Study of xiaozhang recipe combined with lamivudine in treatment of 84 chronic viral hepatitis B patients with compensated liver cirrhosis / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To assess the clinical efficacy of Xiaozhang Recipe (XR) in treatment of chronic viral hepatitis B patients with compensated liver cirrhosis.</p><p><b>METHODS</b>Based on the anti-viral effects of lamivudine, 84 chronic viral hepatitis B patients with compensated liver cirrhosis were randomly assigned to the treatment group and the control group. Patients in the treatment group were treated with XR (consisting of heterophylla falsestarwort root, large head atractylodes rhizome, tangerine peel, green tangerine peel, water-plantain tuber, bugleweed herb, turtle shell, oyster shell, chicken's gizzard-skin endothelium, areca peel, decocted, one dose daily, twice daily). Patients in the control group took Fuzheng Huayu Capsule (consisting of red sage root, walnut seed, gynostemma pentaphyllum, aweto, magnoliavine fruit; five pills each time, three times daily, 30 min before meals). The therapeutic course for all was 12 months. The changes of the Chinese medicine symptom scores, chronic liver disease questionnaire (CLDQ), the liver function, hepatitis B virus deoxyribonucleic acid (HBV DNA) were compared between before and after treatment in the two groups. Meanwhile, B ultrasound was performed on all patients. Changes of the inner diameter of the portal vein and the splenic vein, the length and the thickness of the spleen were recorded.</p><p><b>RESULTS</b>After treatment the Chinese medicine symptom scores and CLDQ obviously decreased in the two groups (P<0.01). Besides, the score in the treatment group decreased more obviously than that in the control group (P<0.05, P<0.01). The Child-Pugh scores obviously decreased in the two groups (P<0.01). However, the comparison between the two groups did not show any statistical significance (P>0.05). The liver function of of the two groups were improved when compared with before treatment (P<0.01), and the treatment group was superior to the control group (P<0.01). The B ultrasound results showed MPV, SPV, the length and the thickness of the spleen obviously decreased in the treatment group (P< 0.01). Only the thickness of the spleen obviously decreased in the control group (P<0.01). The HBV DNA obviously decreased in the two groups (P<0.01), more obviously shown in the treatment group (P<0.01).</p><p><b>CONCLUSIONS</b>XR in combination of lamivudine could improve the liver function of chronic viral hepatitis B patients with compensated liver cirrhosis and HBV DNA, lower their Chinese medicine symptom scores and CLDQ scores, improve their Child-Pugh classification to some extent. It showed favorable effects.</p>

Application of Altemeier procedure in the emergent management of acute incarcerated rectal prolapse / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the perineal rectosigmoidectomy(Altemeier procedure) in the emergent management of acute incarcerated rectal prolapse.</p><p><b>METHODS</b>Clinical and follow-up data of 9 patients with acute incarcerated rectal prolapse undergone Altemeier procedure were retrospectively analyzed.</p><p><b>RESULTS</b>The mean operation time was 1.7 (range 1.0-1.5) hours. The mean total blood loss during surgery was 109 (50-200) ml. The mean time to the first bowel movements was 2.8(1-6) days after surgery. The hospital stay was 5.3(3-10) days. There were no postoperative complications such as anastomotic leakage, intra-abdominal infection, or urogenital dysfunction. One patient developed thrombosis in the mesorectum and one patient had symptoms of anal discomfort. After a mean follow-up of 3.5(5 months-6.5 years) years, no patient had recurrent prolapse. Six months after operation, anal function was Kirwan grade I( in 8 cases and grade II( in 1 case. All the patients were satisfied with the result.</p><p><b>CONCLUSION</b>Altemeier procedure can result in good postoperative anal function when treating incarcerated rectal prolapse, which should be the first choice in emergency treatment.</p>

