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1.
Article in Chinese | WPRIM | ID: wpr-888317

ABSTRACT

OBJECTIVE@#To explore the clinical effect of manual reduction combined with homemade splint external fixation in the treatment of metacarpal fractures.@*METHODS@#A retrospective analysis was performed in 126 patients with metacarpal fracture treated by manual reduction and homemade splint external fixation in the emergency department of our hospital from January 2018 to December 2018, including 102 male, 24 female, ranging in age from 9 to 73 year old, with an average of (33.2±14.3)years old. During the treatment, the X-ray was re-examined regularly, and the external fixation was continued or adjusted according to the X-ray situation. The X-ray showed callus growth. After the fracture was stable, the external fixation was removed to continue functional exercise. The TAM scoring standardwas used to evaluate the hand function, and the fracture healing and complications were summarized.@*RESULTS@#Of the 126 patients, 6 patients were treated with operation because of fracture displacement during the treatment. The other 120 patients were treated with this method and all of them got bony healing. The healing time was (6.3±1.8) weeks. The follow up time ranged from 2 to 12 months, with a mean of (4.4±2.2) months. At the latest follow up, TAM score was used to evaluate the hand function:excellent in 105 cases, good in 13 cases, fair in 2 cases and poor in 0 case. Shortening deformity was found in 7 cases and angulation deformity in 3 cases.@*CONCLUSION@#Manual reduction combined with homemade splint external fixation in the treatment of metacarpal fractures can achieve good clinical results. Homemade splint is easy to obtain materials and low cost, and it is an effective method worthy of clinical promotion.


Subject(s)
Adolescent , Adult , Aged , Child , External Fixators , Female , Fracture Fixation , Fracture Fixation, Internal , Humans , Male , Metacarpal Bones , Middle Aged , Retrospective Studies , Splints , Treatment Outcome , Young Adult
2.
Article in Chinese | WPRIM | ID: wpr-691125

ABSTRACT

<p><b>OBJECTIVE</b>To explore the experience and effect of surgical treatment in old Monteggia fracture in children.</p><p><b>METHODS</b>From January 2013 to December 2017, 32 cases of old Monteggia's fracture were treated including 18 males and 14 females with an average age of(5.3±1.2) years old ranging from 2 to 9 years old. No symptoms of radial nerve injury were found. The preoperative symptoms of the patients were the pain and deformity of the elbow joint, the flexion and extension and the limited forearm rotation. The X-ray showed the union of the ulna or the "arched sign", the dislocation of the radial head or the subluxation of the head. The posterior incision of the ulna ridge was performed in the operation, and the long oblique osteotomy was performed at the most obvious point of the ulna angle deformity. Then the Boyd incision was used to expose the humeral and radial joint and the upper ulnar radial joint. The scar tissue in the joint was cleaned and the radial head was repositioned. On the premise of maintaining the stability of the elbow joint, the ulna osteotomy was treated with plate and screw internal fixation.</p><p><b>RESULTS</b>All 32 cases were followed up for 12 to 24 months with an average of 14.8 months, of which 1 case had incision infection. There were no pain symptoms of elbow and wrist in 32 patients after operation, 29 patients with elbow joint flexion and extension (130±5)°/0°, forearm pronation and supination 90°/(85±5)°; 2 patients with elbow flexion and extension(119°/8°, 121°/7°), forearm pronation and supination (90°/75°, 85°/60°); 1 patient with elbow flexion and extension 90°/10°, forearm pronation and supination 80°/60°. According to Mackay criteria, the result was excellent in 29 cases, good in 2 cases, medium in 1 case.</p><p><b>CONCLUSIONS</b>Ulna osteotomy, elbow posterior capsular release, anterior capsule contraction is a effective method in the treatment of old Monteggia's fracture in children.</p>

