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Extraskeletal Ewing sarcoma is a rare event, and extraskeletal Ewing sarcoma of the thyroid gland is even rarer. It has non-specific clinical manifestation and difficulty in early diagnosis. The diagnosis mainly depends on histology and immunohistochemistry. It possesses the features of high malignancy, high rate of local recurrence, and distant metastasis. Currently, the aggressive multimodal treatment contains surgery, chemotherapy, and radiotherapy. This study presented a case of extraskeletal Ewing sarcoma arising in the thyroid gland of a 30-year-old woman, who presented with supraclavicular mass and sense of dysphagia obstruction in Department of Otolaryngology, Head and Neck Surgery, Second Xiangya Hospital, Central South University in 2018. Imaging studies demonstrated a cystic-solid mass in inferior of the left leaf of thyroid gland and in the posterior of the trachea and esophagus. The patient underwent localized tumor resection. The pathological diagnosis revealed that it was a small round cell tumor, and the immunohistochemistry results were considered to be extraskeletal Ewing sarcoma. Subsequently, the patient was given chemotherapy and local radiation therapy. There was no evidence of tumor recurrence or metastasis.
Subject(s)
Adult , Female , Humans , Combined Modality Therapy , Immunohistochemistry , Neoplasm Recurrence, Local , Sarcoma, Ewing/therapy , Thyroid GlandABSTRACT
Objective@#To investigate blood pressure and vascular remodeling of OSAS by establishing the chronic-intermittent hypoxia model in rat.@*Methods@#Experiments were performed on 35 adult male Sprague-Dawley rats. Animals were randomly divided into four groups: unhandled control group (with 5 rats in it), CIH group at 9/6/3 weeks (with 10 ratsin each group). Rats in CIH group went through 8-hour intermittent hypoxia everyday, and those in control group were raising normally. After 9-week experiment, blood pressure was measured. The changes of the following indexes were observed: pathological changes of aorta and the middle aorta thickness (HE staining), the collagen of aorta wall (Masson staining). The experimental data were analyzed by SPSS 24.0 statistical software. The variance was analyzed by one-way analysis of variance, and the irregularity was selected using the calibration t test.@*Results@#The systolic and diastolic blood pressures of the CIH9, 6, and 3 weeks groups and the control group were: (127±13) and (79±9), (124±11) and (81±7), (101±11) and (75±9), (91±10) and (65±9) mmHg (1 mmHg=0.133 kPa). The systolic blood pressure and diastolic blood pressure of the rats in the week of CIH 9 and 6 weeks were significantly higher than the control group (F=14.64, P=0.000; F=6.81, P=0.000). There was no significant difference in the mean blood pressure between the three groups of CIH and the control group. Membrane thickness in CIH9, 6 and 3 weeks and control group were: (20±2), (19±2), (14±2), (13±3) μm. Compared with the control group, the aortic pathology and thickness of the middle layer of the CIH9 and 6 weeks group were significantly thicker (F=20.24, P=0.000), but there was no significant difference between the CIH3 week group and the control group; the collagen deposition was unchanged compared with the control group.@*Conclusion@#Intermittent hypoxia for 6 weeks or more in rats resulted in the increasement of blood pressure, morphological changes of aorta and vascular remodeling in thickened media.
