Intermittent Internal Fixation With a Locking Plate to Preserve Epiphyseal Growth Function During Limb-Salvage Surgery in a Child With Osteosarcoma of the Distal Femur: A Case Report

Limb shortening is a problem associated with surgery for osteosarcoma of the lower extremity in adolescents, as the tumors frequently occur near the epiphysis. Herein we report the use of a less invasive stabilization system (LISS) and an intermittent fixation method to preserve the growth function of epiphysis in an 11-year-old patient with an osteosarcoma of the distal femur.The 11-year-old male presented with left knee enlargement and pain for 2 weeks, and magnetic resonance imaging (MRI) and biopsy were consistent with osteosarcoma of the left distal femur. After preoperative chemotherapy, en bloc tumor resection was performed with margins based on MRI findings preserving the epiphyseal growth plate, the tumor cavity was filled with inactivated bone and bone cement, and a LISS was used to stabilize the femur. Aggressive postoperative chemotherapy was given. Approximately 105 weeks after surgery radiography showed that the distal end of the plate had moved superior to the epiphysis along with bone growth. Locking screws were placed in the distal part of the LISS plate to stabilize the re-implanted bone, and external fixation was not needed.The patient was able to walk with the crutches 1 week postoperatively, and bear weight on the extremity 6 weeks postoperatively. At 6 years after surgery, the patient''s height had increased 52 cm, shortening of the affected limb was only 1 cm, and the circumference of the affected limb was 2 cm smaller than that of the contralateral limb. There was no significant discomfort in the affected limb, and there was no gait abnormality. The patient could jump and run, and could participate in sports including basketball and badminton to the same degree as his peers.In summary, the novel method of bone reconstruction and fixation provided good results in a child with an osteosarcoma of the distal femur. This fixation method preserves the osteogenic function of the epiphysis and restored bone integrity simultaneously, and provides good functional recovery.     

纸质病案保存期限的思考

本文作者比较了不同时期的纸质病案的使用率,讨论了旧病案的缺点,如难于保存,占用空间及实用价值不大.作者提出了改进保存病案的办法.     

Influence of different preservation solutions and intentional hemodilution of recipient on viability of preserved and transplanted rat kidneys

Abstract. A total of 81 rat kidney grafts, flushed out and cold stored in either Sacks' or University of Wisconsin (UW) solution, were transplanted into hemodiluted (Hct = 30%± 4%) or untreated (Hct = 43%± 3%) recipients. The cold ischemia times (CIT) used were 24 and 36 h. One week after transplantation, the surviving recipients ( n = 67) were contralaterally nephrectomized. The experiment was terminated after a total period of 4 weeks, and the percentage of surviving animals was determined for each treatment. Data was pooled and the results show that grafts cold stored in UW solution were viable to a significantly greater extent and after longer CIT than grafts cold stored in Sacks' solution (47% vs 23%; P < 0. 05). Recipient hemodilution did not improve graft viability (39% vs 32%; NS). Kidneys cold stored for 24 h were viable to a greater extent than kidneys with a CIT of 36 h (50% vs 15%; P < 0. 01).     

腺苷A1受体诱导预处理延迟效应对供心保存的影响及机制探讨

目的　探讨腺苷A1受体激动剂预处理延迟效应对保存大鼠心脏的影响及其机制。方法　Wistar大鼠随机分为 8组 ,A、C组以高选择性腺苷A1受体激动剂 (CCPA)预处理 ;D、E、F组在CCPA预处理前分别注射锰 超氧化物歧化酶 (Mn SOD)反义、有意义、错配寡核苷酸 (ODN) ;B、G组注射生理盐水 ,H组只注射反义寡核苷酸。 2 4h后 ,A、B组用 4℃St.Thomas液保存 4h ,复灌 1h ,而另 6组采取低温缺血 3h ,复灌 1h。观测心功能、磷酸肌酸激酶 (CK mb)、三磷酸腺苷 (ATP)含量等。结果　A组左室内压上升与下降最大速率恢复率 (±dp/dtmax,% )为 6 2 .83± 17.2 7,6 6 .81± 18.99,心肌ATP含量 (10 3 μmol/g)为3.6 7± 1.4 2 ;而B组分别为 4 0 .4 1± 18.2 9,4 4 .70± 2 5 .14 ,1.4 6± 0 .5 4 ;A组均明显高于B组 ,差异均有显著性 (P <0 .0 1orP <0 .0 5 )。C组±dp/dtmax恢复率、ATP、Mn SOD活性均明显高于D、G、H组 (P <0 .0 1orP <0 .0 5 ) ,而与E、F组比较 ,差异无显著性。结论　腺苷A1受体激动剂能诱导预处理的延迟效应 ,改善离体大鼠心脏的保存效果 ,而该效应与Mn SOD的高表达有关。     

Reduction mammaplasty by central pedicle flap with short submammary scar

Reduction mammaplasty was performed in 30 patients by combining the central pedicle flap method with the short submammary scar (3-S) technique to avoid the common drawbacks of currently popular dermoglandular procedures. Reduction was accomplished by using perforating vascular branches from the pectoralis major muscle and its fascia supplying the nipple and breast parenchyme instead of the subdermal plexus. The central vascular pedicle supplying the nipple-areola complex was preserved. Only the periphery of the breast parenchyme was resected circumferentially, with the exception of the inferolateral portion, so as not to injure the sensory nerve. The remaining breast parenchyme was preserved in an inverted cone shape. The nipple-areola complex was safely transposed with great freedom, and the amount of resection was accurately adjusted for symmetry. No cases of nipple-areola complex sensory change occurred postoperatively, and lactation is possible because of preservation of the lactiferous ducts. The length of postoperative scars was reduced by using the short submammary scar technique. We believe this combined method is ideal in patients requiring resections ranging from 200 to 600 g per breast with good skin elasticity and moderate degree of ptosis.Presented at the Sixth Asian Pacific Congress of the International Confederation for Plastic and Reconstructive Surgery, in Seoul, Korea, October 1993.     

