OBJECTIVE To research the result of defect repairing on heel with island-shaped fascial flap of lateral foot. METHODS: Twelve cases of soft tissue defected on heel, who were resulted from trauma, chronic ulcer, chronic osteomyelitis, squamous carcinoma, and necrosis following frozen injury, were treated by transfer of island-shaped fasical flap of lateral foot. RESULTS Only 2 patients suffered marginal necrosis of flap in early stage and healed after changing dressing. The others succeeded completely. All the cases were followed up for 8 to 78 months. There was no recurrence of squamous carcinoma, no fistula or necrosis bone formed. The sensation of the flap recovered. The repaired area was similar to the heel in skin texture. CONCLUSION For the characteristics of heel skin, the transfer of island-shaped fascial flap of lateral foot has the following advantages: Similar structure of skin, reliable nerve and blood supply, simple operative techniques, and large area of donor flap.
ObjectiveTo study the mechanisms of spontaneous rupture of hepatocellular carcinoma and the treatments in the acute phase and the second phase after hemostasis. MethodsRelated domestic and foreign literatures were reviewed. ResultsThe mechanism of spontaneous rupture of hepatocellular carcinoma was still not quite clear. In China, spontaneous rupture of hepatocellular carcinoma was closely related with hepatitis B virus infection. Immune complex deposition in vessel wall led to the injuries of small arteries and bleeding. Treatments included conservative therapy, surgical intervention （lobectomy of liver, hepatic artery ligation, packing, and suturing), transarteial embolization, other medications (percutaneous ethanol injection, radiofrequency ablation, bio-immunotherapy). ConclusionTransarterial embolization has been shown to be highly effective in achieving immediate hemostasis, and can be used as the basis of phase two comprehensive treatment.
To analyze the causes of failure to reduce acute infantile intussusception with gas enema. 441 cases of acute infantile intussusception in our hospital who failed to be reduced with gas-enema, and underwent the operative therapy were analyzed. Result: 92 cases (20.9%) were intestinal necrosis, 184 cases (41.7%) double intussusception, 27 cases (6.1%) organic pathological changes and 8 cases (1.8%) intestinal perforation caused by gas-enema reduction. All the cases had a successful recovery after surgery. Conclusion: The main causes of failure to reduction with gas-enema were as follows: ①double intussusception, ②intestinal necrosis, ③late for visiting a doctor, ④organic pathological changes, ⑤perforation (in the process of gas-enema reduction). The importance of early diagnosis is emphasized.
目的 分析创伤性膈疝的诊断、外科治疗和预后。 方法 对1999年1月-2010年1月收治的16例创伤性膈疝的临床资料进行回顾性分析。 结果 16例均行手术治疗，胸腹腔脏器损伤处理后行膈肌修补，2例手术后死亡，14例痊愈出院。 结论 创伤性膈疝常合并多发伤，胸腹部X线平片、钡餐检查及胸部、上腹部ＣＴ扫描不仅能对膈疝做出正确的诊断，对临床手术指导具有重要的意义。诊断一旦明确，须及时手术治疗，方能降低病死率。
ObjectiveTo review the biological characteristics of self-assembling peptide nanofiber scaffold (SAPNS) and its potential to induce bone repair. MethodsThe literature regarding SAPNS and its application in bone repair was extensively analyzed and reviewed. ResultsSAPNS is derived from natural amino acids, and has the properties of good biocompatibility and non-toxic degradation products. Their microenvironment highly mimics the natural extracellular matrix, and controlled release of growth factors as well as modification with functional motifs can substantially improve their bioactivity. Many studies on cell composite culture and bone defect repair of animal models reveal that SAPNS has the ability to promote the function of bone cells (e.g. adherence, proliferation, and differentiation) in vitro, and enhance new bone tissue formation in vivo. ConclusionSAPNS may be an ideal material for bone repair, but its biologically mechanical properties need further improvement.
Stargardt disease (STGD) is an inherited disorder of retinal pigment epithelium. Three genes have been found to be implicated in STGD including Abca4 (adenosine triphosphate-binding cassette, sub-family A, member 4), Elovl4 (elongation of very long chain fatty acids protein 4) and Prom1 (prominin-1). Target genes can be delivered to the retina by various methods such as lentivirus (LV) vectors, adeno-associated virus (AAV) vectors and non-viral nano-particles. The Abca4-/-, Elovl4-/- and Prom1-/- mice model are used to study the pathogenesis mechanism and treatment of STGD. Retinal function improved significantly upon gene therapy in these models. Based on these works using animal model, phase Ⅰ/Ⅱa clinical trial of Abca4-associated STGD gene therapy are underway. AsaLV vector, equine infectious anemia virus (EIAV) is used to carry the Abca4 gene. These studies will evaluate three dose levels of the EIAV vector for safety, tolerability and biological activity. Moreover, some preclinical attempts to deliver Abca4 via AAV have been made usingamodified AAV vectors because of the large size of the ABCA4 cDNA. The good responses in animal models render STGDavery attractive object for human gene therapy after the successful of the phase Ⅰ/Ⅱ clinical trials of Leber′s congenital amaurosis.
Objective To explore the method and outcome of knee resurfacing arthroplasty in treating late-staged diffuse pigmented villonodular synovitis (PVNS). Methods Between November 2002 and May 2009, 11 cases of late-staged diffuse PVNS were treated, including 3 males and 8 females with an average age of 51.2 years (range, 42-63 years). The diseaseduration was 2.5-10.0 years (mean, 5.2 years). Unilateral knee was involved in all patients, including 7 left knees and 4 right knees. Nine patients had a history of trauma and 2 cases had no obvious inducing factors. The range of motion was (90.1 ± 17.2)° and Hospital for Special Surgery Knee Score (HSS) was 68.9 ± 8.7. After synovectomy, knee resurfacing arthroplasty was performed in all patients. Results Superficial infection of the incision occurred in 1 case at 6 days postoperatively and was cured after debridement; other incisions healed by first intention. Limited flexion and extension, incomplete palsy of common peroneal nerve, and deep venous thrombosis occurred in 1 case respectively, and were cured or improved after symptomatic treatment. All the 11 cases were followed up 38 months on median (range, 13 to 102 months). Two cases developed chronic pain and were not given treatment. Recurrence occurred in 1 case 12 months postoperatively and recovered after synovectomy again. X-ray films showed no signs of loosening, sinking, and bone destruction. At last follow-up, the range of motion was (109.1 ± 18.6)° and HSS score was 86.7 ± 9.3, showing significant differences when compared with those before operation (P lt; 0.05). According to the HSS score system, the results were excellent in 6 cases, good in 3, fair in 1, bad in 1, and the excellent and good rate was 81.8%. Conclusion A combination of knee resurfacing arthroplasty and synovectomy for the treatment of late-staged diffuse PVNS is able to get a good cl inical results in restoration of function, improvememt of the l ife quality, and decrease of recurrence rate.