采用生存分析方法比较不同术式治疗老年转子间骨折对预后的影响

目的:对选择内固定与人工关节置换术治疗转子间骨折的患者进行生存分析,比较两种术式对老年人转子间骨折死亡率的影响。方法:回顾性分析2003年4月至2013年5月收治的110例60岁以上选择内固定或关节置换治疗的股骨转子间骨折患者的临床资料。其中选择内固定手术治疗组83例,男32例,女51例;年龄61.44～98.75岁,平均(78.52±7.98)岁。关节置换组27例,男8例,女19例;年龄71.82～96.54岁,平均(79.99±6.11)岁。观察两组患者的当前生存情况,第1、2、5年总体生存率及平均生存期;两组患者第1、2年死亡率;两组患者第1、2年生存率及平均生存期。结果:所有患者获得随访,时间1～125个月,平均(46.93±29.53)个月。所有患者伤口甲类愈合,无院内死亡病例。其中31例患者死亡,79例患者存活,生存分析显示全部110例患者的1、2、5年生存率分别为(90.7±2.8)%、(82.5±3.9)%和(57.6±6.5)%,平均生存期为(84.137±5.902)个月。内固定组术后1、2年死亡比例分别为7.2%和12.0%,关节置换组分别为14.8%和25.9%,两组比较差异无统计学意义。内固定组1年生存率为(92.6±2.9)%,2年生存率为(85.8±4.3)%,平均生存期为(87.508±6.063)个月,关节置换组分别为(85.2±6.8)%和(73.9±8.5)%,平均生存期为(67.294±11.180)个月,两组比较差异有统计学意义(χ²=6.402,P <0.05).结论:选择内固定手术较人工关节置换术治疗的老年转子间骨折患者术后总体生存情况较佳。     

A potential mechanism for age-related declines in patellar tendon biomechanics.

Injuries to soft tissues such as tendons are becoming ever more frequent among the elderly. While increasing levels of activity likely contribute to these injuries, age-related declines in tendon strength may also be important. Whether these declines in biomechanical properties are associated with changes in fibril diameter or collagen type remains in question. In this study, age-related changes were investigated in patellar tendons from young adult rabbits (1-year old, n = 17) and from rabbits at the onset of senescence (4-year old, n = 33). Patellar tendon biomechanics was correlated with both collagen fibril diameter and with the presence of type V collagen, a known regulator of collagen fibril diameter. We hypothesize that (a) aging from I to 4 years results in significant reductions in patellar tendon biomechanical properties, and (b) these age-related declines are associated with smaller fibril diameters and with the presence of type V collagen. Maximum stress declined 25% between I and 4 years of age (100.7 +/- 5.6 MPa and 74.3 +/- 3.4 MPa, respectively, p < 0.0003) (mean +/- SEM) and strain energy density declined 40% (p < 0.001). The distribution of collagen fibrils from 4-year old rabbits was skewed significantly towards smaller diameters compared to fibrils from 1-year old rabbits (p < 0.001). Type V collagen was observed only in the 4-year old rabbit tendons. These correlations suggest that with increasing age after skeletal maturity, type V collagen may help to regulate the assembly and thus diameter of collagen fibrils and thereby adversely affect patellar tendon strength.     

Adenomatous hyperplasia of the rete testis: Report of two cases

We present two adenomatous hyperplasia of the rete testis (AHRT) cases. One of them was a 67-year old patient with prostatic adenocarcinoma and the other was a 38-year old patient with undescended testis. AHRT is a rarely seen lesion and usually detected as incidental microscopic finding. It may be confused with malignancy and related to testicular atrophy and hormonal imbalance.The treatment of choice is complete excision.     

Urethral and paraurethral leiomyomas in the female patient

Urethral leiomyomas in women arise from the smooth muscle of the urethra and are rare, benign urethral tumors seen primarily in women. We present three cases of urethral leiomyomas identified over a 30-year period at our institution. A 45-year old woman presented with a 1 year history of frequency, nocturia, and hesitancy and was found to have both a 2-cm proximal urethral and a 3-cm posterior bladder leiomyoma. She developed stress urinary incontinence postoperatively and was treated with a Burch colposuspension. A 33-year old woman with hematuria was found to have both a 3-cm urethral and a 3-cm paraurethral leiomyoma at the bladder neck. A 21-year old without urinary complaints was found to have a 3-cm leiomyoma at the urethral meatus. Urethral leiomyomas must be differentiated from paraurethral leiomyomas, which are often asymptomatic and may be removed without disrupting the urethral mucosa or smooth muscle. The removal of urethral myomas may be complicated by the development stress urinary incontinence or urethral stricture.     