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Objective To analyze the clinical characteristics of Brucellar spondylitis and evaluate its surgical treatment effect.Methods From 2002 to 2015,the clinical data of diagnosed patients with Brucellar spondylitis aged ≥65 years old were collected retrospectively in the First Affiliated Hospital of Hebei North University,patients' clinical manifestations and characteristics,laboratory diagnosis,imaging changes and surgical treatment effects were analyzed.Pain and imaging scores and clinical efficacy were evaluated according to follow-up data within 12 months after surgery.Results A total of 38 cases of senile patients with Brucellar spondylitis were studied.The main clinical symptoms during the visit were persistent severe lumbar back pain,local tenderness,obvious percussion pain,muscle spasm,and constrained movements of spine.Rose bengal plate test (RBPT) was positive in 11 cases,serum tube agglutination test (SAT) titer was higher than 1:100 in 28 cases.During the operation,28 cases of patients with inflammatory granuloma or abscess were cultured positive for Brucella.Before surgery,manifestations of X-ray:of which 29 cases showed intervertebral space narrowing,the density increased,and the margins of the verbebral bodies destructed;of which 9 cases showed vertebral body bone sclerosing hyperplasia in the shape of a bird's beak,forming a bone bridge with the adjacent vertebral body margin.Manifestations of CT:of which 29 cases showed different sizes and multiple lesions of the vertebral body margin,and hyperplasia and sclerosis around the lesion,and destruction of the lesion in the new bone tissue to form "lacy vertebra";in 9 cases,the destruction of intervertebral discs showed isodensity shadow,and the hyperplasia and sclerosis of articular surface resulted in the formation of "labial" osteophytes;of which 10 cases showed vertebral body destroyed the plane in which the bilateral psoas were widened and abscess formed.Manifestations of MRI:of which 38 cases showed that the vertebral bodies,intervertebral discs,accompaniment and the intra of vertebral canal were uneven high signal and dural sac or cauda equina compression.The pain scores [(2.1 ± 0.2),(0.7 ± 0.4),(0.2 ± 0.1),(0.0 ± 0.0),(0.0 ± 0.0) scores] at 2 weeks and 1,3,6,12 months after surgery were significantly lower than that before surgery [(9.2 ± 0.3) scores,P ＜ 0.05].The blind imaging evaluation scores [(4.68 ± 0.04),(4.92 ± 0.08),(5.00 ±0.00) scores] at 3,6 and 12 months after surgery were significantly higher than that before surgery [(0.37 ± 0.03) scores,P ＜ 0.05].The cure rates of clinical efficacy [92.11％ (35/38),100.00％ (38/38)] at 6 and 12 months after surgery were significantly higher than that of 3 months after surgery [78.95％ (30/38),P ＜ 0.05)].Conclusions Senile Brucellar spondylitis has the typical imaging features,laboratory examination is helpful to early diagnosis.Surgery is much better to relieve the pain and stable spine function and accelerate rehabilitation.
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Objective: To evaluate the change of tooth root volume and length after rapid maxillary expansion by CBCT three dimensional reconstruction method. Methods: 33 patients underwent rapid maxillary expansion were examined by CBCT before and after treatment. The CBCT images of the first,second premolars and the first molars were segmented and reconstructed by Mimics image processing software for the analysis of the changes of root volume and length. All data were analyzed by SPSS software statistically. Results: After maxillary expansion,all root volumes were reduced(P ＜ 0. 05),more reduction was observed in anchorage teeth than in non-anchorage teeth(P ＜ 0. 05). The length of most teeth roots was not decreased(P＞ 0. 05) except the buccal and distal roots of the first molars(P ＜ 0. 05). Conclusion: Rapid maxillary expansion may result in root resorption and this resorption is mainly based on the volume decrease.
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BACKGROUND: Combined use of multiple interventions for different targets play superimposed or synergistic effects,which has become the current idea for spinal cord injury treatment.OBJECTIVE: To investigate the synergistic effects of low doses of 17-β estradiol combined with bone marrow mesenchymal stem cells (BMSCs) transplantation on the recovery of motor function and inflammatory reactions after spinal cord injury in rats.METHODS: The 10 of 70 male Sprague-Dawley rats served as sham group in which the spinal cord was only exposed but with no treatment, and the rest 60 rats were used to make animal models of spinal cord injury using modified Allen's method and then randomized into four groups (n=15 per group): model, estrogen, stem cell and combined treatment groups. Rats in the stem cell and combined treatment groups were given BMSCs transplantation at injured side; rats in the estrogen and combined treatment groups were given intramuscular injection of 17-β estradiol at 1 and 24 hours after modeling. At 1, 3, 5 and 7 days after modeling, rat functional recovery was evaluated by the Basso, Beatlie, Bresnahan score. The expressions of interleukin-1β and tumor necrosis factor-α in the injured spinal cord were detected by ELISA at 6, 12, 24, and 72 hours after modeling. Apoptosis in nerve cells was observed using TUNEL staining. RESULTS AND CONCLUSION: The Basso, Beatlie, Bresnahan scores were declined significantly after modeling,increased at 5 and 7 days after stem cell transplantation, estrogen treatment or their combined treatment (P < 0.05),especially in the combined treatment group (P < 0.05). The levels of interleukin-1β and tumor necrosis factor-α were elevated gradually after spinal cord injury (P < 0.05), but the levels decreased significantly at 12 and 24 hours in stem cell,estrogen and combined treatment groups (P < 0.05), and this decrease trend was more significant in the combined treatment group compared with the stem cell and estrogen groups (P < 0.05). At 72 hours after modeling, the rate of TUNEL positive cells was highest in the model group (P < 0.05) and lowest in the combined treatment group (P < 0.05).To conclude, the combined use of low doses of 17-β estradiol and BMSCs transplantation can facilitate the recovery of motor function after spinal cord injury by effectively inhibiting apoptosis in nerve cells.
