Objective?To compare the double dorsal phalangeal flap (DDPF) with the combination of digital neurovascular island flap (NVIF) and first dorsal metacarpal artery flap (FDMA) in terms of repairing digit degloving injury.?Methods?From October 2005 to March 2008, DDPF was used to repair 9 patients (9 fingers) with degloving injury of the thumb and index finger and completely amputated thumb and index finger (group A). From August 1996 to June 2007, NVIF and FDMA were used to repair 13 patients (13 fingers) with the thumb degloving injury and completely amputated or necrotic thumb (group B). In group A, there were 7 males and 2 females aged 19-48 years old, there were 4 cases of thumb and index finger degloving injury repair and 5 cases of completely amputated thumb and index finger reconstruction, the skin defect ranged from 6.0 cm × 3.5 cm to 7.0 cm × 4.5 cm, and the interval between injury and operation was 3-10 hours. The size of DDPF harvested during operation was 4.0 cm × 3.5 cm-5.0 cm × 4.0 cm. In group B, there were 10 males and 3 females aged 18-50 years old, there were 5 cases of thumb degloving injury repair and 8 cases of completely amputated or necrotic thumb reconstruction, the skin defect ranged from 6.0 cm × 3.0 cm to 7.0 cm × 4.5 cm, and the interval between injury and operation was 3 hours-5 days, and the size of NVIF and FDMA harvested during operation was 3.5 cm × 3.0 cm-5.0 cm × 4.0 cm. The donor site was repaired with the full-thickness skin graft.?Results?All the flaps survived uneventfully except for 1 case in group A suffering from venous crisis 1 day after operation and 2 cases in group B suffering from FDMA artery crisis 4-12 hours after operation. Those flaps survived after symptomatic treatment. All the wounds healed by first intention. All patients in two groups were followed up for 1-12 years (average 3.2 years). All the donor sites were normal except for 3 cases in group B suffering from flexion contracture deformity of the proximal interphalangeal joint due to the scar contracture in the margin of NVIF donor site. According to Allen test, the skin temperature and color of the donor fingers in two groups were normal under room temperature; 1 case of group A and 6 NVIF donor fingers of group B were pale and cold under ice water. According to sensory recovery evaluation system, 16 fingers in group A were graded as S4, 1 as S3+, and 1 as S2; while in group B, 3 NVIF fingers were graded as S3, 6 NVIF fingers as S2, 4 NVIF fingers as S1, and 13 FDMA fingers as S4. The appearance of the recipient flap was satisfactory and the color was similar to the surrounding skin. The skin temperature and color of the flaps in two groups were normal under room temperature; 2 cases of group A and 4 recipient fingers of group B were pale and cold under ice water. In group A, all the palmar flap of the recipient finger achieved the reorientation of the recipient flap sensation; while in group B, 8 cases achieved the reorientation of the recipient flap sensation, and 5 cases had double sensation. For the two-point discrimination of the flap, group B was superior to that of group A in terms of the palmar aspect (P lt; 0.05), no significant difference was evident between two groups in terms of the dorsal aspect (P gt; 0.05), and the palmar aspect of each group was superior to the dorsal flap (P lt; 0.05).?Conclusion?DDPF is less invasive to donor finger, easy to be operated, able to partially restore the sensory of the injured finger, and suitable for the repair of the degloving injury of the thumb and the index finger. Combination of NVIF and FDMA can restore the fine sensory of recipient palmar flap better and is applicable for those patients suffering from digital nerve defects from the proximal phalanx and with high demand for the recovery of thumb sensory.
Objective To compare the therapeutic effect of procedure for prolapse and hemorrhoids （PPH） and Block repair procedure for rectocele．Methods A retrospective study of 62 patients with surgical treatment for rectocele was analyzed．The patients were divided into PPH group （n=32） and Block group （n=30） according to the different operation procedure．The symptoms score of improvement of the patients after surgery was compared between the two groups， including operation time，intraoperative blood loss， postoperative pain score， required analgesic times， postoperative complications，hospitalization time，and hospitalization expenses．Results The symptoms of constipation of patients in two groups was significantly improved afer operation．Comparing one month with three months of Longo’s obstructed defecation syndrome （ODS） score after the operation，there was no significant difference in the PPH group（P＞0.05）， but significant difference in the Block group（P＜0.01）．Although the expenses of the PPH group was much higher than that of the Block group （P＜0.01）， the outcomes of the PPH group were much better than those of the Block group （P＜0.01）， including the postoperative Longo’s ODS score of one month and three months，operation time，intraoperative blood loss， postoperative pain score，required analgesic times，and hospitalization time．Two cases of lightly postoperative incontinence occurred in the PPH group，but completely recovered after three months in the clinical follow-up．Conclusions The PPH is as safe and effective as Block repair procedure for rectocele. The short time effect and lower recurrence rate of the PPH are better than those of the Block repair procedure．
Objective To evaluate the clinical effects of surgical treatment for 30 patients with discogenic low back pain. Methods A total of 30 patients with 36 intervertebral discs were treated with posterior approach lumbar discectomy and interbody fusion with internal fixation by strict criteria. All patients were followed up for one year. The low back pain before and one year after surgery was evaluated by Japanese Orthopaedic Association (JOA) score and Visual Analogue Scale (VAS) score. Results The patients’ JOA score increased from 14.6±2.3 (before operation) to 27.1±0.9 (one year after operation) (t=–26.936, P<0.001), while the patients’ VAS score decreased from 6.2±1.6 (before operation) to 1.4±0.9 (one year after operation) (t=16.335, P<0.001), and the differences were significant. Conclusion When the conservative treatment is invalid, the operation of posterior lumbar intervertebral fusion is an effective method for the patinets with discogenic low back pain.
