Tumours of the Scalp： A Review of Ten Cases

Background： The scalp is a common site for the development of tumours. Most of these tumours are benign; among the malignant ones, squamous cell carcinoma （SCC）） and basal cell carcinoma （BCC） predominate. In Ghana patients with scalp turnouts do not report to hospital unless they are symptomatic. Data on the condition is therefore scanty. Patients and Methods： The objective of the study was to document the hospital prevalence and the management outcome of patients with scalp tumours. Patients with turnouts of the scalp reporting at the Reconstructive Plastic Surgery and Burns Unit （RPSBU） at Komfo Anokye Teaching Hospital （KATH） who were managed by the author between June 2003 and June 2009 were entered into the study. The patients were examined clinically and the diagnosis confirmed by biopsy. The scalp tumours were excised and the defect closed directly, skin grafted, or repaired with a flap as appropriate. Results： Ten patients with eleven scalp tumours were managed during the study period from June 2003 to June 2009, made up of four males and six females. Their ages ranged from 16 to 70 years, with a mean age of 41.7 years. Two benign scalp turnouts, a sebaceous cyst and a sebeceoma were located in the frontal region; five cases of SCC and one case of basosquamous cell carcinoma （BSC） in the parietal region, two cases of SCC in the temporal region, and one case of SCC in the occipital region of the scalp. Eight of the tumours developed de novo from the scalp; one developed from a chronic burn scar （Marjolin＇s ulcer）; two tumours developed from the scalp of a patient with xeroderma pigmentosum. Two patients had excision and direct closure of the defect; six had excision and skin grafting; two had excision and flap repair. One patient had block dissection of the left cervical lymph nodes, and two patients had adjuvant radiotherapy. Conclusions： Most tumours of the scalp presenting at the RPSBU at KATH are SCC which developed de novo. Chronic burn scars and xeroderma pigmentosum were some of the aetiological factors identified. Early lesions can be cured by excision and skin grafting.     

Schistosoma japonicum: construction of phage display antibody library and its application in the immunodiagnosis of infection

Background A monoclonal antibody would be an effective tool for the detection of circulating antigens in the serum of patients with schistosomiasis, but the traditional way of producing monoclonal antibodies is not cost-effective. The objective of this study was to find a new method for the large-scale production of monoclonal antibodies against Schistosoma japonicum (Sj).Methods A phage display antibody library for Sj was constructed. To obtain a single-chain variable fragment antibody (scFv) against Sj, the library was screened with metabolic antigens from adult Sj worms (Sj-MAg) using enzyme-linked immunosorbent assay. The soluble scFvs selected were used to detect Sj antigens in the serum of acute and chronic schistosomiasis patients.Results Six positive clones with good reactivity to Sj-MAg were obtained from the phage display antibody library of about 1.07 x 106 individual clones. Only two of these six clones bound specifically to Sj-MAg and were chosen for further analysis. Specific soluble anti-Sj-MAg scFvs were produced by inducing the 2 clones with isopropyI-D-thiogalactopyranoside. The characteristics of the scFvs were then determined. The results of Western blot showed that these scFvs could bind to Sj-MAg specifically and had a molecular weight of about 31 kD. When testing serum from schistosomiasis patients with one of the two specific scFvs, its sensitivity was found to be 60% and 37% in acute and chronic patients, respectively, with a specificity of 90%. When the two specific scFvs were combined,their sensitivity was found to be 75% and 57% in acute and chronic patients, respectively, with a specificity of 85%.Conclusions The results indicate that the scFvs are potentially useful for the diagnosis of schistosomiasis. The library construction also provides a useful tool for the further screening of other antibodies for both diagnostic and immunotherapeutic applications and for epitope analysis and vaccine design.     