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Objective:To evaluate the effects of maxillary protraction with or without rapid maxillary expansion in the treatment of Class Ⅲ malocclusion by Meta-Analysis.Methods:The randomized controlled trail,quasi-randomized controlled trail and the clinical controlled trail about the treatment of Class Ⅲ malocclusion by protraction with or without expansion were searched in the database of Cochrane Library,Embase,PubMed,Medline,CBM,Wan Fang,CNKI,VIP.2 authors qualified and extracted the data independently.Then the Meta-analysis was performed by using the RevMan 5.3 software.Results:7 studies with 228 cases were included,114 cases were treated by maxillary protraction with expansion and the other 114 cases by maxillary protraction without expansion.The Meta-analysis showed that:there was no significant difference in SNA,SNB,ANB and SN-PP except ANS-Me,U1-NA,SN-MP.A favorable improvement of the sagittal relationship between maxillary and mandibular was observed by using protraction whether with expansion or not.The expansion did not shorten the course of treatment,but it lowered the inclination of upper incisors,resulting in more clockwise rotation of mandibular plane and increase of the facial vertical dimension.Conclusion:Maxillary protraction with rapid maxillary expansion can be used in the treatment of class Ⅲ malocclusion with incisor labioclination.
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Objective To discuss MRI diagnositic value and evaluation of the treatment of cervical Brucella spondylitis(BS).Meth-ods MRI data of 39 cases with cervical BS in our hospital were collected.Non-operative treatment,minimal invasive surgery and the open surgery were selected according to the MRI manifestations.The correlation was analyzed by consistensy check,imaging score and clinical effect evaluation.The data were analyzed by SPSS15.0.Results 39 cases of patients were examined by MRI before the treatment.37 cases were reviewed after 6 months treatment and 33 cases were reviewed after 12 months treatment.All of the Kappa values were more than 0.75 by imaging consistency check.MRI of cervical BS possessed characteristic expressions.The treatment effect according to MRI classification before the treatment:(1)drug therapy was performed in 14 cases (Group A);(2)minimal inva-sive surgery was performed in 7 cases (Group B);(3)focus clearance and bone graft were performed in 18 cases (Group C);(4)the clinical effects showed the healing rate in every group at different time point was different and the difference had statistical signifi-cance(P0.05). Conclusion MRI classification for cervical BS has important value and guiding significance in the selection of clinical conservative treatment,minimal invasive surgery or the open surgery.
