OBJECTIVE: To explore a method to treat the mostly-isolated finger with its bilateral arteria injury without microsurgery. METHODS: To avoid exacerbating iatrogenically the wound, the methods of therapy mainly included the following procedures: debriding carefully, suturing the cutis and subcutaneous layer to fix internally the fracture without Kirschner wire, and not suturing the broken finger nerve or the broken tendon which had rebound. It was used in the emergency operation. After operation, heat therapy and Anisodamine were used to dilate capillary and micrangium of the unbroken soft tissue of the wounded finger, which was anatomically the only base of blood supply of pars of the wounded finger. RESULTS: In the 34 cases, main blood supply of the wounded finger was restored. The wound healed well in 28 cases. In 6 cases of necrosis in the edge of the wound, the necrosis were excised and the cicatricial healing was achieved. In 31 patients followed up, after the fracture had healed, the nerve and tendon were repaired. CONCLUSION: The methods above should be available for the mostly-isolated finger, especially in a hospital without microsurgery.
ObjectiveTo discuss the key nursing points for patients with infective endocarditis and congenital isolated kidney after valve replacement. MethodsIn December 2012, one infective endocarditis patient with isolated kidney underwent heart valve replacement in our hospital. In addition to actively preventing postoperative infection of the heart valve, our nursing focused mainly on the isolated kidney protection and monitoring, and the related complications. ResultsThe surgery was successful, and the isolated kidney was effectively protected. The patient recovered and was discharged from the hospital. ConclusionFor patients with congenital isolated kidney with infective endocarditis, patients' urine output per hour and 24 h discrepancy quantity should be closely observed after valve replacement surgery. It is also very important to intervene early and carry out comprehensive protection of the renal function.
Objective To summarize selection of therapeutic method for isolated iliac aneurysms and analyze its advantages and disadvantages. Method The clinical data of 21 patients with isolated iliac aneurysms from January 2006 to January 2017 in this hospital were analyzed retrospectively. Results Four patients were treated with an open surgery such as the unilateral iliac prosthetic graft interposition, aorto-biiliac or aorto-bifemoral arterial bypass graft, ligation of internal iliac artery, etc.. Seventeen patients were treated with an endovascular treatment such as the unilateral iliac stent-grafts, bifurcated aortic stent-grafts, or coil embolization alone, etc.. One patient with ruptured isolated iliac aneurysms died during the endovascular repair, and the rest patients were cured after the operation. The average operative time was 2.83 h and 1.58 h, the average hospital stay was 17.5 d and 7.7 d respectively for the patients with the open surgery and the endovascular treatment. Except 1 case of type Ⅰ and 1 case of type Ⅱ endoleaks were found in the patients with the endovascular treatment, no complications such as the ureteral and intestinal injuries, the gluteal muscle claudication, and the sigmoid ischemia were found in all the patients. Seventeen cases were followed-up. The following-up rate was 85%. The following-up time was 1–60 months with an average of 22 months. During the following-up period, the grafts and stent grafts were patent and the aneurysm sac diameter was unchanged. The abscess of the iliac fossa occurred in 1 patient with systemic lupus erythematosus and improved after the symptomatic treatment. Two patients died of other diseases during the following-up period, and the rest had no obvious clinical symptoms. Conclusions Preliminary results of limited cases in this study show that endovascular repair and open surgery in treatment of appropriately selected patients with isolated iliac artery aneurysms is safe and effective. But in special situation, technical controllability of open surgery might be better than endovascular repair, treatment should be selected according to patient’s general condition and anatomy of aneurysm.
