Objective To introduce a method of the surgicalcorrectionof Poland’s syndrome in children. Methods From May 1990 to May 2002, 3 female children with Poland’s syndrome were treated. One child of 12 years old with defects of the right second and third costal cartilages, pectoralis major and pectoralis minor underwent repair of chest wall with graft of autologous costal cartilage from left sixth costal cartilage and transfer of the latissimus dorsi flap. The other 2 children, 3 and 16 years old, with defects of theleft second, third and fourth costal cartilages, pectoralis major and pectoralis minor underwent graft of autogenous costal cartilage from the right sixth costal cartilage and implant of Dexon mesh. Results Three patients were followed up 1, 7 and 10 years postoperatively, respectively.The contour of chest wall in 3 patients were improved. The functions of the chest, back and upper limbs in the deformitis side were good and the growth and development of thechildren were normal during follow-up postoperatively.Conclusion The congenital deformities of multiple systems and parts in the body are involved in Poland’s syndrome so that it is necessary to make a proper surgical plan according to the extent of lesions for a satisfactory result.
ObjectiveTo observe the characteristics of images of fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) in patients with acute retinal necrosis syndrome (ARNS), and investigate the applied value of FFA and ICGA in clinical diagnosis.MethodThe data of the ocular fundus, FFA and ICGA of 20 patients (28 eyes) with ARNS were retrospectively analyzed.ResultsThe images of FFA indicated hyperfluorescence of optic disc in 24 eyes (85.71%) at the late phase; widespread retinal vascular occlusion at the peripheral focus in 23 eyes (82.14%) with some occlusive vascular shadow and the fluorescein in some white-line-like blood vessels; fluorescent leakage at the junction of normal and abnormal retina in 22 eyes (78.57%); retinal detachment in 20 eyes (71.42%), including 9 with retinal hole (45% of the patients retinal detachment); and macular cystoid edema in 8 eyes (28.57%). The images of ICGA showed hyperfluorescence of optic disc in 8 eyes (28.57%) including 5 with dotted staining at the optic disc at the late phase; unclear choroidal vasculature in the peripheral focus in 20 eyes (71.42%); and choriodal scattered hypofluorescent patch at the focus area in 19 eyes (67.85%). At the late phase of ICGA, some intravascular emboli and segments of retinal vascular occlusion were clearly demonstrated. ConclusionThe main manifestations of patients with ARNS in the images of FFA were hyperfluorescence of optic disc and retinal vascular occlusion; and unclear choroidal vessels and scattered hypofluorescent patch at the focus area.Combination of FFA and ICGA is helpful to understand the extent of the lesions and the relations between choroids and retina, which has great significance in diagnosing ARNS.(Chin J Ocul Fundus Dis, 2005,21:100-102)
Objective To evaluate the safety and efficacy of transcatheter angiographic embol ization (AE) in the control of massive haemorrhage from large wound due to crush syndrome after Wenchuan earthquake. Methods From May 12 to May 26, 2008, 11 injured persons in Wenchuan earthquake with massive haemorrhage from large wound due to crush syndrome were treated, including 6 males and 5 females aged 16-36 years old (average 21 years old). All 19 wounds were infected.The hemorrhage was from the hip in 7 cases, the thigh stump in 3 cases, and the shoulder in 1 case. Six patients had hemorrhagic shock. All patients underwent arteriography to locate the bleeding artery, and transcatheter AE was performed according to the result of arteriography. Contrast-enhanced spiral CT scan and three-dimensional angiography were performed 48 hours after AE to evaluate leakage of contrast media and collapse of distal artery of embol ism site. Results Angiography for 11 injured persons after AE showed no occurrence of contrast media leakage, faint shadow to the distal branch artery of embol ic level, and significant increase of blood pressure of the bleeding artery, indicating the embol ization was successful. No active hemorrhage was evident in the wounds 48 hours after AE. For the 6 patients with hemorrhagic shock, obvious decrease of hemorrhage was observed after AE, gradual recovery of blood pressure and vital signs, and stabil ity of their condition were evident after supportive therapy. During the first 24 hours after AE, total volume of infusion was 6 750-19 600 mL (average 8 740 mL), and total volume of blood and plasma transfusion was 1 800-6 400 mL (average 3 500 mL). In 6 cases, contrast-enhanced spiral CT scan demonstrated faint shadow of the distal artery without contrast media leakage, and three-dimensional CT angiography showed collapse of the distal artery; in the rest 5 cases, contrast-enhanced spiral CT scan demonstrated shadow of the distal artery without contrast media leakage, and three-dimensional CT angiography displayed the full-fill ing of distal artery with obviously decreased vascular cavity. No severe compl ications such as muscle necrosis in the buttock and hip, bladder necrosis,dysuria, fecal incontinence, and impotence occurred. Conclusion The transcatheter AE is a safe, fast, effective and miniinvasive method of controll ing massive haemorrhage from large wound caused by crush syndrome after Wenchuan earthquake.
