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Objective To analyze the clinical characteristics of ischemic bowel disease in elderly patients.Methods The clinical data of 83 patients with ischemic bowel disease, including 48 patients aged ≥60 years (elderly group ) and 35 patients aged ＜60 years ( control group ), admitted in our hospital from January 2011 to June 2016 were retrospectively analyzed.The clinical characteristics , underlying diseases, examination methods and treatment were compared between the two groups .Results There were no significant differences in gender , occupation, urban or rural origin between the two groups (P＞0.05).The incidence of acute mesenteric ischemia ( AMI) in elderly group was significantly higher than that in the control group [22.9%(11/48) vs.5.7%(2/35), χ2＝4.534, P ＝0.033];while the incidence of ischemic colitis (IC) in control group was higher than that in the elderly group [94.3%(33/35) vs. 70.8%(34/48), χ2＝7.154, P＝0.007].Elderly group was more prone to misdiagnosis as compared with the control group [58.3%(28/48) vs.34.3%(12/35), χ2＝4.688, P ＝0.030] .Abdominal pain, diarrhea and hematochezia were the most common clinical manifestations of the two groups .Moderate pain and dull pain were the main symptoms of the elderly group accounting for 75.0%(36/48), while colic was the main symptoms of the control group accounting for 65.7%(23/35).The proportion of elderly patients with hypertension, coronary heart disease and cerebral infarction was higher than that of the control group [70.8%(34/48)vs.25.7%(9/35),62.5%(30/48) vs.20.0%(7/35),16.7%(8/48) vs.0(0/35), χ2＝16.504,14.798,4.684,all P＜0.05].The number of patients receiving colonoscopic examination was lower in the elderly group than that in the control group [52.1%(25/48) vs.94.3%(33/35), χ2＝17.127, P＝0.000 ] .The overall effective rate of medical treatment for elderly patients was 90.2%(37/41), mostly of them were chronic mesentery ischemia (CMI) and IC patients; while 11 cases of AMI patients had poor outcomes of medical and surgical treatment including 5 fatal cases.Conclusions The incidence and mortality of AMI in elderly patients with ischemic bowel disease are higher , while CMI and IC have good prognosis.Timely diagnosis, appropriate treatment may improve the cure rate and reduce mortality for elderly patients with AMI.
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Objective To evaluate the curative effect of arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions.Methods Retrospectively analyzed the clinical data of 35 cases who were admitted into our hospital from June 2015 to October 2016 and underwent arthroscopic surgery for the treatment of first-time shoulder dislocation.All the 35 cases were combined with Bankart lesions,and the lacerated glenoid labrum were repaired with suture anchorsy.The postoperative ASES scroe and Rowe score were adopted for the final evaluation.Results All the 35 cases were followed up for 1 to 6 months,3 months averagely.All the patients had satisfactory shoulder function,with no shoulder dislocation occured again.The ASES score and Rowe score after surgery was better than that before surgery with statistically significant difference(P<0.05).Conclusion Arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions has many advantages such as mini-invasion,rapid recovery and satisfactory outcome in function and motion.
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Objective To evaluate the clinical results of arthroscopic arthrolysis for the treatment of elbow stiffness.Methods Totally 34 cases with elbow stiffness caused by trauma who needed to undergo arthroscopic arthrolysis were selected from General Hospital of Shenyang Military Area Command from October 2014 to February 2016.Among them,3 cases were lost to follow-up,and the other 31 cases were included in the study.All the patients were performed arthroscopic arthrolysis.Removed the hyperplasia of osteophyte and girdle,cleaned the articular cavity,restored the smooth of articular surface,and released the joint capsular and ligament around the elbow joint during the operation.Manipulation release was used coordinate with analgesia and rehabilitation therapy after operation.Mayo scores of elbow were used for function evaluation and range of motion(ROM) was collected.Results Patients were followed-up from 9 months to 12 months,(10.4±1.5) months on average.Before the operation,the mean maximal flexion angle of the elbow was (87.6±5.9)°,the extension angle was (35.5±6.4)°,the pronation angle was (75.9±9.6)°,the rotational angle was (67.2±7.4)°,and it was (125.9±6.5)°,(5.0±1.9)°,(82.0±9.1)°,(81.0±7.0)°respectively after operation,and the differences before and after opreation were statistically significant (P<0.05).The Mayo scores was (61.9±7.6) preoperatively and (88.8±4.7) postoperatively,and the difference was statistically significant(P<0.05).Conclusion Arthroscopic arthrolysis has the advantages of clear operative field,minimal invasion and rapid recovery.It can effectively improve the elbow joint activity and arthroscopic arthrolysis is an effective surgical treatment for elbow stiffness.
