MANAGEMENT OF BULBAR URETHRAL ISCHEMIC NECROSIS FOLLOWING PELVIC FRACTURE URETHRAL INJURY REPAIR-A SINGLE CENTER EXPERIENCE

Aims & Objectives:About 10% of pelvic fracture injuries are associated with urethral injury. Most of the urethral injuries are successfully repaired by progressive perineal anastomotic urethroplasty. Bulbar urethral ischemic necrosis is a devastating complication seen in 5-8% of failed PFUI repairs. The objective of this study is to present our experience in management of a bulbar urethral ischemic necrosis developed following PFUI repair. Materials & methods:This is a retrospective study done at our institute, which includes data from feb,2003 to feb,2021. This is a descriptive statical analysis. Total 18 patients were managed using various surgical approaches and followed. Out of 18 patients seven patients underwent staged urethroplasty with Results & Observations: success rate of 85.71%,four underwent pedicled preputial skin tube urethroplasty with success rate of 75%,one underwent non transecting augmented urethroplasty with success rate of 100%,three underwent augmented perineal urethrostomy, two underwent continent diversion procedures, one underwent augmented perineal skin tube perineal urethrostomy. Bulbar urethral ischemic necrosi Conclusions: s following PFUI repair although uncommon, is a devastating complication which can be salvaged by various surgical techniques. Type of procedure chosen depends on individual patient and outcomes vary for each type of procedure

CT manifestations and application progress of airway complications after lung transplantation / 器官移植

With the continuous improvement of surgical techniques and perioperative management, the success rate of lung transplantation has gradually increased, but airway complications after lung transplantation are still common. Airway complications after lung transplantation may reduce the quality of life, increase medical costs, and even threaten the lives of the recipients. In 2018, the International Society for Heart and Lung Transplantation (ISHLT) consensus proposed that airway complications included ischemic necrosis, anastomotic dehiscence, airway stenosis and tracheobronchomalacia. Bronchoscopy remains the gold standard for the diagnosis of airway complications. However, during the follow-up of lung transplant recipients, use of end-inspiratory CT scan combined with end-expiratory or dynamic expiratory CT scan may contribute to identifying a variety of airway complications, evaluating the location and degree of airway complications and providing beneficial supplement for the selection of clinical treatment.

Necrotizing sialometaplasia: Manifestation of a localized unclassified vasculitis.

Necrotizing sialometaplasia is a rare benign and self‑limiting disease, which commonly affects the minor salivary glands. Typically, it involves the seromucinous glands located at palate, buccal mucosa, tongue, tonsil, nasal cavity, trachea, larynx, maxillary sinus, and retromolar trigone. We report two such cases of necrotizing sialometaplasia to create awareness among the pathologists and surgeons because of its close morphological and clinical resemblance to squamous cell carcinoma. We have also documented that, the ischemic necrosis of salivary gland is the result of a vasculitic process.

X ray and CT imaging in the diagnosis of the application of the ischemic necrosis of femoral head / 中国医学装备

Objective:To investigate the diagnosis value of the X-ray and CT imaging, in the ischemic necrosis of femoral head.Methods: Seventy cases of patients with ischemic necrosis of femoral head were given X ray examination and CT examination, comparing two test results of two methods of inspection.Results: The result of statistical analysis, the rate of X-ray examination was 55.7%, the rate of CT examination was 81.4%. By chisquare test, CT examination compared with X-ray had significant difference (x2=1.389,P<0.05).Conclusion: Compared with X-rays, the sensitivity of CT examination in early diagnosis of avascular necrosis is high; CT examination is an effective method in early diagnosis of ischemic necrosis of femoral head.

