Evaluation of surgical resection of pulmonary metastasis of trophoblastic tumor

Objective: To evaluate the role of the lung lobectomy in gestational trophoblastic tumor patients with lung metastases. Methods: A total of 45 cases of trophoblastic tumor with pulmonary metastases treated by lung lobectomy from 1985~2002 at PUMC hospital were retrospectively analyzed. Seven cases were diagnosed as invasive mole and thirty-eight as choriocarcinoma. Results: Lung lobectomy was performed in all of these patients after several courses of chemotherapy. Seven cases of invasive mole reached complete remission. Eleven cases of choriocarcinoma with stage Ⅲa had received average 13 courses of chemotherapy, 10 of them reached complete remission. Seventeen cases of choriocarcinoma with stage Ⅲb had received average 14.3 courses of chemotherapy, 11 of them reached complete remission. Ten cases of choriocarcinoma with stage Ⅳ had received average 15 courses of chemotherapy, six of them reached complete remission. In the 45 patients, histologic examination disclosed haemorrhagic necrotic tissue in 27 patients, 17 of them reached complete remission(63%). Histologic examination also revealed fibrosis around the focus in 16 patients, 14 of them reached complete remission(88%). Tuberculosis was found in 2 patients.Conclusions: Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, lung lobectomy remains an important adjunct treatment in a selected subset of patients. Pathological examinations can help to estimate the prognosis.     

Determination of the optimal frequency of injection of triamcinolone: monitoring change in volume of keloid lesions following injection of 40 mg of triamcinolone

Background

Different dosage protocols may be advocated by different clinicians for the same keloid lesion. The aim of this study was to determine the optimal frequency of injection of triamcinolone for the purpose of reducing the size of keloid, by monitoring volume change in lesions.

Methods

Volume of all lesions was measured, and 40 mg of triamcinolone was injected once. Lesion volume was thereafter monitored weekly for 6 weeks.

Results

Mean pretreatment volume was 6.4 ml. Following triamcinolone injection, mean lesion volume became 5.1, 3.7, 3.6, and 3.6 ml at 1, 2, 3, and 4 weeks postinjection, respectively. The mean lesion volume was 3.7 and 3.9 ml at 5 and 6 weeks postinjection. Mean lesion volume was 1.29 ml lower at 1 week than at pretreatment stage (SD?±?0.8797), 1.35 ml lower in volume at 2 weeks than 1 week (SD?±?1.0386), and 0.138 ml lower in volume at 3 weeks than 2 weeks (SD?±?0.159). Mean lesion volume was 0.0250 ml lower at 4 weeks than at 3 weeks (SD?±?0.3215), 0.1000 ml greater in volume at 5 weeks than 4 weeks (SD?±?0.1713), and 0.2000 ml greater in volume at 3 weeks than 2 weeks (SD?±?0.0418). There is a statistically significant difference between the mean volume at 1 week postinjection and that at pretreatment stage, between 2 and 1 week, and between 3 and 2 weeks (p?≤?0.05). Reduction in volume was found to be most profound and statistically significant within the first 2 weeks postinjection.

Conclusions

This study finds that the optimal frequency of intralesional injection of triamcinolone involves a 2-week injection interval.Level of Evidence: Level IV, therapeutic study

     

Analysis of urgent reconstruction of electrical injuries

Objective:To summarize the reconstruction experience of the electrical injuries in emergency.Methods:All 309 wounds in 105 patients who suffered from electrical injuries were reviewed during a 10year period from Jan.1st 1986 to Dec.31st,1996.Treatment method,patient data and results were compared and analyzed.A comprehensive urgent reconstruction alternative used in all cases included the followings,1)debriding the wound in emergency,2)preserving the vital tissues as much as possible,even devitalized tissues or local necrosis,3) transplanting these vital tissues during the first surgery if the functional reconstruction required,4) nourishing the wound bed by tissue flaps covering with rich blood supply,5)improving flap survival by continuous irrigation for 24-720 hours beneath the flaps with a compound medicine after surgery.Results:Satisfactory results were obtained with the extremity loss ratio of less than 7% in this group compared with 42.5% which was 10 years before 1984 in the same hospital.Conclusions:This urgent comprehensive reconstruction alternative is an effective and workable method for reducing extremity loss of electrical injuries.     