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BACKGROUND:Studies have suggested that interleukin-6 is crucial for inducing cel apoptosis after acute spinal cord injury. OBJECTIVE:To observe the effect of interleukin-6 receptor monoclonal antibody combined with bone marrow mesenchymal stem cel s to treat acute spinal cord injury in rats. METHODS:Thirty Sprague-Dawley rats were randomly divided into sham group, model group (spinal cord injury group), treatment group 1 (interleukin-6 receptor monoclonal antibody transplantation group), treatment group 2 (bone marrow mesenchymal stem cel transplantation group), treatment group 3 (bone marrow mesenchymal stem cel+interleukin-6 receptor monoclonal antibody group), with six rats in each group. In the sham group, the spinal cord was only exposed with no injury, and in the other four groups, rat models of acute spinal cord injury were made using modified Al en’s method. Local injection treatment was performed in al the groups at 28 days after modeling. Basso, Beattie and Bresnahan (BBB) scoring and improved Tarlov scoring were used at 1 day before treatment and 1, 3, 7, 14, 28 days after treatment to test the hindlimb function. At 28 days after treatment, TUNEL method was used to detect cel apoptosis in the spinal cord. RESULTS AND CONCLUSION:Compared with the sham group, BBB scores and improved Tarlov scores were decreased significantly in the other four groups (P<0.05). At 7 days after treatment, the BBB scores and improved Tarlov scores in the treatment group 3 were significantly higher than those in the model group (P<0.05). At 14 days after treatment, the BBB scores and improved Tarlov scores in the treatment groups 1 and 2 were significantly higher than those in the model group (P<0.05);compared with the treatment group 2, the BBB score and improved Tarlov score were significantly increased in the treatment group 3 (P<0.05). Compared with the sham group, the number of apoptotic cel s was significantly increased in the other four groups (P<0.05);compared with the model group, the number of apoptotic cel s was significantly decreased in the three treatment groups (P<0.05);compared with the treatment group 2, the number of apoptotic cel s was significantly lower in the treatment group 3 (P<0.05). These findings indicate that the combined use of interleukin-6 receptor monoclonal antibody and bone marrow mesenchymal stem cel transplantation is better than bone marrow mesenchymal stem cel transplantation alone in the treatment of spinal cord injury, and interleukin-6 receptor monoclonal antibody reduces cel apoptosis in spinal cord injury, which is of positive significance for preventing against acute spinal cord injury.
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Objects To evaluate the immune protective effect of dexmedetomidine on breast cancer dur-ing perioperative radical mastectomy via sevoflurane inhalation general anesthesia. To explore reasonable anesthet-ic strategyfor breast cancer radical mastectomy. Methods Patients were divided into two groups. Patients in ex-perimental group receivedgeneral anesthesia with dexmedetomidine and sevoflurane. Control group means general anesthesia with sevoflurane only. In both groups, the level of cortisol, IL-6, IL-8 and of TNF-αin serum were measured at 5 time points , 30 minutes before anesthesia , after cutting skin , after surgery , 24 h after surgery and 72 h after surgery. Results The amount of anesthetic used to induce general anesthesia in the experimen-talgroup were lower than that of the control group.There is no obvious difference of cortisol , IL-6, IL-8 and of TNF-αin serumat the time of 30 min before anesthesia between two groups.Concentrations ofseveral markersin-creasedafter anesthesia, of which experimentalgroup were lower than that of the control group. Conclusions Dexmedetomidine could be immunoprotective for patient with breast cancer during perioperative radical mastecto-my via sevoflurane inhalationgeneralanesthesia. This study recommends usingmultiple anestheticdrugs to anes-thetize patients of breast cancer when performing radical mastectomy.
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OBJECTIVE@#Background: We detect the effects of Beclinl on paclitaxel-sensitivity in laryngeal carcinoma cell.@*METHOD@#This study used Hep-2, Hep-2-pcDNA3. 1, Hep-2-Beclinl as invitro model. The effect of paclitaxel on the proliferation and cell apoptosis of laryngeal cancer cell lines was evaluated by MTT assay and flow cytometry. The protein expression level of Akt and p-Akt was detected by Western blot. Result: After treated by paclitaxel, the inhibition rate was significantly higher in Hep-2-Beclin cells than in Hep-2-pcDNA3. 1 cells and Hep-2 cells (P0. 05).@*CONCLUSION@#Beclinl enhances paclitaxel-sensitivity by inhibition of PI3K/Akt pathway.
