Objective We searched and reviewed medical evidence to find the guide of treatment for local advanced nasopharyngeal carcinoma. Methods Firstly, we put forward clinical questions. Secondly, we searched medical evidence from Medline (1985-2002), Embase (1984-2000), Cochrane library (2002.1) and ACP. And then we reviewed the results. The key words we used were "nasopharyngeal carcinoma, chemotherapy and radiotherapy randomized" and "meta analysis or randomized control trial". Results Through searching, we got 17 papers including 1 systematic review and 16 randomized control trials, in which there were 8 prospective randomized phase Ⅲ trials. Most of these trials concluded that combination chemo-radiotherapy were better than radiotherapy alone. We think these results were suitable for our patient’treatment decision. Conclusion To treat our patients,we choosed the method of the mutimodality of squeitial neoadjuvant chemotherapy, concurrent chemo-radiotherapy and adjuvant chemotherapy with the drug doses down-adjusted.
We have performed guided chemoembolization on 84 patients of moderate and advanced carcinoma of liver using adriamycin lipiodol emulsion (A/L) since 1986. Result showed that the rate of improvement of symptoms was 86.1%, in 75% cases the AFP were decreased and in 79.2% the size of tumor were reduced. The mean survival time was 10.3 months which was much higher than that of the control group (5.6 months,Plt;0.001). THe survival rates of 1/2,1,2,3 year were 89.3%,43.4%,13.5% and 3.8% respctively that were significantly higher than those of the control group (51.2%, 11.5%,0) (Plt;0.01). Three patients underwent secondary resection after using A/L chemoembolization ans gelatin spinge central embolization with a longer survival rate. This may be a good method of treatment to the nonresectable liver cancers and may also be an easy way for postoperative observation.
【Abstract】 Objective To research the method and effectiveness of V-Y advancement of skin flap pedicled with the upper limb lateral branch in the treatment of small skin defect in the dorsal elbow. Methods Between March 2008 and August 2010, 6 cases of skin defect in the dorsal elbow were treated by V-Y advancement of skin flap pedicled with the upper limb lateral branch, including 4 males and 2 females with a mean age of 53 years (range, 16-76 years). Defects were caused by crushing in 3 cases, by punching in 2 cases, and the disease duration was 4 hours 30 minutes to 7 days (mean, 29.5 hours); and by chronic infection in 1 case, and the disease duration was 12 months. The defect size ranged from 4.0 cm × 2.5 cm to 9.5 cm × 3.5 cm, all complicating by bone or tendon exposure. The flap size ranged from 6.0 cm × 4.0 cm to 12.5 cm × 9.5 cm; the donor sites were sutured directly. Results All flaps survived completely, wounds and incisions at donor sites healed by first intention. Six cases were followed up 6-12 months after operation. The flaps had good texture and color. Two-point discrimination of the skin flap was 12-16 mm. The function of limb was normal, and elbow flexion and extension activity averaged 105° (range, 95-125°). Conclusion It is ideal to treat small skin defect in the dorsal elbow with V-Y advancement of skin flap pedicled with the upper limb lateral branch because of easier operation and less injury at donor site.
ObjectiveTo compare the effectiveness of anterior cruciate ligament (ACL) reconstruction between the ligament advanced reinforcement system (LARS) and bone-patellar tendon-bone (BPTB) autograft. MethodsBetween July 2007 and July 2011, 50 cases (50 knees) of ACL injury were treated with LARS in 24 cases (LARS group) and with BPTB in 26 cases (BPTB group), respectively. There was no significant difference in age, gender, time from injury to surgery, and injury reason between BPTB group and LARS group (P gt; 0.05). The postoperative rehabilitation protocol was performed in 2 groups. ResultsAll incisions healed at the first stage. All patients were followed up 2-3 years. The results of Lachman test, anterior drawer test, and pivot shift test were negative. Screw loosening in femur and tibia occurred in 1 case of each group respectively, anterior knee pain in 2 cases of BPTB group and in 1 case of LARS group. The Lysholm and Tegner scores were significantly higher in LARS group than in BPTB group at 2 and 6 months after operation (P lt; 0.05); but no significant difference was found between 2 groups at 12 and 24 months (P gt; 0.05). The IKDC scores showed no significant difference between 2 groups at different time points after operation (P gt; 0.05). During follow up, KT-1000 arthrometer and knee stability showed significant differences in antedisplacements of the tibia between 2 groups at all time points after operation (P lt; 0.05). ConclusionLARS has less trauma and earlier functional recovery than BPTB autograft for ACL reconstruction, but the long-term effectiveness is similar.