Long-term P300 in hemispherectomized patients

Background In the years around 1990, in Beijing 13antan Hospital Affiliated to Capital Medical University many children with infantile hemiplegia and intractable epilepsy were treated with further modified anatomical hemispherectomy. We report the follow up of the first six cases. To make good use of these precious clinical data and make clear their neuropsychological state, we performed neuropsychological and neurophysiological measurements in these patients, who were at a median of 17.8 years after hemispherectomy. Methods Oddball task was given to the patients and to a normal control group to collect the peak latency （PL） and peak amplitude （PA） of event-related potentials （ERPs）-P300. The P300 data of the two groups were analyzed and the P300 patterns of the six patients are presented. The baseline characteristics and long-term follow-up of the six hemispherectomized patients, especially the long-term seizure control and cognitive function after surgery, are described. Results Five patients had no seizures and one was almost seizure-free during the years after surgery. Clear P300 was obtained from every electrode in the patients. Differences of P300 between patients and normal control group had no statistical significance. And the maximum PA was at the site of electrode Pz or Cz which was consistent with that of the control group and with previous findings. Conclusions Further modified anatomical hemispherectomy has preferable long-term antiepileptic effects. The P300 results of the patients mean that the basic cognitive function of the patients has no difference from the control group. This reflects the plasticity of the hemisphere to some extent and increases the affirmation of the long-term curative effects of further modified anatomical hemispherectomy from both neuropsychological and neurophysiological aspects.     

Common bacteria distribution and antibiotics choice in trauma patients with wounds

Objective The distribution and antibiotics resistance of common bacteria in the trauma patients with wounds were studied to direct the using antibiotics correctly. Methods Secretion bacteriology and bacterial sensitivity were detected for therapy in trauma patients with wounds from 1996 to 2000. The antibiotics resistance were examined. Results A total of 2 396 strains in 3 545 cases-times from wounds were isolated, the positive rate is 67.59%,the first five common strains were Staphylococ-cusaureus, S. epidermidis, Pseudomonasaeruginosa, Enterococcus,and Escherichia coli. The resistances rate to common antibiotics of S.aureus was≥80 % , imipenem/ cilastatin (Tienam) and vancomycin was still effective to the G+ cocci. G- bacteria had higher resistance against the 3rd generation of cephalosporins. Conclusion The bacteriology and the surveillance of antibiotics resistance are important to using antibiotics reasonably. 6 refs,3 tabs.     

Analysis on the imaging features of AIDS with pulmonary fungal infection

Background Pulmonary fungal infection is one type of the common opportunistic infections in AIDS patients. The disease is hard to diagnose because of its complicated imaging features. The objective of this study was to investigate the imaging performance characteristics of pulmonary fungal infection in AIDS patients.Methods Fifty-one patients with AIDS complicated with pulmonary fungal infection and 56 patients of non-AIDS with pulmonary fungal infection were examined by CT scans and high-resolution CT scans. The contrast enhanced scans were performed in patients with the mass or suspected enlarged mediastinal lymph nodes. Results were compared between the two groups.Results The most common fungal infection in the two groups of patients was Candida albicans. The infection rates were 54.8% （28 cases） in the group （AIDS patients with pulmonary fungal infection） and 58.3% （32 cases） in another group （non-AIDS patients with pulmonary fungal infection）. In the two groups, the difference in diffuse distribution and the difference in incidence of affected upper and lower lobes in the bilateral lung fields were statistically significant. The differences in patchy or large consolidation shadow, cavitas, enlarged lymph nodes in mediastinum and pleural effusion were also significant when comparing the two groups.Conclusions The lesion in most of AIDS patients with pulmonary fungal infection tends to exhibit diffuse distribution,patchy or large consolidation shadow covering a more extensive region. The differences between AIDS with pulmonary fungal infection and non-AIDS with pulmonary fungal infection are statistically significant in lesion location and complicated imaging features. The most common fungal infection in AIDS patients is Candida albicans.     

