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Objective:To summarize the clinical manifestations, epidemiological features and progress of diagnosis and treatment of gout in the spinal canal.Methods:A 59-year-old male patient was admitted to the hospital due to back pain, weakness in both lower limbs, hypoaesthesia and feeling of walking and stepping on cotton for more than one month. The preoperative imaging examination showed there were space-occupying lesions in the spinal canal at the T 8, 9 level with severe canal stenosis. The patient underwent posterior T 8, 9 laminectomy decompression, debridement and T 7-T 10 pedicle screw internal fixation under general anesthesia. The thoracic spinal gout was diagnosed by postoperative pathology. Further, the following keywords, "gout", "gout of spinal canal", "gout of spine" and "intraspinal gout", were used to search in the Chinese and English databases. A total of 62 patients with intraspinal gout were retrieved. The age, gender, involved disease, history of gout or hyperuricemia, laboratory indicators and imaging data of 63 patients were collected. Results:A total of 63 patients with intraspinal gout were retrieved. The gender of one patient was unknown. The remaining patients included 54 males (87.1%, 54/62) and 8 females (12.9%, 8/62) with the ratio of male to female 6.75∶1. The average age was 52(35, 67) years (range 20-82 years) and the peak onset period was 60-79 years. Fifty-six cases (88.9%, 56/63) of all patients suffered the disease from one single site of the spine, including 26 cases in the lumbar-sacral (46.4%), 22 cases (39.3%) in the thoracic spine and 8 cases (14.3%) in the cervical spine. However, only 7 patients had the disease at more than two sites at the same time accounting for 11.1% of all patients (7/63). Fifty-three patients (91.4%, 53/58) had a history of hyperuricemia with an average duration of 8.6 years (range 3 months to 28 years). The clinical symptoms of intraspinal gout were not specific. There were 70.5% (43/61) patients had local pain and up to 98.4% (60/61) patients had varying degrees of neurological dysfunction. X-ray examinations often showed no positive results due to technical limitations. Among 41 patients with CT imaging data, 31 cases showed mid-to-high density elliptical or irregular calcifications in the spinal canal and the remaining 10 patients showed medium-low density soft tissue masses. There were 96.2% (51/53) of patients with intraspinal gout showed medium or low signal on T1WI MRI examination but without high signal or low signal on T2WI (40 cases of high signal, 13 cases of high signal or mixed signal). All 63 patients were finally diagnosed by pathological examination and 5 of them with histological features. The main pathological features included foreign body granuloma, red-stained crystal-like deposits in the cytoplasm of foreign body giant cells, birefringent spindle or needle-like crystals under polarized light microscope.Conclusion:Gout in the spinal canal is a rare condition. Dual-energy CT has high sensitivity and specificity in identifying gout and it can provide a more accurate method in diagnosis of spinal gout. However, the final diagnosis depends on postoperative pathology. If case of spinal instability or neurological dysfunction, surgery had to be performed. Hyperuricemia should be treated in order to reduce the risk of acute attacks.
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Tibial plateau fractures are intra-articular fractures of the knee.Restoring the articular surface,axis of lower extremities and function of knee is the main goal of treatment.Open reduction and internal fixation remains the gold standard for the treatment.However,it is more difficult to treat fractures in elderly patients with severe osteoarthritis,osteoporosis,and comminuted knee joints.Open reduction and internal fixation are sometimes difficult to achieve the treatment goal,and the patients are prone to bed-related complications.Total knee arthroplasty (TKA) is the main method for the treatment of traumatic arthritis after knee fracture,but the surgery is difficult with multiple complications.At present,some authors have applied primary TKA to the tibial plateau fractures and reported the advantages including immediate post-operative knee stability,early functional exercise and weight-bearing activities,and no need to consider the meniscus retention,cruciate ligament repair and articular anatomical reduction.This article reviews the surgical advantages,surgery-related issues and expenses to discuss the treatment of tibial plateau fractures in the elderly with TKA,providing reference for the treatment of tibial plateau fractures in the elderly.
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@#Objective To observe the pharmacokinetics and concentration of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) in brain tissue after BCNU-polylactic acid (PLA) delayed release wafer embedded in brain tissues of dogs.Methods 10% BCNU-PLA delayed release wafer were prepared and embedded in brains of 12 dogs. Peripheral blood of dogs was taken and the animals were executed for brain tissue after surgery in different times. BCNU concentrations in blood and brain tissue were quantified by high-performance liquid chromatography.Results BCNU was able to be detected at 22nd hour, and the Cmax (average 243.64 ng/ml) appears at 35th hour after surgery. The average BCNU concentration in brain tissue was 26.60 μg/g at 5th day after surgery.Conclusion BCNU-PLA delayed release wafer is a useful type for treatment of malignant gliocoma.