Total endovascular repair of an intraoperative stent-graft deployed in the false lumen of Stanford type A aortic dissection: A case report

BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.     

Combined surgical and interventional treatment of tandem carotid artery and middle cerebral artery embolus: A case report

BACKGROUND The 2018 American Heart Association/American Stroke Association guidelines for early management of acute ischemic stroke recommend the use of retrievable stents for mechanical thrombectomy in patients with acute internal carotid artery or middle cerebral artery M1 occlusion that can be treated within 6 h from onset.For cases of carotid artery with ipsilateral middle cerebral artery tandem embolization, the operation is more complicated and challenging. We here report a case of a tandem embolism, and the anatomy of the aortic arch was complex.Direct carotid artery incision and thrombectomy can not only prevent the escape of the carotid embolus but also save time during establishment of the thrombectomy access.CASE SUMMARY The patient was a 70-year-old man. He was admitted to hospital due to sudden inability to speak and inability to move his right limb for 3 h. Imaging confirmed a diagnosis of a tandem embolism in the left carotid artery with left M1 occlusion.Carotid artery incision thrombectomy combined with stent thrombectomy was performed. The operation was successful, and 24 h later the patient was conscious and mentally competent but had motor aphasia. His bilateral limb muscle strength level was 5, and his neurologic severity scores score was 2.CONCLUSION Carotid artery incision thrombectomy combined with stenting for carotid artery plus cerebral artery tandem embolization is clinically feasible. For patients with a complicated aortic arch and an extremely tortuous carotid artery, carotid artery incision can be chosen to establish the interventional path.     

胎儿主动脉弓异常的超声诊断线索和方法研究

目的 探讨胎儿主动脉弓异常的超声诊断方法技巧、诊断线索,提高主动脉弓异常的产前超声诊断率.方法 选择2006年1月至2009年12月在我院行产前系统超声检查并获得结果验证的1472例正常和异常胎儿为研究对象,每个胎儿均进行四腔心切面、左右心室流出道切面、三血管气管切面的观察,当怀疑主动脉弓异常时,进一步获得主动脉弓长轴切面和冠状切面及经过气管的冠状切面.结果 产前超声共诊断148例主动脉弓异常,漏诊1例,92例获得结果验证,包括主动脉弓缩窄28例,主动脉弓离断10例,右位主动脉弓及主动脉弓分支异常52例,双主动脉弓2例.24例合并其他严重心脏畸形.主动脉弓缩窄、主动脉弓离断的线索为三血管气管平面均显示主动脉弓内径和动脉导管内径比例失调,主动脉弓内径异常小,四腔心切面显示左心小,左右心不对称;右位主动脉弓及其分支异常在3VTV平面显示主动脉弓位于气管右侧、主动脉弓和动脉导管之间距离增大呈"U"形和(或)在气管后方有发自降主动脉起始段的血管分支-锁骨下动脉.主动脉弓横切面即三血管气管切面、纵切面、冠状切面的显示率分别为 98.4%、90.0%、81.9%.结论 四腔心切面显示左心小,左右心不对称和3VT平面显示主动脉弓内径异常小,主动脉弓与动脉导管内径比例失调是诊断主动脉弓缩窄、离断的线索,主动脉弓和动脉导管之间距离增大是诊断右位主动脉弓的线索,三血管气管平面是诊断主动脉弓异常最易显示和最敏感的切面,主动脉弓冠状切面、纵切面及经过气管的冠状切面对诊断具有补充和鉴别意义.

