Degree of hypercalcemia correlates with parathyroidectomy but not with symptoms

Background

Primary hyperparathyroidism (HPT) is an undertreated disease. This study's purpose is to determine if the calcium levels correlate with prevalence of symptoms and surgical treatment in patients with primary HPT.

经皮透光负压旋切术治疗下肢深静脉血栓形成继发皮肤溃疡的临床研究

目的：探讨下肢深静脉血栓形成（DVTS）继发皮肤溃疡的微创治疗方法。方法：选择DVTS继发皮肤溃疡患者116例,其中经皮透光负压旋切术治疗72例72条下肢（A组）,非手术治疗44例44条下肢（B组）。于A组术后5、20、120和360 d（即B组入院后8、23d、出院后97、337 d）记录皮肤的感染率、坏死率、色素减退率、创面收缩率、溃疡愈合率及溃疡复发率等6项临床指标。结果：术后5 d A组皮肤感染率和皮肤坏死率低于B组（P〈0.05）;术后20 d A组创面收缩率与色素减退率较B组显著改善（P〈0.05）;术后120 d A组溃疡愈合率较B组显著升高（P〈0.05）;术后360 d溃疡复发率A组显著低于B组（P〈0.05）。结论：经皮透光负压旋切术治疗DVTS继发皮肤溃疡效果良好,具有微创性、可操作性、可控制性等特点,可作为外科治疗方法之一。     

Complete ureteral triplication with ectopia

A case of complete ureteral triplication is reported and a brief review of the literature is presented.     

Pediatric endoscopy with flexible fiberscopes

In recent years gastroduodenoscopy has become almost routine in adult patients with upper gastrointestinal disease. This has been particularly true in the diagnosis of bleeding conditions and in the differential diagnosis of ulcers. Even more spectacular is the technique of introducing the scope into the second portion of the duodenum, cannulating the ampulla of Vater, and injecting the biliary and pancreatic duct system with contrast material for radiographic study. By colonoscopy, the advantages of sigmoidoscopy are now being extended all the way to the cecum and even the terminal ileum, including biopsy of tissues and removal of polyps. The purpose of our study is to evaluate these procedures for use in infants and children, to recognize their limitations and to establish proper and satisfactory techniques.     

超声介导腹腔神经节去除治疗胰腺癌疼痛

目的:评价超声介导腹腔神经节去除在胰腺癌疼痛中的疗效。方法:采用B超定位,实时超声动态监测经皮穿刺,于腹腔动脉干根部旁侧注入无水乙醇15ml,对97例胰腺癌痛患者实施腹腔神经节去除术。比较治疗前后疼痛的视觉模拟评分(VAS)以及血清SP水平变化。结果:97例中1例穿刺失败, 成功率98.7％,无急性胰腺炎、胰瘘及出血等穿刺并发症;VAS及SP较术前明显降低(P<0.01,P<0．05),有效率87．5％,显效率76.1％,12例无效。结论:超声介导腹腔神经节去除术安全可靠,能显著减轻胰腺癌疼痛。     

Arterial injury associated with skeletal trauma

A review of 40 cases with combined skeletal and arterial injury. The diagnosis and management of this combination of injuries is discussed, with emphasis on the relative merits of external immobilization as opposed to internal fixation of the fracture. One quarter of these cases eventually came to amputation, and the reason for failure is explored in detail.     

TIPS治疗对门静脉高压症患者食管、胃底组织内微血管生成的影响

目的:研究TIPS治疗对门静脉高压症患者食管、胃底组织内微血管生成的影响,探讨血管生成在门静脉高压症食管、胃底静脉曲张形成中的作用。方法:取门静脉高压症Sugiura术患者的食管贲门吻合圈标本78例。(1)PHT组:术前未行TIPS治疗。食管组织118例,胃组织25例;(2)TIPS组:术前曾行TIPS治疗,食管组织5例,胃组织12例。正常食管组织10例、胃组织8例作为对照组。应用免疫组化技术分别检测食管胃底组织内的微血管密度。结果:食管胃底组织微血管高密度区主要位于粘膜固有层,其次为粘膜下层。粘膜固有层微血管密度3组差别无统计学意义(P>0.05);粘膜下层微血管密度PHT组明显高于正常组(P<0．01)和TIPS组(p<0．05),TIPS组和正常组差别无统计学意义(P >0.05)。结论:食管胃底组织内的微血管密度与门静脉压力改变有关。门静脉高压时,食管胃底组织粘膜下层血管生成活跃,可能参与了食管胃底粘膜下静脉曲张的形成;经TIPS治疗后,粘膜下层血管生成减少。     

Renal vasoconstriction in association with acute pancreatitis

Renal failure is a common complication of pancreatitis. To better understand this association, renal function was evaluated in eleven patients in the acute phase of alcoholic pancreatitis and again during convalescence in seven patients. Parameters measured included glomerular filtration rate, effective renal plasma flow, true renal plasma flow, renal vascular resistance, osmolar clearance, amylase clearance, renal oxygen consumption, cardiac output, and peripheral resistance.Average glomerular filtration rate, effective renal plasma flow, and true renal plasma flow were decreased in the acute phase. Osmolar clearance, amylase clearance, mean arterial blood pressure, renal vascular resistance, and total peripheral resistance rose in the acute phase. Cardiac index and extracellular fluid space remained normal. All parameters returned toward normal with convalescence.The combination of systemic hypertension, increased total peripheral resistance and renal vascular resistance, and normal extracellular fluid space suggests a release of a vasopressor during the acute phase of pancreatitis. The therapeutic implications of these findings including the role of vasodilator infusion are discussed.     

