ABSTRACT
Objective:To report the clinical outcome of finger replantation in Tibetan plateau.Methods:From August, 2018 to August, 2019, a total of 12 patients with 15 amputed digits treated in the Department of Emergency of Lasa People’s Hospital. All these cases were performed replantation without exclusion, including 4 cases of machine-mangled injury, 3 cases of steel rope crushing injury, 4 cases of electric saw injury, and 1 case of rotation avulsed injury. Replantations were performed under microscope by a fresh team of microsurgery surgeons. Antibiotics, anticoagulants and vasodilators were prescribed postoperatively. Application of oxygen inhalation through nasal tube and warm room temperature were advised. Tabaco and coffin were strictly forbidden postoperatively. All patients were regular followed-up after operation.Results:Twelve out of total 15 amputed digits successfully replanted, 3 digits turned to necrosis eventually. The survival rate was 80% (12/15). All cases were followed up for 4-16 months. According to the Functional Evaluation Standard of Replantation by the Hand Surgery Society of Chinese Medical Association, the results were excellent in 3 digits, good in 7 digits, fair in 1 digit, poor in 4 digits. The excellent and good rate was 66.6%(10/15).Conclusion:In this group, the survival rate and excellent and good rate of finger replantation in Tibetan plateau is unexpected high. Thus, it is deducible that digit amputation can be successfully replanted with good functional result when meticulous microsurgical techniques are applied, although the unique adverse factors of Tibetan plateau exist.
ABSTRACT
ObjectiveTo investigate the clinical features of postpartum hemolytic uremic syndrome (PHUS) in Tibetan women, and to improve the diagnosis and treatment of PHUS.MethodsFrom January 2013 to June 2018, 11 patients diagnosed with PHUS in the Tibet Autonomous Regional People's Hospital were enrolled. Clinical manifestations, laboratory testing results, treatments and outcomes were retrospectively analyzed. A descriptive statistical analysis was applied in this study.ResultsThe average age of the 11 patients was (27.0±6.2) years old, and all were Tibetans. Five of them delivered by cesarean section and eight complicated by hypertension. The onset of PHUS was 1-3 d after delivery. The mean hemoglobin concentration [(73.5±26.3) g/L] and platelet count [(51±31)×109/L] remarkably decreased. Patients' renal functions were also significantly impaired with an average serum creatinine level of (517±184)μmol/L. Nine women required hemodialysis, seven received plasma infusion and six underwent glucocorticoid therapy. No patients received plasma exchange or eculizumab therapy due to limited resources. Seven out of the nine patients who underwent hemodialysis could withdraw from dialysis.ConclusionsPHUS is relatively rare, and characterized by acute onset after birth and severe conditions, especially renal injury. However, most patients would have better prognosis after active treatment.