Manejo conservador de la torsión anexial: ¿una alternativa o una obligación frente a un posible error de apreciación por parte del cirujano? / Conservative management of adnexal torsion

Antecedentes: La torsión anexial es una complicación frecuente en ginecología que motiva una cirugía de urgencia y muchas veces conlleva la anexectomía como tratamiento basado en la impresión visual cirujano. Objetivo: Evaluar la contabilidad de la impresión visual del cirujano para la toma de decisiones. Método: Se estudiaron las torsiones anexiales operadas entre enero de 2006 y julio de 2009. Se revisaron las placas de los casos sometidos a anexectomía y se determinó la presencia de compromiso vascular irreversible. Se correlacionó la impresión visual del cirujano con la del patólogo usando la biopsia como estándar dorado. Resultados: En el período de estudio se operaron 51 pacientes. La edad promedio fue 35,5 +/- 2 años (rango: 8-80 años). El 72,6 por ciento de los casos fue abordado por laparoscopia y en 60,7 por ciento de los casos se realizó anexectomía. En 38,7 por ciento de los casos sometidos a anexectomía se demostró en la biopsia un infarto hemorrágico masivo. A mayor intervalo de tiempo entre diagnóstico y cirugía, mayor fue la probabilidad de compromiso vascular (regresión logística, p<0,01). La concordancia entre la impresión del cirujano y del patólogo fue leve (kappa 0,2 +/- 0,16 p<0,02). La sensibilidad, especificidad, valor predictivo positivo y negativo de la impresión visual del cirujano para necrosis isquémica fueron 88,9 por ciento, 26,3 por ciento, 36,4 por ciento, 83,3 por ciento respectivamente. Conclusiones: Este estudio demuestra que la apreciación visual del cirujano es un mal predictor de daño vascular irreversible. Ante la sospecha diagnóstica de torsión debe preconizarse el abordaje quirúrgico precoz e intentar preservar el ovario.

Background: Adnexal torsion constitutes one of the major surgical emergencies in gynecology commonly leading to adnexal removal based on visual assessment of vascular damage. Aims: The goal of present study is to establish the accuracy of the surgeon's visual impression in correctly doing the decision-making. Methods: All cases of adnexal torsion undergoing surgery between January 2006 and July 2009 were recruited. A pathological review was conducted in all cases undergoing adnexal removal to assess the presence of irreversible vascular damage. A correlation was done between pathologist and surgeon assessment using pathological report as gold standard. Results: During the period of study a total of 51 patients were operated. The average age was 35.5 +/- 2 years (range: 8-80 years). The 72.6 percent of cases was approached by laparoscopy and in 60.7 percent of cases adnexal removal was done. In 38.7 percent of those cases treated with adnexal removal a massive ischemic necrosis or complete infarction was demonstrated at biopsy. As longer the time interval was between diagnosis and surgery, major the incidence was of vascular damage (log regression, p<0.01). Slight agreement was observed between surgeon and pathologist (kappa 0.2 +/- 0.16, p<0.02). Sensitivity, specificity, positive and negative predictive values for visual assessment of ischemic necrosis done by surgeon were 88.9 percent, 26.3 percent, 36.4 percent, 83.3 percent respectively. Conclusions: This study demonstrates that visual assessment has a low positive predictive value for irreversible vascular damage. In those cases with presumptive diagnosis of adnexal torsion, an early surgical approach should be prompted to preserve the adnexa.

Interventional Therapy of Ischemic Necrosis of Femoral Head by Continuative Administration of Medicines through Indwelling Catheter in Artery / 实用放射学杂志

Objective To study the curative effect of ischemic necrosis of femoral head(III ,IV stage)by continuative administration of medicine through indwelling catheter in artery.Methods Thrombolysis in 19 cases with ischemic necrosis of femoral head(III,IV stage) were treated with continuative administration of medicines through indwelling catheter in lateral femoral circumflex and medial femoral circumflex artery and obturator arteriae using Seldinger technique.Results All patients were followed-up for 6～12 months.The curative effect was evaluated by angiography,the clinical symptoms and the change of bone.The ratio of the improvement of clinical symptoms was 75.8%,63% of the necrotic area of femoral head showed hyperplasia.Conclusion By continuative administration of medicine through indwelling catheter in artery in treating ischemic necrosis of femoral head (III ,IV stage) has remarkable therapeutic effect.