Objective To investigate the therapeutic effect of V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery for skin defect at the same dorsal finger. Methods Between January 2008 and February 2010, 15 cases of skin defect at the same dorsal finger were treated. There were 9 males and 6 females, aged 15-72 years (mean, 43 years). Defect was caused by saw machine in 6 cases, machines crush in 7 cases, and cutting nodule in 2 cases. The locationswere distal dorsal finger in 2 cases, middle dorsal finger in 6 cases, and proximal dorsal finger in 7 cases. All cases compl icated by exposure of tendon and bone. The size of defect ranged from 0.8 cm × 0.5 cm to 1.4 cm × 1.0 cm. The interval between injury and operation was 3-8 hours. All fingers were treated by V-Y advancement flap from the dorsal cutaneous branch of digital artery, which size was 1.2 cm × 0.8 cm-2.5 cm × 1.0 cm, and the donor site was directly sutured. Fracture reductionand Kirschner wire for internal fixation were performed in the patients with fracture; extensor tendon was repaired with 4-0 thread in the patients with tendon injury. Results All flaps survived completely. The incisions of donor and recipient sites healed by first intention. Ten cases were followed up 6 months to 2 years after operation. The flaps had good texture, color, and appearance; 2-point discrimination of the V-Y flap was 10-12 mm. X-ray examination showed that all finger fractures healedsuccessfully in 5 cases, with an average bone union time of 6 weeks (range, 5-8 weeks). According to the criteria for function assessment by total active motion, the results were excellent in 8 cases, good in 1, and fair in 1 with an excellent and good rate of 90%. Conclusion It is an ideal method to treat skin defect at the same dorsal finger with V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery.
Objective To review researches of treatment of peripheral nerve injury with neuromuscular electrical stimulation (NMES) regarding mechanism, parameters, and cl inical appl ication at home and abroad. Methods The latest original l iterature concerning treatment of peri pheral nerve injury with NMES was extensively reviewed. Results NMES should be used under individual parameters and proper mode of stimulation at early stage of injury. It could promote nerve regeneration and prevent muscle atrophy. Conclusion NMES plays an important role in cl inical appl ication of treating peripheral nerve injury, and implantable stimulation will be the future.
Objective To explore the operative techniques and prel iminary cl inical effect of arthroscopic reconstruction of posterior cruciate l igament (PCL) using l igament advanced reinforcement system (LARS). Methods From June 2006 to July 2007, 9 patients with PCL rupture were treated with LARS under arthroscopic observation. There were 8 males and 1 female, aged 23-49 years old. The left knee was involved in 3 cases and the right knee in 6 cases. The main causes of injuries were sports in 5 cases, fall ing in 1 case and traffic accident in 3 cases. The time from injury to reconstruction was6-20 days (13.6 days on average). There were 2 cases with associated medial meniscus injury and 1 with lateral meniscus injury. X-ray films showed no avulsion fracture of tibial plateau was found. The preoperative Lysholm score was 40-55 (50 on average). According to the preoperative international knee documentation commitee (IKDC) grading, 1 case was graded as C and 8 as D. The Lachman test showed that there was 1 case (+), 6 cases (++) and 2 cases (+++). The operation was performed under arthroscopic observation. The tibial isometric point and tunnel were drilled with the help of a drill bit guide, while the femoral isometric point and tunnel were drilled under the C-arm X-ray machine. The diameter of the bone tunnels was 6 mm, while the diameters of LARS artificial l igaments and canulated interference screws were 7 mm. Results All the patients were regularly followed up for 8-16 months (10.5 months on average). The postoperative Lysholm score was 70-95 (85 on average). There were 5 cases of excellent, 3 of good and 1 of fair, with the choiceness rate of 88%. The postoperative IKDC grading showed that 7 cases were graded as A and 2 as B. The Lachman test showed that no case was positive. Compl ications such as infection, spontaneous rupture or laxity of graft were not observed. Conclusion PCL arthroscopic reconstruction with the use of LARS artificial l igaments leads to a good anatomic reconstruction and knee function with minor injury, rapid recovery and satisfactory cl inical effect.
Objective To review researches of the role of inhibitorof differentiation 2(Id2) in skeletal muscle regeneration. Methods The latest original literature concerning Id2 and its role in skeletal muscle regeneration was extensively reviewed. Results Id2 could form heterodimers by combining with E protein to prevent myogenic regulatory factors (MRFs) forming heterodimers by combining with E protein, to inhibit the transcription activity of MRFs anddifferentiation of skeletal muscle cell. Conclusion Id2 plays an important role in skeletal muscle regeneration.
Objective To investigate the research advance in repair of the peripheral nerve defect with an acellular nerve allograft. Methods The recent related literature was extensively and comprehensively reviewed. The methods and the effects of the allografts with acellular nerves were analyzed. Results The immunogenicity of the allograft was more significantly relieved by the chemical treatment than by the physicaltreatment. The effect of the chemical treatment on the axon regeneration was better than that of the physical treatment. Conclusion Because of the limitation of the host Schwann cell translation in the longsegment acellular nerve allografts, the effect of Schwann cells is not satisfactory and regeneration of the nerve is limited. So, the recellularized treatment with some related measures can enhance the host Schwann cell translation so that this problem can be solved.