.9 ± 6.7)% and (92.1 ± 5.6)% (t=0.505, P=0.615). The sagittal Cobb angles preoperatively, at 1 week and the last follow-up postoperatively of the two groups were respectively 21.0° (12.5°) and 23.0° (12.0°) (U=316.0, P=0.544), 3.0° (5.5°) and 4.0° (4.5°) (U=342.5, P=0.893), 4.0° (5.5°) and 6.0° (6.0°) (U=328.5, P=0.701). There were no significant differences of these radiological results between the two groups in the same time point.</p><p><b>CONCLUSION</b>The paraspinal muscle approach with winglike working channel in the treatment of thoracic and lumbar spine fracture is an efficient surgical option which can acquire satisfactory clinical and radiological results.</p>
Subject(s)
Female , Humans , Male , Blood Loss, Surgical , Drainage , Lumbar Vertebrae , Wounds and Injuries , Operative Time , Orthopedic Procedures , Methods , Pain Measurement , Paraspinal Muscles , General Surgery , Postoperative Period , Pressure , Spinal Fractures , General Surgery , Thoracic Vertebrae , Wounds and Injuries , Visual Analog ScaleABSTRACT
Objective To observe the effect of low intensity pulsed ultrasound (LIPU) in repair of the articular cartilage injury in rabbits. Methods Osteochondral defects in the cartilage surfaces of femoral intercondylar fossae were made in 33 healthy adult New Zealand White rabbits, of which the knee lesions of the left hind legs were treated with LIPU (LIPU group) while that of the right ones used as control group. All animals in two groups were sacrificed respectively at the 2nd, 4th and 8th weeks postoperatively for gross appearance observation and histological examination. Results The ultrasound-treated tissues became more mature with in advance repair or regeneration. The repaired tissues in the LIPU group were near to normal hyaline cartilage tissues at the 8th week postoperatively, while the repaired tissues in the control group were weak, near to fibrocartilaginous tissues. Conclusion LIPU can promote repair of articular cartilage injury in rabbits.