Objective To review the progress in the diagnosis and treatment of tarsal coal ition. Methods Recent l iterature concerning the diagnosis and treatment of tarsal coal ition was reviewed. Results Tarsal coal ition is a bridge between the tarsal bones of the foot. The most common types are talocalcaneal and calcaneonavicular coal itions. Calcaneonavicular coal itions can be diagnosed with an oblique radiograph of the hindfoot. Most talocalcaneal coal itions require computer tomography for diagnostic confirmation. Magnetic resonance imaging may be useful for diagnoses of cartilaginous andfibrous coal ition. Casting is the usual initial treatment for the symptomatic individual. For patients with treatment failure and no degenerative changes, resection of the coal ition can be performed with good results. Isolated subtalar fusion may be performed for patients with failure of talocalcaneal resections. For patients undergoing failure of subtalar fusions and calcaneonavicular resection, tri ple arthrodesis may be performed. During minimally invasive operation, operation indications should be strictly controlled. Conclusion The diagnosis method of tarsal coal ition is clear. The cl inical manifestation combined with imaging examination can improve the diagnosis rate. The surgical indication of tarsal coal ition remains controversial, the randomized prospective studies are still required.
Abstract： Objective To summarize the application experience of Gore-Tex patch in clinical chest wall reconstruction. Methods A retrospective analysis was performed in 33 patients who underwent chest wall reconstruction using Gore-Tex patch from January 2001 to December 2010 in Shanghai Changhai Hospital, Second Military Medical University. There were 19 men and 14 women, ranging in age from 20 to 73 years with a median age of 45.7 years. The surgical strategies included choosing different incisions according to tumor location and size, and preserving normal chest wall soft tissue as much as possible during surgery. Gore-Tex patch was used to reconstruct the huge chest wall defect, and covered by transferred muscle flaps. Results All the 33 patients underwent surgical reconstruction successfully and there was no perioperative death. Complete tumor resection was performed in all the patients, including 25 patients with malignant tumor and 8 patients with benign tumor. The diameter of the resected tumors ranged from 8 to 20 cm. All the patients were followed up from 5 to 60 months, except that 3 patients （9.09%） were lost during follow-up. There was no rejection response, abnormal breathing and foreign body sensation during follow-up. The infection incidence was 3%（1/33）. Conclusion Gore-Tex patch is a safe and effective material for chest wall reconstruction due to its excellent biocompatibility. Appropriate selection of muscle flap for covering Gore-Tex patch can reduce postoperative complications.
Objective To explore the operative method and effectiveness of talocalcaneal coal ition.Methods Between July 2008 and October 2010, 10 patients with talocalcaneal coal ition were treated, including 2 cases ofcongenital talocalcaneal coal ition and 8 cases of secondary talocalcaneal coal ition. There were 4 males and 6 females, aged53.5 years on average (range, 16-70 years). Three patients had middle-facet talocalcaneal coal ition and 7 had posterior-facettalocalcaneal coal ition. The preoperative visual analogue score (VAS) was 9.0 ± 0.4. According to American OrthopedicFoot and Ankle Society (AOFAS) hindfoot scale, the score was 42.4 ± 1.4. Two cases compl icated by subtalar degeneration.Resection of the bone bar and fat packing were performed in 8 cases of simple talocalcaneal coal ition, and resection and subtalararthrodesis in 2 cases of talocalcaneal coal ition combined with subtalar degeneration. Results Primary healing of incisionswas obtained in all patients. Eight patients were followed up 18 months on average (range, 12-36 months). At last follow-up,VAS was 2.0 ± 0.7, showing siginificant difference when compared with preoperative score (t=6.425, P=0.000). AOFAS score was86.9 ± 2.3, showing significant difference when compared with preoperative score (t=7.634, P=0.000). The X-ray films showedthat no recurrence of talocalcaneal coal ition was observed in patients underdoing simple removal of bone bar, and bone fusionwas observed in patients undergoing arthrodesis. Conclusion To achieve satisfactory outcomes for talocalcaneal coal ition, areasonable surgical procedure should be chosen according to the specific facet and complication.
ObjectiveTo investigate the impact of thoracic duct ligation (TDL) on metabolism and postoperative complications during esophagectomy in patients with type-2 diabetes mellitus (T2DM).MethodsWe conducted a retrospective clinical data analysis of 230 esophageal carcinoma patients with T2DM who underwent esophagectomy in our hospital from January 2003 to December 2018. Patients were divided into a TDL+ group (n=112), including 78 males and 34 females aged 63.47±7.23 years, and a TDL– group (n=118), including 84 males and 34 females aged 64.38±7.57 years. We compared the blood glucose, liver function parameters and lipid metabolic parameters at different time points before and after surgery. In addition, we compared the postoperative major complications between the two groups. Propensity score-matched (PSM) was used to control the observed confounders.ResultsCompared with the TDL– group, patients in TDL+ group had higher blood glucose level (P<0.05, except the fourth postoperative day). The total protein and albumin levels on the first and fourth postoperative days in the TDL+ group were lower than those in the TDL– group (P<0.05). The alanine transaminase (P=0.027) and aspartate transaminase (P=0.007) levels on the fourth postoperative day in the TDL+ group were higher than those in the TDL– group. More pulmonary complications (P=0.014) and anastomotic leaks (P=0.047) were found in the TDL+ group.ConclusionGiven that TDL may aggravate metabolic disorders, increase anastomotic leaks and the pulmonary complications, it is cautious to perform TDL, and prophylactic TDL should not be performed routinely for patients with T2DM.
ObjectiveTo investigate the risk factors for lymph node metastasis (LNM) and prognosis of T1-stage esophageal squamous carcinoma (ESC).MethodsClinical data of 387 patients with T1-stage ESC who underwent surgical treatment in our hospital from March 2013 to March 2018 were collected. There were 281 males and 106 females aged 60 (41-80) years. The patients were divided into a lymph node metastasis group (n=77) and a non-metastasis group (n=310). The risk factors for LNM and prognosis were analyzed.ResultsAmong 387 patients with T1-stage ESC, 77 (19.9%) patients had LNM. The incidence of LNM was 8.4% (8/95) in T1a-stage patients and 23.6% (69/292) in T1b-stage patients. Univariate analysis showed that tumor size, differentiation degree, depth of invasion and vascular tumor thrombus were associated with LNM (P<0.05). Multivariate logistic regression analysis showed that invasion depth of tumor [OR=2.456, 95%CI (1.104, 5.463), P<0.05] and vascular tumor thrombus [OR=15.766, 95%CI (4.880, 50.938), P<0.05] were independent risk factors for LNM. The follow-up time was 41 (12, 66) months. The 1-year, 3-year and 5-year survival rates were 98.71%, 89.67% and 86.82%, respectively. Univariate analysis showed statistically significant differences in tumor invasion depth, vascular tumor thrombus and LNM between the survival group and the death group. Cox analysis showed that LNM [OR=3.794, 95%CI (2.109, 6.824), P<0.05] was an independent risk factor for prognosis.ConclusionT1-stage ESC patients with deeper invasion or vascular tumor thrombus have a higher risk of LNM. The prognosis of T1-stage ESC with LNM is relatively poor.