Double ulnar osteomy for the treatment of congenital radial head dislocation

ObjectiveThe aim of this study was to retrospectively evaluate the effects of our double osteotomy technique in the treatment of congenital radial head dislocation (CRHD).MethodsA total 14 children (14 elbows; 71.42% male; mean age: 9.31 ± 3.06 years) with CRHD who underwent double osteotomy of the proximal ulna between April 2010 and June 2015 were included in the study. The patients with CRHD were identified according to medical history, plain radiographs or magnetic resonance imagings. The outcomes were evaluated through comparison of the preoperative and postoperative motion range of elbow and Mayo Elbow Performance Score (MEPS).ResultsAfter a follow-up of 13–35 months (22.29 ± 5.80), compared with pre-operation, the flexion (132.14 ± 3.23° vs 123.21 ± 7.75°, P = 0.003), extension (8.21 ± 4.21° vs 1.07 ± 3.50°, P = 0.003), and pronation of elbow (83.21 ± 4.21° vs 80.36 ± 4.14°, P = 0.011) improved significantly in all patients. Furthermore, the carrying angle was recovered to the normal level (5–15°) in all of these patients (18.57 ± 5.69° vs 8.21 ± 2.49°, P = 0.001). MEPS score was significantly increased postoperatively (96.79 ± 2.49 vs. 90.71 ± 1.82, P = 0.000), with the good outcome in CRHD patients.ConclusionThe results of our study suggested that this double osteotomy on the proximal ulna might be an effective method for the treatment of CRHD.Level of EvidenceLevel IV, Therapeutic Study.     

Characteristics and outcomes of in-hospital cardiac arrest in adults hospitalized with acute coronary syndrome in China

AimsThis retrospective study aims to analyze and explore the clinical characteristics, risk factors, and in-hospital outcomes - including return of spontaneous circulation (ROSC) and survival to discharge - of hospitalized patients admitted with acute coronary syndrome (ACS) suffering cardiac arrest.MethodsACS patients admitted to three tertiary hospitals in Fujian, China, were evaluated retrospectively from January 1, 2012 to December 30, 2016. Data were collected, based on the Utstein Style, for all cases of attempted resuscitation for IHCA. We analyzed patient characteristics, pre-event variables, event variables, and the main outcomes, including ROSC and survival to discharge, and identified the influencing factors on the outcomes.ResultsThe total number of ACS admissions across the three hospitals during this study period was 21,337. Among these admissions, 320 ACS patients experienced IHCA (incidence: 1.50%); 134 (41.9%) patients experienced ROSC; and 68 (21.2%) survived to discharge. The findings indicated that four factors were associated with ROSC, including age <70 years-old, shockable rhythm, duration of resuscitation (≤15 min and 16–30 min), and PCI. Five factors were associated with survival to discharge, including age <70 years-old, shockable rhythm, the duration of resuscitation (≤15 min and 16–30 min), Killip ≤ II, and CCI ≤ 2.ConclusionYounger age, shockable rhythm, and shorter duration of resuscitation were all factors demonstrated to be a predictor of ROSC and survival to hospital discharge.     

Pneumatosis intestinalis and pneumoretroperitoneum post steroid use in a patient with superior mesenteric artery syndrome

Pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the small or large intestine. PI can be both asymptomatic and life-threatening. The patient was a 50-year-old man with previous cervical spine abscess and osteomyelitis post debridement 4 years ago, with a heroin abuse history. He presented with abdominal distension ongoing for 4 days and vomiting for 3 times with fluid content. Abdominal computed tomography revealed pneumatosis with pneumoretroperitoneum.A surgeon was contacted and antibiotic treatment was started. The patient was kept on nothing per os and intravenous fluid supply. A drainage tube was inserted into retroperitoneum space on the same day. Tracing back his history, our patient was discharged from the hospital recently with a diagnosis of superior mesenteric artery dyndrome (SMAS), hypersensitivity pneumonitis, and asbestosis with soft tissue pleural plaques and calcified pleural plaques. During the hospitalization period, hydrocortisone dexamethasone and methylprednisolone were prescribed for hypersensitivity pneumonitis. Steroid use and SMAS maybe the cause of PI. Finally, he was discharged 5 days later with a nasojejunal and drainage tubes and was arranged for OPD follow-up. PI can be asymptomatic or life-threatening, and patient management varies based on the clinical condition. Although in this case PI was found in the emergency department, a patient's past history of underlying disease and medication should be reviewed to find the most possible etiology.     

Palpebral emphysema following a dental procedure

Palpebral emphysema is a rare occurrence after a dental procedure. However, it can be associated with severe complications, such as soft tissue infection, pneumomediastinum, pneumothorax, optic nerve ischemia or even blindness. Early diagnosis and prompt management are mandatory for emergency physicians.     

夏枯草及抗炎1号注射液经肝动脉联合灌注 治疗大鼠晚期肝癌的实验研究

目的:观察夏枯草及抗炎1号注射液经肝动脉联合灌注对大鼠晚期肝癌的治疗作用。方法:建立30只二乙基亚硝胺(DEN)诱发大鼠晚期原发性肝癌模型,随机分为中药组、化疗组和盐水组,每组各10只。经胃、十二指肠动脉至肝固有动脉分别灌注生理盐水0.5mL、夏枯草注射液0.6g/kg+抗炎1号注射液0.45g/kg、顺铂(DDP)4mg/kg+羟基喜树碱(HCPT)1.5mg/kg+5-氟脲嘧啶(5-FU)34mg/kg。结果:与化疗组和盐水组比较,中药组大鼠的一般情况较好,肝重/体重低,病理性肝损害轻,生存率高(90％对60％,70％,P〈0.05)。结论:经肝动脉联合灌注夏枯草及抗炎1号注射液较灌注化疗药物对诱发性大鼠晚期肝癌具有更好的作用。