Objective To establish better treatment for Monteggia fracture by evaluating the operative effect and function rehabilitation in children.Methods From 1994 to 2001, 78 children with Monteggia fracture ( 30 cases of new fracture, 48 cases of old fracture) were treated with open reduction and internal fixation.The patients were randomly divided into two groups. In the first group( 45 cases, 16 new and 29 old), radiohumeral joint was fixed with a Kirschner wire after reduction and without fixation of ulna fracture; in the second group( 33 cases, 14 new and 19 old), both radiohumeral joint and ulna fracture were fixed with Kirschner wire. Two groups were treated with plastersplint after operation. The effect of operation was evaluated according to the function criteria for bending elbow and rotation of forearm. Results All patients were followed up 6 months to 7 years( 4.6 years on average). All wound healed well without bone nonunion, delayed union and infection after operation. In the first group, 37 cases were rated as excellent, 5 good and 3 poor. The effective rate was 93.3%. In the second group, 22 cases were rated as excellent, 7 good and 4 poor. The effective rate was 87.9%.There was no significant difference between two groups( P＞0.05). Conclusion Surgical treatment is the choice for Monteggia fracture in children. It should be treated with single Kirschner wire fixing after open reduction of radiohumeral and plaster-splint .This method is simple, safe and has satisfactory results in fracture healing and function rehabilitation after operation.
Objective To investigate the clinical outcome of open reduction and internal fixation of calcaneal interarticular fractures. Methods From August 1998, 38 calcanneal interarticular fractures in 35 cases, including 8 of type Ⅱ, 14of type Ⅲ and 16 of type Ⅳ according to Sander’s classification, were treatedby open reduction to restore the posterior articular facet, subtalar facet, Bohler angle and Gissane’s angle, following internal fixation by plastic titanicalloy plate. Thirtythree calcanneal interarticular fractures were followed up for6 to 22 months, 12.3 months on average; and the healing time and joint functionwere evaluated according to Maryland Foot Score System. Results The average healing time of fracture was 7.1 weeks, ranging from 5 to 12 weeks; and the joint function was excellent in 18 calcanneus, good in 13 calcanneus, and the satisfactory rate was 93.9%. Conclusion Open reduction and internal fixation with plastic titanium plate is a good choice for calcaneal interarticular fractures.
Objective To discuss peripheral nerve regeneration under immunosuppression. Methods Current research trends about relationship between peripheral nerve injury and immunoreaction, the experimental result of nerve regeneration after using various immunosuppressors, and the clinical findings after human allogenous hand transplantation were extensively reviewed. Results Peripheral nerve regeneration was accelerated under immunosuppression. Conclusion Peripheral nerve injury may induce immunoreaction, which inhibit nerve regeneration and function recovery.
ObjectiveTo investigate the clinical outcome of application of joint prosthesis in limb salvage treatment of mildmalignant tumor at the articular ends of femurs, with severe osteolysis. Methods The treatment of 15 cases of mildmalignant tumor at the articular ends of femurs with severe bone destruction, from 1978 to 1999, was reviewed. There were 10 cases of giant-cell bone tumor and 5 cases of chondrosarcoma, among which there were 5 cases at the stage ofⅠA, 9 cases at ⅠB, and 1 case at ⅡA, with 4 cases at the proximal end and 11cases at the distal end. The tumor was totally removed, with a massive bone defect left at the foci, and then the prosthesis replacement was performed to reconstruct the articular joint. All of the 15 patients were followed up for 9 monthsto 20 years, 4 years and 3 months on average, before clinical evaluation. Results All of the wound healed well, with primary healing. Local relapse occurred in one case and the patient died of lung metastasis; the amputation of the replaced knee joint was performed in one case due to severe infection after trauma; radiograph showed there was slight sunk of the prosthesis in 2 cases after replacement. The other 11 cases recovered well with satisfactory function. Conclusion The limb salvage treatment of mildmalignant tumor at the articular ends of femurswould be available, especially for those with massive bone destruction, when the tumor is removed by whole and rationally marginal resection, followed by properlyutilization of prosthesis and general post-operative exercise.