Stereo-electroencephalography (SEEG) is widely used to record the electrical activity of patients' brain in clinical. The SEEG-based epileptogenic network can better describe the origin and the spreading of seizures, which makes it an important measure to localize epileptogenic zone (EZ). SEEG data from six patients with refractory epilepsy are used in this study. Five of them are with temporal lobe epilepsy, and the other is with extratemporal lobe epilepsy. The node outflow (out-degree) and inflow (in-degree) of information are calculated in each node of epileptic network, and the overlay between selected nodes and resected nodes is analyzed. In this study, SEEG data is transformed to bipolar montage, and then the epileptic network is established by using independent effective coherence (iCoh) method. The SEEG segments at onset, middle and termination of seizures in Delta, Theta, Alpha, Beta, and Gamma rhythms are used respectively. Finally, the K-means clustering algorithm is applied on the node values of out-degree and in-degree respectively. The nodes in the cluster with high value are compared with the resected regions. The final results show that the accuracy of selected nodes in resected region in the Delta, Alpha and Beta rhythm are 0.90, 0.88 and 0.89 based on out-degree values in temporal lobe epilepsy patients respectively, while the in-degree values cannot differentiate them. In contrast, the out-degree values are higher outside the temporal lobe in the patient with extratemporal lobe epilepsy. Based on the out-degree feature in low-frequency epileptic network, this study provides a potential quantitative measure for identifying patients with temporal lobe epilepsy in clinical.
ObjectiveTo observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus.MethodsBetween January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days).ResultsAll 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred.ConclusionThe self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.
ObjectiveTo summarize the clinical morphological classification feature of symptomatic spontaneous isolated celiac artery dissection (SICAD), basing on the relative diameter of the true lumen (TLRD) and type of lesion, and then summarize the reasonable clinical treatment strategies and timing of arterial reconstruction.MethodsRetrospectively analyzed the imaging data, treatment methods, perioperative complications, and follow-up results of 26 symptomatic SICAD patients admitted to the Department of Endovascular Surgery of The First Affiliated Hospital of Zhengzhou University from May 2012 to May 2019, patients were divided into conservative treatment group (n=12) and endovascular intervention group (n=14) according the treatment, and then compared the clinical data of the two groups.ResultsTwelve patients in the conservative treatment group had an average of 12.6 days (5–22 days) and discharged from hospital with better condition, of which 11 patients’ TLRD≥30%. In the endovascular intervention group, 2 patients continued to aggravate the symptoms at the 3rd day of admission and received endovascular intervention, the remaining 12 patients’ symptoms were not significantly relieved or the symptoms reappeared after averaged 11.4 days, whose TLRD<30% or diameter >1.5 cm. Compared with the endovascular intervention group, the duration of symptoms was shorter (P=0.04), proportions of back pain (P=0.02) and chest pain (P=0.04) were lower, TLRD value and proportion of TLRD value>30% (subtype of a) were higher (P=0.01, P=0.02). The average follow-up duration of 26 patients was 28.2 months (12–83 months). The follow-up results of all patients in the conservative treatment group were good and no relevant symptoms had appeared since discharge. One patient in the endovascular intervention group had transient liver function damage, 1 patient had severe deformation of the proximal end of the stent at 1 year after implantation of the celiac artery stent. The remaining patients were stable with no progress.ConclusionsFor symptomatic SICAD, if the clinical symptoms are stable after hospitalization, conservative medication and close imaging follow-up are preferred, if there is no relief of symptoms, continuous organ perfusion and other manifestations based on medication, endovascular intervention can be considered for arterial reconstruction, the early and medium follow-up results were satisfactory under this treatment algorithm. In addition, there are differences in TLRD value between the conservative treatment group and the endovascular intervention group, suggesting that TLRD as the morphological characteristics of the classification has a potential guiding significance for the development of clinical treatment strategy.
Objective To investigate the clinical features and prognosis of acute isolated corpus callosum infarction. Methods The clinical and imaging data of patients with acute isolated corpus callosum infarction diagnosed in the Department of Neurology of Beijing Geriatric Hospital and the Department of Neurology of China-Japan Friendship Hospital from February 2017 to February 2021 were retrospectively selected. Patients were divided into groups according to infarction location, infarction size and prognosis. According to the infarction location, the patients were divided into single-site lesion group and multi-site lesions group. According to the infarction size, the patients were divided into large lesion group and small lesion group. According to the prognosis, the patients were divided into good prognosis group and poor prognosis group. The clinical characteristics, etiology and prognosis of these diseases were observed and analyzed. Results A total of 52 patients were included. Among them, there were 32 males (61.5%) and 20 females (38.5%), with an average age of (65.4±7.1) years. The most common risk factors were hypertension (44 cases, 84.6%), hyperlipidemia (32 cases, 61.5%), and diabetes (28 cases, 53.8%). The most common infarction site was splenium in the single-site lesion group (24 cases, 46.2%). The vast majority of patients (92.3%) had nonspecific clinical symptoms, and only 4 (7.7%) had corpus callosum disconnection syndrome. In the TOAST etiological classification, Large-artery atherosclerosis (LAA) was the most common (25 cases, 48.1%), followed by small-artery occlusion (14 cases, 26.9%), the responsible vascular lesions were the most common in the P1/P2 segment of posterior cerebral artery (10 cases) and the A1/A2 segment of anterior cerebral artery (9 cases). There was no significant difference in etiology between the groups with different infarction location and the groups with different infarction size (P>0.05). Forty-four cases (84.6%) had a good prognosis, and 8 cases (15.4%) had a poor prognosis. Combined with multiple risk factors, multiple involvement of lesions and large infarction size were associated with poor prognosis (P<0.05). Conclusions Acute isolated corpus callosum infarction is a rare type of ischemic stroke, with the most common involvement of splenium. Its clinical manifestations are mostly nonspecific, and a few may be manifested as disconnection syndrome. The etiology is mostly LAA, and the overall prognosis of such patients is good, and the poor prognosis may be related to the combination of multiple risk factors and the wide range of infarcts.
