Objective To observe the efficacy of glucocorticoid and Mecobalamin in the treatment of optic neuritis. Methods Seventy-four patients (118 eyes) with optic neuritis were enrolled in this study. There were 38 patients (55 eyes) with optic nerve papillitis, 36 patients (63 eyes) with retrobulbar neuritis. The patients were divided into treatment and control group, 37 patients (59 eyes) in each group. The treatment group received semiretrobulbar injection of 500 μg Mecobalamin per day, 10 times for one course; after two to three courses changed oral 500 μg Mecobalamin, three times per day. Systemic intravenous injection of 15 dexamethasone mg per day for one week, then prednisolone 30 mg per day orally, the dosage was reduced every five days for 5 mg; oral administration of vitamin B1, 10 mg three times per day, use of energy mixture, vasodilators. Control group underwent the same therapy as the treatment group without Mecobalamin. The efficacy differences between two groups were comparatively analyzed. Results Among 59 eyes in the treatment group, 42 eyes (71.19%) were markedly effective, 15 eyes (25.42%) were valid and two eyes (3.39%) were invalid. The total effective rate was 96.61%. Among 59 eyes in the control group, 30 eyes (50.85%) were markedly effective, 26 eyes (44.07%) were valid and three eyes (5.08%) were invalid. The total effective rate was 94.92%. The difference of total effective rate between two groups was not statistically significant (χ2=1.10, P＞0.05); but there was a difference in markedly effective rate between two groups (χ2=5.65, P＜0.05). Conclusion Mecobalamin combined with glucocorticoids was effective in the treatment of optic neuritis.
Objective To evaluate the visual function before and after photodynamic therapy(PDT) in patients with subfoveal choroidal neovascularization ( CNV) caused by age-related macular degeneration (AMD). Methods Twenty-five consecutive patients (34 eyes) treated with PDT (verteporfin) for subfoveal CNV in age-related macular degeneration diagnosed by fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Visual function including best corrected visual acuity, contrast sensitivity frequency, binocular function, confusion, stereo-vision, color vision, metamorphopsis and central scotoma were examed before photodynamic therapy and 1 week, 1 month, 3 month after photodynamic therapy. The follow-up time varied from 3 months to 2 years (mean 7.6 months). Results The changes of visual function at the 3rd month after photodynamic therapy revealed improving in 13 eyes (38.24%), without any change in 17 eyes (50.00%), and decreasing in 6 eyes (17.65%). Visual acuity with logMRA improved after photodynamic therapy, but without statistic difference. All spatial contrast sensitivity improved. Contrast sensitivity for spatial frequencies 5 cycles per degree (cpd) was better after photodynamic therapy with significant difference (P=0.045).Binocular function, fusion function, stereo function and color vision were slightly improved without statistic difference. Conclusion Damage of visual function in macular degeneration is many-sided. The treatment of PDT for exudative AMD can improve part visual function. (Chin J Ocul Fundus Dis，2004，20：289-291)
Objective To summarize the treatment experience for concomitant diseases of other abdominal organs in laparoscopic cholecystectomy （LC）. Methods The clinical data of 176 patients with LC and concomitant diseases of other abdominal organs were analyzed retrospectively， including preoperatively diagnosed cases （such as 53 with liver cyst， 15 with choledocholithiasis， 7 with chronic appendicitis， 5 with inguinal hernia， 4 with renal cyst， and 6 with ovarian cyst） and intraoperatively diagnosed cases （such as 72 with abdominal cavity adhesion， 4 with internal fistula between gallbladder and digestive tract， 3 with Mirizzi syndrome， and 7 with unsuspected gallbladder carcinoma）. Results All the operation were successfully completed in 176 patients without severe complications， including 53 cases treated with LC plus fenestration of hepatic cyst， 15 with choledocholithotomy， 7 with appendectomy， 5 with tension free hernia repair， 4 with renal cyst fenestration， 6 with oophorocystectomy， 72 with adhesiolysis， 3 with fistula resection plus intestine neoplasty， 2 with intraoperative cholangiography plus choledocholithotomy， 5 with LC plus gallbladder bed complete burning， and 4 cases treated with conversion to open surgery （1 with intestinal fistula repair， 1 with choledocholithotomy， and 2 with radical resection for gallbladder carcinoma）. Conclusions It is safe and effective to treat gallbladder diseases complicated with other concomitant diseases simultaneously with laparoscopic operation， if the principles of surgical operation are followed and the indications and applicable conditions are strictly followed. And conversion to open surgery is necessary.
