Cytogenetic analysis of patients with amenorrhea

Objective: To analyse the cytogenetic examination results and investigate the effect of chromosome abnormalities on amenorrhea.Methods: The routine cytogenetic analysis was performed, including the chromosome G band analysis and karyotype analysis of the cultured peripheral blood lymphocytes from the patients with primary amenorrhea or secondary amenorrhea.Results: One hundred and thirty-seven cases were found with chromosome abnormalities in 234 patients with primary amenorrhea. The incidence of chromosome abnormality was 58.6%. In 309 with secondary amenorrhea, the incidence of chromosome abnormality was 13.6%.The reported abnormalities included the numerical and structural abnormalities of X chromosome, 46,XY, 45,X0/46,XY,and the structural abnormality of autosome.Conclusions: Chromosome abnormality is one of the main causes of amenorrhea. Karyotype analysis of chromosome is absolutely necessary for the diagnosis and treatment of patient with amenorrhea.     

A review of studies on termination of early pregnancy with mifepristone in combination with prostagl

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Thrombolytic Treatment with Brinase® of Dogs with Experimental Pulmonary Embolism

This study evaluates the occurrence of various risk indicators, with particular emphasis on serum lipids one year after a coronary event (development of acute mycoardial infarction (AMI); exposure to either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), prior to and after presentation of the main results from the 4S study. Patients under 70 years of age either hospitalized for AMI or undergoing CABG or PTCA at Sahlgrenska University Hospital in Göteborg were evaluated one year after the event. Patients who had an event during the period January 1, 1993 until December 31, 1993 were evaluated one year later (Period I) and those who had an event during the period September 1, 1995 until August 31, 1996 were evaluated one year thereafter (Period II). In total, 293 patients were evaluated during Period I and 284 during Period II. Mean total serum cholesterol levels fell from 6.2 mmol/l during Period I to 5.3 mmol/l during Period II (p     

Reconstructing opposition of thumb with microsurgical technique

It is well known that the thumbs are impoytant inthe function of hands.After the loss of the thumbs'function,the conventional treatment is to fix the ten-dons,muscles,bones or joints,etc.The results areusually satisfactory in a short period.But some compli-cations,such as loosening of tendons and muscles,andbone nonunion,always appear after a long time. Since the use of microsurgical techniques,thetherapeutic effects have been improved very much.     

Treatment of chronic osteomyelitis with one-stage allograft

Objective: To avoid disadvantages of two-stage cancellus bone autograft, we investigated the feasibility of one-stage allograft for reconstructing the bone defect resulting from debridement of chronic osteomyelitis in limbs. Methods: Between Feb. 1999 and Apr. 2004, 35 cases of chronic osteomyelitis ( 8 cases of nonunion) underwent one-stage allograft after debridement in our hospital. Results: Thirty-five cases were followed up for an average period of 28 months (range, 13 to 55 months), in which 32 cases (91.43%) were found no infection, and 3 cases (8.57%) were confirmed recurrence of infection. Four out of 8 cases of bone nonunion healed in 9.5 months on average (range, 3 to 12 months), and another case also acquired union after redebridement and autograft of ilium due to infection recurrence 35 days after surgery. Renonunion occurred in 3 cases, 2 out of whom healed after secondary operation with autograft. One case of renonunion and 2 cases of infection recurrence refused further treatment. Conclusions: A high rate of infection arrest can be attained when one-stage allograft is used to reconstruct the bone defect of chronic osteomyelitis after debridement in limbs. Therefore, chronic osteomyelitis should not be regarded as a contraindication to one-stage aliogeneic bone grafting. Renonuion, however, achieves a relatively high rate, especially in cases of segmental bone defect.     

Treatment of children with Henoch-Schönlein purpura nephritis with mycophenolate mofetil

Background

Henoch–Schönlein purpura (HSP) can progress to Henoch–Schönlein purpura nephritis (HSPN), and the most effective management remains unclear. Our aim was to evaluate the efficacy of mycophenolate mofetil (MMF) for treating pediatric patients with HSPN and nephrotic-range proteinuria.

