ObjectiveTo summarize the clinical advantages and the treatment of perineal defect of extra-levator abdominoperineal excision, and to discuss the treatments of postoperative complications. MethodsChinese or English literatures about extra-levator abdominoperineal excision were collected to summarize and analyze the clinical signifi-cance of it. ResultsExtra-levator abdominoperineal excision had a lot of advantages in reducing the circumferential resection margin involvement rate and intraoperative perforation rate for patients with low rectal cancer. The huge perineal defect caused by the operation could achieve good healing after appropriate treatment. At the same time, we should avoid the occurrence of urogenital system dysfunction and perineal pain. ConclusionExtra-levator abdomino-perineal excision is a safe and effective procedure aimed at patients with low rectal cancer, and can be applied during clinical practice.
Objective To evaluate the cl inical results of the femoral reconstruction technique in patients with proximal femoral deformity in total hip arthroplasty. Methods Between March 2004 and June 2009, total hip arthroplasty procedures were performed on 25 patients (26 hips) with hip joint disease and proximal femoral deformity, including primary osteoarthritis of the hip joint (2 hips), developmental dysplasia of the hip (8 hips), traumatic arthritis of the hip (14 hips), and tuberculosus arthritis of the hip (2 hips). There were 10 males (10 hips) and 15 females (16 hips), with an average age of 64 years (range, 42-82 years). The disease duration was 10 months to 25 years (mean, 10.6 years). The Harris score was 44.2 ± 5.1, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 45.0 ± 2.7 before operation. According to Berry’s classification system of primary disease, 8 hips were classified as developmental dysplasia of hip, 7 hips as malunion of fracture, 2 hips as chronic tuberculosis, 2 hips as sl ipped femoral epiphysis, 1 hip as previous subtrochanteric osteotomy, 1 hip as previous shelf operation of the acetabulum, and 5 hips as previous internal fixation; according to the anatomic site of the deformity, there were 5 hips of greater trochanter, 10 hips of femoral neck level, 10 hips of metaphyseal level, and 1 hip of diaphysis. Results All wounds healed by first intention. Deep venous thrombosis occurred in 3 patients within 1 week, and were cured with braking and anticoagulant therapy. Bursal synovitis of great trochanter occurred in 1 patient after 6 weeks, and was eased after taking drugs for pain rel ief. All patients were followed up 1 year and 6 months to 6 years, with an average of 3 years and 3 months. The Harris score and WOMAC score at last follow-up were 88.4 ± 3.6 and 82.0 ± 5.2 respectively, showing significant differences when compared with preoperative scores (P lt; 0.05). The X-ray films at last follow-up showed good location of prosthesis and no loosening expect 1 patient who had aseptic loosening and was given revision at 8 months postopera tively. Conclusion Proximal femoral deformity classification will contribute to the choice of prosthesis and surgical strategy,thus the good results of femoral reconstruction and cl inical results would be obtained.
Objective To study the method to prepare the animal model of goat cleft palate by injection of anabasine and the effect of the malformation on the development of the facial mid-part. Methods A total of 40 female boer hybrid goats were selected, aging 8-12 months and weighing 35-55 kg. The mating day was 0 day, and at 30 days the goats assured pregnant byB type ultrasonic test were divided into 4 groups (n=10) according to intramuscular injection of 10 (experimental group 1), 15 (experimental group 2), 20 (experimental group 3) mg/ d, and no injection (control group), respectively, from the 31st to 42nd day. At pregnant 120 days and 1 month after birth, 5 fetal goats of each group were used for three dimensional reconstruction ofskull with CT scan. The maxillary bone width named as PPMM and the maxillary bone length named as APMM were measured then the hard palate general observation was performed and dry skull of goats was harvested to observe the development of maxillary. Results After injection, all pregnant lambs aborted in experimental group 3; 2 pregnant lambs aborted and 8lambs maintained pregnancy in experimental group 2. At 120 days of pregnant, no cleft palate was observed in 5 fetal lambs of experimental group 1 and control group, respectively; cleft palate and maxillary dysplasia occurred in 3 fetal lambs of experimental group 2. Among 11 newborn lambs of experimental group 1 and 8 newborn lambs of control group, no cleft palate was observed;among 7 newborn lambs of experimental group 2, cleft palate occurred in 5 with obvious maxillary dysplasia and eating difficultly. General observation of hard palate and dry skull showed obvious hypoplasia of maxillary in experimental group 2. There were significant differences in PPMM and APMM between the experimental group 2 and the control group at pregnant 120 days and 1 month after birth (P lt; 0.05). Five lambs with cleft palates of experimental group 2 survived for 1-2 months. Conclusion The animal models of goat cleft palate can established by intramuscular injection of anabasine at a dose of 15 mg/d from the 31st to 42nd day of pregnant. The facial character of the induced cleft palate goat is similar to that of human cleft palate.