Objective To explore the difference between bone marrow edema syndrome (BMES) and avascular necrosis of femoral head (ANFH). Methods Recent original articles about BMES and ANFH were extensively reviewed, and were comprehensively analysed. Results The pathology, pathogenesis, clinical features, treatment selection, and prognosis are different between these two diseases. Conclusion BMES and ANFH are two different diseases. Micro-fracture may be the cause of bone marrow edema.
ObjectiveTo investigate the significance of catheter thrombolysis combined with one-stage iliac vein percutaneous transluminal angioplasty (or stent implantation) in the treatment of acute left lower extremity deep venous thrombosis secondary to Cockett syndrome.MethodsForty-one cases of Cockett syndrome complicated with acute left lower extremity deep vein thrombosis were retrospectively analyzed and summarized in our hospital from January 2016 to June 2019. Catheter directed thrombolysis was performed under the protection of filter, and percutaneous transluminal angioplasty or stent implantation was performed in the first stage of the iliac vein stenosis or occlusion after thrombolysis. Compared the circumference of upper and lower legs of 15 cm above and below patella of the healthy and affected limbs, before and after treatment, and analyzed the venous patency rate.ResultsThe average time of using thrombolytic catheter were (7±3) days, and the average dosage of urokinase was (358.32±69.38) ×104 U. A total of thirty-five Bard stents were implanted (35 cases), four cases underwent percutaneous transluminal angioplasty, and two cases gave up treatment. Before and after treatment, the circumference difference of the higher leg, the circumference difference of the lower leg, and the venous patency were significantly different before and after thrombolysis (P<0.01). The venous patency rate was 58%–75% in this group, and the average venous patency rate was (61±10)%. There was no severe bleeding complication occurred. Thirty-five patients were followed up for 3–26 months, the preservation rate of the valve was 82.86% (29/35), and the first patency rate of iliac vein was 100% (39/39). During the follow-up period, thrombosis recurred in one case of untreated iliac vein, and acute thrombosis in the right side of one case was caused by long iliac vein stent entering the inferior vena cava. No pulmonary embolism was found.ConclusionOn the basis of catheter thrombolysis, one stage removal of iliac vein obstruction in the treatment of acute left lower extremity deep venous thrombosis can relieve the clinical symptoms, reduce the recurrence rate of thrombosis, and reduce the occurrence of deep vein thrombosis syndrome after catheter thrombolysis.