3.
Article in Chinese | WPRIM | ID: wpr-256846

ABSTRACT

<p><b>OBJECTIVE</b>To compare the clinical value of narrow band imaging (NBI) and iodine staining for margin determination of early esophageal cancer during endoscopic submucosal dissection (ESD).</p><p><b>METHODS</b>Clinical data of 87 patients with early esophageal cancers undergoing endoscopic submucosal dissection (ESD) were analyzed retrospectively. Patients were assigned to NBI group and iodine staining group according to the staining method before ESD operation. Clinicopathological features, esophageal spasm ratio, operation time, en bloc resection rate, complications, local recurrence, and distant metastases were compared between the two groups.</p><p><b>RESULTS</b>There were 37 patients in NBI group while 50 patients in iodine staining group. Location and size of the lesions between two groups were not significantly different. The ratio of moderate-severe esophageal spasm in NBI group was significantly lower as compared to iodine staining group [10.8%(4/37) vs. 32.0%(16/50), P<0.05]. The average operation time in NBI group was significantly shorter than that in iodine staining group [(42.2±19.5) min vs. (53.3±30.9) min, P<0.05). All the tumors were resected in an en bloc fashion and the R0 resection rate was 100%. Perforations in 2 patients and delayed bleeding in 1 patient were successfully treated by endoscopic methods. Esophageal strictures occurred in 3 patients of NBI group and 4 patients of iodine staining group, who were treated by endoscopic dilation and retrievable stents. During mean 13.2 months (range 4 to 20 months) follow-up periods, local recurrence occurred in 2 patients of NBI group and 2 patients of iodine staining group. These patients received ESD or other surgery.</p><p><b>CONCLUSION</b>Compared with iodine staining, using NBI for margin determination of early esophageal cancer during ESD is more convenient and fast because of distinctly lower degree of esophageal spasm.</p>


Subject(s)
Adult , Aged , Esophageal Neoplasms , Pathology , General Surgery , Esophagoscopy , Methods , Female , Humans , Iodine , Male , Middle Aged , Narrow Band Imaging , Retrospective Studies , Staining and Labeling
4.
Article in Chinese | WPRIM | ID: wpr-256842

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the clinical value of submucosal tunneling endoscopic resection (STER) for rectal submucosal tumors (SMT) originating from muscularis propria.</p><p><b>METHODS</b>Clinicopathological data of 8 cases with rectal SMT originating from muscularis propria undergoing STER in our center from March 2011 to March 2013 were analyzed retrospectively.</p><p><b>RESULTS</b>En bloc STER was performed successfully in all the 8 cases. The tumors location was 5-15 cm from the edge of anus. The resected specimen size ranged from 1.0 to 3.5 cm (average 1.8 cm). The mean procedure time was 51 min (range, 40-70 min). One patient developed mucosa perforation and was repaired with metal clips. One patient developed subcutaneous emphysema in one leg, which was disappeared after two weeks. Postoperative pathological examination revealed schwannoma in 3 cases, leiomyoma in 2 cases, stromal tumor in 1 case, and proliferation of collagen fibers nodular degeneration in 2 cases. Postoperative follow-up ranged from 6 to 30 months and no residual lesion or recurrence was found.</p><p><b>CONCLUSION</b>STER is a safe and effective method for rectal SMT originating from muscularis propria in our initial experience.</p>


Subject(s)
Adult , Aged , Aged, 80 and over , Endoscopy , Methods , Female , Follow-Up Studies , Humans , Leiomyoma , General Surgery , Male , Middle Aged , Rectal Neoplasms , General Surgery , Retrospective Studies , Treatment Outcome
5.
Article in Chinese | WPRIM | ID: wpr-312390

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the clinical application and indication of endoscopic dissection technique for submucosal tumors (SMTs) of the esophagogastric junction (EGJ) originating from the muscularis propria.</p><p><b>METHODS</b>A total of 143 SMTs of the EGJ were treated by endoscopic resection in the Endoscopy Center of Zhongshan Hospital Affiliated to Fudan University between March 2007 and June 2011. The clinical and histopathologic feature, surgical approach, en bloc resection rate, complications, and postoperative follow up were evaluated.</p><p><b>RESULTS</b>There were 74 males and 69 females with a mean age of 49.1 years old. The en bloc resection rate was 94.4%(135/143). There were 126 patients who underwent endoscopic submucosal excavation in an en bloc fashion. Six patients underwent endoscopic full-thickness resection without laparoscopic assistance. Three patients underwent submucosal tunneling endoscopic resection. The other 8 SMTs were partially resected for histological evaluation and the residual tumors were further treated with nylon snare ligation. The mean lesion size was 17.6 mm. The mean procedure time was 45.1 minutes and the mean intraoperative bleeding was 50.0 ml. Perforations occurred in 6 patients and metal clips were used to close the defect. One patient with Mallory-Weiss syndrome was successfully treated with conservative treatment. Pathological examination showed that the lesions were leiomyoma (n=121), gastrointestinal stromal tumor (n=20), granulosa cell tumor (n=1), and intermuscular lipoma (n=1). No local recurrence and distant metastasis were noted during the follow-up (range, 3-48 months).</p><p><b>CONCLUSION</b>Endoscopic resection technique is safe and effective, and should be selected for each patient individually.</p>