Subject(s)
Humans , Apoptosis , Apoptosis Regulatory Proteins , Physiology , Beclin-1 , Cell Line, Tumor , Cell Proliferation , Laryngeal Neoplasms , Pathology , Larynx , Membrane Proteins , Physiology , Paclitaxel , Pharmacology , Phosphatidylinositol 3-KinasesABSTRACT
<p><b>OBJECTIVE</b>To evaluate treatment modalities and prognosis differentiated thyroid carcinoma (DTC) with tracheal invasion.</p><p><b>METHODS</b>Clinical data were reviewed and analyzed in 50 patients treated for DTC with tracheal invasion between January 1990 and June 1998. The different surgical modalities were applied according to the extent of tracheal invasion: shave excision (20 cases), tracheal sleeve resection or tracheal partial resection (23 cases), total laryngectomy or laryngeal closure surgery (7 cases). Thirty-eight cases received postoperative (131)I therapy. Survival rate was evaluated using the Kaplan-Meier analysis.</p><p><b>RESULTS</b>The 5-, 10- and 15-year survival rates of all the cases were 90.0%, 74.0% and 56.0%, respectively. The 5-, 10- and 15-year survival rates were 94.7%, 81.6% and 65.8% respectively in 38 cases with postoperative (131)I therapy and were 75.0%, 50.0% and 25.0% respectively in 12 cases without postoperative (131)I therapy, with statistically significant differences in 5-, 10- or 15-year survival rates between the patients of two groups.</p><p><b>CONCLUSIONS</b>The tumors can be resected radically by corresponding surgery based on the extent of tracheal invasion. Postoperative (131)I therapy can enhance the survival rate of the patients with differentiated thyroid carcinoma involving in trachea.</p>
Subject(s)
Humans , Adenocarcinoma , Kaplan-Meier Estimate , Laryngectomy , Neoplasm Invasiveness , Prognosis , Retrospective Studies , Survival Rate , Thyroid Neoplasms , Diagnosis , Therapeutics , Trachea , Tracheal Neoplasms , Diagnosis , TherapeuticsABSTRACT
OBJECTIVE@#To explore the clinical characteristics and therapies for esophageal perforation complicated with lethal massive hemorrhage caused by esophageal foreign body.@*METHOD@#To retrospective analysis the treatment of massive hemorrhage at the carotid artery or aorta caused by esophageal foreign body in forty seven patients, Foreign body characters, surgical approaches, and postsurgical management were summarized.@*RESULT@#Among 24 patients with cervical esophageal foreign body, the object was removed either by esophagoscopy or through lateral cervical incision. After controlling carotid artery hemorrhage and repairing Fistula of artery from cervical incision, 19 patients survived. For the 23 patients with thoracic esophageal foreign body accompanied with aorta hemorrhea, thoracotomy was performed to remove the foreign body and repair the aortic fistula. Only 3 of these 23 patients recovered from the emergent surgery, other 20 patients died.@*CONCLUSION@#For the patients with esophageal foreign body inducing large vessel impingement, the most reliable therapeutic method is surgical repairing of arterial perforation and extraction of the foreign body via cervical or thoracic incision. Carotid ligation should be considered in patients with recurrent carotid hemorrhage. For the patient with mediastinitis, esophageal exclusion is recommended to prevent infection and to promote healing of aortic perforation after aortic fistula repairing.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Esophageal Perforation , General Surgery , Esophagus , Follow-Up Studies , Foreign Bodies , Hemorrhage , General Surgery , Retrospective StudiesABSTRACT
A total of 38 cases of senile brucella spondylitis disease at our hospital during January 2002 and March 2012 were analyzed .After admission , all of them were definitely diagnosed on the basis of epidemiological history , clinical manifestations , laboratory tests , imaging and pathological examinations . Over a follow-up period of 12 months, 17 cases were cured after standardized drug treatment .Among 21 surgical cases, there were curing (n=17) and improving (n=2).Senile brucellosis spondylitis has distinct serological and pathological characteristics .And formulating the diagnostic criteria may improve its diagnostic rate and reduce its misdiagnostic rate .And standardized drug therapy achieves a better curing rate and a proper timing of surgical intervention improves its clinical outcomes .
