ABSTRACT
Objective:To investigate the efficacy of proximal femoral nail anti-rotation (PFNA) plus bone cement enhancement in the treatment of geriatric osteoporotic femoral intertrochanteric fractures.Methods:A retrospective analysis was conducted of the 52 elderly patients with osteoporotic femoral intertrochanteric fracture who had been treated at Department of Bone and Joint Surgery, The Fourth People's Hospital of Guiyang from September 2012 to October 2018 by PFNA internal fixation plus bone cement enhancement. They were 8 males and 44 females, aged from 65 to 91 years (average, 78 years). The time from injury to operation averaged 4.4 d. By the AO/OTA classification, there were one case of type 31-A1.2, 2 cases of type 31-A2.1, 8 cases of type 31-A2.2, 34 cases of type 31-A2.3, one case of type 31-A3.1, and 6 cases of type 31-A3.3. The patients' operation time, intraoperative bleeding, hospital stay, fracture reduction, postoperative weight-bearing time, fracture union time, function of the affected hip and complications were recorded.Results:The operation time for this cohort averaged 79.4 min, intraoperative bleeding 123.6 mL, and hospital stay 11.9 d. By the Francisco evaluation, the reduction of intertrochanteric fracture was assessed as good in 43 cases and as fair in 9 cases. Of this cohort, 45 were followed up for 5 to 12 months (average, 6 months) and 7 lost to follow-up. By the Harris hip scores at the last follow-up, 14 cases were rated as excellent, 25 as good and 6 as fair, giving an excellent to good rate of 88.9% (39/45). No complications like loosening, cut-out or breakage of implants or femoral head necrosis occurred during follow-up.Conclusion:In the treatment of geriatric osteoporotic femoral intertrochanteric fractures, PFNA plus bone cement enhancement can achieve satisfactory clinical efficacy.
ABSTRACT
ObjectiveTo investigate the expression and clinical significance of CD40 in the spleen of cirrhotic portal hypertension. MethodsExpression of CD40 was determined with S-P immunohistochemistry in spleen specimens from 50 cases of cirrhotic portal hypertension and 15 healthy individuals. ResultsThe CD40 positive rates in normal spleen and cirrhotic spleen were 86.7% and 36.0%, respectively. There was a significant difference between the 2 groups (P＜0.05). There was a negative correlation between the expression of CD40 and Child grades of liver function and cirrhotic splenic types(P＜0. 05). Conclusion CD40 might reflect the changes of splenic immune function,which might be one of more exact clinical examination indexes of splenic immune function.
ABSTRACT
Objective To investigate clinical result of hepatectomy and porta-enterostomy in the treatment of Bismuth type Ⅳ hilar cholangiocarcinoma.Methods Nine patients with Bismuth type Ⅳ hilar cholangiocarcinoma underwent accurate hilar resection(portal parecnchyma resection including about Ⅰ cm of the hilar part of the segments 5 and 4b and caudate lobe beyond the tumor),and the biliary drainage was reconstructed by Roux-en-Y portal parecnchyma-jejunum lpop anastomosis.None of the biliary radicals had to be ligated and all of them were drained into thus constructed"biliary pool".Results Hilar resection was successfully performed in all cases,and there was no postoperative mortality.Aspartate transaminase and alanine transaminase and serum bilirubin decreased evidently four weeks later.Three patients presented postoperative complications.One patient developed a transient anastomotic leakage,while one patient developed self-limiting hemobilia,wound infection occurred in one patient.All three patients were treated conservatively and recovered.The mean Karnofsky performance score was 86,with which they could carry on normal activity with minor symptoms of disease.Two patient died after 9 months and 17 months of extensive metastasis and intrahepatic metastasis respectively.The remaining seven patients are alive by a mean followup of 24.9 months after surgery without any signs of recurrence.Conclusions With accurate hilar resection and portal parecnchyma-to-enterostomy,the patients considerably benefit from the preservation of liver parenchyma and patent biliary drainage and radical resection.So the Hew technique prolongs the survival time and enhances the quality of life of the patients.
