Multiple primary malignancies of the bladder, rectum and kidney: a case report / 中华泌尿外科杂志

Multiple primary malignancies (MPMs) are two or more primary malignancies diagnosed in the same patient at the same time or at a specific time and do not represent progression, recurrence or metastasis of the first tumor.MPMs are extremely rare. In this paper, we reported a case of male patient who was diagnosed with invasive uroepithelial carcinoma, rectal adenocarcinoma, clear cell renal cell carcinoma and sarcomatoid carcinoma of the bladder, and open partial cystectomy, laparoscopic radical operation for rectal cancer, laparoscopic partial left nephrectomy, transurethral resection of bladder tumor and laparoscopic radical cystectomy with ureterostomy were performed, respectively.The patient was followed up for 16 months after the last surgery, with good general condition and no recurrence or metastasis.

Treatment of tibial osteomyelitis with versus without antibiotic cement after radical debridement / 中华创伤骨科杂志

Objective:To compare the therapeutic outcomes between use of antibiotic cement versus non-use of antibiotic cement in the treatment of tibial osteomyelitis after radical debridement.Methods:A retrospective analysis was made of the 68 patients with local tibial osteomyelitis of Cierny-Mader Type Ⅳ who had been treated at Department of Orthopaedic Trauma, The Second People’s Hospital of Shenzhen from January 2010 to June 2015. The dead space was filled with antibiotic-impregnated bone cement beans after radical debridement of the infected bone in 32 of them (cement group) but was not in 36 of them (no-cement group). The operations for both groups were performed by the same surgical team who filled the bone defects after excision of infected bone using Ilizarov bone transport. The 2 groups were compared in terms of Paley functional scores of bone and limb, external fixation index (EFI), infection recurrence rate, total hospital costs and other complications.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative general data ( P>0.05). The cement group was followed up for (71.2±8.9) months and the no-cement group for (71.6±9.7) months, showing no significant difference ( P>0.05). By the Paley functional scores, the good to excellent rate for bone was 100% for both groups (32/32 versus 36/36) while the good to excellent rate for limb was 93.8% (30/32) for the cement group and 94.4% (34/36) for the no-cement group, showing no significant differences between them ( P>0.05). The EFI was (49.0±10.5) d/cm for the cement group and (49.5±11.4) d/cm for the no-cement group, showing no significant differences between them ( P>0.05). The infection recurrence rate at the final follow-up was 3.12% (1/32) for the cement group and 2.78% (1/36) for the no-cement group, showing no significant differences between them ( P>0.05). The total hospital cost was (70,944.1 ± 1,135.5) Yuan RMB for the cement group and (55,205.2 ± 897.3) Yuan RMB for the no-cement group, showing a significant difference ( P<0.05). No serious complications with sequelae were found in either of the 2 groups. Conclusion:In the treatment of local tibial osteomyelitis of Cierny-Mader Type Ⅳ, it is not necessary to fill the dead space with antibiotic cement when radical debridement is achieved.

Comparison of emergency versus selective surgical operations for extra-articular fractures of distal radius complicated with dorsal displacement and comminuted metaphysis in elderly females / 中华创伤骨科杂志