Fracture of the acetabulum in a 14-year-old patient: 20-year review

A case report of 14-year old female with an acetabular fracture involving the anterior column and posterior column-posterior wall is presented here and the findings on 20-year follow-up are described.     

Reoperation for metachronous pulmonary or tracheal lesions after pneumonectomy]

Although aggressive reoperation for metachronous multiple primary lung cancer or intrathoracic recurrence without distant metastases have been recommended to the patients of primary lung cancer and metastatic lung tumor, surgical indication after a previous pneumonectomy is restricted because of residual pulmonary function. We report about 3 reoperated cases for metachronous pulmonary or tracheal lesions after left pneumonectomy. Case 1: A 61-year old male who underwent left pneumonectomy for primary lung cancer was reoperated for tracheal cancer 41 months after the pneumonectomy. Case 2: A 61-year old male who underwent left pneumonectomy for primary lung cancer was reoperated for metachronous multiple primary lung cancer 59 months after the pneumonectomy. Case 3: A 59-year old male who underwent left pneumonectomy for metastatic lung tumor from rectal cancer was re-operated for intrathoracic recurrence 28 months after the pneumonectomy. All cases are alive without recurrence.     

Two case reports of hydronephroureterosis associated with complete double pelvis-ureter accompanied by pyuria and hematuria

We report two cases of hydronephroureterosis of the upper moiety in the complete duplex kidney disclosed by urological examination for pyuria and hematuria. The first case was in a 64-year old female and the second case was in a 68-year old female. Urinary incontinence was not seen in either case. Heminephrectomy was performed because the upper moiety was non-functioning and the upper ureter opened at the vesical neck in these cases. The postoperative course was uneventful.     

Coronary artery bypass grafting in octogenarian

Coronary artery bypass graftings (CABG) in elderly patients are increasing in recent years. Several studies have shown that the rate of complications and mortality is higher in elderly patients than in younger ones. This report presents results of CABG in octogenarians. From January 1996 to December 1999, 362 patients underwent isolated CABG, of whom 15 were over 80 years old (80-year group) and 122 were 70-79 years old (70-year group). Preoperative cardiac function was worse in the 80-year group than in 70-year group [60% vs 29% in Canadian Cardiovascular Society (CCS) class III or IV]. No significant difference was found between two groups in extracorporeal circulation time, aortic clamp time, the number of bypasses and postoperative complications. We conclude that CABG should not be excluded in octogenarians because of their chronological age alone.     

高龄粗隆间骨折股骨头置换从手术到死亡的临床研究

目的观察80岁以上高龄股骨粗隆间骨折人工股骨头置换术从手术到死亡期间的临床治疗效果。 方法对解放军第451医院骨科2003年12月至2010年12月完成的35例80岁以上高龄股骨粗隆间骨折采用人工股骨头置换术的患者进行了从手术到死亡3～11年的随访,观察死亡原因和死亡率,髋关节功能,X线表现等的改变。纳入标准：随访资料完整,经影像学诊断为股骨粗隆间骨折,年龄80岁以上。排除标准：失访者不予纳入。采用χ²检验的Fisher精确概率法对髋关节功能优良率进行比较分析。 结果随访1～7年髋关节功能优良率可保持到80%～84.4%,髋关节功能良好。而随访7年,80%的患者非手术原因死亡。该组35例患者在随访11年时全部死亡。髋关节Harris评分组间优良率显示术后1年和术后3年(P＝0.759)、术后3年和术后5年(P＝0.641)、术后5年和术后7年(P＝0.184)、术后7年和术后9年髋关节功能优良率比较差异无统计学意义(P＝0.311),7年组和11年组髋关节功能优良率比较差异无统计学意义(P＝0.858)。随着随访时间延长,X线异常发生率越来越高。 结论高龄股骨粗隆间骨折患者预期寿命短,采用人工股骨头置换术可获得良好的关节功能,减少术后并发症,是一种很好的治疗方法。     

The New Body Mass Index System in Predicting Renal Graft Outcomes

Background

Obesity has been related to poor renal graft function. The aim of this study was to compare the long-term graft outcomes of living-related kidney recipients regarding donor-to-recipient body mass index (BMI) parameters using the old Quetelet BMI formula and the new Trefethen BMI formula.