Effect of Weikangfu Granule (胃康复冲剂) on the Physiopathologic Figure of Precancerosis of Gastric Mucosa in Patients of Chronic Gastritis with Pi-Deficiency Syndrome

Objective: To study the physiopathologic basis of Weikangfu Granule ( 胃康复冲剂, WKFG)in treating precancerosis of gastric mucosa in patients of chronic gastritis with Pi-deficiency syndrome (CG-PDS). Methods: One hundred and fifteen patients of CG-PDS who suffered from intestinal metaplasia (IM)and atypical hyperplasia (ATHP) of gastric mucosa, were divided into two groups. The treated group (n =61 ) was treated by WKFG with its ingredients modified according to the syndrome type of patients. The constructural changes were detected by optical microscope, screening electronic microscope, transmission electronic microscope and histochemical staining; the nuclear and mitochondrial ultrastructure of gastric mucosa were analyzed with energy dispersion X-ray analyser and image analysis system. And the changes of cAMP,lipid peroxide (LPO), superoxide dismutase (SOD) before and after treatment in the treated group were measured and compared with those of the health control group consisting of 15 volunteers. Results: The symptomatic and pathological therapeutic effect in the treated group were significantly superior to those in the control group (P＜0.05). The contents of Zn, Cu, cAMP, SOD and 3H-TdR LCT in gastric mucosa of the treated group before treatment were all lower than those of the healthy control group, yet all these indexes markedly increased after treatment, while serum LPO level, which increased before treatment was lowered after treatment. All the changes showed statistical significance (P＜0.05 or P＜0.01). Conclusion: WKFG can reverse IM and ATHP in patients of CG-PDS, and the effect may be realized by way of increasing the level of Zn, Cu, cAMP and SOD in gastric mucosa, promoting cell differentiation, enhancing cellular immunity and reducing oxygen free radicals and lipid peroxidation.     

Prevalence of depression in coronary heart disease in China: a systematic review and meta-analysis

Background Coronary heart diseases （CHD） have been identified as one of topmost diseases affecting the Chinese population.However,depression in CHD has not been reported and there are limited high quality empirical studies in China focused on the prevalence of the comorbidity.This study aimed to estimate the pooled prevalence of depression with CHD in China.Methods Systematic review and meta-analysis of published epidemiologic studies on the depression in CHD patients in China were conducted.The research findings dated before 30 September 2013 were obtained from Ovid Medline,EMBASE and two Chinese electronic publication libraries WANFANG and CNKI.We used ＂cardiovascular disease＂,＂depression＂ and ＂China＂ as the search themes in Ovid Medline and EMBASE and ＂cardiovascular disease＂ and ＂depression＂ in WANFANG and CNKI.Random-effects meta-analysis was used to estimate the prevalence of depression in CHD patients.Results Twenty-seven studies were included in the review.Twenty-three studies had 5 236 participants who were hospitalized and four studies had 1 353 participants from community.The overall prevalence of depression in CHD from hospital was 51% （95% CI：0.43,0.58; Ⅰ-squared=97%,P=-0.000）.The prevalence of depression in CHD from community ranged between 34.6% to 45.8%,and the severe depression was found ranging between 3.1% to 11.2%.Conclusions On comparing data with other countries,the prevalence of depression in CHD among admitted patients in China was found to be high.The physicians and healthcare providers should pay more attention to the ＂physical-mental＂ health of the CHD patients.     

Structural and ultrastructural studies of the synovial membrane in temporomandibular joint disturbance syndrome.

To gain further knowledge on temporomandibular joint disturbance syndrome (TM JDS), the synovial membranes of 7 patients and 3 cadavers were examined with light microscope and transmission electron microscope. The results showed that the synoviocytes degenerated or disappeared in TMJDS. The cytoplasm contained numerous fibrils, while the organelles di minished in number. The surface of the synovial membrane was covered with a fibrinoid material. The surface of the synovial membrane was covered with a fibrinoid material. The authors consider that these pathological changes reduce or eliminate the normal functions of the synovial membrane, which may-lead to damage to the articular cartilage. The articular adhesion found sometimes in TMJDS may be related to the changes in the synovial membrane.     

Radioimmunolocalization of human malignant tumors with In-111 labeled monoclonal antibody.