Objective To assess the effect of early antiretroviral therapy on acquired immune deficiency syndrome in Butuo County, Liangshan Autonomous Prefecture. Methods A total of 1 037 patients who underwent antiretroviral therapy between January 1st 2012 and December 31st 2013 in Butuo Coungty were divided into 2 groups. The early treatment group (with CD4+ lymphocyte count >350 /mm3) was group A (n=459) and delayed treatment group (with CD4+ lymphocyte count≤350 /mm3) was group B. After 18-month treatment, the treatment retention rate, clinical effect and the side effects of medication in two groups were observed and analyzed. Results After 18 months, there were 297 (64.7%) and 320 (55.4%) patients who were persisting in treatment in group A and B, respectively; while the mortality was 6.1% (28/459) and 14.4% (83/578), respectively in group A and B. The differences were significant (P<0.001). The rate of virological suppression in group A and B was 64.0% (190/297) and 63.8% (204/320) respectively without any significant difference (P>0.05). Compared with baseline CD4+ T lymphocyte counts, the growth rate of CD4+ T lymphocyte count in group A and B was 5.7% and 37.5%, respectively; the difference was significant (P<0.001) Conclusions Early treatment for acquired immune deficiency syndrome in Butuo County, Liangshan Autonomous Prefecture is effective, however, its growth rate of CD4+ T lymphocyte count is lower than that of delayed treatment. Early treatment doesn’t cause the increasement of the risk of common adverse reactions of medication, and it can reduce the mortality.
Objective To assess the value of arsenious acid in treatment for metastatic liver cancer and inspect its adverse reaction through comparison between the therapeutic effect of arsenious acid-FOLFOX4 combined chemotherapy and that of single FOLFOX4 chemotherapy. Methods Twenty-six patients with metastatic liver cancer were selected from July 2006 to December 2007 in Huadong Hospital. All the cases were averagely divided into therapy group and control group randomly, arsenious acid combined FOLFOX4 chemotherapy was performed in therapy group and single FOLFOX4 chemotherapy in control group. Results The total of 26 cases completed at least 2 cycles of arsenious acid-FOLFOX4 combined chemotherapy or single FOLFOX4 chemotherapy. During 6-24 months follow-up (median 12.5 months), the average survival time of the therapy group was 242 d, the median survival time was 281 d, and the average survival time of the control group was 227 d, the median survival time was 246 d, there was no statistical difference between two groups (Pgt;0.05). Pain: There were 2 cases of complete remission (CR), 5 cases of partial remission (PR), 2 cases of stable disease (SD) in therapy group, the objective effect (CR+PR+SD) was 9 cases. There were 1 case of CR, 3 cases of PR, 2 cases of SD in control group, the objective effect (CR+PR+SD) was 6 cases. Objective efficacy: There were no CR cases in two groups. In therapy group, there were 5 cases of PR, 6 cases of NC, 2 cases of PD, the objective effect (CR+PR) was 5 cases, the benefit (CR+PR+NC) was 11 cases. In control group, there were 2 cases of PR, 4 cases of NC, 7 cases of PD, the objective effect (CR+PR) was 2 cases, the benefit (CR+PR+NC) was 6 cases. There was no significant difference of the objective effect between two groups (Pgt;0.05), but the benefit was significantly different (Plt;0.05). The major toxic reactions were digestive tract side effect, hepatic and hematological toxicity in two groups. Conclusions Arsenious acid-FOLFOX4 combined chemotherapy can lead to good therapeutic effect. Arsenious acid will not increase the adverse reaction of normal chemotherapy.
Objective To evaluate the therapeutic effect and safety of Bupropion hydrochloride sustained-release tablets in the treatment of depression. Methods A total of 48 patients meeting the diagnostic criteria of depression of CCMD-3 were randomly treated with Bupropion hydrochloride sustained-release tablets or Fluoxetine tablets for 42 days. Hamilton depression rating scale, Hamilton anxiety rating scale, clinical global impression and treatment emergent symptom scale were used to evaluate the therapeutic effect. Blood routine test, urine routine test and electrocardiogram were examined before and after the treatment. Results The effective rate of Bupropion hydrochloride sustained-release tablets [83% (20/ 24) ] was higher than that of Fluoxetine tablets [63% (15/ 24)], with a P value of 0.104. The incidence of adverse reactions was 46% (11/24) in both groups. Conclusion The therapeutic effect of Bupropion hydrochloride sustained-release tablets on depression is similar to that of Fluoxetine tablets, with mild adverse reactions to both treatments.