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OBJECTIVE@#To investigate the association and mechanism of EGFL7 expression level with the invasion and metastasis of laryngeal squamous cell carcinoma.@*METHOD@#RT-PCR and Western blotting were used respectively to detect the level of EGFL7 mRNA and protein form 33 fresh laryngeal carcinoma tissues and matched para-neoplastic non-tumor tissues. The immunohistochemistry technique was performed to determine microvessel density (MVD) in 33 tumor tissues. The association of EGFL7 expression and MVD with clinicopathological characteristics was analyzed.@*RESULT@#EGFL7 mRNA and protein expression were both significantly higher in the tumor tissues than in the paraneoplastic non-tumor tissues (P 0.05).@*CONCLUSION@#EGFL7 may have a close correlation with the development of laryngeal carcinoma via its impact on tubulogenesis and vessel shape. EGFL7 might serve as a tumor marker for assessing the progression of laryngeal carcinoma and a guide of clinical therapeutic decisions.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Squamous Cell , Metabolism , Pathology , Endothelial Growth Factors , Genetics , Metabolism , Laryngeal Neoplasms , Metabolism , Pathology , Lymphatic Metastasis , Neoplasm StagingABSTRACT
OBJECTIVE@#To study the correlation of CD44 with epithelial-mesenchymal transition(EMT) and metastasis in nasopharyngeal cancer cells, and explore the possible mechanism of CD44 regulates EMT and metastasis in nasopharyngeal cancer cells.@*METHOD@#The CD44 and EMT-associated proteins in 5-8F and 6-10B nasopharyngeal cancer cell lines were assayed by Western blotting. The erasion trace test was performed to observe the migratory ability of 5-8F and 6-10B nasopharyngeal cancer cells. Using lipid-mediated DNA transfection technique, the low metastatic nasopharyngeal cancer cells 6-10B were transfected in vitro with plasmid which contained CD44 gene, and then new nasopharyngeal cancer cells were obtained. The CD44 and EMT-associated proteins in 6-10B, empty vector transfected and CD44-transfected cells were assayed by Western blotting. The erasion trace test was performed to observe the alteration of migratory ability of nasopharyngeal cancer cells before and after CD44 transfection.@*RESULT@#The expression of CD44 and EMT-associated protein MMP-9 in 5-8F was higher than that in 6-10B, but EMT-associated protein E-Cadherin in 5-8F was lower than that in 6-10B. The migratory ability of 5-8F was higher than that of 6-10B. The expression of CD44 and MMP-9 were significantly higher in the CD44-transfected nasopharyngeal cancer cells than in the control groups. Compared with control groups, the migratory ability of CD44-transfected nasopharyngeal cancer cells was significantly increased.@*CONCLUSION@#CD44 positively regulates the metastatic ability of nasopharyngeal cancer cells, which is relevant to the process of EMT.
Subject(s)
Humans , Carcinoma , Cell Line, Tumor , Epithelial-Mesenchymal Transition , Hyaluronan Receptors , Genetics , Metabolism , Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms , Metabolism , Pathology , Neoplasm Metastasis , TransfectionABSTRACT
BACKGROUND:The surgical method for the treatment of unstable distal radius fracture mainly includes plate internal fixation and external fixator, but both of these two methods have the advantages and disadvantages. Which treatment is more conducive to the rehabilitation of patients, there is stil controversy. OBJECTIVE:To evaluate the clinical effectiveness of internal fixation and external fixator for the treatment of unstable distal radius fractures. METHODS:The relative databases and literatures were searched with the computer and hand to col ect the randomized control ed trials of internal fixation versus external fixator for the treatment of unstable distal radius fractures. After extraction literature data and quality evaluation, RevMan 5.2 software was used for system evaluation. The grip strength, disabilities of arm, shoulder&hand score, complications rates, infection rates, deformity rates and ulnar variance rates were compared between two groups. RESULTS AND CONCLUSION:A total of 9 literatures, involving total y 524 patients were included, 286 patients in the internal fixation group and 238 patients in the external fixator group. There was no significant difference in grip strength between internal fixation group and the external fixator group. The results of Meta-analysis showed that the internal fixation group was better than the external fixator group in the aspects of disabilities of arm, shoulder&hand score, complications rate, infection rate, deformity rate and ulnar variance rate at 3 months and 1 year after treatment. The results indicate that the plate internal fixation is better than external fixator in the treatment of unstable distal radius fractures, but the large sample, double-blind, and high quality randomized control ed trials are stil needed to identify the results.
