Comparison of the clinical efficacy of laparoscopic extralevator abdominoperineal excision (ELAPE) and non-ELAPE for low rectal cancer.

This study was performed to retrospectively analyze and compare the related clinical indicators between extralevator abdominoperineal excision (ELAPE) and non-ELAPE under laparoscopic for low rectal cancer. From June 2018 to September 2021, a total of 80 patients with low rectal cancer who underwent either of the above two types of surgeries at our Hospital were enrolled. Patients were divided into the ELAPE group and non-ELAPE group based on the different surgical methods. Preoperative general indicators, intraoperative indicators, postoperative complications, positive circumferential resection margin rate, local recurrence rate, hospital stay length, hospital expenses, and other related indicators were compared between the two groups. There were no significant differences in the comparison of preoperative indexes between the ELAPE group and non-ELAPE group, including age, preoperative BMI, and gender. Similarly, there were no significant differences in abdominal operation time, total operation time, and the number of intraoperative lymph nodes dissected between the two groups. However, the perineal operation time, intraoperative blood loss, intraoperative perforation rate, and positive circumferential resection margin rate were significantly different between the two groups. In the comparison of postoperative indexes, perineal complications, postoperative hospital stay length, and IPSS score were significantly different between the two groups. The use of ELAPE in treating T3-4NxM0 phase low rectal cancer was superior to non-ELAPE in reducing intraoperative perforation rate, positive circumferential resection margin rate, local recurrence rate, etc.

Clinical characteristics and identification of a novel TGFB1 variant in three unrelated Chinese families with Camurati-Engelmann disease.

BACKGROUND: To investigate the clinical characteristics and molecular diagnosis of Camurati-Engelmann disease (CAEND) in Chinese individuals. METHODS: We recruited six patients aged 14 to 45 years in three unrelated families with CAEND, including five females and one male. Clinical manifestations, biochemical tests, and radiographic examinations were analyzed. The TGFB1 gene variants were further identified by Sanger sequencing. In addition, one female patient was followed up for 5 years. RESULTS: The onset age of the patients ranged from 1 to 6 years. All of them had family histories and consisted of an autosomal dominant inheritance pattern. Gait disturbance, fatigue, progressive bone pain, muscle atrophy, and weakness were the main complaints. Laboratory examinations revealed that the inflammatory markers were at high levels, in addition to the increased bone metabolism indicators. The thickened diaphysis of long bones and the narrowed medullary cavity was observed by radiography. Furthermore, bone scintigraphy detected abnormal symmetrical radioactive concentrations in the affected regions of bone. Sanger sequencing identified a missense heterozygous variant in exon 4 of the TGFB1 gene in families 1 and 2, resulting in Arg218Cys, which confirmed CAEND. Moreover, one novel variant c.669C > G in exon 4 of the TGFB1 gene harboring Cys223Trp was detected in family 3. Subsequent bioinformatics software predicted that the novel variant was pathogenic. Of interest, III:2 in family 3 experienced heart valve defects and tachycardia at birth, which had never been reported in CAEND patients before. Moreover, the response to drug treatment is also full of contradictions and is worthy of further study. CONCLUSION: Besides the typical CAEND manifestations, the new phenotypic characteristics of tachycardia and heart valve defects were first reported in one woman carrying the novel variant p.Cys223Trp in TGFB1 the gene. In addition, we demonstrated that increased bone metabolism indicators and inflammatory markers may possess auxiliary diagnosis for CAEND.

Prevalence of bilateral Discoid Lateral Menisci (DLM) in patients operated for symptomatic DLM with a follow-up study on their asymptomatic contralateral knees: a Magnetic Resonance Imaging (MRI) assessment.

BACKGROUND: The purpose was to investigate prevalence of bilateral discoid lateral menisci (DLM) in Han Chinese patients who received surgery for symptomatic DLM, as well as a follow-up study of their asymptomatic contralateral knees using magnetic resonance imaging (MRI). METHODS: A total of 110 patients [50 males and 60 females; average age: 21.95 ± 12.77 years (range: 6 to 67 years)] admitted to our hospital with symptomatic DLM were treated with arthroscopic surgery. The contralateral asymptomatic knees were evaluated for DLM by MRI. Postoperative clinical evaluation was performed using the Lysholm knee scoring scale and International Knee Documentation Committee subjective knee evaluation. RESULTS: Eighty (72.73%) of 110 symptomatic DLM patients had bilateral DLM, of which 68 (85%) were of homotype (same type). Fourteen of 80 bilateral DLM patients were symptomatic and received operations in both knees. Twelve of remaining 66 bilateral DLM patients with asymptomatic one knee underwent a second arthroscopic surgery as their asymptomatic knees became symptomatic over the five-year interim. Of these 12 cases, seven exhibited no shift and five showed posterocentral meniscal shift. Furthermore, at least two cases showed progression from asymptomatic grade II to symptomatic grade III over the interim. All patients showed significant improvement after surgery. CONCLUSIONS: The bilateral DLM rate of Han Chinese patients with symptomatic DLM was relatively high at 72.7 %, and 85 % of those were of homotype.