Objective To compare the therapeutic effect of percutaneous transhepatic cholangial drainage (PTCD) and operation drainage for the patients with inoperable malignant obstructive jaundice. Methods A total of 131 patients with inoperable malignant obstructive jaundice were treated in this hospital, in which 102 patients had PTCD by placement of metallic stent and (or) plastic tubes to remove obstruction of bile duct (interventional treatment group). Simultaneously 29 patients were selected for operation by intraexternal drainage (operation drainage group). The patients were followed up for comparison of the serum level of total bilirubin, postoperative complications, average length of hospitalization and average cost between the two groups. Results PTCD was successfully performed in all the patients of the interventional treatment group. There were no significant differences of 50% decrease period of average total bilirubin level or postoperative complications between the two groups (Pgt;0.05). The average length of hospitalization and average cost of interventional treatment group were less than those of operation drainage group (Plt;0.05). Conclusions Compare with operation drainage, interventional treatment can reduce average length of hospitalization and average cost, without increase of postoperative complications, which is a main chance of treatment for malignant obstructive jaundice.
OBJECTIVE: To explore a method to treat the mostly-isolated finger with its bilateral arteria injury without microsurgery. METHODS: To avoid exacerbating iatrogenically the wound, the methods of therapy mainly included the following procedures: debriding carefully, suturing the cutis and subcutaneous layer to fix internally the fracture without Kirschner wire, and not suturing the broken finger nerve or the broken tendon which had rebound. It was used in the emergency operation. After operation, heat therapy and Anisodamine were used to dilate capillary and micrangium of the unbroken soft tissue of the wounded finger, which was anatomically the only base of blood supply of pars of the wounded finger. RESULTS: In the 34 cases, main blood supply of the wounded finger was restored. The wound healed well in 28 cases. In 6 cases of necrosis in the edge of the wound, the necrosis were excised and the cicatricial healing was achieved. In 31 patients followed up, after the fracture had healed, the nerve and tendon were repaired. CONCLUSION: The methods above should be available for the mostly-isolated finger, especially in a hospital without microsurgery.
ObjectiveTo evaluate the value of computed tomography examination in the clinical diagnosis guidance and therapeutic effect assessment for patients with uremic pneumonia. MethodsWe reviewed the clinical situation and pathogenesis turnover of 64 cases of uremic pneumonia from February 2011 to January 2013,and analyzed the correlation between image modification and treatment effectiveness. ResultsSixty-four cases of uremic pneumonia had different image manifestations in each phase of the disease course,including 27 cases of pulmonary venous pleonaemia,51 of lung interstitial edema,8 of pulmonary alveoli effusion,and 15 of pulmonary interstitial fibrosis.Dropsy of serous cavity and the heart shape could be viewed by CT scanning.CT rechecking was carried out after hemodialysis and symptom-targeted treatment.The results showed that CT results of 27 cases of pulmonary venous pleonaemia,51 cases of edema in the interstitial tissue and 41 cases of pleural effusion changed significantly after treatment (P<0.001);the image manifestations of 8 cases of pulmonary alveoli edema also changed significantly (P<0.05);the CT result of 15 cases of pulmonary interstitial fibrosis had no change;six cases among the fourteen cases of pericardial effusion were not absorbed by treatment (P>0.05). ConclusionThe diagnosis of uremic pneumonia mainly depends on imaging results.CT scanning plays an important role on the determination of clinical stage,the choice of therapeutic method,and evaluation of curative effect for uremic pneumonia.
ObjectiveTo summarize the clinical characteristics and mid-long term efficacy of children under 15 years with mechanical valve replacement. Methods We retrospectively analyzed the clinical data of 51 children aged 1 to 15 years underwent mechanical valve replacement in Xinhua Hospital between January 2006 and January 2014. There were 32 males and 19 females with mean age of 9.6±4.0 years (ranged 1-15 years). ResultsThe average cardiopulmonary bypass time was 120.50±61.02 minutes, and average aortic cross-clamping time was 68.35±42.68 minutes. One patient died in hospital. There were 6 patients (11.8%) with complications including mitral paravalvular leakage in 1 patient, malignant ventricular arrhythmia in 1 patient, respiratory failure in 1 patient, acute renal failure in 2 patients, and delayed thoracic close in 1 patient. All the children cured and were followed up for 1-96 months. One patient died during the follow-up time. No other redo-valve replacement or complications correlated to anticoagulant occurred. ConclusionsMechanical valve replacement may be necessary in children with extremely dysplastic valves and severe hemodynamic impairment or after failed repair. With appropriate selection of the prosthetic valve and intensive care therapy during the peroperative period, the mid to long term efficacy is optimistic.