Objective To pay attention to the diagnosis and treatment of the complications associated with closed multifractures in metacarpals. Methods From 1997 to 2000, out of 382 patients with closed multi-fractures in metacarpals, 12 had complications. In 7 cases of fractures at the second , third , fourth and fifth metacarpal shaft, complicated by acute compartment syndrome in hand, compartmental fascia were incised for decompress; open reduction and internal fixation were performed. In 4 cases of fractures at the metacarpal base, complicated by acute carpal tunnel syndrome, the fracture was reduced and fixed without transection of the transverse carpal ligament. In 1 case of fracture at metacarpalbase, complicated by direct contusion of the median nerve, the fracture was reduced without treatment of the median nerve. Results All patients were followed up for 3 months. Fracture healed 46 weeks postoperatively. No claw deformity anddysfunction of the median nerve occurred. The arc of motion of the proximal interphalangeal and distal interphalangeal joints were normal.Conclusion During fracture reduction, we should pay attention to the complications associated with closed multi-fractures at metacarpal to decrease hand malfunction.
Objective Using a simple management strategy to investigate the etiologic spectrum of chronic cough in Chengdu city and its suburbs. Methods Chronic cough patients were randomly recruited fromthe outpatient clinic of Sichuan Provincial People ’s Hospital between July 2011 to May 2012. A conception of “Chronic Airway Inflammatory Cough Syndrome, CAICS”was established including several common causes of cough such as cough variant asthma ( CVA) , eosinophilic bronchitis ( EB) , atopic cough ( AC) , and atypical chronic bronchitis. Based on CAICS, a simplified suspected diagnosis procedure of chronic cough was conducted. Patients were empirically treated. Etiology and efficiency of chronic cough was analyzed. Results A total of 148 patients of chronic cough were recruited. The mean age was ( 43. 0 ±13. 0) years old. There were 72 male and 76 female patients with mean ages of ( 39. 7 ±10. 7) and ( 45. 0 ± 14. 2) years old respectively. The males were younger than the females ( P lt; 0. 05) . There was 96. 6% ( 143/148) of patients suspectedly diagnosed and 3.4% ( 5/148) patients were undiagnosed. The suspected causes of these chronic cough patients were as follows, ie. CAICS ( 57. 5% ) , upper airway cough syndrome ( UACS, 21. 5%) , gastroesophageal reflux cough ( GERC, 9. 1% ) , and others ( 8. 4% ) . A single possible cause was found in 95 patients ( 64.1% ) , two possible causes in 41 patients ( 27. 7% ) , and three possible causes in 3 patients( 2. 0% ) . 12.2% of chronic cough patients were combined with allergic rhinitis ( AR) . Among the diseases, CVA, CAICS and UACS were disposed to coexist with AR. The overall efficiency of empiric management strategy of chronic cough was 83. 7% .Conclusions The etiological spectrum of chronic cough in Chengdu acquired by this strategy was generally consistent with previous findings in China.The three most important causes of chronic cough in Chengdu were CAICS, UACS and GERC. This strategy was simple, effective, economic and feasible. It could be a primary management for chronic cough in some hospital.
Objective To establish a repeatable, simple, and effective model of rat crush injury and crush syndrome (CS) so as to lay a foundation for further study on CS. Methods A total of 42 female Sprague Dawley rats (2-month-old, weighing 160-180 g) were divided randomly into the control group (n=6) and experimental group (n=36). The rats of the experimental group were used to establish the crush injury and CS model in both lower limbs by self-made crush injury mould. The survival rate and hematuria rate were observed after decompression. The biochemical indexes of blood were measured at 2, 4, 8, 12, 24, and 48 hours after decompression. The samples of muscle, kidney, and heart were harvested for morphological observation. There was no treatment in the control group, and the same tests were performed. Results Seven rats died and 15 rats had hematuria during compression in the experimental group. Swelling of the lower limb and muscle tissue was observed in the survival rats after reperfusion. The liver function test results showed that the levels of alanine transaminase and aspartate aminotransferase in the experimental group were significantly higher than those in the control group (P lt; 0.05). The renal function test results showed that blood urea nitrogen level increased significantly after 2 hours of decompression in the experimental group, showing significant difference when compared with that in the control group at 12, 24, and 48 hours after decompression (P lt; 0.05); the creatinine level of the experimental group was higher than that of the control group at 4, 8, 12, and 24 hours, showing significant difference at 8, 12, and 24 hours (P lt; 0.05). The serum K+ concentration of the experimental group was higher than that of the control group at all time, showing significant difference at the other time (P lt; 0.05) except at 2 hours. The creatine kinase level showed an increasing tendency in the experimental group, showing significant difference when compared with the level of the control group at 4, 8, 12, and 24 hours (P lt; 0.05). The histological examination of the experimental group showed that obvious edema and necrosis of the muscle were observed at different time points; glomeruli congestion and swelling, renal tubular epithelial cell degeneration, edema, necrosis, and myoglobin tube type were found in the kidneys; and myocardial structure had no obvious changes. Conclusion The method of the crush injury and CS model by self-made crush injury mould is a simple and effective procedure and the experimental result is stable. It is a simple method to establish an effective model of rats crush injury and CS.