Methods

Twelve children, seven boys and five girls, mean age 8.33 (range 6–12) years at the time of HSPN diagnosis with nephrotic-range proteinuria, were treated with MMF. All patients failed steroid treatment, and mean proteinuria at the time of MMF initiation was 5.6 g/d. MMF dosage ranged from 20 to 25 mg/kg per day. Patients also received an angiotensin-converting enzyme inhibitor (cliazapril) at MMF initiation. Mean follow-up was 3.9 (range 2.3–5.5) years.

Results

All patients responded to MMF at a mean of 2.5 (range 1–4 months). Among the 12 patients, MMF was administered for 10 months in five, 12 months in six, and 15 months in one. At last follow-up, all patients had negative proteinuria and normal renal function, and no relapses were noted. No serious adverse effects of MMF were noted in any patient.

Conclusion

MMF is useful for treating pediatric patients with HSPN and nephrotic-range proteinuria.

     

Does Perception of Usefulness of Arthroscopic Simulators Differ with Levels of Experience?

Background  

Some commercial simulators are available for training basic arthroscopic skills. However, it is unclear if these simulators allow training for their intended purposes and whether the perception of usefulness relates to level of experience.     

Impact of age on outcomes of patients with non–muscle-invasive bladder cancer treated with immediate postoperative instillation of mitomycin C

Objectives

To evaluate whether age affects the clinical benefit afforded by immediate postoperative intravesical instillation of mitomycin C in a contemporary cohort of patients with NMIBC.

Involvement of visceral fat in the pathogenesis of albuminuria in patients with type 2 diabetes with early stage of nephropathy

Background  

Visceral obesity has been implicated in the pathogenesis of diabetic nephropathy. Waist circumference has been used as a surrogate measure of visceral fat mass; however, subcutaneous fat mass is also correlated with waist circumference. We therefore conducted this cross-sectional study to clarify the relationship between directly measured sizes of visceral and subcutaneous fat and microalbuminuria in patients with type 2 diabetes (T2DM).     

Study of biological safety of scaffold material with heterologous deproteinized bone

Objective: To evaluate the biological safety of manufactured heterologous deproteinized bone and to provide an experimental basis for clinical applications. Methods: Deproteinized bone (10 mm) and leaching liquor were made from pig ribs with a series of physical and chemical methods, then were evaluated through acute and subacute toxicity test, hemolysis test, pyrogen test, intracutaneous test, intramuscular implantation test and cytotoxity test. Results: No obvious toxicity, hemolysis, pyrogenic characteristics, skin irritation, inflammatory reaction after intramuscular implantation and cytotoxity were observed. Conclusions: The heterologous deproteinized bone has good biological safety and meets all the demands of scaffold material for tissue engineering.     

Management of severe pelvic fracture associated with injuries of adjacent viscera

everepelvicfractureassociatedwithinjuriesofadjacentviscerahasahighmortality .Thefirst”goldenhour”aftertraumashouldbegrasped ,sincethemanagementinthishourcandeterminegreatlywhetherthecritically injuredvictimcouldsurvive .Inthispaper ,theexperienceintheemergencymanagementofsuch patientsisreviewedinordertoimprovethetherapeuticoutcome .METHODSSeventyninepatientswithseverepelvicfractureassociatedwithinjuriesofadjacentvisceratreatedinourDepartmentfromJanuary 1990toDecember 2 0 0 3werereviewedr…     