An anti-human colon carcinoma monoclonal antibody 2C10 was radiolabeled with In-111 and studied in 15 patients with gastrointestinal and ovarian carcinoma. The labelling efficiency approached 100% and immunoactivity of the labeled antibody was over 75%. 2-3 mCi (1 mg) In-111-2C10 was given to the patients intravenously and scintigraphy was performed 72 hours after administration with a gamma camera. Specimens were also scanned in some of the patients. The resected tumors and remote margin were examined immunohistochemically. Positive scintigraphic images were obtained in 12/15 patients with colorectal cancer (10) and ovarian cancer (2). Negative results were seen in the two patients with gastric cancer. The scintigraphic results of 10 patients were confirmed surgically and pathologically. The remaining 5 were confirmed by endoscopy, B-ultrasonography or X-ray CT. Most patients had been definitely diagnosed before imaging except one patient with metastatic focus from ovarian cancer to colon and one with recurrent colon cancer were first detected with RIAD, showing the unique advantage the latfer. The high background radioactivity in the liver, however, is a conspicuous problem to be solved.

     

Fuji Intelligent Chromo Endoscopy and staining technique for the diagnosis of colon tumor

Background Colon cancer is a common malignant tumor in the clinic with an incidence rate that is increasing in recent years. The key point for improving the survival rate is the diagnosis and treatment at an early stage. The purpose of this study was to compare the difference of the Fuji Intelligent Chromo Endoscopy （FICE） and staining technique for the diagnosis of colon tumors and non-tumor lesions.
Methods From March to November 2007, 654 patients were examined with ordinary colonoscopy. Among them 223 patients with colon neoplasm or polypoid lesion were included. The patients were examined with a magnifying ordinary colonoscopy, a magnifying FICE technique and magnifying staining technique. The pit pattern and blood capillary form of the lesion were examined, an endoscopic diagnosis was made and it was compared with the pathologic diagnosis.
Results Four hundred and fifty-one neoplasms were detected in the 223 patients, among those 91.1% （411/451） were detected with the magnifying ordinary endoscopy while 99.1% （447/451） were detected with the FICE technique; there was a significant difference between the two methods. FICE could clearly show the structure and form of mucosal blood capillaries （P 〈0.01） but there was no significant difference between the two methods for showing the pit pattern. The coincident rate of FICE for the diagnosis of tumor and non-tumor lesions was 91.6% （413/451）, that of the magnifying staining technique was 82.0% （370/451） （P〈0.05）.
Conclusions Magnifying FICE could show the mucosal microstructure and blood capillary form and it had a superiority of high coincident rate, high sensitivity and specificity when compared with ordinary magnifying colonoscopy and magnifying staining endoscopy. In addition, it was easy to operate and a biopsy could be taken from the target, so it has a satisfactory clinical practical value.     

Twenty-year trends in major cardiovascular risk factors in hospitalized patients with acute myocardial infarction in Beijing

Background Hypertension, diabetes mellitus, hypercholesterolaemia and current smoking are the strongest modifiable cardiovascular risk factors for acute myocardial infarction （AMI）. We examined their changing trends over the last 20 years. Methods The clinical data of 3498 patients hospitalized in Peking University People＇s Hospital with AMI from 1991 to 2010 were used. Information was collected regarding to patients＇ demographic data, cardiovascular risk factors （hypertension, diabetes mellitus, hypercholesterolemia and current smoking）. To assess trends over time in the prevalence of risk factors, we categorized patients into four groups （1991 to 1995, 1996 to 2000, 2001 to 2005 and 2006 to 2010）. Results Highly significant increases were observed in the prevalence of hypertension from 40.8% to 55.6% for males and from 58.0% to 69.0% for females; and diabetes mellitus from 12.9% to 30.8% for males and from 23.0% to 42.3% for females. Similarly, the prevalence of hypercholesterolaemia decreased from 53.1% to 30.7% for males and from 57.0% to 44.0% for females. The prevalence of current smoking decreased in females from 29.0% to 11.1%, but remained unchanged in males. In addition, the proportion of patients with more than three modifiable risk factors increased from 19.0% to 27.1% and the age at onset of AMI extended to younger as well as older individuals. Conclusions The prevalence of hypertension and diabetes mellitus are still increasing in patients with AMI in Beijing and although the prevalence of hypercholesterolaemia and current smoking decreased, high clustering of risk factors were commonly present. These adverse trends show a compelling need for more effective management of cardiovascular risk factors.     