Objective To improve the prognosis of primary liver cancer with portal vein tumor thrombus （PVTT）， the progress of treatment for primary liver cancer with PVTT was reviewed. Methods The therapeutic approach and its efficacy for primary liver cancer with PVTT were summarized by literature search within recent years. Results PVTT is a common complication of primary liver cancer， the therapeutic approach are surgical resection， transcatheter arterial chemoembolization (TACE), intraportal venous therapy， radiotherapy， ablation therapy, molecular targeted therapy， etc. The excision rate for primary liver cancer with PVTT is low， the treatment is difficult and the outcome is dismal. It remains a poor prognosis at present， and the therapeutic effect need to be promoted. Conclusions The main treatment for primary liver cancer with PVTT should be surgical excision combine with other multidisciplinary comprehensive treatment to improve the survival in patients with PVTT， moreover， the therapeutic approach should be individualized and sequentially according to the patient’s condition and the type of PVTT.
Acute respiratory distress syndrome is one of the forms of respiratory failure that seriously threaten human life. It has the characteristics of very high morbidity, mortality and hospitalization costs. How to treat acute respiratory distress syndrome to improve the quality of life of patients is particularly important. Mechanical ventilation is an important treatment for acute respiratory distress syndrome. This article will review the progress in mechanical ventilation therapy for acute respiratory distress syndrome, including non-invasive mechanical ventilation and invasive mechanical ventilation (tidal volume, lung recruitment, positive end-expiratory pressure, prone position ventilation, and high-frequency oscillatory ventilation), aiming to provide basis and reference for future exploration of the treatment direction of acute respiratory distress syndrome.
Objective To review the progress in the mechanism of injury, diagnosis, classification, and treatment method of Lisfranc injury. Methods Recent l iterature concerning the mechanism of injury, classification, diagnosis, and treatment method of Lisfranc injury was extensively reviewed, analyzed, and summarized. Results Because of the compl icate anatomy and high missed diagnosis rate, CT imaging were often recommended for diagnosis, and MRI could be used if necessary. The current recommendations for internal fixation included the use of Kirschner wires, cannulated screws, absorbablescrews, and plate. Conclusion Classification according to the columnar theory is significant for cl inical guiding. With thecl inical appl ication of internal fixation materials, more choices were provided, which make patients get the best effect.
Objective To investigate the clinical features, diagnosis, and treatment of patients with localized epithelioid sarcoma (ES).Methods From January 2000 to September 2006, 11 patients with ES weretreated. There were 7 males and 4 females aged 14-41 years. The patients’ agesat the initial onset were 9-41 years, averaged 27.7 years. The ES was located in the upper extremity in 7 patients，lower extremity in 3, and abdomen in 1. Among the patients, 10 had a recurrence. Tumor lt; 2cm was seen in 7 patients, 2-5cm in 1, and gt;5 cm in 3. One patient underwent an operation of local resection at another hospital. Seven patients underwent an expanding resection surgery, and the tumors with the surrounding normal tissues 3 cm above were removed. Three patients underwent a radical surgery, including extremity amputation or finger amputation. All the patients underwent routine radiotherapy and chemotherapy after operation. Results All the wounds had a healing at the firstintention without complications. All the flaps survived and the grafted bone had a fusion. Among the 11 patients followed up for 5-54 months averaged 23.2 months, 8 had a recurrence 2-20 months (average, 8.9 months) after operation, witha recurrence rate of 73%. And among the patients, 3 had a further radical surgery of extremity amputation. Four patients had a metastasis in the axillary lymphnodes 6-24 months after operation, and 1 patient had a lung metastasis 10 months after operation. They did not have a further surgical treatment. Four patients died of systemic failure 6-14 months after operation. Conclusion An early expanding resection surgery combined with postoperative chemotherapy and radiotherapy is the therapy of choice for treating ES.