Abstract：

Objective To study the ultrasonographic clues and methods for fetal anomalies of the aorta arch and improve prenatal detection of anomalies of the aorta arch.Methods One thousand four hundred and seventy-two cases fetus who were carried out detailed scan and whose results were confirmed were chose as study objects.Every routine fetal echocardiography included four chamber and left and right outflow tract and three-vessel trachea view(3VT).The more views which included longitudinal and coronary view of the aorta arch and coronary view of the trachea and main bronchus were obtained when the abnormality of aorta arch was suspected.Results One hundred and forty-eight cases with anomalies of aorta arch were diagnosed by ultrasonography.One case was misdiagnosed.Ninety-two fetus with anomalies of aorta arch which included 28 aortic coarctation(CoA) and 10 interrupted aortic arch (IAA) and 52 right-side aortic arch and abnormal aortic branch and 2 double aortic arch were confirmed by postmortem or postnatal echocardiography and surgery.Of the 92 confirmed cases,24 had prenatally diagnosed additional complex intracardiac anomalies.All cases with CoA and IAA presented ventricular and/or great arterial disproportion with smaller left ventricle and aorta diameter on four chamber view and 3VT.Right aortic arch (RAA) and abnormal aortic branch(AAB) displayed aortic arch located on the right side of the trachea and increased distance between the aortic arch and arterial duct and abnormal aortic arch branch-subclavian artery originating from the beginning section of the descend aorta which coursed behind the trachea with U-shaped appearance on the 3VT plane.The display rate of the transverse and longitudinal and coronary view of the aorta arch was 98.4%,90.0%,81.9%,respectively.Conclusions Disproportional ventricular and /or great arterial with smaller left ventricle and aorta diameter are the clues for CoA and IAA.Increased distance between the aortic arch and arterial duct is the clue for RSA.The transverse view of the aortic arch 3VT is the most sensitive for detecting the anomalies of the aortic arch and the most easily be obtained.The longitudinal and coronary view of the aorta arch and coronary view of the trachea and main bronchus are helpful in differentiating the anomalies of the aortic arch.     

Effect of two kinds of laser combined with ultrashort wave on peripheral facial nerve paralysis

Background:Peripheral facial nerve paralysis referred to injury of peripheral nerve trunk and its branches due to direct of rindirect force.Physiotherapy could decrease ischemia.Swelling of nerve tissue and degeneration of myelin sheath and axon.Helium neon laser.Semiconductor laser and ultrashort wave were adopted in this group of peripheral nerve paralysis,effect was obvious.Objective:To investigate the effect of acupoint irridiation of three laser in peripheral facial nerve paralysis.Main prognosis index:recovery:all symptoms disappeared,facial expression was free;Obvious effect:five items of main symptoms(frontal grain disappear,Palpebral fissure widened.dysraphism of eyes,disappear of nasolabial groove,angle of mouth crooked) recovered more than three;No effect:no obvious change of mainclinical symptoms and signs.Result:Recovery,25 cases(67%);Obvious effect,11cases (30%);No effect,2 cases(5%) .6cases once treated by simple acupuncture and moxibustion therapy were cured by multiple therapy.Conclusion:Compared with simple therapy,muliple therapy had an obvious effect,with short therapeutic course,and inhibiting relapse at the same time.     

Pilon骨折的治疗与临床康复

AIM: To analyze the effect of three kinds of method on different types of Pilon fracture and advance the best treatment plan. METHODS: From March 1989 to August 2000,107 patients were regarded as having Pilon fracture by two hospitals, among which 76 cases were followed up. They were divided into three groups according to treatment method. A group included 24 cases with the treatment of manual reduction, traction of calcaneus and plaster ex-opexy. B group included 30 cases with the treatment of AO key-shaped anatomical steal plate. C group included 22 cases with the treatment of limited internal fixation combined with exopexy stand. RESULTS: After 6 months to 8 years follow-up, it was found that three kinds of treatment methods had obvious differences on the complications and effects of different types of fracture. In A group, the excellent and good rate of treatment on I type fracture was 70%, II type was 25%, Ⅲ type was 0%. In B group, the excellent and good rate of treatment on I type fracture was 7     