Methods

From November 2002 to November 2010, 62 consecutive living-related kidney transplantations were reviewed retrospectively. Four donor-to-recipient BMI parameters were used: (1) BMI difference by the old formula, (2) BMI difference by the new formula, (3) BMI ratio by the old formula, and (4) BMI ratio by the new formula. Long-term outcomes, including graft survival (GS) and rejection-free graft survival (RFGS) either overall or at 5 years post-transplantation, were analysed according to these parameters.

Results

The baseline demography was similar among tertiles according to the four BMI parameters tested. Although there is no significant difference in the long-term survivals by the old and new BMI formula, we found that the area under receiver operating characteristic (ROC) curve is larger using the new formula, either by BMI difference (0.584 vs 0.559 in 5-year GS and 0.658 vs 0.636 in 5-year RFGS) or by BMI ratio (0.584 vs 0.561 in 5-year GS and 0.644 vs 0.626 in 5-year RFGS). The same trend was observed in overall survival outcomes.

Conclusion

The new Trefethen BMI formula seems to predict long-term renal graft outcomes better than the old Quetelet BMI formula.     

Vascular reconstructive surgery for elderly patients with internal carotid artery stenosis at the cervical portion

PURPOSE: We encounted increasing numbers of elderly patients suffering from stenotic lesions of the cervical internal carotid artery. Most of them have been considered to indicate a need for carotid artery stenting. The purpose of this study was to clarify with regard to the modality of treatment and perioperative complications the effectiveness of vascular reconstruction procedure in elderly patients. PATIENTS AND METHODS: Ninety eight lesions in 91 patients with stenosis of the internal carotid artery were treated surgically. Eighty lesions received carotid endarterectomy (CEA), and 18 lesions received percutaneous transluminal angioplasty (PTA) with or without stent. Treatment with PTA-with-or-without-stent has been opted in cases of patient with such conditions as radiation-induced stenosis, re-stenosis after CEA, unfitness for general anesthesia, bilateral lesions both of which need to be reconstructed with in a short interval. We divided the patients into 4 groups according to their age; under 70-year-old group, 70-to-74-year old group, 75-to-79-year old group, and over 80-year-old group. Vasoreconstructive procedures were performed for 41 patients in the under 70-year-old group, for 31 in the 70-to-74-year old group, for 21 in the 75-to-79-year old group, and for 5 in the over 80-year-old group. RESULT: The overall surgical morbidity rate was 2% (2 of 98 cases) and there was no mortality. Tweleve patients (12.2%) experienced transient neurological deficits. Two patients exhibited perioperative complications in gastrointestinal organs, but none of the patients experienced cardiac complications. Elderly patients tend to experience systemic complications such as gastrointestinal complications as well as transient neurological deficits, which appear as restlessness, possibly due to hyperperfusion syndrome. The perioperative complication rate in elderly patients (putting the patients of the 70-to-74-year old group, the 75-to-79-year old group, and the over 80-year-old group together) was, statistically, significantly higher than those in patients of under the 70-year-old group. However, when two treatment modalities, CEA and PTA-with-or-without stent, were compared, there was no significant difference in the perioperative complication rate. CONCLUSION: Careful patient selection and prudent perioperative management enabled us to perform vasoreconstructive surgery even for elderly patients with internal carotid artery stenosis in a relatively safe manner with an acceptable complication rate. Decision making in selecting treatment modality, CEA or PTA with or without stent, should not be based solely on aging.     

Aortocoronary endothelial cell-seeded polytetrafluoroethylene graft: 9-year patency

We report a 71-year old man with coronary artery disease. Complete coronary revascularization was not possible with autologous grafts; therefore, a 4-mm expanded polytetrafluoroethylene graft was implanted that had been seeded preoperatively with autologous vascular endothelial cells. At 9-year follow-up, the patient is asymptomatic and shows a patent graft.     