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Objective To study the effect of the uncellular tissue engineering complexes of autolegous red bone marrow wrapped by facial flap with vessels in repair of large segment bone defect infected with low virulence bacteria so as to provide evidence for the clinical application. Methods The study included 38 cases of limb bone defect infected with low virulence bacteria after trauma.Autologous red bone marrow (ARBM) was taken to prepare uncelluar tissue-engineered complexes with osteoinductive absorbing material (OAM) containing bone morphogenetic protein (BMP).A facial flap with capillary network originating from an anonymous vessel adjacent to the bone defect was prepared to wrap the tissue engineered bone and fill the bone defect.Pathological focus clearance and tissue-engineered complexes compounded with ARBM implantation were performed in 18 cases (Group A) and pathological focus clearance and tissue-engineered complexes of autolegous red bone marrow wrapped by facial flap with vessels implantation in the other 20 cases ( Group B).The blood routine and supersensitive CRP were examined to monitor the inflammation reaction; X-ray was used to observe the bone defect repair; histology and bacteriology examinations were performed in partial cases at 3,6,12,18 months after operation. Results Six months after operation,5 cases of Group A were infected and the bacteria cultivation was as positive as that before the operation.The histological observation at ( 14.0 ± 0.5 ) months after operation showed that fibrous connective tissues between the bone fracture ends existed in the pathological area in 10 cases,of whom four cases were filled with inflammatory fibrous granulation tissues and few dead bones in the pathological area,and the bacterial examination was positive.There was no infection in Group B after operation.The histological observation manifested periosteum like tissues formation from the primary facial flap,mature bone structure formation in the primary pathological area and non-inflammatory infiltration in 16 cases and the bacteria cultivation was negative in these cases.The external fixation frame was taken out (12.2 ± 0.3 )months after operation because the synostosis appeared and the structure was stable in the other seven cases including three cases in Group A and four in Group B and the histological and bacterial examination were not performed.At each time point after operation,not only the blood routine but also the supersensitive CRP and the X-ray quantification grade of Group B were significantly more than those of Group A (P ＜ 0.05 ). Conclusions The uncellular tissue-engineered complexes of autolegous red bone marrow wrapped by facial flap with vessels is a feasible method for repairing the infected bone defect by first intention,since it can resist infection,obviously promote the bone recovery and advance the quality and quantity of osteanagenesis.
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Objective The tissue engineering technique and the microsurgery technology is combined to construct the uncellular tissue engineering complex with vascularization and membrane guided dual effect. Through comparing study of using the simple biomembrane guided bone regeneration technique to construct the uncellular tissue engineering complex to repair the large segment bone defect in the animal body,the bone reparative effect of the tissue engineering bone wrapped by pedical fascial flap with vessels and that wrapped by the simple biomembrane was compared, thus to provide experimental evidence for the clinical application. Methods Twenty-four Newzland 5-month-old rabbits were used to build the bilateral periosteumincluded bone defect modelsin the middle piece of the ulna and the length of the defect was 1 cm. Autologous red bone marrow was implanted in the tissue engineering bone which was prepared by osteoinductive absorbing material including BMP. The prepared tissue engineering bone was implanted in the bone defect area. The right side was wrapped by the simple absorbable biomembrane, whereas the left side was wrapped by pedical fascial flap with blood supply. At the fourth, eighth, twelfth and sixteenth week after the operation each group was examined by the radiograph (x-ray), the light density measurement, gross morphology and histological inspection,bone shape measurement analysis in the repairing area and the biomechanics measurement at the twelfth week. The data was analyzed to test the difference of the bond defect repair. Results The radiograph, gross morphology and histological inspection showed the growth of vessels in the implant area, the quantity and the forming speed of the bone trabecula and, the cartilaginous tissue, the formation of the mature bone structure,remodeling of the diaphysis, recanalization of the cavum ossis and the absorption and the degradation of the implant of the group of pedical fascial flap with blood supply was superior to that of the group of the simple absorbable biomembrane. At the fourth, eighth, twelfth and sixteenth week after the operation the bone trabecula area were( 20. 35 ± 2. 41 ) %, ( 40. 21 ± 1.97 ) %, (66. 67 ± 3.44 ) % and ( 86. 47 ± 3.99) % respectively in the group of pedical fascial flap with blood supply, and were ( 7. 46 ± 2.64 ) %, ( 20. 66 ± 2. 28 ) % , ( 40. 22 ±1.84)% and(58. 18 ± 1.79) respectively in the group of the simple absorbable biomembrane. At the same time point after the operation the light density were 0. 636 ± 0. 012,0. 596 ± 0. 062,0. 552 ± 0. 009 and 0. 451 ±0. 008 respectively in the group of pedical fascial flap with blood supply, and 0. 742 ± 0. 032,0. 713 ± 0. 022,0. 655 ±0. 018 and 0. 606 ±0. 015 respectively in the group of the simple absorbable biomembrane. The units of blood vessel reproductive area in the bone repair junctional zone were ( 18.75 ± 2. 09 ) %, ( 37.41 ± 3.22 ) %,(53. 06 ±2. 18)% and (36.72 ±4. 73)% respectively in the group of pedical fascial flap with blood supply,and (5. 34 ± 1.17 ) %, (9. 48 ± 2.96) %, ( 22.43 ± 2. 21 ) % and ( 26. 27 ± 3. 14 ) % respectively in the group of the simple absorbable biomembrane. The biomechanics intension was 26.62 ± 3.96 in the group of pedical fascial flap with blood supply and 18. 38 ±0. 71 in the group of the simple absorbable biomembrane at the twelfth week after the operation. All of the differences were significant( P ＜0. 05 ). Conclusion The pedical fascial flap with blood supply has significant effect in promoting the tissue engineering bone to vascularize and promoting the bone formation by vascularization. The membrane guided bone regeneration technique restricted not only the growth of the fibrous connective tissue in the reparative process of the large segment bone defect effectively, but also the ability of fast and effective vascularization, thus the chronic creep and substitution process would be needed. Simple application of the biomembrane can compensate the shortcoming of chronic creep of the implanted material by the growth of the external callus.