Plastic surgery treatment on cicatricial deformation in child burn of hand

Background:cicatricial deformation in child burn of hand often leads to severe squaelae.According to different causes of disease,different plastic surgery were adopted.The key of operation lies in skin repairing,articulation dealing,and thumb correcting,which aim is to resume normal longitudinal and transverse arce,holding and clenching ability.Objective:To investigate plastic surgery treatment on cicatricial deformation in child burn of hand.Unit:first People‘s Hospital of Yancheng City.Subjects:34 cases of burn were investigated including 23 males,11 females,aged 5-12 years old.Cicatricial reason:deep degree Ⅱ burn,19 cases;degree Ⅲ burn 11 cases;electric injury,4 cases.Scar type:hypertrophic scar,21 cases,areophic scar,13 cases.portion:dorsum of hand,22 cases,palm,12 cases.Time from healing to dealing:within 6 months,9 cases,within 1 year,8 cases,1-2 years,13 cases,over 3 years,4 cases.Intervention:Before operation,hypertrophic scar and adhesive web-space were cleaned with soap solution,1:5000 bromogeramine,30 min per time,twice a day.Anesthesia:general anesthesia to simple cicatricial contracture,scar removing,relaxing and free graft were adopted,full split thickness graft of palm,intermediate split thickness graft of dorsum of hand.To severe contracture,besides complete removing and full and intermediate split thickness graft,repairing of extensor tendon and articulate surgery,proximal finger joint was fixed at functional position when function couldn‘t be resumed.Tourniquet was used routinely,great saphenous venous and dorsal cutancous branch of radioulnar nerve avoiding exposing extensor tendon,fixed with plaster support and kirschner pins for some cases.Direct skin flap was used after incision and relaxing in 19 cases,skin flap graft was combined with repair in 15 cases.To scar contracture of part between thumb and index finger,because soft tissue had a good condition in this part,“Z”plastic operation was adopted for linar scar,local transfering of dorsal skin flap i 5 cases.To slight false web-space and adhesion,“Z”plastic operation was adopted,“M”or “T” skin flap repair to severe deformation and reconstructing of web-space with free skin graft when necessary.Result:Following up for 3-6 months,hand function recovered completely,improved obviously in 12 cases,no obvious effect was found in cases of deep burn.Conclusion:Different plastic surgery has an obvious effect on child hand bur,but the recovery of function needed long and effective rehabilitation therapy.     

Evaluation of diaphragmatic dysfunction after surgical treatment of type A aortic dissection by ultrasound: Incidence,risk factors and influence on outcomes北大核心CSCD

Objective: To study the incidence, possible risk factors, and influence on patient outcomes of diaphragmatic dysfunction in patients after surgical treatment of type A aortic dissection using ultrasound. Methods: Patients who received replacement of hemiarch or total arch with concomitant procedures concerning aortic pathology, and an elephant trunk procedure for the descending aorta were prospectively enrolled in this study from February to May 2017. After surgery, they were transferred to the cardiac surgical intensive care unit. They were divided into two groups based on diaphragmatic excursion: diaphragmatic dysfunction (DD) group and diaphragmatic function normal (DN) grouBilateral diaphragmatic excursions were evaluated using ultrasound during spontaneous breathing trial by T-tube. The differences in demographic characteristics, operation-related variables and outcomes were compared between the two groups. Results: A total of 42 patients were enrolled in this study, and 32 of them suffered from diaphragmatic dysfunctions. Compared with DN group, the excursion of the influenced diaphragm in DD group was significantly reduced[(0.450 ± 0.331)cm vs. (1.801 ± 0.616)cm, P<0.01], while the excursion of the non-influenced diaphragm was not reduced[(2.013±0.655)cm vs. (1.801±0.616) cm, P=0.254]. Diaphragmatic thickness was comparable [(0.184±0.028)cm vs. (0.189±0.028)cm, P=0.559] between the two groups while thickening fraction was significantly reduced in DD group[(4.67%±3.63)% vs. (23.58%±10.69)%, P<0.01]. Meanwhile, respiratory rate was significantly higher in DD group as compared to DN group [(24.13 ± 4.98)times/min vs. (20.50 ± 3.17)times/min, P=0.037]. Patients in DD group showed longer cross-clamp duration[(121.78±27.75)min vs. (93.10±18.84)min, P=0.004] and longer cardiopulmonary bypass duration [(208.09±32.78)min vs. (182.70±24.38)min, P=0.03] than patients in DN grouFurthermore, binary logistic analysis indicated that longer cross-clamp duration was the potential risk factor for diaphragmatic dysfunction after type A aortic dissection surgery. Mechanical ventilation duration was longer in DD group than in DN group (88 h vs. 37 h, P=0.194) but without statistical significance. The usage of noninvasive ventilation was significantly increased in DD group as compared to DN group (46.88% vs. 10%, P=0.036). Other outcomes such as post-operative complications, mortality, ICU length of stay were comparable between the two groups. Conclusions: Diaphragmatic dysfunction was very common after surgical treatment of type A aortic dissection. Longer duration of cross-clamp was considered as a potential risk factor of diaphragmatic dysfunction. A sequential management of noninvasive ventilation after extubation was feasible for diaphragmatic dysfunction after surgical treatment of type A aortic dissection. © 2018 Chinese Medical Association. All rights reserved.     

