OBJECTIVE To study the compression factor and clinical manifestation of the compression of the palmar cutaneous branch of the median nerve. METHODS Anatomic study was done on both sides of 2 cadavers and 6 cases of hand injury in the debridement, the origin, course, branch of the palmar cutaneous branch of the median nerve were observed. From 1995 to 1998, 12 patients of compression of the palmar cutaneous branch were treated by local blockade injection. Among them, there were 8 males and 4 females, aged from 23 to 65 years and the course of disease ranged 3 to 12 months. RESULTS The palmar cutaneous branch of the median nerve was (1.3 +/- 0.1) mm in diameter, it could be pulled when the wrist dorsi-extension. All cases showed good recovery of hand function and no recurrence after 4 to 12 months follow-up. CONCLUSION The palmar cutaneous branch compression syndrome is closely related to the local anatomy. The diagnosis is definite according to the clinical symptoms and signs, and local blocking is effective on the most patients.
Objective To compare the clinical results of different thoracic incision approaches for congenital heart disease in children. Methods Retrospective analyses of the clinical results of different thoracic incision approaches for 1 669 children with congenital heart disease was performed. All patients were divided into median sternotomy group(Med group), right thoracotomy group (Rat group),and lower partial median sternotomy group (Pt group) according to different thoracic incision. Two hundred and forty five children underwent atrial septal defect(ASD) repair, 1 005 children underwent ventricular septal defect(VSD) repair and 419 children underwent tetralogy of Fallot(TOF) correct repair from Jan. 1999 to Dec. 2001. Results In ASD repair the incidence of pulmonary complications after operation in the Rat group was significantly higher than that in Med group and Pt group ( P lt;0 05). The percentage of pulmonary hypertension before operation in Med group was significantly greater than th...更多at in the Rat group and Pt group ( P lt;0 05), but the incidence of pulmonary complications in Rat group was significantly higher than that in the Med group and Pt group in children with VSD( P lt;0 05). The concentration of hemoglobin , the oxygen saturation and the percentage of transannular patch in Med group were significantly higher, lower and greater respectively than those in the Pt group and in Rat group in children with TOF( P lt;0 05). Conclusion The approaches to be selected should guarantee to correct the cardiac anomaly satisfactorily, reduce the postoperative complications maximally and ensure success of their operations.
ObjectiveTo examine the differences between totally thoracoscopic surgery and median sternotomy in scope of trauma, postoperative recovery and postoperative complications. MethodsWe retrospectively analyzed the clinical data of 331 patients with cardiac myxoma in our hospital between January 2001 and November 2015. The patients were devided into 2 groups by the different methods of operation:a totally thoracoscopic surgery group including 196 patients with 71 males and 125 females at a mean age of 50 (42.00-57.50) years, and a median sternotomy group including 135 patients, with 53 males and 82 females at a mean age of 52 (38.00-61.00) years. The clinical records of the two groups were compared in scope of trauma, postoperative recovery, and postoperative complications. ResultsThere was shorter time in breathing machine and ICU time (P<0.001), and fewer volume in blood transfusion, blood loss (P<0.001) in the totally thoracoscopic surgery group. There was less pain and postoperative complications (P<0.001) in the totally thoracoscopic surgery group. The aortic clamp time in the totally thoracoscopic surgery group was not significantly different compared with that in the median sternotomy group (P=0.15) While cardiopulmonary bypass time was shorter in the median sternotomy group (P<0.001). ConclusionTotally thoracoscopic surgery is a safe and reliable method in treating cardiac myxoma. Our results suggest that totally thoracoscopic surgery has the advantage of fewer blood loss, blood transfusion, and postoperative complications compared with median sternotomy surgery. Totally thoracoscopic surgery leads to earlier recovery and less pain.
Objective To summarize the experience of extraanatomic aortic bypass grafting through median sternotomy for onestage treatment of aortic coarctation and associated cardiac diseases, and to improve surgical effect of the diseases. Methods Between July 1997 and July 2008, 31 consecutive patients(20 male,11 female; age 31.9±11.7 years) with aortic coarctation and associated cardiac anomalies underwent onestage surgical repair through median sternotomy. The associated cardiac anomalies included: aortic valve insufficiency or stenosis(n=22); mitral valve insufficiency or stenosis (n=9); patent ductus arteriosus (n=5); ascending aortic aneurysm (n=4); ventricular septal defect (n=3); coronary artery disease (n=2). Extra-anatomic aortic bypass grafting was used to repair the coarctation. Routing of the grafts was: ascendingto posterior pericardial descending aorta (n=9) and ascendingtoinfrarenal abdominal aorta (n=22). Concomitant cardiac procedures included: aortic valve replacement in 16; Bentall procedures in 6; mitral valve repair or replacement in 9; ascending aortic replacement or aortoplasty in 4; patent ductus arteriosus closure in 5; ventricular septal defect closure in 3 and coronary artery bypass grafting in 2. Results One patient died of septic shock 39 days after operation with an inhospital mortality of 3.2%. Mean systolic blood pressure gradient between upper and lower extremities decreased from 64.2±25.3 mm Hg preoperatively to 13.7±10.2 mm Hg postoperatively (Plt;0.05). Twentyseven patients were followed up from 4 to 73 months, there were no late deaths，reoperations or graftrelated complications. Conclusion Extraanatomic aortic bypass grafting can be performed simultaneously through median approach in patients with aortic coarctation and associated cardiac diseases. It is an effective and safe treatment option for onestage surgical repair in adults and adolescents. Both ascendingto posterior pericardial descending aorta and ascendingtoinfrarenal abdominal aorta bypass have favorable results.