Surgical intervention and radiotherapy outcome of solitary plasmacytoma of cervical spine / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical features, treatment methods and outcome of solitary plasmacytoma of cervical spine.</p><p><b>METHODS</b>From January 1995 to December 2007, the data of 23 cases with solitary plasmacytoma of cervical spine was analyzed. There were 16 males and 7 females (mean age 56 years, range: 32 - 76 years). Two cases underwent radiotherapy alone and 21 patients received surgery. According to WBB staging system, surgical procedures were defined as total or subtotal resection (6 cases), appendix resection (4 cases), sagittal resection (3 cases) and total spondylectomy (8 cases). All surgical cases were managed using an anterior approach, posterior approach or combined anterior and posterior approach. The cervical spinal reconstruction was achieved through anterior cervical titanium plate and titanium mesh cage filled with auto iliac graft or bone cement, or anterior and posterior combined instrumented fusion. All patients received radiotherapy as adjunctive therapy.</p><p><b>RESULTS</b>Follow-up of the 23 cases lasted 24.0 - 143.0 months (mean: 64.7 months). Neck pains obviously improved, and nerve compression symptoms disappeared or improved after surgery. Neurological function improved by 1 - 2 grades based on Frankel grading system. All the internal fixations were fused well and stability of the cervical spine was fine and no spine instability could be seen in our series. The bone graft fusion rate was 100%. During the follow-up period, 6 surgical cases had local recurrence and finally progressed to multiple myeloma (MM) and 3 died. Two cases without surgical treatment progressed to MM in 1 year and 1.5 years after confirmed diagnosis. They were given systemic chemotherapy. The other 15 patients had disease-free survival and after surgery and adjunctive radiotherapy. Obvious abnormity were not found in such examinations as M protein, bone marrow aspiration and emission computed tomography or PET-CT examinations.</p><p><b>CONCLUSIONS</b>Solitary plasmacytoma of cervical spine is rarely seen clinically. Surgery is recommended as the primary management for patients with overt bone destruction and spinal instability or neurological dysfunction. Tumor excision with adjunctive radiotherapy can obviously reduce local recurrences and lower the possibility of progression to MM. The patients with progression to MM should receive chemotherapy according to chemotherapy protocol while the prognosis is comparatively worse.</p>

Clinical observation of transarterial chemoembolization combined with sorafenib for advanced hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To observe the efficacy and side effects of transarterial chemoembolization (TACE) combined with sorafenib for advanced hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Forty patients with HCC were treated with sorafenib (400 mg bid) after TACE. The efficacy was evaluated according to RECIST 1.1 criteria, and side effects were assessed by NCI CTC 3.0 criteria.</p><p><b>RESULTS</b>Among the forty cases, one case achieved complete remission (CR), seven cases achieved partial remission (PR), nineteen cases achieved stable disease (SD) and thirteen cases had progressive disease (PD). The disease control rate (DCR) was 67.5%. The overall survival time was 1 - 18 months, and 1-year survival rate was 54.0%. The major adverse events were hand-foot skin reaction, diarrhea and thrombocytopenia.</p><p><b>CONCLUSION</b>The combined therapy of TACE and sorafenib is effective and well tolerated for advanced HCC.</p>

Value of protective stoma in intersphincteric resection for ultra-low rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the value of protective stoma in intersphincteric resection (ISR) for ultra-low rectal cancer.</p><p><b>METHODS</b>Clinical data of 56 ultra-low rectal cancer patients without involvement of external anal sphincter treated during January 1999 to July 2009 with trans-anal ISR plus trans-abdominal total mesorectum excision and coloanal anastomosis were retrospectively analyzed. The patients were divided into two groups based on whether they received protective ostomy: ostomy group (16 cases) and ostomy-free group (40 cases). The postoperative complications as well as anal functional restoration were compared between the two groups.</p><p><b>RESULTS</b>Sixteen cases (32.1%) of the 56 patients received protective stoma. The complication rate of anastomosis and anus complication rate in the ostomy-free group were significantly higher than those in ostomy group [35.0% (14/40) and 40.0% (16/40) vs. 1/16 and 1/16; P < 0.05]. In the ostomy-free group, one patient developed anastomotic dehiscence and tumor recurrence, the patients was given permanent colostomy, and the other three patients with lesions in the anastomosis and anus received ostomy and secondary surgical treatment, with a reoperation rate of 10.0% (4/40). The anal function of patients in the two groups were both decreased after the operation. The rate of patients got Kirwan grade I anal sphincter function in the 3rd, 6th and 12th month after protective stoma operation was 11/16, 13/15 and 11/13 in the ostomy group, respectively; and those were 30.0%, 37.5% and 45.0% in the ostomy-free group, respectively. Anal function was significantly better in the ostomy group than that in the ostomy-free group during the same postoperative period (P < 0.05).</p><p><b>CONCLUSION</b>Protective stoma can avoid anastomotic leakage following ISR for ultra-low rectal cancer, and alleviate the suffering of anal incontinence in the early postoperative period, and is conducive to the restoration of anal function.</p>