青年与老年直肠癌临床对比分析

目的探讨青年与老年直肠癌的临床、病理及预后差异。方法中国医学科学院肿瘤医院自1990年1月至2000年1月收治40岁以下直肠癌患者138例（青年组），65岁以上者163例（老年组），对这组患者的病例资料进行生存分析和预后的多因素分析。结果青年组Ⅲ期直肠癌患者比例（53．6％，74／138）明显高于老年组（34.3％，55／163）；P=0．001；青年组中黏液腺癌和低分化腺癌患者比例（28．2％，39／138）也高于老年组（10．4％，17／163）P〈0．001。青年组和老年组5年生存率分别为50．4％和64．1％．两组比较差异有统计学意义（P〈0．05）；而按照TNM分期进一步分析显示．同期别两组的生存率差异均无统计学意义（P〉0．05）。多因素分析结果显示，肿瘤T分期（P=-0．001）和淋巴结转移（P〈0．05）是影响两组患者预后的独立因素。结论与老年直肠癌相比，青年直肠癌患者的病期较晚、肿瘤分化程度较低，影响其预后；但相同病期者生存率相似。早期诊疗是提高直肠癌总体生存率的关键。     

Two cases of uric acid stones unsuccessfully dissociated by oral chemolysis

We report two patients with renal uric acid (UA) stones in whom chemolysis by oral administration of alkaline citrate and allopurinol was unsuccessful. The stone in a 58-year old female did not dissolve because her urinary pH remained low throughout the day after alkaline citrate administration. The stone in a 50-year old man did not dissolve because his urinary pH was 5.5-6.0 after alkaline citrate administration. Alkalization of the urine helps reduce the stone size and the calcification of the stone. Extracorporeal shockwave lithotripsy was performed and the stone composition showed mixed calcium oxalate and calcium phosphate. The indication of oral chemolysis of uric acid stones is discussed.     

A case of mononucleosis complicated by acute nephritis

We report a case of mononucleosis in a 30-year old female patient which was complicated by acute, moderate renal failure presumably due to interstitial nephritis.     

Tailgut cyst: report of three cases and review of the literature

Introduction: Tailgut cysts or retrorectal cystic hamartomas are congenital developmental lesions which are often misdiagnosed due to their rare incidence, anatomical position and variable clinical presentation.

Case report: We report three clinical cases: one of a 67-year old woman with high fever and anal bulging; the second case was a 50-year old woman with diffuse abdominal pain and the third case was a 52-year old woman with high fever and no abdominal or rectal pain. The rectal examination and MRI indicated the presence of a tailgut cyst. In all the cases a complete resection through a posterior perineal route was performed. Histopathological examination confirmed the diagnosis of a tailgut cyst, with a malignant component identified in the third case.

Discussion: The discussion presents a brief review of the relevant information described in the literature to highlight the cornerstones for appropriate diagnosis and treatment of a tailgut cyst. Tailgut cysts are to be considered in the differential diagnosis of retrorectal or presacral masses as malignant transformation can occur.     

老年胃十二指肠溃疡急性穿孔的外科治疗:附89例报告

目的　探讨老年胃十二指肠溃疡急性穿孔的外科治疗。方法　回顾分析近 10年 89例老年胃十二指肠溃疡急性穿孔的治疗效果 ,对年龄、合并症、发病至手术时间、手术方式、全身炎症反应综合征 (SIRS)和多器官功能障碍综合征 (MODS)等影响预后的因素进行分析。结果　 78例行单纯修补 ,11例行胃大部分切除 ;死亡 12例。 70岁以下年龄组术后并发症发生率及死亡率低于 70岁以上年龄组 (P <0 .0 5 ) ;发病至手术时间 12h以内组并发症发生率、死亡率低于 12h以上组 (P <0 .0 5 ,P <0 .0 1) ;合并单种并存病组的并发症发生率、死亡率低于两种或以上组 ( P <0 .0 5 ,P <0 .0 1) ;MODS两器官受累组的死亡率低于两器官以上组 (P <0 .0 5 )。手术方式的选择与并发症发生率、死亡率和治疗效果无明显差异 ( P >0 .0 5 )。结论　对老年胃十二指肠溃疡急性穿孔的手术应以单纯修补为主。     

Hydatid cyst of the rib with intramedullary involvement

Osseous localization is uncommon for a hydatid cyst. We present a case of a hydatid cyst with rib involvement spreading through the bone marrow in a 62-year old woman.     

Hydatid Cyst of the Rib with Intramedullary Involvement

Osseous localization is uncommon for a hydatid cyst. We present a case of a hydatid cyst with rib involvement spreading through the bone marrow in a 62-year old woman.