Data mining-based detection of acupuncture treatment on juvenile myopia

OBJECTIVE:We applied data mining techniques to the study of acupuncture as a treatment for juvenile myopia,with the aim of identifying hidden patterns in the data.METHODS:Fifty patients with juvenile myopia were selected and treated with acupuncture,and data mining was used to analyze the effects of treatment and the influence of behavioral variables.Clustering analysis was used to divide myopia patients into two classifications before acupuncture treatment.Artificial neural network BP algorithm was adopted to analyze the roles of different factors in changes in diopters.An association algorithm was used to analyze factors associated with the subjective experience of acupuncture and average diopter.RESULTS:The two classification results were fully consistent with the understandings of the ophthalmic circles.The duration of using the Internet and watching TV every day was the main factor that affected vision.Acupuncture feelings and therapeutic effect have a strong correlativity.A good or above experience’s score of acupuncture could slow the progression of juvenile myopia.CONCLUSION:Collecting data from patients with juvenile myopia by using data mining can extract hidden potential rules and knowledge from the research evidence.The decision support can be provided to improve the doctor’s clinical acupuncture treatment effects.     

Treatment of extremely-lateral lumbar disc herniation with METRx through intertransversal route

To study the feasibility and effects of disc resection in patients with extremely-lateral disc herrniation (ELDH) with microendoscopic tubular retractor (METRx) through intertransversal route. Methods: In the period from March 2000 to December 2002, 9 patients with ELDH underwent disc resection with METRx system through intratransversal route and the clinical outcome was evaluated with Nakai standard. Results: The operation time ranged from 60 to 120 min with an average of 75 min; the blood loss ranged from 50 to 120 ml with an average of 60 ml; and the hospitalization time ranged from 5 to 19 d with an average of 13 d. No wound infection, neurological damages, pseudomeningocele or other complications occurred. The rate of excellent and good outcome was 88.9%. Conchusion: Disc removal in patients with ELDH can be done with METRx system and satisfactory restdts are obtained.     

STUDIES ON ERYTHROCYTE INSULIN RECEPTOR IN PATIENTS WITH CORONARY HEART DISEASE

Erythrocyte insulin binding studies were performed in 30 patients with coronary heart disease (CHD) and 29 healthy subjects. The results showed that the patients with CHD had decreased concentration of insulin receptors on erythrocytes as compared with the controls, 111.3±25.1 versus 198.6±24.9 sites/RBC, and increased receptor affinity resulting in insulin binding (B/T) within normal value. These findings may explain the phenomenon found by a number of researchers that a decreased glucose tolerance and an elevated insulin response to oral glucose are present in patients with CHD. Furthermore, the relationship of plasma lipids to serum insulin and insulin receptor was examined. Among the controls, the influence of sex and age on insulin receptor was also evaluated. A hypothesis about the pathogenesis of atherosclerosis was suggested from the results of the present studies.     

Pure Mucinous Carcinoma of the Breast：a Clinicopathologic Analysis with 56 Patients

Objective To assess recent trends and prognostic features in the treatment of pure mucinous carcinoma（PMC） of the breast.Methods Fifty-six patients diagnosed with PMC of the breast in our hospital from December 1982 to June 2008 were included.We evaluated the general information and tumor characteristics of the patients,examined the relationship between these factors and prognosis.Fisher＇s exact test was applied to analyze tumor characteristics.Results The mean age of the patients was 53.7 years.The majority of the patients presented with early stage disease.Tumor size was found not a significant prognostic factor in this study.Mean follow-up period was 39 months and no breast cancer-related deaths were identified in the patient cohort.Conclusions PMC of the breast has a favorable prognosis.Tumor size does not appear to significantly impact survival.     