IgG4-related disease is an immune-mediated chronic inflammatory disease with fibrosis, which can affect almost all organs in the body. In a few cases, only a single organ is affected. The incidence of isolated IgG4-related mediastinal disease is even rarer. This article reports a rare case of isolated IgG4-related middle mediastinal disease and provides a detailed description of its diagnosis and surgical treatment. The patient had a good prognosis and did not receive any medication such as corticosteroids after surgery. Follow-up after 6 months showed no recurrence.
Objective To investigate the surgical approach and efficacy of reconstruction of the isolated left vertebral artery (ILVA) in single upper hemisternotomy for total aortic arch replacement. Methods From March 2017 to October 2023, patients who underwent total aortic arch replacement under single upper hemisternotomy in General Hospital of Northern Theater Command were selected. According to the presence of ILVA, they were divided into a conventional group and an ILVA group. All the ILVA group underwent intraoperative ILVA reconstruction. The perioperative clinical data between two groups were compared. Results A total of 504 patients were collected, including 471 males and 31 females, with an average age of 50.4±11.4 years. There was no increase in the duration of cardiopulmonary bypass or postoperative hospitalization in the ILVA group (n=31) compared to the conventional group (n=473), and the rates of perioperative complications and in-hospital mortality were not significantly different between the two groups. There were 2 (6.45%) patients of acute cerebral infarction and 2 (6.45%) patients of perioperative death in the ILVA group, with no spinal cord injuries. Conclusion ILVA reconstruction during total aortic arch replacement in single upper hemisternotomy is feasible, safe, and effective, and prioritizing off pump ILVA-left common carotid artery transposition.
ObjectiveTo investigate the impact of anatomical variations of the isolated left vertebral artery (ILVA) on clinical outcomes and imaging outcomes in patients with Stanford type B aortic dissection (TBAD) who underwent thoracic endovascular aortic repair. MethodsThe clinical data of patients with TBAD in West China Hospital, Sichuan University from January 2016 to December 2023 were collected, and the differences of clinical outcomes and imaging outcomes between patients with and without ILVA were compared. ResultsBased on the inclusion criteria and the result of propensity score-based matching, 82 patients with TBAD were included, including 17 patients with ILVA (ILVA group) and 65 patients without ILVA (control group). There was no significant difference between the two groups in terms of the radiological and surgical information (P>0.05). The median time of the follow-up for these 82 patients were 37 months, during which there were no significant differences in aortic-related death, aortic event, stroke, adverse aortic remodeling, type Ⅰ A endoleak, and retrograde progression between the two groups (P>0.05). Compared with the control group, the re-intervention rate [HR=2.56, 95%CI (1.55, 8.11), P=0.03] and the incidence of type Ⅱ internal leakage [OR=1.36, 95%CI (1.08, 2.11), P=0.04] in the ILVA group were higher. ConclusionsNo significant differences were observed for ILVA patients in terms of serious adverse events such as aortic-related death and retrograde progression, comparing with the patients with normal aortic arch. However, the patients with ILVA were more susceptible to complications such as reintervention and type Ⅱ endoleak, which warranted the necessity of intensive postoperative follow-up for these patients.