Objective To evaluate whether minimally invasive (MI) cardiac surgery has advantages over conventional median sternotomy (MS), so as to provide evidence for clinical diagnosis and therapy. Methods We searched CBM, VIP, CNKI, PubMed, and Elsevier databases from 1995 through 2008. The literature about the therapeutic effect of minimally invasive cardiac surgery and conventional median sternotomy was identified. The data was extracted, and the methodological quality was evaluated by two reviewers independently. The Meta-analyses were performed using RevMan 4.2 software. Results A total of 8 studies involving 492 MI patients and 712 MS patients met the inclusion criteria. Of these eight studies, two studies were randomized trials and the other six studies were retrospective cohort studies. The results of meta-analyses showed that the MI group had a better postoperative effect, and the cardiopulmonary bypass time (WMD=16.45, 95%CI 2.56 to 30.35, P=0.02), chest-tube drainage (WMD= –132.63, 95%CI –208.53 to –56.72, P=0.0006) and hospitalization stay (WMD= –1.22, 95%CI –2.14 to –0.30, P=0.009) of MI group were less than those of MS group, but the aorta clamping time (WMD=0.47, 95%CI –1.35 to 2.29, P=0.61) and operating time (WMD=26.67, 95%CI –8.91 to 62.25, P=0.14) were not significantly different between the two groups. Conclusion The minimally invasive cardiac surgery has a better postoperative therapeutic effect than conventional median sternotomy cardiac surgery.
ObjectiveTo review and analyze the long-term results of delayed repair of median nerve injury. MethodsBetween January 2004 and December 2008, 228 patients with median nerve injury undergoing delayed repair were followed up for more than 4 years, and the clinical data were retrospectively analyzed. There were 176 males (77.19%) and 52 females (22.81%), aged 2-71 years (median, 29 years). The main injury reason was cutting injury in 159 cases (69.74%);203 cases had open injury (89.04%). According to the injury level, injury located at area I (upper arm) in 38 cases (16.67%), at area II (elbow and proximal forearm) in 53 cases (23.25%), at area III (anterior interosseous nerve) in 13 cases (5.70%), and at area IV (distal forearm to wrist) in 124 cases (54.39%). The delayed operations included delayed suture (50 cases, 21.93%), nerve release (149 cases, 65.35%), and nerve graft (29 cases, 12.72%). ResultsFor patients with injury at area I and area II, the results were good in 23 cases (25.27%), fair in 56 cases (61.54%), and poor in 12 cases (13.18%) according to modified Birch and Raji’s median nerve grading system;there was significant difference in the results between 3 repair methods for injury at area II (χ2=6.228, P=0.044), but no significant difference was found for injury at area I (χ2=2.241, P=0.326). Twelve patients (13.18%) needed musculus flexor functional reconstruction. Recovery of thenar muscle was poor in all patients, but only 5 cases (5.49%) received reconstruction. Thirteen cases of nerve injury at area III had good results, regardless of the repair methods. For patients with injury at area IV, the results were excellent in 6 cases (4.84%), good in 22 cases (17.74%), fair in 72 cases (58.06%), and poor in 24 cases (19.35%) according to Birch and Raji’s grading system;there was significant difference in the results between 3 repair methods (χ2=12.646, P=0.002), and the result of delayed repair was better. ConclusionThe results of delayed repair is poor for all median nerve injuries, especially for high level injury. The technique of repair methods vary with injury level. For some delayed median nerve injuries, early nerve transfer may be a better choice for indicative patients.