Objective To summarize clinical experience of a single stage surgical approach on patients with TaussigBing anomaly combined with side by side relationship of great arteries. Methods From May 2000 to Sep. 2007, 26 patients (age 3.1±2.2 months) with TaussigBing anomaly with side by side great arteries underwent the single stage operation, including arterial switch operation (n=25), and Kawashima operation (n=1). Aortic arch obstruction was present in 13 patients. The corrections of aortic arch obstruction included descending aorta end to end anastomosis to aortic arch or end to side anastomosis to ascending aorta. Results The hospital mortality rate was 11.5% (3/26). There was no operative death in continuous 15 patients after Jun. 2005. 21 patients were followed up for 1 to 5 years. The patients’ growth and development were improved obviously. The sizes of the hearts were smaller than those before operations. The pulmonary blood flow was decreased obviously. Two patients required re-operations because of supravalvular pulmonary stenosis. Conclusion Taussig-Bing anomaly with side by side great arteries has complex anatomical characters. In order to improve the operative outcomes, the optimized operative strategies should be considered in according with different anatomies.
ObjectiveTo evaluate the effectiveness of Ilizarov technique-based transverse tibial bone transport on the treatment of severe diabetic foot ulcer (Wagner grades 3 to 5) complicated with systemic inflammatory response syndrome (SIRS).MethodsBetween August 2014 and December 2017, 33 patients with severe diabetic foot and SIRS were treated with Ilizarov technique-based transverse tibial bone transport. There were 27 males and 6 females, with a mean age of 60.6 years (range, 34-79 years). All of them suffered from type 2 diabetes mellitus. The duration of diabetes was 1-28 years (mean, 10 years) and the duration of diabetic foot was 1-12 months (mean, 2.7 months). According to Wagner classification, there were 8 cases in grade 3, 23 cases in grade 4, and 2 cases in grade 5. The wound healing condition was observed after operation, and the limb salvage rate was calculated. The changes in body temperature, heart rate, respiratory rate, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein concentration were assessed. The skin temperature of the dorsum of the foot was measured, and the visual analogue scale (VAS) score was used to evaluate the improvement of foot pain.ResultsAll 33 patients were followed up 3-30 months (mean, 14.1 months). All ulcers healed and the healing time was 3-12 months (mean, 5.3 months); the limb salvage rate was 100%. Postoperative body temperature, heart rate, respiratory rate, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein concentration were significantly lower than those before operation (P<0.05). The skin temperature of the dorsum of the foot was (32.64±2.17)℃ at 1 month after operation, which was significantly improved when compared with preoperative value [(31.28±1.99)℃] (t=0.05, P=0.00); but there was no significant difference in skin temperature compared with healthy side [(32.46±2.10)℃] (t=2.04, P=0.41). The VAS score was 2.4±0.7 at 1 month after operation, which was significantly improved when compared with preoperative score (4.3±0.8) (t=3.10, P=0.00).ConclusionIlizarov technique-based transverse tibial bone transport is an effective way to treat severe diabetic foot complicated with SIRS. It can promote foot ulcer healing and avoid amputations.