超声心动图评价动脉导管对胎儿先天性心脏病的诊断价值

目的 探讨超声心动图评价动脉导管在胎儿先天性心脏病中的诊断价值.方法 以三节段诊断法进行胎儿超声心动图检查,依胎位不同在不同切面检查动脉导管,切面包括动脉导管与右肺动脉形成的"V"形征切面,动脉导管与主动脉弓峡部形成的"V"形征切面,动脉导管与左、右肺动脉形成的"三指征"切面,左肺动脉、动脉导管、主动脉弓峡部形成的"Z"形征切面,测量动脉导管的内径及流速.结果 检出先天性心脏病胎儿31例,13例经尸体解剖得到证实,其中动脉导管狭窄者4例,均为右心梗阻性疾病;动脉导管增宽3例,均为左心梗阻性疾病;动脉导管内测及反向血流者2例;动脉导管流速增高者5例,其中包括4例右心梗阻性疾病、1例左心梗阻性疾病,5例胎儿动脉导管未见异常;1例胎儿动脉导管缺如.结论 超声心动图评价动脉导管是筛查胎儿先天性心脏病的重要内容,有助于快速确定诊断.

Abstract：

Objective To explore the value of ductus arteriosus in ultrasound diagnosis of fetal congenital heart disease by echocardiography. Methods The fetal echocardiography was performed with three segments diagnosis method. According to the fetal position, the ductus arteriosus was examined in different sections which include the "V" shape sign section formed by ductus arteriosus and right pulmonary artery,the "V" shape sign section formed by ductus arteriosus and the gorge of aortic arch,the three fingers sign section formed by ductus arteriosus,left and right pulmonary artery,the "Z" shape sign section formed by left pulmonary artery, ductus arteriosus and the gorge of aortic arch. The flow velocity and the inner diameter of the ductus arteriosus were measured. Results Thirty-one cases with congenital heart disease were evaluted. Thirteen cases were approved by autopsy. Among those fetus, 4 cases went with ductus arteriosus stenosis and they all accompanied with right heart obstructing disease,3 cases went with dilated ductus arteriosus and they all accompanied with left heart obstructing disease. Retrograde were explored in 2 fetus. The flow velocity of 5 fetus ductus arteriosus were higher than the normal fetus and 4 cases of them with right heart obstruction, 1 cases with left heart obstruction. Five fetal ductus arteriosus were normal. One fetal ductus arteriosus was absent. Conclusions Assessant of ductus arteriosus by echocardiography is an important content in screening fetal congenital heart disease. It can help us to diagnose quickly.     

时间-空间相关成像技术对正常胎儿心脏大动脉空间角度的定量研究

Objective To establish the reference ranges of the spatial angles among cardiac chambers and great vessels in second and third trimester fetuses measured by spatiotemporal image correlation (STIC).Methods Volume images of 352 normal fetuses from 20 to 38 weeks of gestation were recruited in the study.An off-line analysis of acquired volume datasets was carried out with multiplanar mode.Parameters measured included angles between:(1) the 4-chamber view and the left ventricular long axis view; (2) the left ventricular long axis view and main pulmonary artery; and (3) the ductal arch and aortic arch.The relationships between above-mentioned angles and gestational age were assessed by correlation and regression analysis.Results The angle between the 4-chamber view and the left ventricular long axis view (range:55.7° - 35.7°,mean:45.7° ± 5.12°) was uncorrelated with gestational age (r = 0.03,P = 0.51).In contrast,the angle between the left ventricular long axis view and main pulmonary artery,and the angle between the ductal arch and aortic arch were correlated with gestational age (P ＜ 0.001),and the correlation coefficient was - 0.53 and 0.57 respectively.The best-fit exponential curve regression equations of the angle between the left ventricular long axis view and main pulmonary artery was:Y = 154- 4.24X +0.05X2 ,and the angle between the ductal arch and aortic arch was:Y = - 20.8 + 2.65X - 0.37X2.Conclusions The angles among cardiac chambers and great arteries of fetuses from 20 to 38 weeks of gestation can be quantitatively measured by STIC.The reference ranges provide a reliable quantitative standard to estimate the spatial relationships of the cardiac large arteries of fetuses,which may be clinically useful in prenatal screening congenital heart disease.     