Subject(s)
Adenocarcinoma , General Surgery , Adult , Aged , Endosonography , Esophagogastric Junction , Pathology , Female , Follow-Up Studies , Gastroscopy , Methods , Humans , Male , Middle Aged , Retrospective Studies
6.
Article in Chinese | WPRIM | ID: wpr-321554

ABSTRACT

<p><b>OBJECTIVE</b>To prospectively evaluate the clinical value of different magnifying chromoendoscopy(MCE) methods in screening gastric precancerous lesions and early cancers.</p><p><b>METHODS</b>Between March 2010 and October 2011, among all the patients aged over 40 who received esophagogastroduodenoscopy at Zhongshan hospital, Fudan University, suspicious lesion was detected in 699 patients, who were randomly assigned to three groups: epinephrine dye(n=240), indigo carmine dye(n=246), and acetic acid-indigo carmine mixture dye(n=213). Diagnosis was made according to surface patterns and microvessels of the lesion. Pathological diagnosis was used as the gold standard. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement(Kappa) test. McNemar Paired chi-square test was used to compare the concordance of three MCE methods, regular white light, magnification alone, and NBI magnifier before and after MCE.</p><p><b>RESULTS</b>Pathological examination showed inflammatory lesions in 415 patients, intestinal metaplasia in 190, low grade intra-epithelial neoplasia in 17, and high grade intra-epithelial neoplasia or early cancer in 77. The percentage of patients with consistent endoscopic and pathological diagnosis was 77.1%(185/240) for epinephrine dye, 80.5%(198/246) for indigo carmine dye, and 81.2%(173/213) for acetic acid-indigo carmine mixture dye. Kappa values were 0.579, 0.502, and 0.667 respectively(all P<0.01). For the screening of high grade intra-epithelial neoplasia or early cancer, the diagnostic sensitivities were 84.0%, 83.3%, and 92.9%, respectively, and the specificities were 98.6%, 97.3%, and 98.4%. All the three chromoendoscopy methods improved the diagnostic accuracy for precancerous lesions compared with conventional gastroscopic observation with white light(all P<0.01). Indigo carmine and acid-indigo carmine mixture dye improved the diagnostic accuracy of magnification alone(both P<0.05). There was no significant difference in diagnostic accuracy between each MCE method and magnifying NBI observation(all P>0.05).</p><p><b>CONCLUSION</b>NBI magnification and all the three MCE methods may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.</p>


Subject(s)
Acetic Acid , Adult , Aged , Aged, 80 and over , Coloring Agents , Epinephrine , Female , Gastroscopy , Methods , Humans , Indigo Carmine , Male , Middle Aged , Precancerous Conditions , Diagnosis , Pathology , Prospective Studies , Sensitivity and Specificity , Staining and Labeling , Methods , Stomach Neoplasms , Diagnosis , Pathology
7.
Article in Chinese | WPRIM | ID: wpr-290849

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the feasibility, efficacy, and safety of metallic clips for closure of full-thickness defects in the stomach wall.</p><p><b>METHODS</b>Forty-eight rabbits were randomly divided into 4 groups with 12 in each group using random digits table. A 2 cm×2 cm full-thickness defect was created in the gastric body. No closure was performed in the first group; in the second group, mucosa closure with metallic clips; the third group, closure of full-thickness gastric tissue with metallic clip; the fourth group closure with 3-0 silk suture. After operation the animals were sacrificed at the third day and the seventh day. Wound healing was evaluated. Bursting pressure was recorded. HE and Masson staining was performed to inspect wound inflammation and tissue fibrosis situation.</p><p><b>RESULTS</b>After operation all the animals in the first group died within 34 hours, while those in other groups survived. No intraperitoneal bleeding or infection were seen in the survived animals. General observation showed that the metallic closure group caused less intraperitoneal adhesions. Operative time was shorter in the second and third group compared to the fourth group [(45.8 ± 1.6) min and (42.5 ± 1.5) min vs. (48.0 ± 1.4) min, P<0.05]. The bursting pressure on the third day was lower [(36.9 ± 4.6) mm Hg and (39.8 ± 4.1) mm Hg vs. (50.5 ± 4.2) mm Hg, P<0.05]. There was no significant difference in bursting pressure on the 7th day among the three groups [(95.0 ± 7.9) mm Hg and (97.8 ± 6.8) mm Hg vs. (98.5 ± 7.0) mm Hg, P>0.05]. HE staining revealed that metal closure had a better healing and Masson staining reflected no significant difference in healing at the same time point.</p><p><b>CONCLUSIONS</b>Metal clips closure full-thickness defects in the stomach, regardless in full thickness or mucosa closure, is as safe and effective as suture closure.</p>