Objective To compare the functional outcomes between emergency operation and delayed selective operation for extra-articular fractures of distal radius complicated with dorsal displacement and comminuted metaphysis in elderly females.Methods Included for this study were 60 elderly female patients who had been treated at Department of Orthopedic Trauma,The Second People's Hospital of Shenzhen from March 2016 to March 2017 for extra-articular fractures of the dorsally displaced distal radius with a volar locking plate.They were all female,aged from 65 to 80 years (average,73.8 years).Of them,30 received surgical operation on the day or the next day after injury (emergency group) and the other 30 did 5 to 15 days after surgery (mean,8 days) (selective group).Follow-ups were conducted at 4,12 and 48 weeks after surgery to assess the ranges of motion (ROMs) of the wrist and forearm,grip strength (GS),the Disability of Arm,Shoulder and Hand (DASH) scores and complications.Results The 2 groups were comparable because there were no significant differences between them in their preoperative general data (P ＞ 0.05).A 4 weeks after operation,the ROMs,GS and DASH scores were all significantly improved in both groups,but the ROM of dorsal extension (49.6° ± 4.1°),ROM of volar flexion (58.6°± 3.5°),ROM of supination (78.1° ± 7.5°),ROM of pronation (81.4°± 7.0°),GS (58.5％ ± 11.2％) and DASH scores (17.3 ± 7.9) in the emergency group were all significantly better than those in the selective group (37.0° ± 6.3°,45.1 ° ± 3.6°,70.7 ° ± 9.6°,67.1 ° ± 10.3°,37.3％ ±9.1％ and 32.5 ± 9.6,respectively) (all P ＜ 0.05).At 12 weeks after operation,the ROM of dorsal extension (64.8° ± 7.9°),ROM of volar flexion (70.5°± 9.7°),GS (80.4％ ± 9.9％) and DASH scores (7.7 ± 4.9) in the emergency group were significantly better than those in the selective group (41.2°± 7.0°,61.6°±10.9°,66.9％ ±18.2％ and 14.2±7.3,respectively) (P ＜0.05),but there were no significant differences between the 2 groups in ROM of supnition or pronation (P ＞ 0.05).At 48 weeks after operation,there were no significant differences between the 2 groups in ROMs,GS or DASH scores (P ＞ 0.05).Postoperatively,superficial infection happened in one case and the extensor pollicis longus muscle tendon was ruptured in another in the emergency group.Conclusion In the elderly women with dorsally displaced extra-articular fracture of the distal radius,emergency surgery with a volar locking plate may lead to better functional recovery within 12 weeks post-surgery than the elective or delayed surgery.

Clinical implications of circulating mucosal associated invariant T (MALT) cells in septic patients / 中国感染与化疗杂志

Objective To investigate the number and activation status of circulating mucosal associated invariant T (MAIT) cells in patients with sepsis.Methods Flow cytometric method was used to determine the number and percentage of MAIT cells and their expression of activation molecule CD69.Results The circulating MAIT cells dropped significantly at early stage of sepsis in septic patients.The MAIT cells in the sepsis group continued to express high levels of CD69 on day 1 and day 3 after admission to ICU.Conclusions Remarkable decrease of circulating MAIT cells may portend the possibility of sepsis in patients with severe infection.

Endovascular stent-grafts for acute Stanford type B aortic dissection / 中华普通外科杂志

Objective To assess the results of emergency endovascular stent-grafting for patients with acute Stanford type B aortic dissection(type B AAD)within 24 hours of onset.Methods Between June 2007 and October 2008,30 patients with acute type B aortic dissection underwent emergency endOVascular stent-grafting within 24 hours of presentation.Under general anesthesia,stent-graft was deploved at the proper position of first tear entry through femoral artery under X-ray monitering.Follow-up by CT was performed 1 w,1 m ,3 m,6 m,1 y postoperatively to observe the efficacy and complications such as endoleak,migration and fracture of stent-graft. Result The technical success rate was 100%;13.4%(4 cases) endoleak rate was identified immediately after deployment.Follow up was made between 1 month to 19 months,averaging at(12±8)months,3.3%type-1 endoleak Was observed after 6 months;One patient died within 30 days possibly of dissection rupture;One patient died of acute liver failure during the follow-up. Conclusion Endovascular repair with stent-graft within 24 hours of presentation was effectivefor the treatment of acute type B aortic dissection.

The closed re-infusion of intestinal juice for intestinal fistula / 肠外与肠内营养

Objective: To investigate the influence of the closed re-infusion of intestinal juice and EN on the treatment of intestinal fistula.Methods: The study group was composed of 21 patients of intestinal fistula from October 2004 to December 2006.The fistulae was in the 50 cm of the proximate jejunum and caused by trauma and operatin.The leak amount of intestinal juice was more than 1 000 mL.The protein level in serum and the absorption rates of the glucose,fat and nitrogen after the reinfusion of the intestinal juice were measured.Resutls: The protein level in serum and the absorption rates of the glusose,fat and nitrogen was increased after the re-infusion of the intestinal juice.Conclusion: The absorption of the glucose,fat and nitrogen in EN and the protein level in serum can be increased after the closed re-infusion of the intestinal juice.