Thining anterolateral thigh perforator flap for repairing of scar contracture deformity after hand trauma: a report of 12 cases / 中华显微外科杂志

Objective:To explore the method and effect of free thining anterolateral thigh perforator flap (ALTP) in repairing soft tissue defect of scar contracture deformity after hand trauma.Methods:From March, 2015 to August, 2019, 12 patients who suffered scar contracture after hand trauma were repaired with thin ALTP. First, completely resected the scar contracture tissue from the hands and restored the normal bone structure and force line of the hand. The area of hand wound defects were 5.0 cm×6.0 cm-8.0 cm×10.0 cm. The wound was repaired by free ALTP, and the flap was micro-thinned for the first time. The flaps did not carry broad fascia, and the donor sites were directly sutured. The wound healing, the flap appearance, texture, sensation, scarring of the donor area, and functional recovery of the affected hand were observed regularly after surgery. The patients were followed-up by outpatient review and WeChat.Results:All the flaps survived well after the operation. Two cases suffered crisis because hematoma entraps vein cause by bleeding from perforator branch. After surgical exploration, the flaps survived successfully. All 12 flaps were followed-up successfully, including 6 cases reviewed in outpatient clinic, 4 cases followed by WeChat video and 2 cases by telephone consultation. The follow-up time was 3-20 months, with an average of 11 months. The flaps were not bloated, soft, non-pigmented, and beautiful in appearance. Only linear scars remained in the donor sites. The gripp function, palm function, thumb opposition function and finger function of the affected hand were largely restored. According to the TAM method of Upper Limb Function Evaluation of the Chinese Medical Association: 7 cases were excellent, 4 cases were good, and 1 case was fair.Conclusion:The thinning ALTP can be used to repair the scar contracture deformity after hand trauma. It can carry different tissues for 3-dimensional repair. After operation, the flap has a beautiful appearance, the donor site can be closed directly, and the damage of donor site can be reduced. It is an effective method to repair the hand contracture deformity.

Clinical characteristics and diagnosis of early hydatidiform mole / 中华妇产科杂志

Objective@#To evaluate the clinical characteristics and diagnostic strategies of early hydatidiform mole.@*Methods@#A retrospective cohort study was conducted of 526 women with hydatidiform mole who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and ChildHealth Care Hospital from Feb. 2013 to Feb. 2018, including 484 women with gestational age less than or equal to 12 weeks (the early group) and 42 women with gestational age greater than 12 weeks (the late group). The clinical characteristics between the two groups were compared, and the pathological diagnosis and pre-evacuation ultrasound examination of the early group were further discussed.@*Results@#Compared with the late group, the clinical characteristics of the early group tended to be atypical, and the incidence of vaginal bleeding, excessive uterine size, theca lutein cysts (>6 cm) and pregnancy complications decreased significantly (all P<0.05). The serum level of β-hCG in the early group was significantly lower than that in the late group (Z=-2.382, P=0.017). While there was no significant difference in the pre-evacuation ultrasound detection rate between the two groups (53.5% vs 66.7%; χ2=2.697, P=0.101). Five hundred and fifteen patients completed the follow-up, and 38 patients with post-mole neoplasia were all cured. There was no significant difference in the malignant transformation rate of hydatidiform mole between the two groups (7.0% vs 11.9%; χ2=0.745, P=0.388). In the early group, 302 cases of complete hydatidiform mole (CHM), 179 cases of partial hydatidiform mole (PHM) and 3 cases of unclassified hydatidiform mole (UHM) were histologically diagnosed, according to pathological morphology combined with p57KIP2 immunohistochemical staining. Compared with pathological diagnosis, the overall pre-evacuation ultrasound detection rate in the early hydatidiform mole was 53.5% (259/484), which was significantly better for complete (78.1%, 236/302) versus partial (11.7%, 21/179) hydatidiform moles (χ2=199.224, P<0.01). There was significantly weak negative correlation between the overall ultrasound detection rate and gestational age of hydatidiform mole (r=-0.211, P<0.01). The gestational age of early PHM was significantly longer than that of CHM (68.0 vs 58.5 days; Z=-8.048, P<0.01).@*Conclusions@#The clinical presentations of early hydatidiform mole are not typical. Although ultrasound examination identifies only about half of hydatidiform moles, ultrasonography is still an important auxiliary examination method. Morphological examination combined with p57KIP2 immunohistochemical staining could effectively diagnose early hydatidiform mole, so as to reduce the missed diagnosis of hydatidiform mole.