【Abstract】Objective To study the advances in clinical application of shape memory alloy (SMA) in general surgery. Methods The literature in the recent years on the advances of SMA was reviewed. Results At present clinical application of SMA have been developed. Different stents could dilate the benign and malignant stricture of blood vessels, biliary ducts, cola, recta and gastric outlet obstruction. The SMA catheter system was effective for peroral cholangiopancreatoscopy. Novel nitinol basket instrument might be useful for percutaneous cholecystolithotomy. Compression anastomoses was safe and sound in gastrointestinal surgery using a device made of SMA. Nitinol stent could be used in transjugular intrahepatic portosystemic stent shunt (TIPSS) with satisfactory results. Nitinol occlusion devices was superior to stainless steel coils. The Simon nitinol filter represented a new generation of venous interruption devices designed to prevent recurrent pulmonary embolism. Conclusion Clinical application of SMA will be increased by the development of endoscope, laparoscope and interventional technique.
Objective To analyze the treatment and effect of bacterial liver abscess over the past two decades in one single center. Methods The total 198 patients with bacterial liver abscess during the last twenty years were studied retrospectively. They were divided into three groups according time: 1989-1995 group, 1996-2002 group and 2003-2008 group. Gender and age of patient, location, number and size of abscesses, treatment, hospital days, morbidity of complications and mortality among the groups were compared. Results There were 54, 69, 75 cases in 1989-1995, 1996-2002 and 2003-2008 group respectively. No significant differences were found in gender and age of patient, location, number and size of abscess among three groups （Pgt;0.05）. In 1989-1995 group, 35 cases (64.8%) were treated with laparotomy, 8 cases (14.8%) with laparoscope, and 11 cases (20.4%) with percutaneous treatment (needle aspiration or catheter drainage). In 1996-2002 group, 15 cases (21.8%) were treated with laparotomy, 21 cases (30.4%) with laparoscope, 31 cases (44.9%) with percutaneous treatment (needle aspiration or catheter drainage), and 2 cases (2.9%) were treated with antibiotherapy. In 2003-2008 group, 5 cases (6.7%) were treated with laparotomy, 13 cases (17.3%) with laparoscope, 54 cases (72.0%) with percutaneous treatment (needle aspiration or catheter drainage), and 3 cases (4.0%) were treated with antibiotherapy. The constituent ratio of treatment was significantly different among three groups (P＜0.05). The hospital days was (18.5±12.2) d, (16.4±12.8) d and (20.1±14.6) d, the morbidity of complications was 9.3% (5/54), 4.3%(3/69) and 4.0%(3/75), the mortality was 3.7%(2/54), 1.4%(1/69) and 1.3% (1/75) respectively, but there were no significant differences of three indexes among three groups. Conclusion With the development of surgical techniques, effective antibiotic therapy and percutaneous treatment (needle aspiration or catheter drainage) have been the main therapeutic methods, and laparoscopy and laparotomy are necessary supplement.
Objective To assess the effectiveness and safety of reptilase in the treatment of bleeding due to internal diseases. Methods The Cochrane Library, MEDLINE, VIP, and CNKI were searched. The quality of included studies was evaluated and meta-analysis was performed for the results of homogeneous studies. Results Forty studies involving 2 879 participants related to a variety of internal diseases were included. All included studies were inadquate in reporting randomization, concealment of allocation and blinding. Meta-analysis based on included studies showed that reptilase could better alleviate bleeding compared with the control group in intrecranial encephalic hemorrhage （RD 0. 24, 95 % CI 0. 01 to 0.48）, hypertension induced intrecranbd hemorrhage （RD -0.20, 95% CI -0. 38 to -0. 03）, in hemostasis rate within 24 hours in hemoptysis （RD 0.41, 95% CI 0.17 to 0. 64）, in upper alimentary tract hemorrhage （ RD 0.39, 95% CI 0.03 to 0. 76 ）, in newborn upper alimentary tract hemorrhage （RD 0.32, 95% CI 0. 23 to 0.41 ）. Only one case of hypersensitivity occured in reptilase group. Conclusions Reptilase is an effective and safe hemostasia remedy for hemorrhage of internal diseases. Due to high risk of selection bias and detection bias of included studies, the evidence is not b enough to judge whether reptilase is better than other hemostatics. Our results suggest that further and larger-scale trials of the use of reptilase in the treatment of hemorrhages of internal diseases are needed.