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Objective To compare the clinical effects of G-arm X-ray machine and C-arm X-ray machine in percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) of thoracolumbar spine.Methods The clinical data of ninety-five patients with thoracolumbar OVCF treated with PKP from May 2016 to August 2017 in Yanan University Affiliated Hospital were retrospectively analyzed.They were divided into two groups according to the different guiding fluoroscopy methods used during the operation.Forty-six cases in G arm group completed PKP under the guidance of G arm X-ray machine,Forty-nine cases in C arm group completed PKP under the guidance of C arm X-ray machine.The operation time,fluoroscopy times,cement leakage cases,the height of injured vertebral leading edge,Cobb angle of kyphosis,visual analogue score and Oswestry dysfunction index were recorded before and after operation,and the related indexes were analyzed and compared.Results Two groups of patients were successfully completed surgery,no complications of vascular and nerve injury.The operation time and fluoroscopy times in G arm group were less than those in C arm group (operation time:(29.6±4.5) min vs.(42.5±5.3) min,and fluoroscopy times in G arm group:(9.1±2.0) vs.(16.9±3.2));the difference was statistically significant (t =-12.747,12.870,P＜ 0.01).Postoperative height of injured vertebral leading edge(G arm group (22.3±5.3) mm),C arm group (22.4±5.1) mm),kyphosis Cobb angle (G arm group (9.2±3.8)°,C arm group (9.3±3.7) o),visual analogue score (G arm group (2.1±0.7)points,C arm group (2.2±0.9) points),Oswestry dysfunction index (G arm group (21.3±8.5) points,C arm group(21.5 ± 8.3)points),compared with preoperative(the hight of injured vertebral leading edge of G arm group (18.2 ±5.3) mm,C arm group (18.4±5.2) mm,Cobb angle of injured vertebra G arm group (15.7±4.4) °,C arm group (15.9±4.3) °,visual analogue score of G arm group (7.8± 1.2) points,C arm group (7.7± 1.1) points,Oswestry dysfunction index score of G arm group(41.2±8.3)points,C arm group (41.5±8.2) points),the difference was statistically significant (t =-3.709,-3.844,-7.582,-8.144,27.827,27.088,11.360,11.999,P＜0.01),but there was no significant difference between the two groups (P ＞0.05).Conclusion Using G-arm X-ray machine to assist PKP in the treatment of thoracolumbar spine OVCF can effectively shorten the operation time,reduce the intraoperative fluoroscopy time,and the clinical effect is satisfactory.
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Objective To explore the clinical application value of percutaneous kyphoplasty ( PKP ) under the guidance of G arm X ray machine in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods The medical records of eighty-two patients (94 vertebral bodies) with OVCF treated with PKP were collected retrospectively. Thirty-nine cases ( 44 vertebral bodies ) were guided by G-arm X-ray machine to implement PKP,which were recorded as G-arm group. Forty-three cases (50 vertebral bodies) were guided by C-arm X-ray machine to carry out PKP,which were recorded as C-arm group. The operation time, intraoperative fluoroscopy times, bone cement leakage cases, preoperative and postoperative anterior height of injured vertebrae,Cobb angle of injured vertebrae,visual analogue scale scores and Oswestry disability index of the two groups were recorded. Results There was significant difference in operation time and intraoperative fluoroscopy times between the G-arm group and C-arm group (the operation time:(31. 6±5. 2) vs. (45. 8±6. 7) min,the intraoperative fluoroscopy times: (9. 5±2. 3) times vs. (18. 7±3. 5) times,t=-10. 64,-13. 91,P<0. 05) ,while there was no significant difference in the number of bone cement leakage ( P>0. 05) . Compared postoperative and preoperative anterior height of injured vertebrae, Cobb angle of injured vertebrae, visual analogue scale scores and Oswestry disability index scores of G-arm group and C-arm group respectively, the differences were significant ( t=-3. 41 vs. -3. 28, 6. 67 vs. 7. 66, 26. 63 vs. 25. 75 and 10. 41 vs. 11. 90, P<0. 05). There was no significant difference between the two groups (P>0. 05). Conclusion The treatment of OVCF with PKP guided by G-arm X-ray machine could significantly shorten operation time, reduce the intraoperative fluoroscopy times and the operative difficulty,and increase operation safety than PKP guided by traditional C-arm X-ray machine.