Repair of flexor tendon defects of rabbit with tissue engineering method

OBJECTIVE: To repair rabbit tendon defects with tissue engineering method. METHODS: The third passage of fetal skin fibroblast cells was labeled with 5-bromo-2' deoxyuridine (Brdu) and then seeded on human amnion extracellular matrix (HA-ECM). Using 1 cm-long-Achilles tendon defects as repairing models in the experimental group, tendon defects were core bridged with polydioxanone (PDS) and then capsulated with the complex of fibroblasts-HA-ECM. In the control group I, defective tendons were sutured with PDS following the former procedure and capsulated with HA-ECM (without fibroblasts). In the control group II, only PDS was applied to connect the defective tendons. Gross examination, light microscopy, scanning electronmicroscopy and biomechanical measurement of the repaired tendons were respectively performed at postoperative 1, 2, 3 month as well as immunohistochemical examination. RESULTS: The optimal cell concentration for seeding fibroblasts was 3.5 x 10(6) cells/ml. Cells grew well and radiated or paralleled on HA-ECM. Immunohistochemistry showed that the labeled seed fibroblasts played an important role in tendonization. The results of light microscopy, electron microscopy, and biomechanical assessment suggested that the rate and quality of tendonization in the experimental group was superior to those of the control group I and II. The tensile strength in the experimental group was the greatest, the next was in the control group I, and the worst in the control group II (P<0.05). CONCLUSIONS: HA-ECM is the excellent carrier for fibroblasts. Fibroblasts-HA-ECM complex has the capability to repair tendon defect and to tendonize with rapid rate and good performance three months after operation. Its tensile strength is 81.8% of that of normal tendon.     

Who's Listening? Experiences of Women with Breast Cancer in Communicating with Physicians

The purpose of this qualitative study was to describe communication behaviors and attitudes of physicians that were most important to women living with breast cancer. Two focus group sessions were conducted, 1 month apart, involving 15 women who were members of a community-based breast cancer support group in Vancouver, British Columbia, Canada. Group dialogue was audiotaped, and notes were taken at each session by the coinvestigators, also members of the support group. Audiotapes, coinvestigators' written notes from the two focus group sessions, and the written homework assignments were used in the qualitative data analysis. Conceptual themes were identified and grouped to discern patterns within the data. The women were asked the following: (a) What were the most helpful things your doctor said or did at the time of your diagnosis? (b) What does a good intervention feel or look like? They were then asked to describe behaviors and attitudes they would like to influence in medical students who might later be communicating with women facing a diagnosis of breast cancer and to indicate which behaviors and attitudes they felt were most important. Women's positive experiences with physicians were characterized by communication based on active listening, awareness of the women's knowledge of their illness, honesty, and partnership. Physicians who showed interest in their patients as persons and who used touch to communicate caring were perceived as supportive communicators. Not surprisingly, there were similarities between the participants' positive experiences with their own physicians and the behaviors and attitudes desired in future physicians. Once again, “listening” was ranked as most important, followed by willingness to discern the individual patient's knowledge level.     

Emergent treatment of patients with traumatic aorta ruptures

Objective ： To discuss our experience on the diagnosis and treatment of thoracic aorta rupture （TAR） that is one of the main common causes of death in the victims under blunt chest trauma. Methods： Between July 2001 and March 2006, 9 patients （6 men and 3 women, aged from 20 to 54 years ） suffering from acute traumatic aorta rupture after motor vehicle accidents received emergent surgical treatments in our hospital. Based on our experience in the rescue of the first TAR patient we introduced a practical procedure on the diagnosis and treatment of TAR in our department. All the other patients generally followed this procedure. Eight patients received contrast material enhanced helical computerized tomography scan before the operation. The leakage of coustrast medium from the aorta isthmus was found, and diagnosis of TAR was confirmed. Seven patients underwent immediate operation within 14 hours after accidents. One patient was treated on the 5th day of the accident because of delayed diagnosis of aortic rupture. All patients received general anesthesia with double lumen endotracheal tube and normothermic femoro-femoral partial cardiopulmonary bypass, with beating heart and aortic clamping. One patient received simple repair, and others received partial replacement of thoracic aorta with artificial vascular graft. Results： Seven TAR patients were successfully salvaged. Three patients combined brain injury as well as extremitiy hemiplegia before operation. After treatments one was fully and two partially recovered without paraplegia. Conclusions： Proper practical protocol is emphasized for the surgical repair of TAR because it will reduce the mortality of severe blunt chest injury.     