Relationship among Lymph Vascular Space Invasion with Clinicopathological Factors and Prognosis in Early Cervical Cancer / 实用妇产科杂志

Objective:To investigate the relationship among lymph vascular space invasion (LVSI) with clinicopathological factors and prognosis in early cervical cancer(CC).Methods:Retrospective analysis was conducted on 280 cases of early CC that were surgically treated at Dalian Maternal and Child Health Care hospital between January 2009 and June 2012.Univariate analysis was performed to study the relationship between LVSI and clinicopathological factors,the clinicopathological factors statistically associated with LVSI in univariate analysis were studied by multivariate analysis to identify the independent risk factors of LVSI.Results:①Univariate analysis showed that histological type,histological differentiation,lymph node metastasis and cervical stromal invasion depth were significantly correlated with LVSI (P ＜ O.05).Multivariate analysis showed that LVSI was an independent risk factor for differentiation,lymph node metastasis,and the depth of invasion.②The 5-year disease free survival(DFS) of LVSI positive patients was 74％,and the overall survival(OS) was 80％.The 5-year DFS and OS of LVSI negative patients were 93％ (P ＜ 0.05).Conclusions:LVSI can reflect the potential risk of lymph node metastasis to some extent.LVSI is the independent risk factor of lymph node metastasis and can significantly reduce the DFS and OS.Patients with LVSI positive may have deeper infiltration and poorer differentiation,but more studies are needed to confirm it.

Radial artery pedigreed conjoined perforator flap repair cross-joint long-shaped skin and soft tissue defects in fingers / 中华显微外科杂志

Objective To explore the method and clinical effect of radial artery pedigreed conjoined perfora-tor flap for repairing cross-joint long-shaped skin and soft tissue defects in fingers. Methods From June, 2015 to June,2017,six patients with cross-joint long-shaped skin and soft tissue defects of the fingers were treated with radial artery pedigreed conjoined flap which axis was the artery superficial line, and carried two radial artery perforators, in order to enlarge flap cut range to repair.The size of flaps ranged from 3.0 cm ×6.0 cm to 3.5 cm ×7.5 cm.The donor site was directly sutured. After operation, all patients were followed up for 3 to 8 months. All the necessary parts are observed, such as the flaps appearances, textures, the donor sites, checked the flap sensation, activity functions of the fingers. Results Six cases of flap all survived.The wounds healed well(phase I),and all patients were followed up for 3 to 8 months, with an average of 5 months. All the flaps do not obviously bloat, the textures were soft,the colors are normal,the appearances of flaps were similar to recipient sites. The donor sites healed well only with linear scars. Conclusion Using radial artery pedigreed conjoined perforator flap to repair cross-joint long-shaped skins and soft tissue defects in fingers that it not only can enlarge the cut range but also cut conveniently, the textures are close to recipient sites.Therefore,it is an ideal repair way.

Clinical significance of centralized surveillance of hydatidiform mole / 中华妇产科杂志

Objective To explore the clinical significance of centralized surveillance of hydatidiform mole.Methods From Feb.2013 to Feb.2017 all patients with hydatidiform mole,who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and Child Health Care Hospital,were registered centrally for serum hCG monitoring and treatment if necessary.Prophylactic chemotherapy was not administered regardless of risk factors for malignant transformation of hydatidiform mole.The risk factors included age of over 40 years,excessive uterine enlargement for presumed gestational age,a serum hCG level greater than 5 00 000 U/L,large theca lutein ovarian cysts (＞6 cm),and a history of previous hydatidiform mole.The centralized surveillance of hydatidiform mole was based on the central pathology review,team cooperation and service improvement.Their treatments and outcomes were analyzed retrospectively.Results A total of 407 women of hydatidiform mole were registered with histopathology confirmation,including 70 high-risk hydatidiform moles.The follow-up rate was 97.5％ (397/407).The incidence of post-mole neoplasia was 8.1％ (32/397),which was diagnosed in 22.9％ (16/70) of high-risk and in 4.9％ (16/327) of low-risk hydatidiform moles,showed statistically significant difference between high-risk and low-risk groups (x2=25.108,P＜0.01).Thirty-two patients with post-mole neoplasia were all at low risk of International Federation of Gynecology and Obstetrics (FIGO) score (range,0-6) and received complete remission with chemotherapy alone in 31 of them except one treated by hysterectomy.The primary cure rate of single-agent chemotherapy was 60.0％ (18/30).Patients with low-risk or high-risk post-mole neoplasia were both 16.There were no significant differences between the two groups in interval that was end of antecedent pregnancy to start of treatment,the serum level of hCG before treatment,clinical stage or risk factor score (all P＞0.05).Conclusions The risk of malignant transformation is increased in high-risk hydatidiform mole,however,the high risk factor itself does not affect the prognosis in patients with timely diagnosis and treatment of post-mole neoplasia.Therefore,prophylactic chemotherapy is not recommended to high-risk hydatidiform mole patients.Centralized surveillance of hydatidiform mole is practical in a local hospital of China and could greatly improve the prognosis of post-mole neoplasia.