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ObjectiveTo evaluate the applicable value of attitude control system combined with attitude controllable intelligent capsule endoscope for stomach examination.MethodsA total of 15 patients were recruited to the study.Manipulability of movement and posture change of capsule endoscope,diagnostic efficacy for such locations as gastric cavity,bulb and descending duodenum,image quality and patients'compliance were assessed.ResultsThe procedure was completed in 14 patients.One failed due to downfall of the endoscope to duodenum within 5 min. Mean operation time was ( 23.7 ± 6.5 ) min ( from 5 to 30 min).Ten cases of superficial gastritis,one case of superficial gastritis with bile regurgitation and 1 case of ulceration of the duodenal bulb were diagnosed.No abnormalities were found in 3 others.Endoscopic images were of high quality and only a few were influenced by gastrointestinal peristalsis.All patients showed compliance with no discomfort.Capsule endoscopes were discharged within 2 or 3 days.ConclusionAttitude control system combined with attitude controllable intelligent capsule endoscope in stomach examination is feasible and valuable in clinic.
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<p><b>BACKGROUND</b>The investigations of prevalence and risk factors of peripheral arterial disease (PAD) in type 2 diabetic patients have been carried out in many countries and regions, except for Central China. In this study, we determined the prevalence of PAD in type 2 diabetic patients and the related factors that gave rise to increasing of the risk of PAD development in Wuhan, China.</p><p><b>METHODS</b>The study enrolled 2010 patients aged 60 years and older who were regularly visiting the Central Hospital of Wuhan that is a public hospital from 2005 to 2010, where all residents of the city were offered the medical services. PAD was defined as an ankle-brachial index < 0.90 in either leg. To evaluate the role of various risk factors in PAD development, uniformed interviews, clinical examinations and laboratory investigation of all of participants were performed in this study. The correlation between potential risk factors and PAD was analyzed.</p><p><b>RESULTS</b>In Wuhan, the prevalence rate of PAD was 24.1% in elderly diabetic patients. Totally, 291 patients with PAD had at least one weak but not absent dorsalis pedis pulse in both feet, while 541 patients without PAD showed this way. At least one absent dorsalis pedis pulse was found in 192 patients with PAD as well as 10 patients without PAD. The results of multivariate regression analysis suggested that the age, smoking history, hypertension, diabetic neuropathy and macroangiopathy gave rise to significant increase of PAD development in type 2 diabetic diseases.</p><p><b>CONCLUSIONS</b>The prevalence of PAD in elderly patients with type 2 diabetes in Wuhan was close to the prevalence that was reported in other regions of China and other Asian countries. Control of the related risk factors and early diagnosis of PAD may play a role in PAD prevention and improving prognosis.</p>
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Aged , Female , Humans , Male , Middle Aged , China , Epidemiology , Diabetes Mellitus, Type 2 , Epidemiology , Peripheral Arterial Disease , Epidemiology , Prevalence , Risk FactorsABSTRACT
BACKGROUND: In recent years, percutaneous laser disc decompression (PLDD) has been developed gradually in China. But there have been fewer further studies on the indications and contraindications for the use of the therapy.OBJECTIVE: To analyze the therapeutic effect after the choice of the indications for PLDD.DESIGN: A case-paired observational analysis with the patients as the subjects.SETTING: The Department of Radiology and Department of Soft Injuries of the 474 Hospital of Chinese PLA.PARTICIPANTS: We recruited inpatients of the 474 Hospital of Chinese PLA after PLDD between August 1998 and December 2004 as subjects for this research. Totally 68 cases were involved. According to the same gender, the closeness in age, the cases were matched and divided into 2 groups (eg. If there were 2 or more than 2 cases with the same age, the case whose disease course is the closest one was chosen): poor indication group (n=34) and good indication group (n=34).METHODS: A pillow was put under the belly of the patient who lay face down on the angiographic bed with the side with serious symptoms near the outside of the bed (the side where doctor operated). Symbols were marked on the body surface under the fluoroscopy. The waist was subjected to conventional sterilization and was paved with a piece of sterile cloth. 