手术联合腔内治疗合并动脉硬化的急性下肢动脉缺血23例临床观察

目的：探讨手术联合腔内的方法治疗合并动脉硬化狭窄的急性下肢动脉缺血高龄患者的技术要点及疗效。方法：回顾性分析2008年9月-2010年9月收治的23例（26肢）合并动脉硬化的下肢动脉缺血高龄患者DSA下行腔内联合手术治疗的临床资料和治疗效果。结果：26条肢体（23例）经双腔Fogarty导管取栓、动脉内膜剥脱术,并行相应球囊扩张加支架置入术,或辅助人工皿管旁路手术或／和自体静脉补片成形术,救治成功20例（87．0％）,截肢1例（4．3％）,死亡2例（8．7％）。结论：伴有全身动脉粥样硬化的大多数动脉缺血高龄患者,手术联合腔内的个体化治疗方案,有助于提高重建下肢动脉供血的救治率。     

Mid-term results with an anatomic stemless shoulder prosthesis in patients with primary osteoarthritis

ObjectiveThe introduction of a stemless prosthesis in shoulder arthroplasty represents a novel design whereby the proximal humerus is restored anatomically, while leaving the diaphysis of the humerus untouched. The aim of this study was to present the mid-term results of total evolutive shoulder system (TESS; Biomet^®), a stemless shoulder prosthesis.MethodsThe study included 38 consecutive patients (18 men and 20 women; mean age: 66 years; range: 55-81 years) treated with shoulder arthroplasty between 2009 and 2011 with TESS for primary glenohumeral arthritis. Total shoulder arthroplasty (TSA) was performed in 28 cases (74%), hemi-shoulder arthroplasty (HSA) in 10 (26%). Constant score, active range of motion, patient satisfaction rate, and radiological assessment were analyzed. Mean time of follow-up was 37 months.ResultsConstant score improved from 21.8 points (28.6 adjusted for age) preoperatively to 74.1 points (86.6 adjusted for age) postoperatively. Active range of motion increased significantly from the pre- to postoperative status. Eighty-nine percent were very satisfied or satisfied with shoulder replacement surgery. One cemented glenoid was revised due to aseptic loosening. None of the components were found to be loose at the final follow-up. No signs of stress shielding were seen.ConclusionsThis study shows promising results of this implant concept in the short- to mid-term. These results are comparable with the results achieved with long-established arthroplasty designs.Level of EvidenceLevel IV, Therapeutic Study.     

Vertebral anomalies associated with esophageal atresia and tracheoesophageal fistula with reference to the initial operative mortality

In a series of 40 patients with esophageal atresia and tracheoesophageal fistula, the incidence of musculoskeletal anomalies was 45% (18 patients). An extra mesodermal segment was found in 15 patients (13 paired thoracic vertebrae and 13 paired ribs in nine patients; six lumbar vertebrae in 6 patients). The mortality in grade A infants with an extra mesodermal segment was significantly higher than in those infants with a normal spine (p > 0.01). It is suggested that segmentation or abnormal segmentation of the embryo may be important as a cause of esophageal atresia.     

An alternative in management of lingual thyroid: excision with implantation

An 8-yr-old boy with a severely symptomatic lingual thyroid underwent excision of the lingual thyroid with implantation into the left anterior thigh. Six years after operation the patient remains euthyroid with demonstrable evidence of normal functioning thyroid tissue isolated to the site of implantation.     

Aortocoronary saphenous vein bypass. Results in 1,492 patients, with particular reference to patients with complicating features

During a 33-month period ending June, 1972, 1,492 patients underwent aortocoronary saphenous vein bypass (ACB). The early mortality with ACB alone was 7.1%, while mortality was more than double (14 of 86 patients died) when ACB was combined with resection or plication of a ventricular aneurysm. Twenty of 84 patients died in the early period following combined ACB and valve resection. One patient among 8 who had concomitant resection of an ascending aortic aneurysm died after operation. Factors that increased mortality in this series were advanced age, female sex, high coronary artery scores, left main coronary artery lesions, high left ventricular end-diastolic pressure, left ventricular dysfunction, congestive heart failure, the requirement for endarterectomy to perform the anastomosis, and recent acute myocardial infarction. Actuarial data from patients who underwent ACB without concomitant procedures show an annual attrition rate of 2.7% per year, which compares to rates of 4, 6, and 10% for patients with single, double, and triple coronary disease treated without operation. In 311 men and women under the age of 70 who had a coronary artery score below 13 and none of the other risk factors, the early mortality was 1.6% (5 patients) and the late mortality was 1.0% (3 patients).     

Late Embolization of Prosthetic Mitral Valve Occluder with Survival Following Reoperation

Embolization of the occluder from a prosthetic mitral valve is an extremely rare event. Previous reports in the literature have described the uniformly fatal outcome of this complication. A case in which the occluder from a Wada-Cutter mitral prosthesis embolized five years following implantation is presented. The patient survived following emergency reoperation. Several unique features of escaped mitral poppet are discussed. Depending upon cardiac reserves, patients who have this complication may live long enough to allow emergency operative intervention and eventual recovery.