The potential of carcinoembryonic antigen, p53, Ki-67 and glutathion Stransferase-π as clinico-histopathological markers for colorectal cancer

Objective： Colorectal cancer is one of the major contributors to cancer death worldwide. Lack of reliable colorectal cancer markers has hampered the management of these cancer patients. Our main purpose was to study the correlation between histopathological variables of colorectal adenocarcinomas and identify histopathological markers that are of prognostic value in patients with colorectal cancer. Methods： In the present study, we examined the expression of carcinoembryonic antigen （CEA）, p53, Ki-67 and glutathion Stransferase （GST） -n by using immunohistochemical staining methods in 126 colorectal carcinoma patients and evaluated the lymph node metastasis status in these patients by histopathological examination. Results： The positive rates of CEA, p53, Ki-67 and GST-π expression in the colorectal cancer tissue specimens examined were 95.23%, 55.56%, 53.38% and 82.30%, respectively. Expression of p53 and Ki-67 was significantly correlated with the Dukes stages of the tumor, with higher levels of these proteins in Dukes＇ C and D tumors than those in Dukes＇ A and B tumors. Furthermore, the expression of p53, GST-π and Ki-67 correlated with prognosis of patients with colorectal cancer. Additionally, the expression of p53 in colorectal cancer was closely related to the expression of Ki-67 and the expression of GST-π was directly correlated with that of p53. Conclusion： The expression of CEA, p53, Ki-67 and GST-π was correlated with various clinical features of patients with colorectal cancer. The combined use of these histopathological markers appeared to be a promising tool in predicting the prognosis of patients with this type of cancer.     

Evaluation of the therapeutic efficiency of mandibular anterior implant-supported fixed bridges with cantilevers

Background Dental implant technology has developed rapidly in recent years. However, the use of implant-supported fixed bridges with cantilevers has been controversial. The purpose of this study was to evaluate the clinical results of the mandibular anterior implant-supported fixed bridges with a cantilever. Method Thirty-three patients （15 males, 18 females; mean age, 42.6 years; range 20-54 years） with two missing anterior mandibular teeth had single implant-supported fixed bridges with a cantilever. Clinical examination was recorded and radiographs were taken. The mean duration of follow-up was 30 months （15-44 months）. Results All implants survived. Loosening or fracture of the prosthesis was not observed. All patients were satisfied with the treatment. The mean bone resorption values after 12, 24, and 36 months of implant loading were 0.94, 1.18 and 1.35 mm respectively. The changes of gingival papilla height ranged from 0 to 0.5 mm. There was significant difference between 1-year and 2 or 3 years restoration groups regarding the average gingival height changes （P 〈0.05）. Conclusion After careful and precise selection of patients, restoration with a single implant-supported fixed bridge with a cantilever can be recommended if two anterior mandibular teeth are missing.     

Increased expression of receptor activator of nuclear factor-κB ligand in osteoblasts from adolescent idiopathic scoliosis patients with low bone mineral density

Persistent generalized low bone mineral density (BMD) has been reported in patients with adolescent idiopathic scoliosis (AIS).However,the exact mechanisms and causes of the low BMD in AIS patients are largely unknown.The purpose of this study was to examine the relationship between the receptor activator of NF-κB ligand (RANKL)/osteoprotegerin (OPG) levels in osteoblasts (OBs) from AIS patients with low BMD and with comparison made between the patients and controls.Twenty AIS patients and eight age-matched controls were included in the present study.The BMD of lumbar spine and proximal femur was measured in all subjects.OBs from the cancellous bone of each subject was harvested and primarily cultured.The mRNA and protein expression of RANKL and OPG in OBs was detected by RT-PCR and Western blotting.The results showed BMD was lower in AIS patients than in controls.A significantly higher mRNA and protein expression of RANKL was observed in OBs from AIS patients,while no significant difference was found in the expression of OPG between AIS patients and controls.As a result,RANKL/OPG ratio in patients with AIS was remarkably higher than controls.Our study preliminarily demonstrated expression of RANKL was higher in OBs from AIS patients with low BMD as compared with controls,suggesting the unbalanced RANKL/OPG ratio caused by an over-expression of RANKL in OBs may be responsible for the low BMD in AIS patients.     