主动脉夹层急诊救治与临床路径探讨

目的 探讨主动脉夹层(aortic dissection,AD)的临床特点与急诊救治方法及路径.方法 采用回顾性分析方法,收集2000年1月至2009年12月中南大学湘雅医院急诊科收治的784例主动脉夹层患者的临床资料等分别进行对比及统计分析,分析其存活率、病死率及有效率.结果 首发症状以痛疼为主占77.7%(609/784),原有高血压病史占86.5%(678/784).确诊至术前784例均行急诊内科救治,存活率81.5%(639/784),病死率18.5%(145/784),无效157例(20.0%),总有效率(83.1%),其中传统治疗有效率(76.4%),三联四程序化治疗有效率(89.8%)(P<0.05),差异具有统计学意义.在院急诊死亡139例(17.7%).其中24 h内死亡26例(18.4%),48 h内死亡47例(33.8%),72 h死亡66例(47.2%).确诊后拒绝治疗92例,其中72 h内死亡81例(88.04%),两组病死率相比较,具有统计学意义(P<0.05).结论 详细病史、体查及CT和MRI主动脉造影检查是诊断主动脉夹层的主要手段,镇痛、镇静、降压是急诊救治的重要方法.急诊早期确诊和有效救治为争取早期手术及进一步治疗赢得了时间,是提高AD生存率的关键.

Abstract：

Objective To investigate the clinical features of aortic dissection (AD) and emergency treatments. Methods Data from 784 patients with aortic dissection were collected in the Department of Emergency from January 2000 through December 2009. A retrospective analysis was carried out to determine the survival rate, mortality rate and treatment efficiency. Results Pain was the most common onset symptom (77.7% , 609/784). The majority of patients (86.5%) had essential hypertension (678/784). All the patients with preoperative diagnosis of aortic dissection underwent emergency medical intervention by internists resulting in 81.5% survival rate (639/784) and 18.5% mortality rate (145/784). There were 157 patients without improvement (20.0% ) and the total efficiency rate was (83. 1% ). The efficiency rate of conventional treatment was 76.4% , while the efficiency rate of triple four-procedure treatment was 89. 8% (P<0.05). Of them, 139 patients (17. 7% ) died in the hospital. Among them,. 26 patients died within 24 hours (18.4% ) and 47 cases died within 48 hours (33. 8% ) and 66 patients died within 72 hours (47.2% ). There were 92 patients who refused treatments after diagnosis, and among them, 81 patients died within 72 hours (88.04% ). The difference in mortality rate between two groups was significant (P<0.05). Conclusions The diagnosis of aortic dissection depends on detailed history, physical examination and CT or MRI imaging. Analgesia, sedation and control of blood pressure are essential for emergency treatments. Early diagnosis and effective emergency treatments are the critical strategy for the early surgical intervention and time window for further treatment to improve the survival rate of AD.     

奎的平与氯氮平对精神分裂症患者临床康复的对照研究

Background:Bilateral thalamus infarction near median line is uncommon in clinic.Reports concerned with this conditions were more less.It is characterized by conscious disorder and Korsakoff syndrome.The main caused may be the injury of intralaminar nuclei,dorsomedial nuclei,and injury of cortical matter,mammalillary bodies,fasciculus thalamicus around cerebral chamer III.Comprehensing the disability characteristics in pateints with bilateral thalamus infarction near median line is important for direction of rehabilitation.While study of survival time will improve evaluation of prognosis. Design:Patients recruited from June 1997～ October 2000 were analyzed. Unit:Intraneural Department of First People's Hospital of Yunnan Province. Subjects:55 subjects with MRI proved bilateral thalamus infarction near median line entered study.These patients included 3 women,2 men(age ranging from 50 to 77 years old,mean age:68.6 years).The period from onset to admission ranged from 5 hours to 2 days.All subejcts experienced acute bilateral thalamus infarction near median line.All had hypertension previously,1 had diabetes,2 had auricular fibrillation. Intervention:All patients received management which was conducted according to protocol for treatment of ischemic cerebrovascular diseases. Patients clinical characteristics were summari-zed and analyzed.Follow up was conducted to determine the survival period. Main evaluation indexes:Survival time and conscious disorder were evaluated. Result:All patients showed different level of conscious disorder.3 cases developed thalamic dementia,2 developed vision numb,In 1 case,condition progressively deteriorated manifesting as moderate coma progressed to deep coma,and bilateral mydriasis.Finally,this patients died of central respiratory and circulatory failure after 8 days.4 cases with favorable prognosis discharged,3 out of them died within 1 year after discharge.Survival subject suffered from reduced memory was followed up till now. Conclusion:Concious or cognitive disorder ,vision bumb are common among patients with bilateral thalamus infarction near median line.Their prognosis are poor.In the current study,the number of case was samll,so further study is needed.     

