Objective To assess the clinical effect of microsurgicaltreatment for bone defect of the first carpometacarpal joint. Methods From February 2001 to August 2004, the pedicled free graft of second tarsometatarsal joint was transplanted to repair bone defect of the first carpometacarpal joint according to the shape and area of tissue defect of hand in 3 patients. The dosalis pedis flap was simultaneously used to repair soft tissue defect of carpometacarpe and the big thenar in 2 cases. The donor site was sutured directly or covered byintermediate thickness skin flap. Results The vessel of the bone flaphad constant anatomical location，the operation procedure was easy. Moreover it had minimal effect ondonor, the flap of dosalis pedis could be used to repair soft tissue defect in this area. Three cases were followed up 1 to 2 years.The shape of the reconstituted thumb was normal. The healing time of clinical fracture of the first carpometacarpal joint was 2 to 3 months. The function recovery of the reconstituted thumb was satisfactory. Conclusion It is an effective method to repair bonedefect of the first carpometacarpal joint with the pedicled second tarsometatarsal joint graft.
Objective To evaluate the value of the application of laparoscopic hepatectomy in hepatolithiasis. Methods The clinical data of 35 patients with hepatolithiasis performed with laparoscopic hepatectomy were analyed retrospectively. Operations included laparoscopic left lateral sectionectomy， left hemihepatectomy， cholecystectomy， choledocholithotomy， choledochoscopy， and T-tube drainage. Results All operations of 35 patients were performed complete laparoscopically. The mean operative time was 205 minutes （150-370minutes）. The mean blood loss was 330mL（50-1 000mL）. Patients felt less pain without administration of painkillers after operation. Ambulation resumed on thefirst day and liquid diet resumed on the second day after operation. The average hospital stay was 12.7 days （4-15d）. There was no death. The excellent and good rate of operation was 71.4% and 25.7%， respectively. Conclusion Laparoscopic hepatetomy is an effect and minimally invasive alternative method for hepatolithiasis in slective patients.
ObjectiveTo explore the clinical effects of exogenous glutamine on patients suffering from sepsis with hypoalbuminemia in emergency department. MethodsEighty-six patients with sepsis and hypoalbuminemia enrolled from January to November 2013 in the Emergency Department of our hospital were randomly divided into treatment group and control group. Forty-three patients in the control group were given conventional treatments, while the other 43 in the treatment group were treated with glutamine therapy based on the conventional treatments. The clinical efficacy of the two groups including inflammatory markers, albumin level, APACHEⅡ score and SAPSⅡ score, mortality, length of hospital stay were analyzed on day 7, 14, and 28 after being enrolled. A comprehensive analysis of the clinical effects in these two groups was performed. ResultsEighty-six cases were enrolled in this study. The mortality on day 14 and 28 in the treatment group was significantly lower than that in the control group (P<0.05). Inflammatory markers (WBC count, CRP concentration, and PCT concentration) in patients of the treatment group were gradually decreased, whereas serum albumin levels were gradually increased compared with the control group (P<0.05). The cure rate of patients in the treatment group was significantly higher than that in the control group, while the average length of stay was shorter than the control group (P<0.05) on day 28. ConclusionExogenous glutamine supplementation can improve patient cure rates and reduce hospital stays which has good clinical effects on patients with sepsis and hypoalbuminemia in emergency department.