Surgical outcome and clinical follow-up in patients with symptomatic myocardial bridging

Background Myocardial bridging with systolic compression of the left anterior descending coronary artery (LAD) may be associated with myocardial ischaemia. The clinical outcome in patients with surgical treatment for symptomatic myocardial bridging remains undetermined. This study assessed the middle- and long-term results of surgical treatment for symptomatic myocardial bridging. Methods From 1997 to 2006, 37 463 patients received selective coronary angiography in the Fuwai Cardiovascular Hospital, Beijing, China. Of these, 484 patients had angiographic diagnosis of myocardial bridging. Of the 484 patients, 35 underwent surgery for treatment of myocardial bridging with significant systolic arterial compression. Among the surgical treatment patients, 24 presented with other cardiac disorders, and the remaining 11 symptomatic patients with isolated myocardial bridging were included in the follow-up study. Results The angiographic prevalence of myocardial bridging was 1.3% in this study. The coronary angiographies of the 11 patients revealed myocardial bridging in the middle segment of LAD causing systolic compression ≥75% (ranging from 75% to 90%). The mean age of patients was 48.4 years. Surgical myotomy was performed in 3 patients and coronary artery bypass grafting (CABG) in 8 patients. Eight patients were operated on with an off-pump approach and 3 with a cardiopulmonary bypass technique after median sternotomy. Conversion to on-pump CABG surgery was necessary in 1 patient because of perforation of the right ventricle. The left internal mammary artery was used in all patients with CABG. The acute clinical success rate was 100% with respect to the absence of myocardial infarction, death or other major in-hospital complications. All of the patients were followed up clinically. The median follow-up was 35.3 months (range: 6 to 120 months). Nine patients were free from symptoms and one of them continued taking beta blockers. The remaining 2 patients with myotomy had atypical chest pain. One received coronary angiography again and no stenosis was found two years after operation; while exercise testing was performed in the other patient and revealed no evidence of myocardial ischaemia. None of the patients sustained a myocardial infarction or other major adverse cardiac events (death or vessel revascularization) during follow-up.Conclusions Myocardial bridging is a relatively common angiographic finding. Surgical myotomy or CABG should be limited to patients who are refractory to oral medication. Surgical relief of myocardial ischaemia due to systolic compression of intramyocardial coronary arteries can be accomplished with low operative risk and excellent middle- and long-term results.     

Total hip arthroplasty for patients with osteoarthritis secondary to hip pyogenic infection

Background Pyogenic hip arthritis occurs most often in young patients. Delayed treatment causes significant anatomical deformation of bony and soft tissue structures leading to premature onset of secondary osteoarthritis. Total hip arthroplasty （THA） in patients who had osteoarthritis secondary to hip pyogenic infection has been associated with high complication rates. Methods We analyzed 19 THAs performed from April 2003 to July 2008 in adults with osteoarthritis secondary to hip pyogenic infection （average age 40.7 years; range 34-52 years）. There were 7 males and 12 females, the average age of infection was 10.6 years （range 7-13 years） and the average quiescent period of infection was 29.5 years （range 22-41 years）. The count of white blood cell （WBC）, erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） were examined routinely before surgery. The duration of followup was 34 months （range 6-52 months）. Results There was no evidence of infection according to laboratory values, intraoperative exploration and bacterial culture of joint fluids and synovial tissues. Split fracture above the lesser trochanter occurred in two hips and healed without adverse sequelae after fixation with wires. One patient with sciatic nerve palsy was successfully treated by positioning the hip in extension and the knee in flexion with complete resolution of motor symptoms one month later. There were no cases of dislocation, deep vein thrombosis, or postoperative reinfection. The symptoms and hip joint activities were significantly improved. The median Harris hip score improved from 47.3 preoperatively to 89.7 and the median range of motion from 53% to 125%. Conclusions It is safe and efficient to perform THA in patients who had osteoarthritis secondary to pyogenic hip arthritis when the infection is quiescent. The key points of successful surgery are exclusion of active infection preoperatively, quiescent period of infection more than ten years and adequate intraoperative soft tissue releases.