Objective To study the mid-facial development characteristics of the goats with cleft palate after in-utero surgical repair at different stages. Methods Twenty-four Boer hybrid female goats were selected, aged from 8 to 12 months and weighing from 35 to 55 kg. The mating day was designated for 0 day. At 30 days, pregnant was confirmed by B-ultrasound test, and the goats were divided into 5 groups (experimental groups 1, 2, 3, 4, and normal control group). Twenty pregnant goats of 4 experimental groups (n=5) were injected DL-anabasine (15 mg/day) from 31 to 42 days to establish cleft palate model of fetal lamb, 4 pregnant goats of normal control group used as controls without injection. At pregnant 65, 90, and 120 days, cleft palate was repaired in the uterus in experimental groups 1, 2, and 3, while cleft palate was not repaired in experimental group 4. After 1 month of birth, the maxillary bone width (posterior premolar morphological measurement, PPMM) and the maxillary bone length (anterior premolar morphological measurement, APMM) were measured with CT scanning. The dry skull of goats were harvested for gross observation. Results There was no significant difference in PPMM and APMM between experimental group 1 and the normal control group (P gt; 0.05), but there were significant differences between experimental groups 1 and 4 (P lt; 0.05) at 1 month after birth. Significant differences were oberved in PPMM and APMM between experimental group 2 and normal control group, experimental group 4 (P lt; 0.05). There were significant differences in PPMM between experimental group 3 and normal control group, experimental group 4 (P lt; 0.05), in APMM between experimental group 3 and normal control group (P lt; 0.05). Five goats with cleft palate in experimental group 4 died at 1-2 months after birth. Conclusion At pregnant 65 days, in-utero surgical repair of cleft palate has less influences on mid-facial development. The earlier repair is performed, the higher risk of miscarriage was.
Abstract: Objective To investigate the clinical results of the coronary artery bypass grafting (CABG) for coronary artery disease (CAD) patients with completed hypothyroidism. Methods Twentyone CAD patients with hypothyroidism (hypothyroidism group) operated by a single surgeon from September 2002 to June 2009 in our department were enrolled in this study. Among them, there were 6 males and 15 females. Their average age was 60.4 years old. Three patients underwent CABG with onpump beating heart; one underwent CABG with onpump arrested heart; and 17 patients underwent CABG with offpump beating heart. All patients on thyroxine replacement therapy underwent CABG after free triiodothyronine（FT3）,free thyroxin（FT4）, thyroidstimulating hormone（TSH）, total triiodothyronine（TT3） and total thyroxin（TT4） were obviously improved. At the same time, twenty CAD patients without hypothyroidism were chosen as the control group (control group). Among them, there were 6 males and 14 females with an average age of 62.1 years old. The data of thyroid gland function and clinical prognostic indicator were observed after the operation. Results For the hypothyroidism group, one patient with pericardial effusion, heart failure and low thyroxine before surgery died during the onpump operation. Among the 20 survivors who had undergone CABG with beating heart, 17 were offpump CABG patients. Followup was done for 230 months. Postoperative eject factor of the survivors were significantly higher than their preoperative eject factor (55%±21% vs. 48%±17%). Twenty patients in the control group all survived. There was no significant difference in cardiac index ［2.7±1.4 L/(min·m2) vs. 2.8±1.5 L/(min·m2), t=0.530, P=0.530］, hospital stay (12.2±4.7 d vs. 10.1±3.9 d , t=0.170, P=0.170), or mechanical ventilation time (17.6±9.1 h vs. 15.1±13.7 h, t=0.120, P=0.120) between the hypothyroidism group and the control group. Perioperative thyroxine examination showed that there was no profound impact on thyroxine by offpump CABG. Conclusions With full preparation made before operation, CABG with beating heart is comparatively safe for CAD patients with hypothyroidism. The key of the treatment is perioperative thyroxine replacement therapy. There is much risk to perform onpump CABG on patients with severe hypothyroidism.
Objective To investigate the application of the fibrous envelope of tissue expanders for the tension reduction. Methods Between June 2005 and May 2011, 21 patients with facial scar were treated with skin soft tissue expansion. There were 6 males and 15 females, aged 19-33 years (mean, 24.5 years), including 19 cases of hypertrophic scar and 2 cases of atrophic scar with disease duration of 1-31 years. The scars ranged from 4 cm × 2 cm to 25 cm × 10 cm. The tissue expander was implanted under normal skin adjacent to lesions in the first stage. And the post-expanded skin flap was designed as advance flap or transpositional flap as supplement in the second stage. Fibrous envelope at the base was fixed to the periosteum or fascia nearby first, and then sutures were used between envelopes at the base and on the skin flap or to the dermis of the skin flap to keep the mouth and lower eyelid in proper position. It reduced the tension of incision and maintained the contour of the face and neck. Results After the first stage operation, 2 cases had replaced expanders because of infection and leakage. No complication of infection or hematoma occurred after the second stage operation. The patients were followed up 1-18 months (mean, 10.2 months); of them,12 were followed up more than 1 year. No secondary deformity (deviation of mouth angle, eyebrows pulling, or eyelid ectropion) occurred. The flaps had good appearance and color. The satisfactory results were achieved. Conclusion In skin soft tissue expansion of the face, the fibrous envelopes at the base could reduce the tension of the incision and prevent the deformity of the mouth and lower eyelids.