Treatment of 209 cases of liver injury

Objective: To summarize the experience of the treatment of traumatic hepatorrhexis. Methods: The clinical data of 209 cases of liver trauma treated in the three affiliated hospitals of the Third Military Medical University from 1989 to 1999 were retrospectively analyzed. Among the 209 patients, 108 (51.7%) had Grade Ⅲ or more severe liver injury. Operative treatment was performed in 186 cases and preservative treatment in 23. Results: In the operated group, 169 patients were cured. The eomplications occurred in 18 patients and 17 of them died. In the non-operated group, the complications occurred in 22 patients and only 1 of them died. Conclusions： Severe injury and delayed treatment are two major factors leading to death from liver injuries.Surgical intervention is still the principal measure to treat traumatic hepatorrhexis. The indications for non-operative treatment should be carefully selected.     

Comparison of the safety of three methods of lumbar transpedicular screw fixation

Objective: To choose a proper method of lumbar transpedicular screw fixation at different lumbar levels among the three methods (Roy-Camille's method, Magerl's method and Du's method) in the Chinese population. Methods: Three-dimensional ( 3-D ) images were reconstructed with image data of 42 adult lumbar segments that were scanned by Electron Beam CT. The three methods of lumbar pedicle screw fixation were simulated on the 3-D reconstructed images and the parameters of implanting pedicle screws were measured. Results : There was statistically significant difference at the distance from the entrance point to the pedicle axis between the three methods (P<0.001). The distances measured by Du's method were shortest from L1 to L4, and the distances measured by Magerl's method were shortest at L5 (P<0.05). There was no significant difference from L1 to L2 (P >0.05) but significant difference from L3 to L5 at inserting safe ranges of TSA (transverse section angle) was found between the three methods (P<0.05). From L3 to L4, the inserting safe ranges of TSA measured by Du's and Magerl's methods were significantly larger than that measured by Roy-Camille's method (P<0.05), but there was no significant difference between them (P > 0.05). At L5, the inserting safe ranges of TSA measured by Magerl's method were largest among the three methods (P <0.05). Conclusions: Among the three methods, Du's method is the best choice from L1 to L4 because its distance from the entrance point to the pedicle axis is shortest and the safe range of TSA is largest: Magerl's method can be used from L3 to LS and is the best choice at L5; Roy-Camille's method is applicable at L1 and L2.     

Outcome of multimodality treatment of Ewing��s sarcoma of the extremities

Background:

The management of Ewing’s sarcoma family of tumors (ESFT, Ewing’s sarcoma/primitive neuroectodermal tumor) has been established as a multimodality treatment. Advances in imaging and diagnostics, chemotherapy, surgical techniques, radiotherapy and prosthetic technology have resulted in drastic changes in the outcome of this disease, with most of the recent studies having 5-year survival rates of more than 60%. The Indian patients present at a more advanced stage and the compliance of treatment is suboptimal. While there is plenty of data in the world literature on the outcome of Ewing’s sarcoma, there is paucity of data in Indian patients. Therefore, we conducted the present study to analyze the outcome of multimodality treatment of ESFT of the extremities at a tertiary nonprofit institute over a decade.

Materials and Methods:

34 patients who had histopathologically proven diagnosis of Ewing’s sarcoma of the extremities and had received treatment at our institute from 1997 through 2007 were included for analysis. The majority of patients had involvement of the femur (35%), followed by tibia (17%), fibula and foot (15% each), humerus (12%) and soft tissue of thigh (6%). Twenty-nine patients presented with localized disease (Enneking stage II B) while five patients presented with metastases (Enneking stage III). All patients received Vincristine, Actinomycin D, Cyclofosfamide + Ifosfamide and Etoposide (VAC+IE)-based chemotherapy and local treatment was offered to all but three patients having multicentric disease. The local treatment offered were, radiation (n= 15), surgery (n= 12) both surgery and radiation (n=4). All patients were analyzed for oncological outcome (event-free and overall survival, local and systemic relapses) by clinical and imaging evaluation and functional outcome by using the musculoskeletal tumor society (MSTS) score. These outcomes were correlated with age, sex, size of tumor, stage at presentation, modality of local treatment and site of relapse.