Orthopedic trauma of limbs associated with vascular injuries

Objective： To evaluate the treatment for patients with major vascular injuries associated with traumatic orthopedic injuries. Methods： A total of 196 patients, aged from 4-67 years with the mean age of 29.88 years, had major vascular injuries associated with traumatic orthopedic injuries and were treated in our hospital in a period of 44 years. The most common mechanism of trauma was blunt trauma （67.3 % ）, open injuries accounted for 32.4 % and 54.5 % of the injuries were located in the lower extremities. The vascular injury frequently happened in the femoral artery （26. 7 % ） and popliteal artery （ 20. 3 % ）. The treatment principle consisted of aggressive resuscitation, Doppler imaging and stable bone internal fixation with subsequent vascular repair and debridement. The vascular repair for injuries included end-to-end anastomosis （80 cases, 39.6 % ）, interpositional vein graft （94, 46.5 % ）, vascular decompression through fracture distraction （ 18, 8.9% ）,arterial ligation （6, 3.0% ）, vein patch （2, 1. 0%）, bypass graft （ 2, 1.0% ）, venous repair including autogenous vein graft （9, 24. 3%） and ligation （28, 75.7% ） and prophylactical fasciotomy （15. 7. 4%）. Postoperative amputation was performed in 16 cases （16.3%）. Results： No intraoperative death was observed and all fractures united within 6 months. Limbs were salvaged in 180 patients （91. 8% ）. Among these patients, early complications were found in 19 patients （9. 7 % ） and late complications were observed in 8 patients （4.1% ）. Conclusions： A well-organized approach, based on a specific treatment principle, not only improves clinical outcome but also does good to excellent functional recovery for patients with severe orthopedic injuries and concomitant vascular lesion.     

Evaluation of the treatment of clubfeet with the Diméglio score

Between January 1994 and November 1997, 17 children with 25 clubfeet were treated and evaluated. This group was divided into a group of only conservatively treated feet (group A, n=13) and a group of feet which had conservative treatment and complementary operative treatment (group B, n=12). Both groups were evaluated according to the Diméglio classification method in which the objective clinical evaluation is scored only. This was performed for the starting-point (at presentation until 2 weeks after birth), with the necessary information received from the patient's files where all the passive limitations were recorded in a standardized way and also for the end-point (at the time of the follow-up). After comparing these results to each other, all 25 feet had improved after treatment and the operative group had improved more than the conservative group, however the end result was equal, because the operated feet were more severely deformed before the treatment. After treatment, the results were considered acceptable in 92% of the feet, comparable to 93%, 75-85%, 88%, 77%, and 96% in other studies. Moreover, the forefoot adduction was the most common residual sign in the treated feet, confirmed by results in other studies. We conclude that the Diméglio method is an appropriate tool for the follow-up of clubfeet from birth to the end of treatment.     

An exploration of patients’ expectation of and satisfaction with surgical outcome

Purpose

The majority of studies of surgical outcome focus on measures of function and pain. Increasingly, however, the desire to include domains such as patients’ satisfaction and expectations had led to the development of simple measures and their inclusion into clinical studies. The purpose of this study was to determine patients’ pre-operative expectations of and post-operative satisfaction with the outcome of their spinal surgery.

Methods

As part of the FASTER randomised controlled trial, patients were asked pre-operatively to quantify their expected improvement in pain and health status at 6 weeks, 6 and 12 months following surgery using 100 mm visual analogue scales (VAS), and to indicate their confidence in achieving this result and also the importance of this recovery to them. Patients were then asked to rate their satisfaction with the improvement achieved at each post-operative review using 100 mm VAS.

Results

Although differences between patients’ expectation and achievement were minimal 6 weeks post-operatively, there was a clear discrepancy at 6 months and 1 year, with patient expectations far exceeding achievement. There were significant correlations between failure to achieve expectations and the importance patients attached to this recovery at each post-operative assessment, but not with their confidence in achieving this result. Satisfaction levels remained high despite expectations not being met, with discectomy patients being more satisfied than decompression patients.

Conclusions

Patients’ pre-operative expectations of surgical outcome exceed their long-term achievement. The more importance the patient attached to a good outcome, the larger is the discrepancy between expectation and achievement. Despite this, satisfaction levels remained high. The impact of unrealistic expectations on outcome remains unclear.