ObjectiveTo explore the pathogenesis, diagnosis and treatment of superior mesenteric artery syndrome (SMAS) complicated with Wernicke encephalopathy (WE). MethodsThe clinical data of 11 cases of SMAS patients complicated with WE were retrospectively analyzed. ResultsOf 9 SMAS patients complicated with WE, 8 patients were gradually awake and the time of consciousness recovery was from 7 d to 9 weeks (mean 5.2 weeks). Another 1 patient died of multiple organ failure attributed to severe condition. The symptoms of ophthalmopegia and ataxia in the rest 2 patients improved. All of symptoms such as ataxia, nystagmus, tinnitus, nausea, and sweating gradually disappeared. The nystagmus disappeared from 3 h to 4 d (mean 2.3 d) in five patients and the ataxia disappeared from 3 d to 12 weeks (mean 7.0 weeks) in 4 patients. The tinnitus, nausea, and sweating in 6 patients disappeared within 1 week. ConclusionImproving the understanding of SMAS complicated with WE is important during clinical practice and early diagnosis and intervention is the key point for a good prognosis.
Diagnosis and surgical procedures were studied in this paper. Twentyfive cases of insulinoma were treated surgically from 1970 to 1997, in which 10 patients had Whipple′s triad so that the early diagnosis could be made. The sites of tumours were found in 10 out of 12 undergoing. Selective celiac angiongraphy with the accuracy rate of 83%, but B-ultrasonography and CT gave only 10% (4 out of 25) and 40%(8 out of 20) respectively. In this series, 5 cases underwent bodytail pancreatectomy and 20 cases enucleation of insulinoma. Blood glucose levels were tested during operation in 15 cases, and they all reached the normal level one hour after the tumours were completely removed. The authors consider that Whipple′s triad is the main basis in diagnosis of insulinoma. The selective celiac angiongraphy play an important role in detecting and locating the tumour. If diagnosis is made, surgical operation should be taken. The blood glucose monitoring during operation is the hallmark for complete resection of insulinomas.
Objective To investigate the effectiveness of hinged external fixator with mini-plate to treat terrible triad of the elbow. Methods Between August 2008 and June 2011, 11 patients with terrible triad of the elbow were treated with hinged external fixator combined with mini-plate. There were 9 males and 2 females, aged 22-56 years (mean, 34 years). The injuries were caused by falling from height in 8 cases and traffic accident in 3 cases. All patients were closed injury. The time from injury to operation varied from 8 hours to 7 days (mean, 3.7 days). According to Mason classification standard, all radial head fractures were type IV and complicated by posterior dislocation of the elbow; according to Regan-Morrey classification standard, ulna coronary process fractures were type I in 3 cases, type II in 3 cases, and type III in 5 cases. Results All the patients achieved primary healing of incision after operation and no nerve injury occurred. The patients were followed up 12-20 months (mean, 15 months). Two cases had screw channel infection after 12 weeks of operation, and 1 case had mild heterotopic ossification of the elbow after 4 months of operation. X-ray films showed that all fractures healed from 8 to 20 weeks (mean, 16 weeks). No recurrent dislocation or instability of the elbow occurred. At 12 months after operation, the elbow range of motion (ROM) were 120-145° (mean, 135°) in flexion, 0-25° (mean, 10°) in extension, 50-90° (mean, 70°) in pronation, and 50-80° (mean, 60°) in supination. According to Mayo elbow function evaluation standard, the results were excellent in 5 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. Conclusion Hinged external fixator with mini-plate can enhance postoperative stability of the elbow. This therapy is beneficial to early functional exercise and obviously decrease the disability rate caused by complex damage on the elbow.