Results:

At the final follow-up (mean, 26 months; median, 17 months; range, 3–97 months), the overall and event-free survivals were 47 ± 12% and 34 ± 9%, respectively. Sixty-two percent of the patients presented with a tumor size more than 8 cm. On correlation with age, sex, size of tumor, stage at presentation, modality of local treatment and site of relapse, no correlation of survival was seen with any of the variables except event-free survival with size of the tumor. The functional outcome of all the patients was satisfactory (MSTS score >16 out of 30). No patient underwent amputation.

Conclusion:

Although the demographic profile, stage at presentation and the local and systemic treatment regimen followed in our study was similar to the world literature, the outcome of Ewing’s sarcoma in Indian patients were found to be inferior to that reported in the western literature. Larger multicentric studies with longer follow-up are required to exactly determine the key areas crucial in improving this outcome.     

Treatment of open supracondylar fracture of humerus

Objective: To explore the injury mechanism and treatment principle of open supracondylar fracture of humerus. Methods: The data of 32 patients with open supracondylar fracture of humerus hospitalized in our department in the recent 20 years were analyzed retrospectively. On an average, they were followed up for 30 months. The relationship between the fracture type,situation of wounds, operating time, operating method and time for postoperative functional exercise and final function of elbow joint were evaluated with Flynn scoring standard. Results: Excellent therapeutic effect was found in 14 cases, good in 12 and bad in 6, with the percentage of fine therapeutic effect of 81.25 %. Conclusions:For the patients with open supracondylar fracture of humerus, debridement and internal fixation should be made as early as possible, for thorough debridement and correct internal fixation are the key points to improve the prognosis.     

Does timing of presentation of penile fracture affect outcome of surgical intervention?

Objective

To assess the effect of timing of presentation of cases with penile fracture on the outcome of surgical intervention.

Patients and Methods

Between January 1986 and May 2010, 180 patients with penile fracture were treated surgically in our center. To assess the effect of timing of presentation, patients were classified into 2 groups: group I with early presentation (≤24 hours) and group II with delayed presentation (>24 hours). All patients were contacted by mail or phone and were re-evaluated. All patients were reevaluated by questionnaire and local examination. Patients with erectile dysfunction were evaluated by color Doppler ultrasonography.

Results

Group I included 149 patients (82.8%) and group II included 31 (17.2%). In group I, patients presented to the emergency department from 1-24 hours (mean, 11.8) after occurrence of the penile trauma. Although patients in group II presented from 30 hours to 7 days (mean, 44.7 hours). Both groups were similar regarding etiology of injury, clinical presentation, surgical findings, and incidence of associated urethral injury. Mean follow-up period for group I was 105 months, and for group II it was 113 months. After such long-term follow up, 35 (19.4%) patients had complications; however, there was no statistically significant difference between both groups.

Conclusions

Cases of penile fracture with early or delayed presentation up to 7 days should be managed surgically. Both groups have comparable excellent outcome with no serious long-term complications.     

Effects of repeated administration of human chorionic gonadotropin on the biosynthesis of testostero

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The New Concept of Bariatric Surgery in China—Reevaluation of Surgical Indications and Criteria of Therapeutic Effect of Laparoscopy for Treatment of Obesity

The etiology of morbid obesity is multifactorial and is related to inheritance, physiology, metabolism, sociocultural, behavioral, and psychological factors. In China, the incidence of obesity is increasing with the improvement of the standard of living each year. The USA is known as the nation that has a high prevalence of overweight and obese individuals, as indicated from the Nutrition and Health Status report. Obesity in China is a growing phenomenon that cannot be ignored. In this paper, we review the relatively new concept of bariatric surgery in China.     

Genetics of Paget’s Disease of Bone

Paget’s disease of bone (PDB) is a common condition, which is characterised by focal areas of increased and disorganized bone remodeling. Genetic factors play an important role in the disease. In some cases, Paget’s disease is inherited in an autosomal dominant manner and the most common cause for this is a mutation in the SQSTM1 gene. Other familial cases have been linked to the OPTN locus on Chromosome 10p13 and still other variants have been identified by genome wide association studies that lie within or close to genes that play roles in osteoclast differentiation and function. Mutations in TNFRSF11A, TNFRSF11B and VCP have been identified in rare syndromes with PDB-like features. These advances have improved understanding of bone biology and the causes of PDB. The identification of genetic markers for PDB also raises the prospect that genetic profiling could identify patients at high risk of developing complications, permitting enhanced surveillance and early therapeutic intervention.     