Clinical application of intersphincteric resection in the anal-preserving operation for ultra-low rectal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of intersphincter resection (ISR) combined with total mesorectal excision (TME) and colon-anal anastomosis in the treatment for ultra-low rectal carcinoma.</p><p><b>METHODS</b>To review and analyze retrospectively the data of 34 patients with ultra-low rectal carcinoma (without external anal sphincter involvement) who received treatment of ISR, TME and colon-anal anastomosis.</p><p><b>RESULTS</b>Partial resection of internal sphincter was performed in the patients with a distal edge of the tumor greater than or equal to 2 cm from the dentate line. Subtotal removal of the rectum was performed between 1 cm and 2 cm. Total resection was performed in less than 1 cm or involvement of dentate line. Reconstruction of digestive tract was done by manual colon-anal anastomosis. The average distance from distal excised margin to the tumor was 2.3 (1.8 - 3.2) cm among 34 patients. The pathological types were as follows: 28 cases of adenocarcinoma (11 were well differentiated, 17 moderately differentiated), 1 case of papillary carcinoma and 5 cases of villous adenoma with malignant change. The postoperative pathological stages were: Dukes stage A in 28 cases, stage B in 1 and stage C in 5 cases. The pTNM staging was 28 cases in phase I, 1 in phase IIa, 4 in phase IIIa and 1 in phase IIIb. The T stages of the patients were as following: 16 Tl, 17 T2 and 1 T3. Postoperative anastomotic stenosis occurred in 3 cases, anastomotic dehiscence in 2 cases and rectovaginal fistula in 2 cases. The ability of controlling feces of patients decreased significantly in the early postoperative period, and restored gradually at 6 to 12 months after operation. Anastomotic recurrence occurred in 1 case at 5 months after operation and liver metastasis in 1 case at 40 months.</p><p><b>CONCLUSION</b>With strictly grasping indications, radical resection can be attained and anal sphincter preserved by ISR combined with TME and colon-anal anastomosis. It is an effective sphincter-preserving operation.</p>

Results of hip resurfacing for developmental dysplasia of the hip of Crowe type I and II / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recently, the new generation of metal-on-metal total hip resurfacing arthroplasty is well known for preserving the proximal femoral bone stock, minimizing the risk of postoperative dislocation using large femoral heads, and expecting low wear of metal-on-metal articulation for longer prosthesis survival. It also has the advantage in biomechanical loading in the proximal femur. The osteoarthritis secondary to developmental dysplasia of the hip (DDH) has been the most common reason for total hip arthroplasty. Most of the patients are young and active, who require improved range of motion of the hip besides relief of the pain, even expect to resume the ability to run and jump after the joint arthroplasty, thus to be allowed an active lifestyle. The objective of the current study was to evaluate the early outcome of resurfacing arthroplasty for the mild DDH cases (Crowe type I and II).</p><p><b>METHODS</b>Between September 2005 and May 2007, twenty-one consecutive patients (twenty-six hips) with the diagnosis of osteoarthritis secondary to DDH underwent metal-on-metal resurfacing arthroplasty. The average age at the time of surgery was 46.5 years (range, 37-59 years). Six patients (28.6%) were male and fifteen (71.4%) were female. Clinical and radiographic results were observed. The follow-up was performed at 6 weeks, 3, 6, 9 months and then yearly.</p><p><b>RESULTS</b>All patients were followed for a mean of 18 months (9-29 months). During the follow-up period no complications, such as dislocation of hip joints, infection or femoral neck fracture occurred. The clinical outcomes, as rated with the Harris hip score, improved significantly compared with the preoperative ratings. The mean postoperative Harris hip score was 90.7, compared to 35.5 preoperatively. The radiographic analysis showed that all prostheses were fixed with no radiolucencies. All of the patients who had equal limb lengths preoperatively had equal lengths postoperatively. Of the nine patients with preoperative limb-length discrepancy of 0.8 to 1.2 cm, all regained equal limb length postoperatively. In addition the pain was nearly completely relieved, the range of motion was remarkably improved and no restriction was needed after operation regarding early exercise.</p><p><b>CONCLUSIONS</b>The new generation of metal-on-metal resurfacing arthroplasty may be a reasonable option for DDH of the Crowe types I and II.</p>

Survey of Japan moxibustion methods / 中国针灸

Japan moxibustion methods originate from China and form moxibustion methods with Japanese characteristics and diathermal moxibustion as main, in combination with Japanese practice in development course. In the present paper, diathermal moxibustion and folk traditional moxibustion methods in Japan are introduced and moxibustion methods between China and Japan are preliminarily compared.