Objective To review the injury mechanism and the treatment progress of terrible triad of the elbow, and to analyze the direction of further research. Methods Related literature concerning terrible triad of the elbow was extensively reviewed and comprehensively analyzed. Results The main treatment of terrible triad of the elbow is operation. The ultimate goal of treatment is to reconstruct sufficient stability of the elbow. The treatment includes fixation of the coronoid by suture, screw or plate; fixation of radial head by screw and plate, partial or complete replacement of the radial head; fixation of lateral collateral ligament and the medial collateral ligament by bone suture or anchors and the application of the external fixator. These surgical treatments have their own indications and advantages, most get satisfactory results. Conclusion Generally, surgery is needed to maintain the stability of the elbow for patients of terrible triad elbow. However, medial ligament repair or not, the choice of approach, and mechanism of injury still need further study.
Objective To explore the operation procedure and effectiveness of terrible triad of the elbow joint. Methods Between October 2006 and June 2010, 11 cases of closed terrible triad of the elbow joint were treated by operation. There were 8 males and 3 females with an average age of 32 years (range, 21-53 years). The mechanism of injury was fall ing from height in 4 cases and traffic accident in 7 cases. The time from injury to admission was 30 minutes to 9 days. According to Regan-Morrey classification for fractures of the ulnar coronoid, there were 5 cases of type I, 5 cases of type II, and 1case of type III; and according to Mason classification for fractures of the radial head, there were 4 cases of type I, 5 cases of type II, and 2 cases of type III. The elbow joint range of motion (ROM) was (63 ± 9)° at flexion and extension, and the forearm ROM was (71 ± 8)° at pronation and supination. All cases underwent reduction and fixation by lateral approach combined with medial approach according to McKeeps operation process. After operation, the affected l imb was immobil ized with plaster at elbow joint flexion of 90° and in forearm neutral position, then passive physical exercises were carried out, and finally active physical exercises were done after removing plaster at 4 weeks. Results All incisions healed by first intention. Eleven cases were followed up 7-27 months (14.5 months on average). The X-ray films showed good reduction, the cl inical heal ing time was 8-19 weeks with an average of 11 weeks. Mild ectopic ossification of the elbow joint occurred in 3 cases at 6 months after operation, mild degenerative change in 1 case at 18 months after operation. At last follow-up, the elbow joint ROM was (103 ± 14)° at flexion and extension, and the forearm ROM was (122 ± 13)° at pronation and supination, showing no significant difference when compared with the values of normal elbow joint (P gt; 0.05) and significant difference when compared with the preoperative values of affected elbow joint (P lt; 0.05). According to Mayo elbow performance score, the results were excellent in 5 cases, good in 5 cases, and fair in 1 case with an excellent and good rate of 90.9%. Conclusion The surgical treatment of terrible triad of the elbow joint can restore sufficiently elbow stabil ity, allow early motion postoperatively, and enhance the functional outcome.
Objective To retrospectively reviewed the operative therapy of the terrible triad of the elbow. Methods From October 2003 to September 2007, 10 cases of terrible triad were treated, with an elbow dislocation and an associated fracture of both the radial head and the coronoid process. There were 3 males and 7 females with the age of 18-66 years. The injury was caused by traffic accidents in 4 cases, fall ing from a height in 4 cases, and tumbl ing in 2 cases. The coronoid process fractures of the patients were 5 cases of type I, 3 cases of type II and 2 cases of type III according to Regan- Morrey classification. The radial head fractures of the patients were 1 case of type I, 6 cases of type II and 1 case of type IIIaccording to Mason classification, and their radial heads of the other 2 patiants were resected before they were in hospital. The general approach was to repair the damaged structures sequentially from deep to superficial, from coronoid to anterior capsule to radial head to lateral l igament complex to common extensor origin. And selected cases were repaired of the medial collateral l igaments and assisted mobile hinged external fixation to keep the forearm fixed in functional rotation position. The function of the elbows were evaluated with the criteria of the HSS2 score system. Results The other wounds healed by first intention except 1 case which had infection 7 days after operation and whose soft tissue defect in posterior elbow were repaired with the pedicle thoracoumbil ical flap. The patients were followed up 6 to 51 mouths (mean 24.9 mouths). The fracture heal ing time was 6 to 20 weeks (mean 9.6 weeks). Six mouths postoperatively, the mean flexion-extension arc of the elbow was 106.5° (85-130°), and the mean pronation-supination arc of the forearm was 138°( 100-160°) respectively. According to the criteria of the HSS2 score, the results were excellent in 4 cases, good in 4 cases, and fair in 2 cases. No compl ications such as stiffness and ulnohumeral arthrosis occurred. The radial nerve injury was found in 1 patient 1 day after operation who was treated with neurolysis, and the nerve function was recovered after 4-6 months. And heterotopic ossification occurred in 6 patients 6 months after operation and radiographic subluxation developed in 1 patient 36 months after operation, and conservative treatment weregiven. Conclusion The terrible triad of the elbow can lead to serious elbow instabil ity and should be treated with operationto restore the anatomic structures, to repair the articular capsule and the collateral l igament, using the adjuvant hinged external fixation and early exercise to avoid immobil ization and recover the articular function.
