局部减压法辅助治疗早产儿静脉输注脂肪乳外渗

目的 探寻早产儿脂肪乳外渗后的治疗方法和护理措施.方法 将静脉输注脂肪乳外渗的早产儿38例随机分为观察组和对照组各19例.观察组局部减压后再采用50%硫酸镁湿敷,对照组只采用50%硫酸镁湿敷.结果 观察组脂肪乳外渗部位肿胀消退时间较对照组显著缩短（P＜0.05）.观察组外渗局部皮肤有2例出现淤斑,对照组有9例出现淤斑、水疱、破溃或硬结等,两组比较,差异有统计学意义（P＜0.05）.结论 局部减压后再使用50%硫酸镁湿敷治疗早产儿脂肪乳外渗效果良好,局部并发症少,操作简便.     

全视网膜光凝联合睫状体光凝治疗视网膜中央静脉阻塞引起的新生血管性青光眼

目的观察全视网膜光凝术联合经巩膜睫状体光凝术治疗视网膜中央静脉阻塞引起的新生血管性青光眼的临床效果。方法选取因视网膜中央静脉阻塞引起的新生血管性青光眼,分A组和B组。A组,白内障轻度,能行全视网膜光凝术;B组,白内障较重,不能行全视网膜光凝术。A组7例患者行全视网膜光凝联合睫状体光凝术。B组,7例患者仅行睫状体光凝术。结果 A组患者眼压下降,新生血管消失或部分消失,视力提高或保持视力;B组部分患者眼压下降,前房见积血或新生血管部分消退,部分患者眼压仍高,需二次睫状体光凝,视力光感或无视力。结论全视网膜光凝联合睫状体光凝能有效治疗视网膜中央静脉阻塞引起的新生血管性青光眼。     

微创经皮肾镜联合盏颈切开治疗小儿肾盏憩室

目的探讨微创经皮肾镜联合肾盏憩室盏颈切开术,治疗小儿肾盏憩室的临床疗效。方法回顾分析采用微创经皮肾镜联合肾盏憩室盏颈切开术,治疗小儿肾盏憩室6例患者的临床资料;采用B超定位引导穿刺目标肾盏,同时以柱状电极切开盏颈部狭窄;统计手术时间、术中出血量、住院时间以及术后并发症。结果 6例肾盏憩室患者均I期微创经皮肾镜成功进入目标肾盏,并行柱状电极切开盏颈部狭窄。手术时间为35～120 min,平均50 min;术中出血35～100 mL,平均45 mL,术后7～10 d出院。术后复查2例患者肾盏憩室消失,3例憩室明显缩小,1例憩室缩小不明显。结论微创经皮肾镜联合盏颈切开,治疗小儿肾盏憩室创伤小,安全、有效。     

A nomogram based on age,prostate-specific antigen level,prostate volume and digital rectal examination for predicting risk of prostate cancer

Nomograms for predicting the risk of prostate cancer developed using other populations may introduce sizable bias when applied to a Chinese cohort. In the present study, we sought to develop a nomogram for predicting the probability of a positive initial prostate biopsy in a Chinese population. A total of 535 Chinese men who underwent a prostatic biopsy for the detection of prostate cancer in the past decade with complete biopsy data were included. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) status, % free PSA and transrectal ultrasound (TRUS) findings were included in the analysis. A nomogram model was developed that was based on these independent predictors to calculate the probability of a positive initial prostate biopsy. A receiver-operating characteristic curve was used to assess the accuracy of using the nomogram and PSA levels alone for predicting positive prostate biopsy. The rate for positive initial prostate biopsy was 41.7% (223/535). The independent variables used to predict a positive initial prostate biopsy were age, PSA, PV and DRE status. The areas under the receiver-operating characteristic curve for a positive initial prostate biopsy for PSA alone and the nomogram were 79.7% and 84.8%, respectively. Our results indicate that the risk of a positive initial prostate biopsy can be predicted to a satisfactory level in a Chinese population using our nomogram. The nomogram can be used to identify and counsel patients who should consider a prostate biopsy, ultimately enhancing accuracy in diagnosing prostate cancer.     

The free triple chimeric dorsalis pedis flaps for repair of multifinger soft tissue defects: A report of two cases

The reconstruction of complex hand injury such as multifinger soft tissue defect remains a challenging problem. Two cases of repair of multifinger injury with exposed bones using the free chimeric flaps based on the dorsalis pedis vessels are presented. Two male patients, 46 years old and 36 years old, suffered from a thermocompression injury to the dorsum of fingers resulting in soft tissue defects of multiple fingers. The chimeric free flap was designed and applied to cover the defects. The donor sites were covered by skin grafts. The postoperative courses were uneventful. Both patients were followed up for 10–12 months. The maximal flexion angle of the distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints were 40°–85° at the end of the follow‐up. The protective sensation was achieved on the dorsal fingers. The report suggests that the free chimeric flaps based on the dorsalis pedis artery may be an alternative for the reconstruction of the multifinger dorsal soft tissue defects. © 2013 Wiley Periodicals, Inc. Microsurgery 33:660–666, 2013.     