Repair of skin and soft tissue defects in upper limbs with low abdominal superficial artery flap / 中华显微外科杂志

ObjectiveTo investigate the clinical effects of applying low abdominal superficial artery flap to repair skin and soft tissues defects in upper limbs.MethodsTotal 42 cases with soft tissues defects were recruited in this study.Seven cases were repaired using skin flaps with circumfiexa ilium superficial artery.Five cases were repaired using osteocutaneous flaps based on circumfiexa ilium superficial artery.Eleven cases were repaired using flaps with superficial epigastric artery.Seven cases were repaired using flaps with circumfiexa ilium superficial artery,lateral branches of superficial epigastric artery and musculocutaneous perforators of the fourth lumbar artery.Six cases were repaired using flaps with origin of circumfiexa ilium superficial artery,medial and lateral branch of superficial epigastric artery,and the deep and cutaneous branch of circumfiexa ilium superficial artery.ResultsAfter surgery,forty-two flaps all survived.Flaps areas were between 5 cm × 6 cm-9 cm × 30 cm.Followed up 6-24 months,the appearance,texture,color and function of flaps were recovered well and did not need to trim again.ConclusionLow abnominal superficial artery flap could be used to repair skin and soft tissues,also its texture is so thin and areas can be direct sutures,which,is an ideal method to forearm repairment.

Clinical study of tamsulosin in prevention of urinary retention after radical hysterectomy / 中国医师进修杂志

Objective To study the clinical value of tamsulosin in prevention of urinary retention after radical hysterectomy.Methods Sixty-six patients after radical hysterectomy were enrolled in this study, and divided into two groups in random.Thirty-three cases in the treatment group were treated with tamsulosin 0.2 mg once every night,3 days before the catheter was drawn.While 33 cases in the control group only with placebo.Catheter keeping days, residual urine volume at first extraction,the rate of urinary retention and urinary tract infection,hospitalization time and drug adverse reaction were compared in two groups.Results Catheter keeping days and hospitalization time were shorter in the treatment group than those in the control group(P< 0.05).The residual urine volume at first extraction was(38.2 ± 5.6) ml in the treatment group and (168.5 ± 11.8) ml in the control group,there was significant difference between two groups (P< 0.05).The rate of urinary retention was 18.2%(6/33) in the treatment group and 36.4%(12/33) in the control group,there was significant difference between two groups (P <0.05).There was no adverse reaction resulted from tamsulosin in the treatment group.Conclusion Tamsulosin is an effective drug which could prevent and treat the urinary retention after radical hysterectomy.

Re-evaluating the relationship of serum CA125 value and prognosis in endometrial cancer / 中国医师进修杂志

Objective To investigate the role of various CA125 value in serum in instructing the treatment of endometrial cancer. Method The preoperative CA125 serum level of 147 cases of endometrisl cancer was examined by radioimmunoassay. Results Among patients with endometrial cancer, the CA125 level was higher in stages Ⅲ and Ⅳ than that in stages Ⅰ and Ⅱ (P<0.01). The sensitivity and specificity of CA125 > 20 kU/L in diagnosis of the endometrial cancer were 70.7% and 98.0%, and CA125 > 35 kU/L were 58.2% and 100.0%, respectively. The CA125 value of eases with cytological positive in abdomen was higher than that of cases with cytological negative. Conclusion The examination of CA125 serum level is valuable in the judgement of operative stages and lymph node metastasis in endometrial cancer.

Effect of environmental supplementation of iodine on infant mortality and growth in children in Xinjiang, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the effect of iodine supplementation on infant mortality and growth in Xinjiang.</p><p><b>METHODS</b>Urine iodine, height and head circumference (HC) of children aged 5 years in two townships was measured before and yearly after iodine supplementation of irrigation water. Height and HC were expressed as Z scores (United States children used as the reference group). Neonatal and infant mortality rates were obtained from official records in three counties from 1988 to 1999, and analyzed by a logistic regression model.</p><p><b>RESULTS</b>The odds ratio of infant mortality decreased 56.49% and neonatal mortality 65.71% respectively after iodination; there was no significant difference in the odds ratio of infant or neonatal mortality between experimental and control areas without iodination. In Langru township, the mean height of 5 year-old children increased from 95 cm in 1992 to 106.9 cm in 1998 - 1999, and HC from 48.4 cm to 50.5 cm. Median urine iodine increased from <10 to 176 micro g/L. In Bakechi township, mean height increased from 91 cm in 1993 to 106.5 cm in 1998 - 1999, HC from 48.7 to 49.6 cm, and median urine iodine from 39 to 138 micro g/L.</p><p><b>CONCLUSION</b>In Xinjiang, adequate iodine treatment markedly decreased infant and neonatal mortality, and largely preventing stunting of height and HC in children.</p>