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ObjectiveTo investigate the injury mechanism,clinical characteristics and surgical treatments of Segond fracture combined with anterior cruciate ligament (ACL) injury.MethodsNine patients suffering from Segond fracture combined with ACL injury were treated between January 2008 and December 2010.All the patients revealed ACL and medial collateral ligament (MCL) breakage under arthroscopy.Furthermore,one patient was associated with lateral collateral ligament (LCL) breakage and medial meniscus injury,four with medial meniscus tear and two with lateral meniscus tear.All the patients underwent arthroscopic tendon allotransplantation,ACL reconstruction and MCL repair.Besides,synchronous LCL reconstruction was performed in one patient,meniscus suture in three and meniscus plasty in four.Six patients with large Segond fracture fragments were fixed with two hollow lag crews and three with relatively small fracture fragments fixed with one hollow lag crew.ResultsThe mean followup period was 12 months,which showed average postoperative Lysholm score of 59 points and satisfactory clinical outcome.ConclusionsSegond fracture is often combined with ACL injury and is predictive for ACL injury.In ACL reconstruction,large Segond fracture blocks should be reduced and fixed and the combined injuries also should be treated in the same period.
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Objective To study the protective effects of aldioxa tablets on aspirin-induced gastric mucosal lesions in rat model. Methods Sixty healthy male Wistar rats were randomly divided into five groups: Ⅰ (injury group), Ⅱ (control group), Ⅲ (sucralfate protective group), Ⅳ (aluminium hydroxide protective group), and Ⅴ (aldioxa protective group). The three protective groups were treated with sucralfate, aluminium hydroxide and aldioxa tablets respectively before gastric mucosal injury was induced. Then the ulcer index (UI), epithelial damage scoring (EDS) were measured, and the pathological changes on histological sections and ultrastructural sections of gastric mucosa were assessed under microscope or electron microscope. Results The data of group Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ obtained were as follow: ulcer index: 42.13±6.22, 3.13±1.46, 8.63±3.48, 18.00±6.16, 8.00±3.17, respectively; epithelial damage scoring: 3.67±0.49, 1.25±0.45, 1.41±0.51, 2.42±0.79, 1.50±0.52, respectively. In comparison with injury group, the ulcer index and epithelial damage scoring of gastric mucosa in aldioxa protective group were significantly decreased. Conclusions The results revealed that aldioxa tablets had a significant protection effect on rats with acute gastric mucosal injury induced by aspirin.
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BACKGROUND:Studies have demonstrated that the success rate of isolation of umbilical cord blood mesenchymal stem cells (UCB-MSCs)is low,which also lacks of unified identification method.OBJECTIVE:To modify the traditional in vitro isolation and culture method of UC8-MSCs to obtain a higher success rate and to observe its biological characteristics.DESIGN,TIME AND SETTING:In vitro observation of cytology.The study was performed at the Ninth People's Hospital of Shanghai Jiao Tong University Medical College between April 2006 and January 2007.MATERIALS:A totaI of 28 UCB samples were obtained from full-term normal delivery.Department of Matemity,Shanghai Red House Hospital.The written informed consent was obtained from the puerpera and their families.METHODS:NeonataI umbilical cord blood was collected under sterile condition.Mononuclear cells (MNCs) were separated from using lymphocyte isolation medium by centrifugation and suspended in α-minimum essential medium(α-MEM)containing 10% fetal bovine serum.The medium was half exchanged after 5-7 days of primary culture and then was totally exchanged every 3-4 days.The confluent cells were divided into 2 groups.In group 1.when the round megakaryocytes were confluent and fusiform fibroblast-like cells were fell off.the cell suspension was transferred to new culture dish;in group 2.when the round megakaryocytes dominated the majodty,the culture medium was replaced by α-MEM containing 15% calf serum,followed by culture in α-MEM containing 10% fetal bovine serum when the round megakaryocytes fell off.The fifth passage of UCB-MSCs was harvested for subsequent osteoinduction in vitro.MAIN OUTCOME MEASURES:The cell morphology was observed by microscopy;Flow cytometry was used to examine the surface antigen phenotype;alkaline phosphatase and oil red staining was performed to detect cell differentiation capacity.RESULTS:Of 28 samples of UCB,attaching cells were obtained from 20 samples(6/10 in group 1,14/18 in group 2),fibroblast-like cells that could passage steadily(4 samples in group 1,9 in group 2)were cultured from 13 0f 20 samples with success rate of 46.4%,among which MSCs were passaged steadily up to P22.UCB-MSCs were all positive for MSC-related antigens such as CD29 and CD105,but negative for CD34,CD45 and CD106.Incubation of UCB-MSCs under special condition resulted in a differentiation of osteoblast and adipocyte.CONCLUSIONMSCs exist in UCB,which have multi-differentiation capacity,and passage steadily.The modified in vitro culture method improves culture success rale of UCB-MSCs.