5 Ml of lydocaine was used for anesthesia. 8-12 cm to the posterior central midline of the diseased side, an incision was made to insert the needle according to the fat and thinness of the patients, and attention to the angle adjustment was needed to enter the intervertebral disc through "the secure triangle"beneath the nerve root so that 5 mm of the exposed front segment covered the needle end completely. Cautery was made with 15 W laser for every 1s after an interval of 4 s. The total output power of laser was adjusted according to the area of intervertebral disc, which was usually 1 200-1 700joules. The gas produced should be drawn out during the cautery, and this was done at least for 3 times. If the patient felt the distending pain, drawing out gas should be performed at any time. The puncturing needle and fiberoptics were pulled out after the operation, and band-aid was applied to the local area. The patients lay at the supine position to let the doctor examine the remission and functional recovery. When the patients were discharged, modified Macnab standard was used to evaluate the therapeutic effect. Evaluation criteria: According to the modified Macnab standard, the therapeutic effect can be classified into the following types: excellent means disappearance of pain, no limitation in motor function, with complete recovery of normal working and movement; good means that the patients showed occasional pain, but were able to do light job; passable means that the patients showed partial improvement, but still felt pain, and were not able to work and move; poor means that the patients showed signs of nerve compression that further operation was needed. The therapeutic effect of being excellent and good was combined as good therapeutic effect,and that of being passable and poor was combined as poor therapeutic effect. X2test was performed to the paired numerative data by the author.MAIN OUTCOME MEASURES: ① General evaluation of the therapeutic effect of the poor indication group and good indication group according to modified Macnab standard when the patients were discharged from the hospital; ② Comparison of the curative effect between the group with intervertebral disc herniation ≥ 0.6 cm and the group with intervertebral disc herniation ＜ 0.6 cm; ③ Comparison of the therapeutic effect of the group complicated with spinal canal stenosis and the group with normal spinal canal; ④ Comparison of the therapeutic effect between the group with good indications and other groups with poor indications.RESULTS: All the 68 patients entered the result analysis. ①The therapeutic effect in the good indication group was obviously better than that in the poor indication group, with a significant difference [85%(29/34),56%(19/34) ,χ2=5.06,P ＜ 0.05]. ② The therapeutic effect was significantly better in the group with intervertevbral disc herniation ＜ 0.6 cm than in the group with intervertevbral discs herniation ≥ 0.6 cm, but without significant difference [75 % (6/8), 50% (4/8),χ2=0.25, P ＞ 0.05]. ③The therapeutic effects were close in the group complicated with spinal canal stenosis and the group with normal spinal canal, but without significant difference [80% ( 12/15 ), 73 ( 11/15 ) ,χ2=0,P ＞ 0.05].④ The therapeutic effect in the group with good indications was obviously better than that in other groups with poor indications, with a significant difference [100%( 11/11 ), 36%(4/11), χ2=5.14,P ＜ 0.05].CONCLUSION: It could improve the therapeutic effects of PLDD when indications were properly chosen.