Objective To investigate the relationship between expression of retinal intercellular adhesion molecule-1 (ICAM-1) and blood-retinal barrier (BRB) rupture and therapeutic effect of intravitreous injection with triamcinolone acetonide (TA) on blood-retinal barrier rupture in rats with diabetes mellitus (DM). Methods Diabetic model of Wistar rats was induced and were divided into normal control group, DM-4-month group and DM-6-month group. Each group was subdivided into immunohistochemcial staining and BRB measurement groups. BRB measurement group was further divided into non-TA treatment group, 1-week-TA treatment group, and 2-week-TA treatment group. The rats were intravitreously injected with 5 mu;l TA. The digested retinal preparation was stained by immunohistochemcial method to observe the expression of retinal ICAM-1 and morphological changes. The mean optic density (A) value of endothelial cells was measured by image-analyzing software to quantify the expression of ICAM-1. BRB changes were measured by content test of retinal Evans blue (EB). Results In the immunohistochemcial staining groups, there was no significant positive expression of ICAM-1 in retinal capillary in control group. Compared with the control, there was significant positive expression of ICAM-1 in DM-4-month group (P＜0.001) with some morphological changes such as irregular width of capillary caliber, and there was enhanced positive expression of ICAM-1 in DM-6-month group (P＜0.001) with aggravated morphological changes and even acellular capillary. In the BRB measurement groups, there was no significant difference of EB content(P＞0.05) among control groups. The EB content in two DM groups significantly increased compared with that in the controls (Plt;0.001), and higher in DM-6-month group than that in DM-4-month group (Plt;0.01). In TA treatment groups, the EB content in all the DM groups significantly decreased (Plt;0.001) but with no significant difference among the groups(P＞0.05). EB content in DM-4-month group after 2-week treatment almost reached to normal value (P＞0.05) while was higher in the rest of TA treatment groups than that in the control group (Plt;0.05). Rectilinear correlation between A value of endothelial cells and the retinal EB content(r=－0.959)was found. Conclusion There is a positive relation between the expression of ICAM-1 and BRB rupture in retina of DM rats, and intravitreous injection with TA can effectively alleviate BRB rupture. (Chin J Ocul Fundus Dis, 2006, 22: 24-27)
Objective To evaluate the efficacy of transpupillary thermotherapy（TTT）on three kinds of intraocular benign tumors. Methods Seventeen patients with 3 kinds of intraocular tumors，3 eyes of 3 patients with papillary hemangioma，9 eyes of 9 patients with choroidal hemangioma and 8 eyes of 5 patients with choroidal osteoma were treated with transpupillary thermotherapy.All patients underwent pretreatment ocular examination，including visual acuity，biomicroscopy for anterior segment and fundus examination，fundus fluorescein and indocyanine green angiography，optic coherence tomography，perimetry test，ultrasonography，and CT.TTT was conducted with infrared diode laser at810nm.with power of 360-1200 mW;beam diameter of 3 mm or combined 2-5 spots according to the tumor size;the exposure time was 60-80 seconds.The treatment was completed in one session，and another treatment was given 1-3 month later if active leakage demonstrated.The follow-up period was 6-36 months（mean 14.5 month）. Results The best corrected visual acuity with Snellen chart on average for papillary hemangioma was 0.17 before TTT and 0.27 after;for choroidal hemangioma was 0.39 before TTT and 0.46 after;for choroidal osteoma was 0.20 before TTT and 0.31 after.Three eyes with papillary hemangioma had operation to release subretinal fluid and intraocular laser coagulation;the tumor remained reddish color with dilated vessels and patches of hemorrhages on the surface.After TTT the color appeared pale yellowish，hemorrhages absorbed，subretinal fluid subsided，and choroidal retinal atrophy disclosed along the lower border of the tumor.In 9 eyes with choroidal hemangioma, the red-light area disappeared, subretinal fluid subsided, and the pigment proliferation in the treatment area was found.Eight eyes with choroidal osteoma had choroidal neovessels and macular hemorrhages;after TTT blood disappeared，subretinal fluid absorbed，and the color of tumor showed pale yellow with dark pigment and thin scar tissue.There was no significant complication associated with TTT. Conclusions Transpupillary thermotherapy is effective on papillary hemangioma，circumscribed choroidal hemangioma and choroidal osteoma either as preliminary or supplementary treatment. (Chin J Ocul Fundus Dis, 2006, 22:181-184)