Effect of Curettage and DBM-CaSO4 Graft for the Treatment of Ischemic Necrosis of the Capital Femoral Epiphysis in Immature Pigs / 대한정형외과연구학회지

PURPOSE: The purpose of this study was to determine the effect of curettage and DBM complex graft as a new treatment modality for LCP disease using piglet capital femoral epiphysis ischemic necrosis model. MATERIALS AND METHODS: Five to six weeks old piglets were used for the experiment. Ischemic necrosis of the capital femoral epiphysis was surgically induced by cervical ligation on both sides. Three weeks following ischemic insult, the left hip joint was approached medially. About 15% of the necrotic capital femoral epiphysis was curetted through a window which was opened at medial cervical cortex, then, demineralized bone matrix complex was engrafted. The right femoral heads served as controls. Piglets were sacrificed three, six, nine, and twelve weeks following were harvested for histologic examination. RESULTS: In control group, photomicrographs of specimens showed central necrosis and fibrovascular invasion in capital femoral necrosis at three weeks after ischemic insult. Six, nine, and twelve weeks following ischemic insult, fibrovascular invasion advanced without noticeable new bone formation and collapse of femoral head progressed. At twelve weeks, definite coxa plana developed. In curettage and DBM complex graft group, there was evident new bone formation observed in the site of DBM complex graft. At three weeks, new bone formation along with fibrovascular invasion was observed around the engrafted DBM complex mainly in the cervical metaphyseal area. At six and nine weeks, new bone formation progressed into the engrafted DBM complex in the cervical metaphysis and around the engrafted DBM complex in the capital femoral epiphysis. At twelve weeks, new bone along with new cartilage formation was observed in the capital femoral epiphysis. CONCLUSION: In conclusion, curettage and DBM complex graft is thought to be an effective treatment modality that promote regeneration of ischemic necrosis of capital femoral epiphysis.

Treatment Ischemic Necrosis of the Femoral Head with Vacularized Iliac Graft in Young Patients with Sickle-Cell Disease / 中国修复重建外科杂志

Objective To investigate the therapeutic effects of the vacularized iliac graft for ischemic necrosis of the femoral head in Niger young patients with sickle cell disease. Methods From November 1998 to Apirl 2001, 12 patients(5 males and 7 females, aging 11-22 years) with sickle cell disease suffered from ischemic necrosis of the femoral head in 14 hips. The lesion was on one hip in 10 patients and on bilateral hip in 2 patients. Necrosis was classified as Ficat Stage Ⅲ-Ⅳ in all patients. Twelve hips in 12 patients were treated with vascularized iliac graft in Maradi Province Hospital of Niger. The effects were evaluated on the basis of the Harris hip score and radiological examination. Results The patients were followed up 24-30 months after operation(27.4 months on average). The clinical results were satisfactory though no radiological evidence of improvement was noted. The mean Harris hip score increased from 75 points to 90 points. Pain relief and hip function improvement were achieved in all patients. No patients needed revision during short-term follow-up of 24-30 months. Conclusion The method is recommendation for treatment of ischemic necrosis of the femoral head in the Ficat Stages Ⅲ- Ⅳ in young patients with sickle cell disease for pain relief and restoration of hip joint function. This procedure may prolong the timing and acting of total hip arthroplasty.

The Application of Intramedullary Decompression and Pressor Infusion for ischemic Necrosis of Adult Femoral Head / 实用放射学杂志

Objective To observe the curative effect of adult ischemic necrosis of femoral head by intramedullary decompression and arterial pulse pressor infusion.Methods 82 patients with ischemic necrosis of femoral head were treated in the combined treatment of percutaneous intramedully decompression and pulse pressor five medicine combined infusion in target vessels using ZC-Ⅰ-discome.Results By follow-up for 12～48 months,the painful in hip joint was alleviated and joint movement was also improved.The regenerative vessels and bone in femoral head and neek were obvious.Conclusion This therapcutic methods is safe and superior to single interventional medicine treatment for ischemic necrosis of femoral head.