Subject(s)
Animals , Pilot Projects , Rabbits , Stomach , General Surgery , Surgical Instruments , Suture Techniques , Sutures , Wound Healing
8.
Chinese Journal of Epidemiology ; (12): 1171-1175, 2012.
Article in Chinese | WPRIM | ID: wpr-289558

ABSTRACT

Objective To explore the relationship between the concentration of serum magnesium and the short-term outcome of patients with acute ischemic stroke,in order to provide evidence for improving the outcomes.Methods Patients with acute ischemic stroke under study,were from four hospitals in Shandong province.Data on demographic characteristics,life style related risk factors,history of cardiovascular disease,blood pressure at admission and other clinical characteristics were collected for all the participants.The outcomes were defined as National Institutes of Health Stroke Scale (NIHSS) ≥ 10 or death.According to NIHSS,the subjects were divided into two groups:death/NIHSS≥ 10 and NIHSS< 10.Concentrations of Mg2+ were categorized into four levels according to the quartiles of serum magnesium.Cox proportion hazard regression analysis was used to evaluate the association between serum magnesium concentrations and the short-term outcome of acute ischemic stroke.Results In the death/NIHSS≥10 group,concentrations of serum magnesium and the time from onset to admission were lower than that in the NIHSS< 10 group while the systolic blood pressure on admission,the proportion of low density lipoprotein abnormal,impaired fasting glucose and history of auricular fibrillation were all higher than that in the NIHSS< 10 group.Without the adjustment of multiple factors,when comparing to the lowest quartile of serum magnesium level,the fourth quartile (highest) seemed to have had a tendency of reducing the risk of death/NIHSS ≥ 10 (RR=0.47,P< 0.05).When multiple factors were adjusted (adjust serum calcium,potassium level and other factors),the fourth and the third quartiles could both reduce the risk of death/ NIHSS≥10 (RR values were 0.39 and 0.54,P<0.05,respectively).With or without the adjustment of multiple factors,there appeared a dose-response relationship between serum magnesium concentrations and the risk to death/ NIHSS≥10 (trend P<0.05).Conclusion Higher serum magnesium concentrations could reduce the risk to death/NIHSS ≥ 10,suggesting that there was a dose-response relationship between magnesium and the risk to death/NIHSS ≥ 10.

9.
Article in Chinese | WPRIM | ID: wpr-259375

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the role of CD40 ligand (CD40L) in dendritic cells (DC) of CEA transgenic mice and to evaluate the specific cellular immunity induced by activated DC.</p><p><b>METHODS</b>Bone marrow cells of the CEA transgenic mice were used to generate immature dendritic cells under the condition of GM-CSF and IL-4. CD40L was added to activate dendritic cells into mature phenotype. Dendritic cells cancer vaccine was pulsed with CEA526-533 peptide which made the vaccine specific for cancer immunity. The immunophenotype molecules were identified by flow cytometry. The cytokines produced by cells were determined by ELISA. T cells proliferation was measured by (3)H-thymidine essays.</p><p><b>RESULTS</b>Immunophenotype molecules expressions of CD40L-activated dendritic cells were significantly higher than those in control group. IL-12 secretion by CD40L-activated dendritic cells was (937.81+/-51.99) pg/10(6) DC, significantly higher than that in control group [(83.06+/-8.58) pg/10(6) DC, P<0.01]. CD8(+) T cells proliferation induced by CD40 L-activated dendritic cells was stronger as compared to control group (P<0.05), and the secretion of IFN-gamma was(33.900+/-4.550) ng/L, significantly higher than that in control group [(5.226+/-0.460) ng/L, P<0.01]. Splenocytes proliferation induced by CD40 L-activated dendritic cells was stronger as compared to control group (P<0.01), and the secretion of IFN-gamma was (69.802+/-11.407) ng/L, significantly higher than that in control group [(2.912+/-0.562) ng/L, P<0.01].</p><p><b>CONCLUSION</b>The method of using CD40L to stimulate bone marrow-delivered dendritic cells promotes the maturation and activation of dendritic cells, which enhances the cellular immunity in CEA transgenic mice.</p>


Subject(s)
Animals , CD40 Ligand , Allergy and Immunology , Physiology , Dendritic Cells , Cell Biology , Allergy and Immunology , Metabolism , Immunity, Cellular , Allergy and Immunology , Mice , Mice, Inbred C57BL , Mice, Transgenic
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