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OBJECTIVE@#To review the clinical manifestations and management of nasal sinus mucoceles with visual loss.@*METHOD@#Medical records for 23 patients of paranasal sinus mucoceles with visual impairment were re viewed retrospectively during 8-year period (from 2002 to 2010). Ten mucoceles were found in the frontal or fronto-ethmoidal sinuses, 6 in the ethmoidal sinuses, 7 in the sphenoidal or spheno-ethmoidal sinuses. Because the majority of early chief complaints were problems related to vision, patients were often seen by ophthalmologists first. Poor vision was more common in patients with sphenoid or spheno-ethmoidal sinus mucoceles because of their proximity to the optic nerve. CT and MRI were important tools for diagnosing nasal sinus mucocele. The patients received endoscopic surgery to remove mucocele and to decompress the optic nerve. Steroid therapy was given postoperatively and routine examination with endoscopy were carried out during follow-up.@*RESULT@#Postoperatively, the majority of symptoms, such as exophthalmos, epiphora, diplopia and headache, disappeared in all patients. However, vision recovery was observed only in some patients. Recovery of vision depended on the timing of surgery and severity of initial visual loss. Delay in treatment can seriously compromise recovery of vision impairment. Moreover, patients without light perception before surgery had poor visual recovery even if optic nerve decompressions were performed.@*CONCLUSION@#Endoscopic surgery is effective to nasal sinus mucocele with visual loss. Because visual recovery depends on prompt diagnosis and surgical intervention, a good understanding of the disease and prompt imaging studies are important.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Cysts , Diagnosis , General Surgery , Paranasal Sinus Diseases , Diagnosis , General Surgery , Retrospective Studies , Vision, LowABSTRACT
Objective To study the effect of repairing limbs bone defect by using uncellular tissue engineering complex of autolegous red bone marrow wrapped by facial flap with vessels to provide evidence for clinical application. Methods Nineteen cases of limbs bone defect were chosen, among them, 3 cases were with benign bone tumor,6 cases were with open fracture causing bone defect and 10 cases were with bone hypotoxic infection after operation. Took autolegous red bone marrow to prepare uncelluar tissue engineering complex with osteoinduction active material (OAM) containing bone morphogenetic protein (BMP). Prepared a facial flap with capillary network originating from an anonymos vessel adjacent to the bone defect,wrappad the tissue engineering bone and filled the bone defect. On a certain time after the operation, the patients were tested by X-ray. Results All the 19 cases were followed up in 1st,3rd,6th, 10th, 12th and 18th month after the operation. There were 3 cases that the implanted tissue engineering bone completely replaced the bone defect in 6th month displayed on X-ray,6 cases in 10th month,9 cases in 12th month and 1 case in 18th month. None of the cases had bone infection or bone absorption. Osteanagenesis and bone molding had come true in all cases. Conclusions The uncellular tissue engineering complex of autolegous red bone marrow wrapped by facial flap with vessels shows double effects in inducing osteanagenesis and the vascularization, and it is feasible in the recovery of large area bone defect. The complex can promote bone recovery and advance the quality and quantity of osteanagenesis.