Objective To observe the complication after embolizing the bilateral internal il iac arteries and the median sacral artery of dogs by different combinations and embolization levels with gelfoam particle, and to provide a reference for safety appl ication of gelfoam in cl inic. Methods Sixteen common grade adult healthy dogs (weighing 10-13 kg, 14 males and 2females) were randomly divided into 5 groups. Under the monitoring of digital subtraction angiography (DSA), the embolization was performed with gelfoam particle (diameter, 50-150 μm) in bilateral internal il iac arteries and the main branch of the median sacral artery (group A, n=3), in bilateral internal il iac arteries and the first branch of the median sacral artery (group B, n=3), in the main branch of bilateral internal il iac arteries (group C, n=3), in the unilateral internal il iac artery and the main branch of the median sacral artery (group D, n=4), and in the main branch of unilateral internal il iac artery (group E, n=3). Under the DSA, the anatomic relationships of the abdominal aorta, bilateral external il iac arteries, bilateral internal il iac arteries, and median sacral artery were observed before embol ization. The survival dogs were observed and the specimens of bladder, rectum, sciatic nerve, and gluteal muscles were harvested for the general and histological observations at 3 days after embolization. Results In dogs, there was no common il iac artery; bilateral external il iac arteries originated from the abdominal aorta and the starting of the median sacral artery had variation. Seven dogs (3 in group A, 3 in group C, and 1 in group D) died within 2 days after embolization, and the others survived to the end of the experiment. In the dead dogs of groups A, C, and D, the darkening and necrosis of the rectum were observed; the bladder presented lamellar obfuscation and focal hemorrhage and edema; and the median urinary volume in bladder was 270.6 mL. In survival dogs, no obvious change was observed in the rectum; the bladder only manifested l ight edema; and the median urinary volume in bladder was 137.0, 220.5, and 28.0 mL, respectively in groups B, D, and E.The rectum and bladder of dead dogs in groups A, C, and D manifested the disrupted cells, generous inflammatory cells infiltration, and desquamation of epithel ial cells; the rectum and bladder of survival dogs in groups B, D, and E manifested l ight inflammatory cells infiltration and edema; the embol ized artery mainly focused on the arterioles whose diameter was 100-200 μm. The sciatic nerve and gluteal muscles of each group had no obvious change except for l ight edema. Conclusion When the internal il iac artery and median sacral artery are embol ized with gelfoam particle with a diameter of 50-150 μm, to ensure the safeness of pelvic organs, the embol ized artery can not exceed the first branch when the 3 arteries are embol ized at the same time, or reserve at least unilateral internal il iac artery when embol ized to the trunk , or it will result in pelvic organ necrosis and perforation.
Objective To investigate surgical strategies using bilateral pectoralis major muscle flaps for the treatment of sternal dehiscence after cardiac surgery. Methods From May 2005 to October 2010，21 patients with sternal dehiscence, sternal osteomyelitis and mediastinitis after cardiac surgery were admitted to Beijing An Zhen Hospital of Capital Medical University. There were 13 male patients and 8 female patients with their age of 53-72 （64.5±7.8） years. There were 19 patients after coronary artery bypass grafting （CABG） and 2 patients after heart valve replacement. The non-viable and necrotic bones were debrided and sternal wires partially or completely removed. The sternal origins of pectoralis major were released on both sides. The pectoralis major muscle flaps were tensionlessly sutured across medially over the sternal defect. Multiple suction drains were placed and removed in due time. The skin was intermittently closed. Results All the pectoralis major muscle flaps lived well after surgery，and all the patients were discharged in 2 weeks after surgery. Twenty patients were discharged with complete wound closure，and 1 patient had wound fistula and infection after removal of suction drains that was healed after another surgery to resect the wound fistula. During 6 month follow-up，sternal wound healed well in all the patients with normal thoracic appearance，and none of the patients had abnormal respiratory movement, infection recurrence or persistent infection. Conclusion Bilateral pectoralis major muscle flap technique is a positive and efficient surgical strategy for the treatment of refractory sternal dehiscence after cardiac surgery.
Median nerve electrical stimulation is a common peripheral nerve electrical stimulation treatment technology in clinic. With simple operation, it has been widely used in clinical to promote coma after craniocerebral trauma, relieve pain, improve cognition, Parkinson’s disease and so on. However, its mechanism has always been a hot topic and difficult part. At present, there are a large number of clinical efficacy studies and animal experiments of median nerve electrical stimulation at home and abroad. This article reviews the clinical application and animal experiments of median nerve electrical stimulation in recent years, and summarizes its mechanism, hoping to contribute to relevant clinical applications and research.
Objective To use a meta-analysis method to establish quantitatively the association between the HER-2/neu gene amplification/enhanced protein expression status and the 5-year post-operative survival rate or median survival time in women with epithelial ovarian carcinoma. Methods We searched and screened Chinese and English literature published since 1989 to collect all retrospective cohort studies on the prognostic significance of HER-2/neu status in this population. The survival data were analyzed using Ludwig’s centered signed rank and the DerSimonian-Laird method. Results In total, 25 studies involving 3 251 patients were included. HER-2/neu was positive in 27.1% (95%CI 0 to 54.8%) of patients, which was not related to the pathological stage, type or grade of epithelial ovarian carcinoma. In HER-2/neu positive cases, the median survival time was shortened by 0.65 years, and the 5-year survival rate was lowered. The hazard ratio (HR) for mortality was 1.22 (95%C 1.09 to 1.36). By subgroup analysis, HER-2/neu protein expression was found to be most significant in prognostic assessment. Patients with a b positive value of HER-2/neu had an increased HR for the 5-year survival; and platinum-based chemotherapy was demonstrated to be less effective in HER-2/neu positive ovarian carcinoma. Conclusion In gynecological oncology, it is reasonable to measure HER-2/neu as a routine pathological marker to predict a patient’s prognosis and to determine the most appropriate adjuvant chemotherapy regimen.