ABSTRACT
Objective To discuss the diagnosis and surgical treatment of insulinoma. Methods The clinical data of 32 patients with insulinoma were analyzed retrospectively. Of the 32 patients, 19 patients were performed with simple tumor enucleation, 10 patients with pancreatic body and tail resection, 3 patients with pancreaticoduodenectomy. Results In this study, 20 cases were diagnosed and localized the tumor by type-B abdominal ultrasonic and enhanced spiral CT before operation and 12 cases by intraoperative type-B ultrasonic. Within all patients,9 tumors located in the head of pancreas, 15 tumors in the neck , 8 tumors in the tail. The clinical symptoms in 32 cases disappeared after operation with 2 cases followed by pancreatic leakage. Of all 32 cases with insulinoma,28 tumors were diagnosed as benign and the other 4 as malignant. Conclusions The mainly clinical manifestation of insulinoma is typical whipple triad. Preoperative qualitative diagnosis is practicable according to the clinical symptom and laboratory examination. Combined imaging examinations might be helpful in improving the positive test rates. Intraoperation exploration and ultrasonography are the chief methods for the tumor localization. Site, size, number and depth of the tumor are the key points determining the surgical method style.
ABSTRACT
Objective To investigate the therapeutic effect of the meso-cavo-atrial shunt (MCAS) in the treatment of combined Budd-Chiari syndrome (BCS). Methods The clinical data of 17 cases of combined BCS with all or bilateral hepatic vein occlusion and long range occlusion or obstruction of inferior vena cava (IVC) were admitted to the Qilu Hospital from February 2000 to May 2004. All patients were treated by MCAS with artificial blood vessels. The pre- and postoperative clinical symptoms, the IVC and portal venous (PV) pressures, the incidence of postoperative complications and the patency rate of the artificial vessels were analyzed. The survival of patients was analyzed using the Kaplan-Meier analysis, and the data were analyzed using the chi-square test and t test. Results No patient died during the perioperative period, and the symptoms of 15 patients disappeared or were relieved after operation, with a significant difference compared with those before operation (χ2 =9.78, P <0. 05 ). Three patients had complications after the operation. The postoperative PV and IVC pressures were decreased by 1.2 cm H2O (1 cm H2O =0.098 kPa) and 18.5 cm H2O, respectively. There were significant differences in the decrease of IVC and PV pressures ( t = 2.38, 3.06, P < 0.05 ). The 1-, 3-, 5-year survival rates were 16/17, 15/17 and 14/17, respectively, and the 5-year patency rate of the artificial vessels was 14/17.Conclusions MCAS can simultaneously relieve IVC and PV hypertension for patients with combined BCS. The postoperative complication rate was decreased, the 5-year survival rate and the patency rate of the artificial vessels were improved after the treatment, so MCAS is an optional surgical method for treating combined BCS.
ABSTRACT
Objective: To investigate the expression of human telomerase reverse transcriptase (hTERT)in benign and malignant gastric diseases and its clinical significance. Methods: The expression of hTERT in 126 gastric tissue specimens obtained by surgery and endoscopy were studied by SP immunohistochemical method. The specimens included 10 cases of nomal mucosa,26 of chronic gastritis, 22 of benign ulcer,5 of leiomyoma, 3 of hyperplastic polyps, 50 of gastric cancer, 2 of maligmant lymphoma and 8 of sarcoma. In precancerous lesions,there was 54 cases of atypical hyperplasia,including 18 low grade, 25 of intermediate and 11 high grade. The positive expression rates and relations of clinical characters were analyzed. Results: hTERT was not or seldom expressed in normal and benign gastric diseases, while it was highly expressed in malignant lesions.There was a significant difference between them(P
ABSTRACT
Objective: To investigate the role of expression of Caspase-9 in megalosplenia of cirrhotic portal hypertension. Methods: Using SP immunohistochemistry method to examine theexpression of Caspase-9 in the specimens of 50 cases of megalosplenia with cirrhotic portal hypertension and 15 cases of traumatic spleen of normal man. Results: The Caspase-9 positive rates in the traumatic spleen and megaloplenia were 26.7% and 76.0%, respectively. There was a significant difference between the groups(P