双侧中线旁丘脑梗死5例致残特点及生存期调查

Background:Bilateral thalamus infarction near median line is uncommon in clinic.Reports concerned with this conditions were more less.It is characterized by conscious disorder and Korsakoff syndrome.The main caused may be the injury of intralaminar nuclei,dorsomedial nuclei,and injury of cortical matter,mammalillary bodies,fasciculus thalamicus around cerebral chamer III.Comprehensing the disability characteristics in pateints with bilateral thalamus infarction near median line is important for direction of rehabilitation.While study of survival time will improve evaluation of prognosis. Design:Patients recruited from June 1997～ October 2000 were analyzed. Unit:Intraneural Department of First People's Hospital of Yunnan Province. Subjects:55 subjects with MRI proved bilateral thalamus infarction near median line entered study.These patients included 3 women,2 men(age ranging from 50 to 77 years old,mean age:68.6 years).The period from onset to admission ranged from 5 hours to 2 days.All subejcts experienced acute bilateral thalamus infarction near median line.All had hypertension previously,1 had diabetes,2 had auricular fibrillation. Intervention:All patients received management which was conducted according to protocol for treatment of ischemic cerebrovascular diseases. Patients clinical characteristics were summari-zed and analyzed.Follow up was conducted to determine the survival period. Main evaluation indexes:Survival time and conscious disorder were evaluated. Result:All patients showed different level of conscious disorder.3 cases developed thalamic dementia,2 developed vision numb,In 1 case,condition progressively deteriorated manifesting as moderate coma progressed to deep coma,and bilateral mydriasis.Finally,this patients died of central respiratory and circulatory failure after 8 days.4 cases with favorable prognosis discharged,3 out of them died within 1 year after discharge.Survival subject suffered from reduced memory was followed up till now. Conclusion:Concious or cognitive disorder ,vision bumb are common among patients with bilateral thalamus infarction near median line.Their prognosis are poor.In the current study,the number of case was samll,so further study is needed.     

Influence of the length of time elapsed from ingestion of paraquat to hemoperfusion on prognosis in patients with acute paraquat poisoning北大核心CSCD

Objective To explore the influence of the length of time elapsed from ingestion of paraquat to hemoperfusion on prognosis in patients with acute paraquat poisoning. Methods The investigation was carried out with retrospective analysis. A total of 303 patients with acute paraquat poisoning were admitted to the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of China Medical University from January 2009 to December 2012. According to the length of time between ingestion and hemoperfusion, patients were divided into three groups, Group A; the time interval between ingestion and hemoperfusion <4 h; Group B; 4h≤the time interval between ingestion and hemoperfusion < 8 h; Group C: 8 h≤ the time interval between ingestion and hemoperfusion < 12 h. Compared the extent of target organ injury, 28-d mortality and the survival time of non-survivors among three groups for determining the influence of the length of time elapsed from ingestion to hemoperfusion on the prognosis of patients. Results Totally 303 patients with average age of 34. 8 ± 10. 8 years old (ranging from 15 to 72 years), and 117 male and 186 female. The median estimated amount of 20% paraquat ingested was 50 mL (ranging from 10 to 270 mL, IQR; 45 mL). The hemoperfusion was employed (3. 6 ± 1. 2) times (ranging from 2 to 5 times) for every paitient within 24 h after ingestion. The overall mortality rate was 68. 6% (208/304) during a 28 days follow-up period, and only 95 of 303 patients survived. The median length of time between paraquat ingestion and hemoperfusion at the emergency department was 6. 6 h (ranging from 1.4 to 11.5 h, IQR: 3. 5 h). However, it was 7. 2 h (ranging from 3. 1 to 11. 5 h, IQR: 2. 4 h) in non-survivors and 4. 9 h (ranging from 1.4 to 7. 6 h, IQR: 1. 5 h) in survivors. The difference was statistically significant (U = 2.014, P = 0.043). The difference in 28-day mortality among three groups was statistically significant (χ2 = 9.21, P = 0. 009), and the difference m average survival time of non-survivors among three groups was statistically significant (F = 3. 31, P = 0. 038). The length of time between ingestion and hemoperfusion and the survival time of non-survivors was a negative correlation (r2= 0. 421, P = 0. 045). The difference in ALTmax SCrmax AMYmax and PaO2max as the severity indicators of acute liver injury, acute kidney injury, acute pancreas injury and acute lung injury among the three groups were statistically significant (all P < 0. 05). Conclusions Employment of hemoperfusion within 4 h after ingestion can attenuate the degree of target organ injury, reducing 28 day mortality of patients with acute paraquat poisoning.     