Idiopathic Acute Gastric Dilatation with Ischemic Necrosis

Acute gastric dilatation without obstructive or organic disease is rare, but is possible after a gastric or an abdominal operation in cases of trauma, retroperitoneal hematoma, diabetic gastroparesis, hypoxemia, electrolyte imbalance, etc. However ischemic necrosis due to acute gastric dilatation is very rare and has been reported only in patients who has anorexia nervosa or overeat suddenly. If the distended stomach is not decompressed successfully by using a conservative method or if the process proceeds to ischemic necrosis, operative treatment is necessary. We experienced a case in which the stomach was acutely distended, and mutiple ischemic necroses had developed. The patient was a 27-year-old woman and had no specific underlying disease in her medical history. After overeating, the stomach was distended acutely. During the operation, mutiple ischemic necroses were found in the stomach. A total gastrectomy and Roux-en-Y esophagojejunostomy were performed.

Two periosteal flap pedicled with anterior superior iliac and anterior inferior iliac branches of lateral femoral circumflex vessel transposition for the treatment of Perthes disease / 中华显微外科杂志

Objective To provide an effective and convenient microsurgical method for ischemic necrosis of femoral head in children (Perthes disease) Method Basing on anatomic study, two periosteal flap pedicled with anterior superior iliac and anterior inferior iliac branches of lateral femoral circumflex vessel transposition was designed for the treatement of Perthes disease Result Eleven patients were performed with this method, and the average period of follow up was 2 1 years (range 1～3 5 years) The good and excellent rate was 82 percent Conclusion The operative method can not only provide with plenty of blood supply,but also increase osteogenic ability of the femoral head So, it is an effective method for the treatment of Perthes disease

Clinical study on ischemic necrosis of femoral head in children / 中华显微外科杂志

Objective To provide an new operative method for ischemic necrosis of femoral head in children Method The disease was treated by comprehensive operation,which are transposition of posterior great trochanter periosteal flap pedicled with profound branches of medial circumflex femoral vessels and decompression of epiphasis of femoral head Results Forty two patients were performed in seven years The period of follow up is above one year in 37 cases and average three years and six months The good and excellent rate is 86 percent Conclusions This new operation can provide with effective decompression and blood circulation and various osteogenic factors It is suitable with patients of Catterall Ⅰ～Ⅳ

Intravertebral Vacuum Phenomenon / 대한정형외과학회잡지

There are several reports on the intervertebral vacuum phenomenon since Maldague s report in 1978. This disease is, however, considered as uncommon and miscellaneous entity. We performed retrospective review of 27 collapsed vertebral bodies of 21 osteoporotic patients to define the clinical, radiological and pathological characteristics of intravertebral vacuum phenomenon. Simple radiographs and MRIs were reviewed and the pathological findings from 6 specimens were matched with MRI. Intravertebral air shadows were shown in all cases either on A-P or lateral view, more definite on extension lateral views. Basically, it was considered as a burst fracture with loss of anterior and middle column height. The extent of collapse could be classified as complete or incomplete and the shape of spinal canal intrusion as bulging or local beak type. 12 cases of MRI findings were classified in to three types by T1, T2 and gadolinium enhancement patterns. The extent of spinal canal intrusion was less then 50% in all cases but neurolgic deficits were examined in 10 cases. Pathologically, necrotic trabeculae with fibrous granulation tissue was mixed with reactive new bone and callus formation in some area. This phenomenon is considered not so uncommon, which can be noticed easily in lateral flexion/extension view. Basically, this is a burst fracture with nonunion from ischemic necrosis and neurologic status should be carefully obserued.