Evaluation of the results of fine-needle aspiration liver biopsies and the complications in 2528 cases / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the value of fine-needle aspiration biopsy (FNAB) in diagnosing primary liver cancer (PLC) and its major complications.</p><p><b>METHODS</b>From June 1, 1985 to May 31, 2005, 2528 patients who were presented with suspected PLC underwent ultrasound-guided FNAB in the Cancer Hospital of Fudan University. The results were retrospectively reviewed.</p><p><b>RESULTS</b>Of those 2528 cases, there was malignancy in 2061 patients (81.53%), of which 1704 were diagnosed as primary liver neoplasms; 41 were diagnosed as metastatic carcinoma, and 316 were not further classified as primary or metastatic. No malignancy was found in 431 cases (17.05%). In 36 cases (1.42%), suspicious malignancy or anaplasia was suggested. Follow-up results showed that all the 2061 positive cases were verified to be malignant and there were no false positive cases. 163 of the 431 negative cases were verified to be malignant in the follow-ups, of which 136 cases were PLC; 28 of the 36 suspicious malignancy or anaplasia were proven to be malignant (all were PLC). The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of our FNAB for diagnosing liver malignancy were 91.52%, 100.00%, 100.00%, 59.10% and 92.44%, respectively, and 81.01% cases were diagnosed by FNAB in all the 2096 cases with PLC. Cytological examinations of the smears obtained by FNAB correctly distinguished primary and secondary malignancy in 77.49% of the patients. After FNAB, 11 patients (0.44%) had intraperitoneal hemorrhages and 5 cases (0.20%) had needle tract implantation metastases.</p><p><b>CONCLUSIONS</b>FNAB is important and effective for determining the malignancy potential of liver tumors, especially for PLC. Complications related to FNA were rather rare, therefore, this technique may be easily applied to clinical practice.</p>

Three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the response and tolerance in hepatocellular carcinoma (HCC) patients treated by three-dimensional conformal radiotherapy (3DCRT) combined with. transcatheter arterial chemoembolization (TACE).</p><p><b>METHODS</b>Fourty-six HCC patients confirmed by cytology or histology were studied. All patients underwent TACE 1 to 3 courses. Then they received 3DCRT after an interval of about one month. 3DCRT was given with the field covering the tumor with a generous margin. 6 MV X-ray was used. The total dose was 30 - 54 Gy, in daily 2 Gy fractions. Immediate response was recorded according to the WHO criteria carried out by serial CT scan one month after 3DCRT. Irradiation toxicities were scored by the RTOG criteria. Acute liver toxicity was graded according to the common toxicity criteria (CTC) of National Cancer Institute. Late toxicity was focused on radiation-induced liver disease (RILD).</p><p><b>RESULTS</b>Partial response was observed in 8 (17.4%) patients. Stable disease and progressive disease was observed in 35 (76.1%) patients and 3 (6.5%) patients, respectively. No complete response was observed at the time of the response evaluation. The overall survival rate at 1-, 2- and 3-year was 60.9%, 39.1% and 28.3%, respectively, with a median survival period of 16 months. The 1-, 2- and 3-year local progression-free rate was 73.9%, 56.5% and 39.1%, respectively. The 1-, 2- and 3-year distant metastasis rate was 15.2%, 21.7% and 34.8%. Univariate analysis showed that favorable prognostic predictors for survival were: T3 stage, CACA 2001 stage I, absence of portal thrombosis, Child-Pugh grade A and irradiation dose of >45 Gy. Irradiation dose and liver cirrhosis were identified by Cox-regression analysis as independent predictors for survival. Two patients experienced CTC grade 1 acute hepatic toxicity and three patients experienced grade 3 acute hepatic toxicity. Two patients developed RILD. Three patients experienced RTOG grade 1 acute gastrointestinal complication and one patient experienced acute gastrointestinal bleeding. Five patients experienced RTOG grade 1 leucopenia, and five patients experienced grade 2 leucopenia.</p><p><b>CONCLUSION</b>3DCRT combined with TACE is safe and effective for HCC. It is worthy of a further dose escalation study.</p>