Objective To investigate the expression of connective tissue growth factor（CTGF）in human proliferative membranes of proliferative vitreoretinopathy（PVR），and the relationship among CTGF，transforming growth factor-beta; receptor（TGF-beta;R）and extracellular matrix（ECM）. Methods Immunohistochemistry method of streptavidin-biotin-peroxidase complex（SABC）was used to detect the expression of CTGF，TGF-beta;RⅡ，fibronectin（FN），collagen Ⅰ，and collagen Ⅲ protein in43periretinal membranes（PRM）of PVR obtained by vitrectomy，and the correlations of the expression of CTGF，TGF-beta;RⅡ and ECM were analyzed by statistics. Results CTGF and TGF-beta;RⅡ protein highly expressed in PRM of PVR and most of the CTGF-positive cells were epithelial cells.The result of immunohistochemistry showed that the positive rates of CTGF and TGF-beta;RⅡ protein were 70.6% and 76.5%in PVR C membranes，and 73.9% and 69.6%in PVR D membranes respectively.Relationship between positive expression and membranesprime; grades appeared no statistical correlation(P＞0.05).Statistical analysis showed that there was a correlation between the expression of CTGF and TGF-beta;RⅡ，FN，and collagen Ⅰ and Ⅲ protein，respectively. Conclusions The expression of CTGF and TGFbeta;RⅡ protein is up-regulated in PRM of PVR，which suggests that the activation of TGF-beta;RⅡ is involved in the production of CTGF，and CTGF is closely related to the production of ECM and play an important role in the pathogenesis of PVR. (Chin J Ocul Fundus Dis, 2006, 22: 192-195)
Objective To investigate the effect of methylprednisolone on the expression of glial fibrillary acidic protein (GFAP) and proliferating cell nuclear antigen (PCNA) in Müller cells of rats’ retinae injured by laser. Methods Forty SD rats were randomly divided into two groups and inflicted with laser photocoagulation.The rats in treatment group were given methylprednisolone by intraperitoneal injection with a dose of 30 mg/kg for 3 days.At the 3rd,7th,14th,and 28th day after photocoagulation respectively, the eyes were enucleated,fixed and cut into sections.Immunohistochemical examination was used to detect the expression of PCNA and GFAP. Results After photocoagulation the Müller cells expressed PCNA both in the treatment and control group,and the expression of PCNA decreased sharply after 3 days. The expression of PCNA in treatment group was less than that in control group. After photocoagulation the Müller cells also expressed GFAP and the expression of GFAP lasted for at least 28 days ,and the expression of GFAP expression in the treatment group was less than that in the control group. Conclusion Methylprednisolone can reduce the expression of GFAP and PCNA in Müller cells of rats’ retinae injured by laser. (Chin J Ocul Fundus Dis, 2002, 18: 299-301)
Objective To study the progressive development of the retinas through an observation on the histological changes of the retinas from neonatal mice of different day-ages. Methods The retinas from the mice of 1 to 20 days of age were examined by light microscopy,and from 1 to 3 days,by autoradiography. Results The retinas of the mice below 3 days of age only had the RPE cells layer,the neuroblast layer and the ganglion cell layer.With the increase in dayage,the retinas developed gradually and would be mature in the 20th day. Conclusions The retinas of mice is a kind of immature tissue before the 20th days,so it can be considered as transplantation donors. (Chin J Ocul Fundus Dis, 1999, 15: 174-176)
Objective To determine whether the vitreous cavity and the subretinal space of different species animals support the induction of immune deviation to soluble antigen and to observe its maintenance time. Methods Bovine serum albumin(BSA)was used as a soluble antigen and inoculated into the anterior chamber(AC),the vitreous cavity(VC)and subretinal space of different animals(rat,rabbit and monkey)respectively.Recipient animals were immunized with BSA and complete Freundrsquo;sadjuvant. Delayed-type hypersensitivity(DTH)was assessed by skin challenge.The maintenance time of deviant immune response was evaluated in the fixed time interval. Results All the animals receiving intraocular antigen inoculation did not display DTH reaction.The maintenance time of immune deviation after inoculation of antigen in different sites is (1)anterior chamber:70 days in rat,90 days in rabbit,320 days in monkey;(2)vitreous cavity:100 days in rat,１50 days in rabbit,360 days in monkey;(3)subretinal space:50 days in rat,70 days in rabbit,300 days in monkey. Conclusions The maintenance time of immune deviation varied with different species of animals and different intraocular compartment.The evolution of organisms is synchronous with that of immune system. (Chin J Ocul Fundus Dis, 1999, 15: 170-173)