Reconstructive treatment of sclerosing osteomyelitis of the entire femur of 30 years’ duration with avoidance of segmental resection

We describe the successful operative treatment of a patient with chronic sclerosing osteomyelitis of the femur in which en bloc resection was avoided. Therapy consisted of combined endoscopic, computed tomography and bone scan-guided fenestration and intramedullary reaming, with removal of all sclerotic zones and normalization of the cortical thickness. An adequate supply of oxygen to the area was ensured by improved vascularisation and the application of hydrogen peroxide. At the medium term follow-up no recurrence was seen, and hip and knee function was normal. Received: 20 November 1997     

Declaration of the 2^nd Meeting of the Committee on Clinical Application of Human Organ Transplantation of China and National Summit of Clinical Application and Management of Human Organ Transplantation

We, medical practitioners of human organ transplantation, met in the 2nd Meeting of the People＇s Republic of China Ministry of Health Committee on Clinical Application of Human Organ Transplantation and National Summit of Clinical Application and Management of Human Organ Transplantation in Guangzhou, Guangdong Province, People＇s Republic of China, on 13 and 14 November 2006.     

Survey of hand surgeons’ and therapists’ perceptions of the benefit of common surgical procedures of the hand

Objective: The objectives of this survey were (1) to study if surgeons’ perceptions of the benefit of six surgical procedures differ if they consider themselves as patients instead of treating a patient, (2) to evaluate the role of five predetermined factors that may influence decision-making, and (3) to assess how uniformly hand surgeons and hand therapists perceive the benefits of the surgical treatments.

Methods: The members of the national societies for Hand Surgery and Hand Therapy were asked to participate in the survey. Six patient cases with hand complaint (carpal tunnel syndrome, flexor tendon injury, dorsal wrist ganglion, thumb amputation, boxer’s fracture, and mallet fracture) and a proposed operative procedure were presented, and the respondents rated the procedures in terms of the expected benefit. Half of the surgeons were advised to consider themselves as patients when filling out the survey.

Results: A survey was completed by 56 surgeons (61%) and 59 therapists (20%). Surgeons who considered themselves as patients had less confident perception on the benefit of carpal tunnel release compared with surgeons, who considered treating patients. Hand surgeons and hand therapists had similar perception of the benefits of surgery. The expected functional result was regarded as the most important factor in directing the decision about the treatment.

Conclusions: Surgeons tended to be more unanimous in their opinions in cases, where there is limited evidence on treatment effect. The agreement between surgeons and therapists implies that the clinical perspectives are similar, and probably reflect the reality well.     

Outcome of surgical treatment of post-traumatic tricuspid insufficiency

Objective: To investigate the optimal time and procedure of surgical treatment of traumatic tricuspid insufficiency. Methods: From May 1984 to September 2004, eight patients underwent operation for traumatic tricuspid valve insufficiency. All patients, male, aged from 7 to 67 years [median: 38 years, mean: (38.5±18.1) years]. The intervals between trauma and operation ranged from 1 month to 20 years [median: 19 months, mean: (52.5± 80.3) months)]. In seven patients, tricuspid insufficiency was attributed to blunt chest trauma including vehicle accident in three patients and the other patient is a stab wound. Diagnosis was confirmed by echocardiography. Pre-operative cardiac functions in patients were classified as New York Heart Association ( NYHA ) classes Ⅱ-Ⅳ. During operation, the anterior leaflet of the tricuspid valve was completely or partially flailed as a result of chordal rupture in all patients. Chordal rupture of septal leaflet was found in one patient. Anterior leaflet was perforated in two patients. Septal leaflet was retracted and adherent to ventricular septum in two patients. Valve repair was intended for all patients. Finally, valve repair was performed successfully in 3 patients and tricuspid replacement was performed in 5 patients. Results: No early or late death occurred. With a follow-up through clinical manifestation and echocardiography for 7-129 months [median; 39 months, mean: (53.4±42.8) months], all patients were classified as NYHA class I, without any changes. Conclusions : The satisfactory treatment of traumatic tricuspid insufficiency can be obtained by surgical treatment. Earlier surgery may increase the feasibility of tricuspid valve repair and prevent the deterioration of right ventricular function.