Treatment and clinical rehabilitation of Pilon fracture

AIM：To analyze the effect of three kinds of method on different types of Pilon fracture and advance the beat treatment plan.METHODS:From March 1989 to August 2000,107 patients were regarded as having Pilon fracture by two hospitals,among which 76 cases were followed up.They were divided into three groups according to treatment method.A group included 24 cases with the treatment of manual reduction,traction of calcaneus and plaster exopexy.B group included 30 cases with the treatment of AO key-shaped anatomical steal plate.C group included 22 cases with the treatment of limited internal fixation combined with exopexy stand.RESULTS:After 6months to 8years follow-up,it was found that three kinds of treatment methods had obvious differences on the complications and effects of different types of fracture.In A group,the excellent and good rate of treatment on I type fracture was 70%,Ⅱ type was 25%,Ⅲ type was 0%.In B group,the excellent and good rate of treatment on I type fracture was 78.6%,Ⅱ type s 87.5%,Ⅲ type was 37.5%.In C group,the excellent and good rate of treatment on I type was 75%,Ⅱ type was 80%.CONCLUSION:Summarizing kinds of factors,the treatment of A group applied in I type fracture,B group applied in Ⅱ type fracture and C group applied in Ⅲ type fracture.     

估算的肾小球滤过率在冠状动脉旁路移植术预后价值的研究

Objective To evaluate the postoperative prognosis of the modification of diet in renal disease formula (MDRD) in coronary artery bypass graft surgery (CABG) in hospital or 4 years after hospitalization. Methods Two hundred and seventy-two CABG patients were divided into 3 groups according to the levels of estimated glomerular filtration rate (eGFR) including 35 cases in eGFR < 60 ml/min group, 119 cases in 60 ≤ eGFR < 90 mL/min group and 118 cases in eGFR ≥90 ml/min group. The prognostic factors of CABG patients were analyzed by COX proportional hazards models. Kaplan-Meier survival analysis was used to compare survival curves among the three groups stratified by eGFR levels. The Log-rank statistic was used for comparing between groups. Results By multivariate COX regression adjustment for body mass index, smoking, hypertension, hyperlipaemia, diabetes mellitus, previous MI, perioperative PCI and etc. , the relative risk (RR) of the increasing age for cardiac events was 1.077(95% CI 1.002-1.158,P =0.044). RR of left ventricular ejection fraction (LVEF) was 0.005(95% CI 0.000-0.456,P =0.022). RR of eGFR was 0.968(95% CI 0.948-0.988,P =0.002). The survival rate in the first, second, third and fourth year were same in every group. The survival rate of group with eGFR < 60 ml/min, 60 ≤ eGFR < 90 ml/min and eGFR≥ 90 mL/min was 76.4%, 93.1%, and 96.6%. The survival rates among three groups were statistically significant. In the survival curve of 4 year follow-up after CABG, the survival rate of group with eGFR < 60 mL/min was lower than that of 60 ≤ eGFR < 90 ml/min group and eGFR ≥ 90 ml/min group. Conclusions The preoperative eGFR is an independent risk factor in evaluating cardiac events in hospital and after hospitalization. It has a higher prognosis value in patients undergoing CABG.     

弥可宝对肘管综合征致肘、腕、环指功能障碍恢复的作用

1 Subject and method 1.1 Subject 60 cases of middle and severe cubital tunnel syndrome from 1992 to 2000 were divided into three groups randomly: Group A was the Mikebao group: 20 cases including 17 male cases and 3 female cases, their ages were from 22～ 45 with the average one as 25; Group B was the vitamin B12 group: 19 cases including 17 male cases and 2 female cases, their ages were from 24～ 50 with the average one as 27; Group C was the control group: 21 cases including 19 male cases and 2 female cases, their ages were from 23～ 60 with the average one as 26. all the patients were sick at single sides, 42 cases were on the right side and 18 cases were on the left side. Causes: 15 cases were with elbow injury history and limited elbow movement, others were of no obvious causes. Courses: 5～ 72 months with the average one as 15 months. Clinical manifestation and signs: 49 cases were with elbow sour and swelling, 58 cases were with adductor pollicis muscle atrophy and 54 cases were with claw hand.Electromyography examination: ulnar nerve movement of the 60 cases at the elbows were obviously slow and CMAP (compound muscle active potential) latent periods were prolonged. All the Tinel sign of ulnar nerves were positive, one cases was with muscle paralysis and partial functional disorder at the median nerve domain, it was proven to be CTS after operation.     