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[Objective]To explore the value of magnetic resonance imaging (MRI) for articular cartilage lesions after bone bruise of distal femur under arthroscopy.[Method]Articular cartilage lesions of 29 cases of distal femur bruises diagnosed by MRI were examined under arthroscopy,12 cases of them combined with medial and lateral meniscus injury,17 combined with anterior cruiciate ligament rupture.[Result]The distal femur articular cartilage lesions examined under arthroscopy were corresponding to MRI findings.The lesions showed by arthroscopy were in direct proportion to MRI.These lesions were classified into Ⅰ-Ⅳ degrees.[Conclusion]Arthroscopic examination showed correspondent result to MRI findings for articular cartilage lesions.Sometimes MRI couldn't deliver the severity of cartilage lesions because of instrument factors.Arthroscopy is considered as the golden standard of evaluation for articular cartilage lesions after bone bruises.
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[Objective]To discuss the postoperative effect of the posteromedial structure injury (medial collateral ligament,MCL,posterior oblique ligament,POL) of the knee.[Method]Fourteen cases of complex posteromedial structure injury were treated from January 2002 to October 2007,twelve of which combined with ACL injury and two combined with PCL injury.Classification of posteromedial structure injury:typeⅠ,8 cases,ruptured from the femur with small bone fragment;type Ⅱ,2 cases,ruptured from the femur without bone fragment;typeⅢ,2 cases,the structure were torn from the body area,and type Ⅳ,2 cases,ruptured from the tibia.The injury were repaired by different techniques according to the classification.Eight cases applied star-shaped steel plate,four with GⅡ anchor screws(2 attached to the femur and 2 to the tibia adhesion respectively),and 2 cases with end-to-end suture.The ruptured ACL and PCL were reconstructed by arthroscopy.Autologous semitendinosus and gracilis were used for 8 ACL reconstruction and B-T-B technique for the other two ACL reconstruction.Two ruptured PCL were reconstructed with allograft of Achilles tendon.[Result]All cases were followed up for twelve months at average(6-18 months) except two cases only for four months.The functional score of the knees were improved from 56.7(50-60) preoperatively to 81.2(74-94) postoperatively in average valued by Lysholm system.Ten cases received normal knee flexion and extension range after repair of the posteromedial structure while 2 cases with restricted 5 degree extension.Nine cases received excellent result in lateral stress test while 2 cases with "+" and 1 case with "++" at zero angle.[Conclusion]Early repaire for the posteromedial structure injury will deliver excellent knee stability.
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[Objective]To report the mid-term results and main points of modular femoral prosthesis in total hip revision surgery for Paprosky type Ⅲ bone defect of the proximal femur.[Method]Nine cases of Paprosky type Ⅲ bone defect of the proximal femur were treated with modular femoral prosthesis MP and ZMR from May 2003 to October 2006.There were 5 males and 4 females with the age range of 39-65 years(mean age 57 years).All the patients were followed up for 8-34 months(mean 19 months).Causes for revision included loosening and osteolysis of primary cemented prosthesis in 7,and coral face prosthesis sterile loosening in 2.The shortest time from the last operation to the revision was 4 years,and the longest was 12 years.There were 5 of type ⅢA and 4 of type ⅢB according to the Paprosky bone defect classification.[Result]The Harris score was 35 points(28-54) before operation and 85(70-90) after operation.Seven patients walked without the help of crutches,one had a mild pain in the thigh and a leg crispation of 2.5 centimeter,and the other having a medium pain in the thigh limping with a crutch.No significant loosening,infection or osteolysis of distal femur was found.One prosthesis sinking 12 mm in 1 case.[Conclusion]Total hip revision surgery for Paprosky type Ⅲ femoral bone defect using modular femoral prosthesis has optimal mid-term results.It offers stabilization both in the initial and late stages.Due to the separation of prosthetic stem from the proximal prosthesis,the implantation is easy to fix.Modular femoral prosthesis,which is benificial to control offset,anteversion angle,and limb length makes the total hip revision surgery simpler and safer.