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BACKGROUND: Percutaneous laser disc decompression(PLDD) is a new technology developed to treat lumbar herniated disk inrecent years; however,only limited literature has been reported about cohort study on its indications.OBJECTIVE: To treat patients with lumbar disc herniations by PLDD and evaluate the effects of PLDD in releasing painandimproving lumbar function after operation.DESIGN: Non-randomized concurrent controlled trial based on thepatients.SETTING: Department of Radiology of the 474 Hospital of Chinese PLA.PTICIPANTS: This study recruited totally 173 patients ( 101 males and 72 females aged from 18 to 75 years) who received PLDD in the Department of Radiology of the 474 Hospital of Chinese PLA from July 1998 to August 2002 and were followed up for over one year.METHODS:The 173 patients were divided into good indication group (Group A, n = 139) and poor indication group(Group B, n =34). Group B was further divided into extrusion group(Group B1 of 8 patients),lumbar canal stenosis group(Group B2 of 15 patients) and other conditions group (Group B3 of 11 patients). VAS scoring criteria and modified Macnab criteria were used to evaluate the curative effects.MAIN OUTCOME MEASURES: Primary results: the degree of pain and lumbar function. Secondary results:the success rate of puncture as well as adverse events and side effects.RESULTS: The success rate of puncture was 96. 3％ for performing through L5 - S1 and 100％ through L3-4 and L4-5. In Group A, excellent postoperative effects were seen in 63 cases, good in 51 cases, fair in 20 cases and poor in 5 cases, with 82.0％ excellent and good rates. The excellent and good rate in Group B was 55.9％. Postoperative back pain could be relieved several days later. Other complications such as disc infection,psoas hematoma,rupture of colon,injuries of nerve roots and bloodvessels did not occur. There was a significant difference between Group A and Group B(x2=10.38, P ＜0.05).CONCLUSION: (① PLDD is a convenient, safe and reliable procedure in treating lumbar disc herniation because of its high success rate, satisfactory results and fewer complications.② Proper selection of indications helps improve the curative effects of lumbar disc herniation.
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BACKGROUND: Percutaneous laser disc decompression (PLDD) and automated peroutaneous lumbar discectomy (APLD) have been widely used in the treatment of lumbar intervertebral disc prolapse.OBJECTIVE: To compare the symptoms and improvements of patients after receiving PLDD and APLD and analyze the characteristics of the two operations.DESIGN: A non-randomized concurrent controlled observation.SETTING: The 474 Hospital of Chinese PLA.PARTICIPANTS: Totally 106 inpatients with lumbar and leg diseases of different extent were selected from the 474 Hospital of Chinese PLA as the subjects. The patients were divided into APLD group( n =46) and PLDD group( n = 60) according to different intervention measures.INTERVENTIONS: APLD group: The dilating tube was probed at different levels, and working cannula of 4.8 mm was retained at last. The fenestration was made at the fibrous rings with the trepan, then nucleus pulposus of about 1 - 5 g was clipped by the pliers for nucleus pulposus. Electric discectomy apparatus was used to aspirate the nucleus pulposus of about 0.5 - 1.5 g at 600 - 300 rounds per minute. The electric discectomy apparatus and working cannula were pulled out after operation. PLDD group: The stylet was removed and optical fibers were inserted with the naked front segment (5 mm) com pletely going beyond the needle end. Cautery was made with 15 W laser for 1 s once a time at the interval of 4 s. The total output power of laser was adjusted between 1 200 - 1 700 joules. The patients lay at supine position to be examined for pain relief and functional recovery, and then they were sent back to the ward with flatbed cart for bed rest of 3 days. Therapeutic effects were evaluated according to modified Macnab' s criteria. The curative effect was presented as percentage.operations.excellent(47.8% ), 18 good(39. 1% ), 5 passable (10.9%), and 1 poor APLD group, there were 29 cases of excellent(48.4% ), 20 good (33.3%), 9 passable (15.0%), and 2 poor(3.3% ), with 81.7% excellent the two groups. Pain in the lumbar part usually sustained for several days,then was relieved and disappeared gradually. One patient in APLD group had infection of intervertebral disc. No complications occurred in PLDD group.CONCLUSION: PLDD and APLD do not differ significantly in excellent and good rate of treating prolapse of lumbar intervertebral disc. Compared with APLD, PLDD is a more convenient and minimally invasive technique causing fewer complications.