Individualized minimally invasive treatment for adult testicular hydrocele: A pilot study

BACKGROUND Hydrocelectomy is the gold standard for the treatment of hydrocele,but it often causes complications after surgery,including hematoma,infection,persistent swelling,hydrocele recurrence,and chronic pain. In recent years,several methods for minimally invasive treatment of hydrocele have been introduced,but they all have limitations. Herein,we introduce a new method of individualized minimally invasive treatment for hydrocele.AIM To present a new method for the treatment of adult testicular hydrocele.METHODS Fifty-two adult patients with idiopathic testicular hydrocele were included. The key point of this procedure was that the scope of the resection of the sheath of the tunica vaginalis was determined according to the maximum diameter(d) of the effusion measured by ultrasound and the maximum diameter of the portion of the sheath pulled out of the scrotum was approximately πd/2. The surgical procedure consisted of a 2-cm incision in the anterior wall of the scrotum,drainage of the effusion,and dissection of part of the sheath of the tunica vaginalis. After the sheath was peeled away to the predetermined target extent,the pulled-out sheath was removed. The intraoperative findings and postoperative complications were analyzed.RESULTS All patients were successfully treated with a median operation time of 18 min.The median maximum diameter of the effusion on ultrasound was 3.5 cm,and the median maximum diameter of the resected sheath was 5.5 cm. Complications occurred in four(7.7%) patients: two(3.8%) cases of mild scrotal edema,one(1.9%) case of scrotal hematoma,and one(1.9%) case of wound infection. All of the complications were grade I-II. Recurrent hydrocele,chronic scrotal pain,and testicular atrophy were not observed during a median follow-up of 12 mo.CONCLUSION We report a new technique for individualized treatment of testicular hydrocele,which is quantitative and minimally invasive and yields good outcomes. Further study is warranted to verify its potential value in clinical practice.     

Clinical course of percutaneous cholecystostomies:A crosssectional study

BACKGROUND Although cholecystectomy is the standard treatment modality,it has been shown that perioperative mortality is approaching 19%in critical and elderly patients.Percutaneous cholecystostomy(PC)can be considered as a safer option with a significantly lower complication rate in these patients.AIM To assess the clinical course of acute cholecystitis(AC)in patients we treated with PC.METHODS The study included 82 patients with GradeⅠ,ⅡorⅢAC according to the Tokyo Guidelines 2018(TG18)and treated with PC.The patients’demographic and clinical features,laboratory parameters,and radiological findings were retrospectively obtained from their medical records.RESULTS Eighty-two patients,45(54.9%)were male,and the median age was 76(35-98)years.According to TG18,25 patients(30.5%)had GradeⅠ,34(41.5%)GradeⅡ,and 23(28%)GradeⅢAC.The American Society of Anesthesiologists(ASA)physical status score wasⅢor more in 78 patients(95.1%).The patients,who had been treated with PC,were divided into two groups:discharged patients and those who died in hospital.The groups statistically significantly differed only concerning the ASA score(P=0.0001)and WBCC(P=0.025).Two months after discharge,two patients(3%)were readmitted with AC,and the intervention was repeated.Nine of the discharged patients(13.6%)underwent interval open cholecystectomy or laparoscopic cholecystectomy(8/1)within six to eight weeks after PC.The median follow-up time of these patients was 128(12-365)wk,and their median lifetime was 36(1-332)wk.CONCLUSION For high clinical success in AC treatment,PC is recommended for high-risk patients with moderate-severe AC according to TG18,elderly patients,and especially those with ASA scores of≥Ⅲ.According to our results,PC,a safe,effective and minimally invasive treatment,should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.     

Endovascular Repair of Type B Aortic Dissection： Long-term Results of the Randomized Investigation of Stent Grafts in Aortic Dissection Trial

<正>Nienaber and colleagues carried out the INSTEAD-XL trial to evaluate the long-term outcomes and morphology after thoracic endovascular aortic repair(TEVAR)for uncomplicated type B aortic dissection.A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR(n=72)versus optimal medical treatment alone(n=68)were analyzed retrospectively for aorta-specific,all-cause outcomes,and disease progression using landmark statistical analysis of years 2 to 5 after index procedure.Cox regression was used to compare outcomes between groups;all analyses are based on intention to treat.During follow-up,the risk of all-cause