Triamcinolone intravitreal injection and intraocular pressure in macular edema associated with retinal vein occlusion.

PURPOSE: To study the risk factors of increased intraocular pressure (IOP) response to triamcinolone acetonide intravitreal (IVTA) injection in eyes with macular edema associated with retinal vein occlusion. METHODS: Eighty-nine eyes with macular edema associated with retinal vein occlusion first received periocular injection of 40 mg triamcinolone acetonide (TA) and were followed for one month. According to the diversity of IOP after periocular TA (PTA) injection, they were divided into the elevation IOP group (group A, 26 eyes) and the normal IOP group (group B, 63 eyes). They then received 4 mg TA intravitreal injection. IOP measurements were recorded after PTA and IVTA injections, and were followed for six months. RESULTS: Both PTA and IVTA injections caused a rise in IOP, but it was higher in the IVTA injection (40.45%) than in the PTA injection (29.21%). The mean rise in IOP was more significant in eyes with IVTA injection (28.08 ± 8.24 mmHg) than in eyes with PTA injection (20.87 ± 4.07 mmHg). Patients with an elevation IOP above 6 mmHg after PTA injection had a 73.08% chance of developing a pressure of 24 mmHg or higher, whereas only 12.70% of those with an elevation IOP below 6 mmHg after PTA injection experienced pressure elevation. CONCLUSION: IOP response to PTA injection is a good way to judge IOP response to IVTA. If the patient is highly sensitive to corticosteroid, treatments other than IVTA injection are used to avoid the increased risks associated with intravitreal corticosteroid injection.

[Arthroscopic treatment of acute greater tuberosity fractures of the humerus].

OBJECTIVE: To study the outcome in the arthroscopic treatment of acute greater tuberosity fractures. METHODS: Twelve cases with acute great tuberosity fractures received reduction with arthroscopic treatment from August 2006 to December 2007. There were 7 males and 5 females. Eight cases were on left side and 4 on right side. The patients were operated at a mean age of 38 years old (range: 2745). The fractured fragments in displacements were greater than 5 mm. X-ray film and Constant score were used to evaluate the post-operative outcome. RESULTS: Three hollowed threaded screws with a washer were used to fix the big fractured fragments. The post-operative follow-up was a mean of 18 months (range: 14-33). The fracture fixations were excellent and bone union occurred. The patients received a mean Constant score of 92 (86-100) at the last follow-up. CONCLUSION: Arthroscopic treatment of acute greater tuberosity fractures is quite efficacious.

Single-bundle posterior cruciate ligament reconstruction with remnant preservation: lateral versus medial-sided augmentation technique.

OBJECTIVE: To compare the results of lateral versus medial-sided augmentation techniques in single-bundle posterior cruciate ligament (PCL) reconstruction with remnant preservation. METHODS: Forty-two cases of isolated chronic PCL ruptures were reconstructed in a single-bundle manner with remnant preservation. The patients were randomly separated into two groups: in the medial-sided augmentation (MSA) group the graft passed through the medial side of the remnant and in the lateral-sided augmentation (LSA) group it passed through the lateral side. RESULTS: Nineteen patients in the MSA group and 17 in the LSA group were followed up for a minimum of 2 years. At the final follow-up, the average side-to-side differences in posterior laxity were 1.6 ± 1.2 mm and 1.5 ± 1.3 mm respectively in the MSA and LSA groups. According to the International Knee Documentation Committee (IKDC) scale, patient numbers graded as normal, nearly normal and abnormal were 14 (73.7%), 4 (21.1%), and 1 (5.3%) in the MSA group, and 13 (76.5%), 3 (17.6%), and 1 (5.9%) in the LSA group. The IKDC subjective scores were 93.1 ± 3.8 and 92.6 ± 4.1, the Lysholm scores were 95.0 ± 4.6 and 93.7 ± 4.2, and the Tegner scores were 5.4 ± 0.9 and 5.6 ± 0.7 respectively in the MSA and LSA groups. Statistical analysis showed no significant differences between the MSA and the LSA group regarding all subjective and objective results. CONCLUSION: In single-bundle PCL reconstruction with remnant preservation, similar subjective and objective results can be obtained with MSA and LSA techniques.