Modified posterior soft tissue repair for the prevention of early postoperative dislocation in total hip arthroplasty

Purpose

Dislocation following total hip arthroplasty (THA) with the posterior approach has been quite a common and bothering complication. Previous researches suggest that careful repair of the posterior structures significantly reduces this risk. The purposes of the present study were to describe a modified posterior soft tissue repair procedure in THA using a suture anchor (TwinFix Ti 5.0, Smith & Nephew, Andover, MA) and evaluate the early postoperative dislocation rate.

Methods

From July 2004 to June 2008, 220 consecutive primary total hip arthroplasties were performed using the modified surgical approach. The average age in the group was 46.4 years (range from 21 to 90) at the time of the procedure. The rate of postoperative hip dislocation, as well as any signs of complications related to the technique, has been observed and analyzed in this study.

Results

There was no postoperative dislocation following primary THA in 220 cases, and no signs of complications related to the technique, such as greater trochanteric fractures and sciatic nerve palsy, have been noted in any of the cases at their most recent follow-up.

Conclusions

These initial results demonstrate that the modified repair in THA using the suture anchor can serve as an effective and reliable mean for prevention of early postoperative dislocation     

PTH‐enhanced structural allograft healing is associated with decreased angiopoietin‐2–mediated arteriogenesis,mast cell accumulation,and fibrosis

Recombinant parathyroid hormone (rPTH) therapy has been evaluated for skeletal repair in animal studies and clinical trials based on its known anabolic effects, but its effects on angiogenesis and fibrosis remain poorly understood. We examined the effects of rPTH therapy on blood vessel formation and osseous integration in a murine femoral allograft model, which caused a significant increase in small vessel numbers, and decreased large vessel formation (p < 0.05). Histology showed that rPTH also reduced fibrosis around the allografts to similar levels observed in live autografts, and decreased mast cells at the graft‐host junction. Similar effects on vasculogenesis and fibrosis were observed in femoral allografts from Col1caPTHR transgenic mice. Gene expression profiling revealed rPTH‐induced angiopoietin‐1 (8‐fold), while decreasing angiopoietin‐2 (70‐fold) at day 7 of allograft healing. Finally, we show anti‐angiopoietin‐2 peptibody (L1‐10) treatment mimics rPTH effects on angiogenesis and fibrosis. Collectively, these findings show that intermittent rPTH treatment enhances structural allograft healing by two processes: (1) anabolic effects on new bone formation via small vessel angiogenesis, and (2) inhibition of angiopoietin‐2–mediated arteriogenesis. The latter effect may function as a vascular sieve to limit mast cell access to the site of tissue repair, which decreases fibrosis around and between the fractured ends of bone. Thus, rPTH therapy may be generalizable to all forms of tissue repair that suffer from limited biointegration and excessive fibrosis. © 2013 American Society for Bone and Mineral Research.     

Secondary diabetes associated with 5‐fluorouracil‐based chemotherapy regimens in non‐diabetic patients with colorectal cancer: results from a single‐centre cohort study

Aim The aim of the study was to analyse the prevalence and characteristics of secondary diabetes induced by 5‐fluorouracil (5‐FU) based chemotherapy in non‐diabetic patients with colorectal cancer (CRC). Method A total of 422 consecutive CRC patients who received 5‐FU‐based chemotherapy were retrospectively analysed. Fasting plasma glucose (FPG) levels were determined before each cycle of chemotherapy during active treatment and regular follow‐up. The prevalence and characteristics of secondary hyperglycaemia were investigated, with special focus on the clinical outcome. Results Among the 422 CRC patients, 60 had pre‐existing hyperglycaemia. In the remaining 362 with normal FPG levels before chemotherapy, 42 (11.6%) and 41 (11.3%) patients developed diabetes and impaired fasting glucose during the study period. Among the 42 secondary diabetic patients, 22 (52.4%) received anti‐diabetes drug therapy, in 7 (16.7%) cases the FPG level returned to normal without any active intervention, and 13 (30.9%) cases received diet control and physiotherapy. Thirty‐one (8.6%) patients developed diabetes. Based on the Common Terminology Criteria for Adverse Events, an adverse event over Grade 3 occurred in seven cases during follow‐up. Diabetes‐related adverse events had a serious negative impact on chemotherapy in six cases. Diabetes‐related death occurred in three patients. Conclusions Secondary diabetes associated with 5‐FU‐based chemotherapy occurs in around 10% of CRC patients, with a significant negative impact on treatment and clinical outcome. 5‐FU‐related diabetes should be regarded as a common side effect of 5‐FU treatment.