The effect of myocardial preservation technique on supraventricular tachycardia following aortic valve replacement

We studied 100 patients who underwent an isolated aortic valve replacement (AVR) between 1974 and 1991. The patients were divided into the following two groups and compared: group A, which consisted of 40 patients operated on before 1978 who underwent continuous left coronary perfusion with blood; and group B, which consisted of 60 patients operated on after 1979 in whom St. Thomas solution was used in combination with topical cardiac cooling. Moreover, we divided the group B patients into two subgroups: group Bl, who underwent AVR before 1986 during which we administered St. Thomas solution with ice slush every 30 min; and group B2, who had AVR after 1986 in which we used St. Thomas solution with a cold saline (4°C) solution and treated with a small amount of slushed ice every 15 min. The incidence of supraventricular tachycardias was 15% in group A, 50% in group BI, and 15% in group B2. The severity of preoperative New York Heart Association (NYHA) functional class, the type of valve lesions, cardiothoracic ratio, left ventricular function, aortic clamp time, bypass time, and use of drugs did not correlate with the incidence of supraventricular tachycardias in either group A or B. In group B2 patients, we paid a lot of attention to cooling the right atrium as well as the left ventricle by immersing the whole heart using a 4°C saline solution, which led to a remarkable reduction of the incidence of supraventricular tachycardia. This fact indicates that right atrial preservation is one of the most important factors for reducing the incidence of supraventricular tachycardia.     

4℃保存外周血造血干细胞动态观察

本文对4℃条件下不同时间保存后的外周血造血干细胞(peripheral bloodhematopoietic stem cells,PBHSC)数进行了动态观察。在本实验中以定向造血祖细胞(CFU-GM)作为观察PBHSC的指标。结果表明:随着保存时间的延长,PBHSC集落数逐渐下降;0小时与24小时保存后的干细胞数无显著差异;24小时与48、72、96、120小时保存后的干细胞数有高度显著差异;48小时与72、96、120小时保存后的干细胞数无显著差异。同时发现,红细胞的存在有利于PBHSC的4℃保存。     

Mechanical emergency recanalization of the left main coronary artery

Acute occlusion of the left main coronary artery is normally fatal. According to the literature, only a few cases have been treated by intracoronary thrombolysis; the prolonged period of ischemia, however, resulted in severe left ventricular dysfunction and numerous complications. Therefore, effort should be directed to recanalize the left main coronary artery within the shortest possible interval. We followed this approach in a case of acute occlusion of a subtotal stenosis of the left main coronary artery which could be mechanically reopened and dilated within a few minutes. The intervention resulted in immediate reversal of profound cardiogenic shock and complete restoration of normal left ventricular function. At hospital discharge, the patient was asymptomatic with a negative bicycle stress test. Immediate mechanical recanalization and angioplasty appear to be a feasible approach in life-threatening coronary occlusion.     

Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors

Abstract The aim of the present investigation was to study the frequency of pulp revascularization in therapeutically reimplanted incisors as well; is its relationship with the following factors: width of apical foramen, duration of extra-alveolar lime, storage conditions and postoperative administration of antibiotics. Out of 72 immature teeth (width of apical foramen 1.1–5.0 mm) the pulp was revascularized in 13 (18%), while in 88 mature teeth (width of apical foramen 1.0 mm or less) no revascularization occurred. Among parameters tested statistically in immature teeth, a significantly increased frequency of revascularization (p < 0.05) was only found in teeth reimplanted within 45 minutes after avulsion, when compared with teeth reimplanted after a longer extra-alveolar time, and in mandibular incisors when compared with maxillary incisors (p < 0.01). All teeth in which revascularization did not occur exhibited a periapical radiolucency and/or external inflammatory root resorption.     

Effects of cooling and heating of the tooth on pulpal blood flow in man

Abstract Laser Doppler flowmetry (LDF) was used to study the changes in pulpal blood flow (PBF) evoked by application of cold or heat to the palatinal surfaces of teeth 11 or 21 in nine young subjects. Switching from a thermode temperature of 33° to 5° G on average induced a slow decrease of PBF to about 80% of control, and also warming to 39°C evoked a small reduction in most subjects. Inter individual differences were large, however, and both cooling and warming sometimes triggered a rise in PBF. In contrast, skin blood flow, as recorded with LDF in the forearm, invariably rose during warming and fell during local cooling. The results suggested a more complex interaction between local and nervously mediated effects of moderate changes in temperature in the tooth pulp than skin, and that the previous held view of cold and heat decreasing and increasing PBF, respectively, is wrong.