Rapidly Destructive Coxarthrosis / 대한정형외과학회잡지

From August 1976 to February 1997, we have experienced 29 cases of rapidly destructive coxarthrosis in 23 patients who represented severe hip pain and destruction of the femoral head more than 50% within one year. The retrospective analyses of clinical, radiographic and operative findings of 2090 hips in 1534 patients, who have been diagnosed as ischemic necrosis of femoral head were performed to investigate the correlation between ischemic necrosis of the femoral head and rapidly destructive coxarthrosis. The incidence of rapidly destructive coxarthrosis was 1 % of the overall ischemic necrosis of the femoral head. The average duration of hip pain was 9 months. The average age of the patients was 56 years old and most of them were male. The cultures of synovial fluid for bacteria were negative in all cases except one case of non-pathogenic organism. But, the erythrocyte sedimentation rate and C-reactive protein were elevated. The pathologic findings were not different from the ischemic necrosis except the destruction of articular cartilage. Therefore, we concluded that rapidly destructive coxarthrosis is a subtype of ischemic necrosis of the femoral head.

Histopathologic Correlation of Magnetic Resonance Image Findings in Ischemic Necrosis of the Femoral Head (INFH) / 대한정형외과학회잡지

Magnetic resonance image of INFH were correlated with histologic sections. Seventeen patients withe eighteen hips were included in this study. reoperative radiographs and MRI were taken for the patients. Three hips were in stage II, nine hips were in stage III, and remaining six were in stage IV respectively(Ficat and Alert). These hips were replaced with artificial joint and resected heads were examined. The specimens were bisected along the imaging plane, and studied histologically and matched with respective MR images of T1 and T2. Specimen MRI was performed on three femoral head immediately after femoral head removal. Necrotic portion of the femoral head in earlier stage showed higher signal intensity in T1-weighted image. Subchondral void, necrotic bone and saponified fat were responsible for low signal intensity in necrotic portion. Low signal band adjacent to the necrotic foci represented inner fibrous tissue and outer reactive sclerotic bone. Outside the fibrous band, the signal intensity diminished compared with normal fatty marrow. these findings were attributed by cellular infiltration and trabecular bony proliferation. MRI patterns were variable in various stages, but corresponded well with histologic findings.

Idiopathic Entero-colic Lymphocytic Phlebitis: A case report

Localized enterocolic lymphocytic phlebitis is characterized by selective phlebitis involving the small to medium-sized veins and venules, infiltration exclusively by lymphocytes, and no other systemic vasculitis or inflammatory bowel disease. This vasculitis can be a rare cause of intestinal ischemia. We experienced a case of enterocolic lymphocytic phlebitis in a 72-year-old woman, who presented with abdominal pain and distension. The resected colon and terminal ileum showed striking lymphocytic phlebitis affecting the veins and venules of the bowel and mesentery which resulted in ischemic injury of the bowel. This vasculopathy was the only demonstrable cause of ischemia. Arteritis and arteriolitis was not found. There is no clinical or laboratory evidence or a history of extraintestinal vasculitis. The etiology of this clinicopathological entity has not been elucidated. Herein, we report the clinicopathological findings in this patient who presented with ischemic intestinal necrosis caused by localized intestinal lymphocytic phlebitis associated with thrombosis.

EFFECTS OF CORYDALIS TURTSCHANINOVII F.YANHUSUO (LARGE LEAF TYPE) ON EXPERIMENTAL MYOCARDIAL ISCHEMIA / 第二军医大学学报

In this paper, the effects of rhizoma corydalis turtschaninovii f.yanhusuo (large leaf type5 LLYH) on experimental myocardial ischemia and coronary blood flow are reported.LLYH was showed to be active in increasing the tolerance of mice to monobaric hypoxia and prolonging survival time of the animal under the high oxygen consumption condition induced by large dose of isoproterenol.It decreased the severity of myocardial ischemic necrosis induced by large dose of isoproterenol in mice and reduced the extent of myocardial infarction in Wistar rats 12 h after ligation of the root of th,e left coronary artery.In anesthetized open chest cats, coronary blood flow was increased by LLYH infusion with slight decrease in heart rate and blood pressure.