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Intraductal papillary neoplasm of the bile duct (IPNB) is a rare type of bile duct tumors with different classification criteria and has a better prognosis than cholangiocarcinoma. Clinicians lack the awareness of this disease due to its low incidence rate. This article reviews recent research advances in the etiology and pathogenesis, pathological characteristics, clinical features, differential diagnosis, treatment and prognosis of IPNB, in order to improve the clinical diagnosis and treatment of IPNB.
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Objective@#To explore the flap design and clinical applications of the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery in defect reconstruction.@*Methods@#Between September 2009 and December 2018, 27 patients with soft tissue defects from lower extremities were involved in this study, including 15 males and 12 females, with an average age of 34.6 years old (range, 3 to 73 years old). Before surgery, the type of the flap to be used was designed preliminarily by evaluating the location, size and shape of the lesion or defect. The perforators of the lateral circumflex femoral artery were explored using an ultrasound Doppler probe, marked on skin. The computed tomographic angiography was also used to get more information of the branches of the lateral circumflex femoral artery when possible. The propeller flaps were divided into typeⅠ, Ⅱ, Ⅲ, and Ⅳ according to the perforators that originated from the transverse, descending, oblique, and rectus femoris branches of the lateral circumflex femoral artery, respectively. The type Ⅱ flap was subdivided into type Ⅱa and type Ⅱb flaps that were based on antegrade and reverse flow from the descending branch. The defects were reconstructed using the perforator propeller flap.@*Results@#Twenty-seven patients underwent reconstruction of defects using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery including 3 type Ⅰ flap, 12 type Ⅱa, 2 type Ⅱb, 10 type Ⅲ and 3 type Ⅳ. The size, pedicle length and rotation angle of the flaps were 12 cm×6 cm to 30 cm×15 cm, 4 cm to 15 cm, and 60 to 180 degrees, respectively. Total necrosis occurred in one flap and small-sized distal necrosis in another one. Minor complications occurred in two flaps and the remaining propeller flaps survived completely. All patients were followed up from one to 25 months and mean follow-up time was 9.9 months. Tumor recurrence was noticed in one patient. All patients were satisfied with the final functional and aesthetic outcomes.@*Conclusions@#For appropriate cases, reconstruction of defects from the groin to the knee could be achieved by using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery, with advantages of easy-to-operate and minor donor-site morbidity.
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Objective To discuss the methods of specification and quantification of thinking process of syndrome differentiation and treatment of old and famous TCM practitioners; To inherit the clinical experience and ideas of TCM practitioners more effectively. Methods Based on one typical case of Professor Lv Renhe treating chronic nephritis, indexing the prescriptions with TCM Subject Headings thesaurus and analyzing them with “Chinese medicine prescription intelligence analysis system” (“CPIAS” for short), relative dose, comprehensive property, comprehensive taste, comprehensive channel tropism, and prescription efficacy were under quantitative analysis. Results The typical case included two prescriptions of initial diagnosis and six diagnosis. CPIAS quantitative analysis showed that relative dose, comprehensive property, comprehensive taste, comprehensive channel tropism, and prescription efficacy were in accordance with syndrome differentiation and treatment of Professor Lv Renhe for chronic nephritis. Conclusion This method has guiding significance for studying and inheriting the speculative regularities and academic thoughts of Professor Lv Renhe.
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To develop a handling platform for loading, unloading, fixation, deployment, withdrawal and etc of medical materials in field conditions. Classified handling was performed for different function units with the de-vice developed, which was composed of a trolley, a railroad, a hydraulic handling board, a fixation belt and a vehicle-mounted tractor. The platform could enhance the efficiency of materials handling, which behaved well in the hos-pital without any handling device. The modular handling platform is easy to unload, carry, transport, fix and maintain, and thus is worthy popularizing practically.
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10.3969/j.issn.1000-3606.2013.06.010
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Objective:In order to prevent tracheostomal stenosis (TSS) instead of laryngectomy cannulas after total laryngectomy, Nickel\|Titanium shape memory alloys(NI\|SMA) stents in tracheostome were produced and applicated in clinic. Methods: The diameter of NI-SMA is 0.8mm, and Ni 50%, Ti 50%. The shape of the Ni\|SMA stent is the two\|threeth of circumference and its diameters are 18mm, 19.5mm, 21mm. The stents were implanted between the first and the second tracheal cartilage ring of the stump in twenty\|two patients with advanced laryngeal carcinoma or hypopharyngeal carcinoma or esophagul carcinoma in neck. All the patients were free of laryngectomy cannulas after operation. Results: Nieteen patients healed at one stage. Infections after operation were seen in three cases. Eight patients received radiotherapy after total laryngectomy. The NT\|SMA stent did not influence radiotherapy after operation. The TSS occured in six of the patients. A simple procedure named “doughnut” for widening stenosis was performed successfully with an electric cautery knife in all the patients with tracheostomal stenosis after operation. Conclusions: The results suggested that the NT\|SMA stents can prevent from traheostenosis instead of metal laryngectomy cannulas after total laryngectomy.
ABSTRACT
Intraductal papillary neoplasm of the bile duct (IPNB) is a rare type of bile duct tumors with different classification criteria and has a better prognosis than cholangiocarcinoma. Clinicians lack the awareness of this disease due to its low incidence rate. This article reviews recent research advances in the etiology and pathogenesis, pathological characteristics, clinical features, differential diagnosis, treatment and prognosis of IPNB, in order to improve the clinical diagnosis and treatment of IPNB.