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<p><b>OBJECTIVE</b>To investigate the etiologic agents of the SARS and develop diagnostic method for this disease.</p><p><b>METHODS</b>Thirty-six nasopharyngeal aspirate specimens from 27 patients with SARS in Shenzhen were collected. The samples were aliquotted to three parts and subjected to molecular assays for human metapneumovirus, chlamydia and a novel coronavirus, which was reported recently to be the etiologic agent of SARS. Nested RT-PCR was used to amplify the RNA polymerase gene of the novel coronavirus and the PCR products were sequenced directly or after cloned to pMD18-T vector.</p><p><b>RESULTS</b>Human metapneumovirus and chlamydia genes were detected in none of the specimens using the RT-PCR and nested-PCR, respectively. The novel coronavirus gene were amplified in 6 of 36 specimens, the sequence analysis indicated that this novel coronavirus is unrelated to any other coronavirus reported previously. The nucleotide and deduced amino acid alignment between this coronavirus and others was not more than 40% and 70% to 82%, respectively, while the nucleotide sequence cloned from the 6 patients were identical.</p><p><b>CONCLUSIONS</b>The SARS patients in Shenzhen were infected with coronavirus and this novel coronavirus is associated with SARS. The sequence analysis indicated that the coronavirus from SARS patients in Shenzhen is the same as that identified from other areas such as Canada and Hong Kong. A specific diagnostic nested RT-PCR was developed to identify this novel coronavirus infection.</p>
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Cloning, Molecular , DNA, Viral , Genetics , Genetic Variation , RNA, Viral , Genetics , Reverse Transcriptase Polymerase Chain Reaction , Severe acute respiratory syndrome-related coronavirus , Genetics , Sequence Analysis, DNA , Severe Acute Respiratory Syndrome , VirologyABSTRACT
Objective To investigate the CT imaging features and its diagnostic value in patients with epibulbar dermoid and dermolipoma. Methods Twelve cases with epibulbar dermoids and dermolipomas were retrospectively analyzed. There were 5 dermoids and 7 dermolipomas, and a distinct female predominance (11/12). The lesions located at the external canthus, and were almost always uniocular and single (right=9, left=3). Transverse plain CT scan was performed in all patients, contrast enhanced CT scan in 5 cases. The clinical aspects, pathological features, and CT findings were then described. Results Crescent-shaped hypodensity lesion attached to the epibulbar was detected in all cases on CT scan. The diameter ranged from 8 mm?5 mm to 25 mm?15 mm. The lesion had a thin wall (1- 3 mm) under the conjunctiva lateral, and could have middle enhancement. Conclusion CT can show the lesion′s range and characteristics, as well as the relationship with the adjacent structures. CT has great directive value for operating on these tumors, and reducing the complications.
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Objective To study the effect of selection of indications in percutaneous laser disc decompression(PLDD).Methods Lumbar disc herniation treated by PLDD with satisfactory and unsuited indications in 34 cases respectively were matched studied.Results The curative effect was 85.3% and 55.9% in satisfactory indication group and unsuited indication group respectively (?~2=5.06,P
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Objective To study of percutaneous laser disc decompression(PLDD)in the patients of lumbar disc herniations.Methods 66 patients were treated with PLDD.The mean age of the 48 male and 18 female patients was 39.3 years old.Results 58 patients of all,or 87.9% showed excellent or good result.15 patients(78.9%)showed excellent and 2 patients(10.5%) were good,2 patients(10.6%) were fair or poor under 30 year old.15 patients(44.1%)showed excellent and 17(50.5%)patients were good,2(5.9%)patients were fair in 31~50 years old.2(15.4%) patients showed excellent and 7(53.8%)patients were good,4(29.8%)patients were fair or poor over 51 years old.Conclusion PLDD is safe and convenient method of treating lumbar disc herniations.
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AIM:To investigate the functional changes and histopathological basis of Oddi's sphincter under hypercholesterolemia. METHODS:Twenty - four New Zealand rabbits were equally divided into be groups ran- domly. Experimental groups Ⅰ and Ⅱ fed with cholesterol - added forage for 4 and 8 weeks respectively before sacri- ficed. Images, functions and histopathological characteristics of Oddi's sphincters of experimental groups were studied and compared with control group by cholangiography, catheter manometry, and quantitative analysis of nitric oxide synthase. RESULTS: The hasal pressures of proximal low - pressure segment of Oddi's sphincter of hath experimen- tal groups Ⅰand Ⅱ (20.9?6.1 mmHg, 25 .6?9.1 mmHg, respectively) were higher than those of control group sig- nificantly (11 .7?2. 8 mmHg, P