Objective To evaluate the safety and efficacy of steroid withdrawal in modern triple immunosuppressant (Cycloproine/Tacrolimus, Mycophenolate Mofetil and Steroid) on renal transplantation recipients. Methods We searched MEDLINE (1966-Sep. 2005), OVID (1966-2004), EMBASE (1984-2004), The Cochrane Library (Issue 4, 2005), CBMdisc (1994-2005), and handsearched 7 Chinese Journals. Randomized controlled trials (RCTs) adopting modern triple immunosuppressant, and comparing steroid withdrawal (SW), group and steroid continuing group (SC) were selected. The quality of included studies was evaluated and graded according to Cochrane Reviewer’s Handbook 4.2.5, and meta-analysis was performed by using RevMan 4.2.7 software. Results Nine RCTs including 1 681 patients (845 in SW and 836 in SC) were identified. The average follow-up time was 6-12 months. No significant difference was found in using CsA or Tac in modern triple immunosuppressant. The results of our meta-analysis showed: ① the risk of acute rejection was two times higher in SW than SC (RR 2.05, 95% CI 1.54 to 2.72, P lt;0.000 01), mainly Banff grade I (mild) (RR 1.92, 95% CI 1.16 to 3.17, P =0.01); but no significant differences were found on Banff grade II and III between the two groups. ② the rate of graft and patient survival and chronic rejection were the same between two groups. ③ Steroid withdrawal decreased the incidence of opportunistic infection (mainly caused by simplex herpes virus and Candida) and urinary tract infection. While the incidence of CMV and sepsis infection has no significant difference between two groups. Conclusion Steroid withdrawal within 3 months in modern immunosuppressive regimen ① increases the risk of Banff Grade I rejection reaction, but the moderate and severe rejection are similar between the two groups; ② doesn’t affect the rate of graft, patient survival, and chronic rejection; ③ decreases the incidence of opportunistic and urinary tract infection, but doesn’t improve the CMV infection and sepsis. To prophylaxis serious infection, steroid withdrawal is worth considering under sufficient immunosuppressive regimen. The key point is to balance the benefit and harm for individual recipients.
目的 探讨含左氧氟沙星的三联疗法作为一线方案对幽门螺杆菌感染治疗的有效性和安全性。 方法 选择2008年9月－2011年3月125例确诊为幽门螺杆菌感染的初治患者，随机分为雷贝拉唑、阿莫西林联合左氧氟沙星组（A组）和雷贝拉唑、阿莫西林联合克拉霉素组（B组），经治疗7 d后比较两组根除率和不良反应发生率。 结果 A、B组幽门螺杆菌符合方案分析根除率分别为91.8%、77.6%，意向性治疗根除率分别为88.9%、72.6%，A组根除率高于B组，差异有统计学意义（P＜0.05）。A、B组不良反应发生率分别为4.8%、3.2%（P＞0.05）。 结论 以左氧氟沙星、阿莫西林、雷贝拉唑为组合的三联疗法能显著提高幽门螺杆菌感染的初治成功率，不良反应少，安全有效。