Objective
lt;brgt;To evaluated the effect of transpupillary thermotherapy (TTT) on age-related macular degeneration (AMD).
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lt;brgt;Methods
lt;brgt;Sixty-two cases (62 eyes) of exudative AMD were managed with TTT. Before treatment, 58 cases underwent fundus fluorescein angiography(FFA),42 cases underwent simultaneous indocyanine green angiography (ICGA), and 56 cases underwent optic coherence tomography (OCT).TTT was delivered using a 810 nm diode laser with variable spot sizes 0.5-3.0 mm and power range 60-40 mW,60 seconds duration. Sixty-two cases were followed up for 1-10 months with 4.8 months average.
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lt;brgt;Results
lt;brgt;The visual acuities of last visit were compared with those before the treatment. The visual acuity was unchanged in 43 cases (69.3%), improved in 15 cases (24.2%), and declined in 4 cases (6.5%). OCT was re-done in 51 cases and compared with OCT images before TTT treatment. The height of macular edema was unchanged in 29 cases (56.9%), decreased in 18 cases (35.3%), and increased in 4 cases (7.8%). The amelioration of visual acuity was compatible with that of macular configuration in the majority of cases (74.5%). Only in 13 cases (25.5%) the amelioration of visual acuity lagged behind that of macular configuration. The re-treatment was performed in 18 cases (29.1%), probably due to insufficiency of laser power. No side-effect was found.
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lt;brgt;Conclusion
lt;brgt;TTT makes most of the cases of exudative AMD retaining or improving their visual acuity. The employment is secured. Further exploration is needed in order to obtain the parameters of the laser treatment.
(Chin J Ocul Fundus Dis, 2002, 18: 180-183)
Objective To explore the effect of the platelet-rich plasma (PRP) on proliferation and osteogenic differentiation of the bone marrow mesenchymal stem cells (MSCs) in China goat in vitro. Methods MSCs from the bone marrow of China goat were cultured. The third passage of MSCs were treated with PRP in the PRP group (the experimental group), but the cells were cultured with only the fetal calf serum (FCS) in the FCS group (the control group). The morphology and proliferation of the cells were observed by an inverted phase contrast microscope. The effect of PRP on proliferation of MSCs was examined by the MTT assay at 2,4,6 and 8 days. Furthermore, MSCs were cultured withdexamethasone（DEX）or PRP; alkaline phosphatase (ALP) and the calcium stainingwere used to evaluate the effect of DEX or PRP on osteogenic differatiation of MSCs at 18 days. The results from the PRP group were compared with those from the FCS group. Results The time for the MSCs confluence in the PRP group was earlier than that in the FCS group when observed under the inverted phase contrast microscope. The MTT assay showed that at 2, 4, 6 and 8 days the mean absorbance values were 0.252±0.026, 0.747±0.042, 1.173±0.067, and 1.242±0.056 in the PRP group, but 0.137±0.019, 0.436±0.052, 0.939±0.036, and 1.105±0.070 in the FCS group. The mean absorbance value was significantly higher in the PRP group than in the FCS group at each observation time (P＜0.01). Compared with the FCS group, the positive-ALP cells and the calcium deposition were decreased in the PRP group; however, DEX could increase boththe number of the positiveALP cells and the calcium deposition. Conclusion The PRP can promote proliferation of the MSCs of China goats in vitro but inhibit osteogenic differentiation.
摘要:目的: 探討自發性食管破裂的診斷和治療經驗。 方法 :對我院1996年2月至2009年8月收治的8例自發性食管破裂患者的診斷和治療作回顧性分析。 結果 :全組患者7例行手術治療,1例行保守治療。6例患者行修補手術,其中4例行分層縫合,2例行全層縫合。1例行食管切除胃食管吻合術。本組痊愈7例,死亡1例。 結論 :早期診斷和早期治療是自發性食管破裂的治療原則。確診患者,若病情允許,應首選手術治療。Abstract: Objective: To explore the clinical diagnosis and treatment of spontaneous esophageal rupture. Methods :The clinical features, diagnosis and surgical treatment of 8 patients with spontaneous esophageal rupture were retrospectively reviewed. Results :There were 7 cases treated by surgical therapy and 1 case for conservative treatment. 6 cases were treated by surgical repair including 4 cases of layered suture and 2 cases of singlelayer suture. 1 case was treated by esophagus resection and gastroesophagostomy. In the whole group, 7 cases were cured and 1 case died. Conclusion :The therapeutic principle of spontaneous esophageal rupture are early diagnosis and early treatment. For diagnosed patient, surgical procedure is the first choice if condition permitted.
Objective To explore effects of several immunosuppressants on cytokine expressions after repair for a sciatic nerve injury in a rat model. Methods The sciatic nerves of 42 rats were cut and suturedend to end. After operation, the rats were divided into 6 groups. Group A(n=9) was served as a control with no medicines given. Group B (n=9) was given methylprednisolone 20 mg/(kg·d) for 2 days. Groups C(n=9) and D(n=3) were given FK506 1 mg/(kg·d) for 2 weeks and 4 weeks respectively, and were given the same doses of methylprednisolone as Group B. Groups E and F were given CsA 2 mg/(kg·d) for 2 weeks and 4 weeks respectively, and were given the same doses of methylprednisolone as Group B. The sciaticnerves were sampled at 1, 2 and 4 weeks postoperatively. And immuneohistochemistry stainings of interleukin 1β(IL-1β)， tumor necrosis factor α(TNF-α), interferon γ(IFN-γ) and macrophage migration inhibitory factor(MIF) were performed. The staining results were compared and analyzed. Results The expression peaks of IL-1β and IFN-γ were found at the 1st week postoperatively in Group A. Then, the expression decreased rapidly at the 2nd week and disappeared at the 4th week. As for TNF-α and MIF, they were only found to have a low expression until the 1st week in Group A. In groups C-F, the expression peaks of IL-1β, TNF-α and IFN-γ were found at the 2nd week, while the expression peak of MIF was still at the 1st week, and the expression of all the cytokines extended to the 4th week. The expressions of these cytokines in Group B were just between the expression levels of Group A and Groups C-F. Conclusion Immunosuppressants can delay the expression peaks and significantly extend the expression time of IL-1β, TNF-α, IFN-γ and MIF after repair for a sciatic nerve injury in a rat model.
A retrospective study of 65 cases of huge sacrococcygcal teratomas were surveyed. The long term functional prospect of the benign tumor was excellent. The characteristics of the normal and pathological anatomy of the pelvic floor were mentioncd. Based on these, the authors described some personal experiences of the procedures, and discussed some problems of the reconstruction of the pelvic floor.
Objective To investigate the value of laparoscopy in resetting and repairing of inguinal incarcerated hernia. Methods Clinical data of 11 patients with acute inguinal incarcerated hernia treated with laparoscopy from March 2007 to February 2008 were reviewed, including 3 cases of direct inguinal hernia and 8 cases of oblique inguinal hernia. Results There were 7 patients with incarcerated hernia who were reset automatically after general anaesthesia, and 4 patients who were reset with laparoscopy. All the hernias were repaired with the transabdominal preperitoneal (TAPP) method after observed or improved the blood cycle of the incarcerated intestinal tract under laparoscopy. Average follow-up time was 6.6 months (2-12 months) after operation. Good recover and no recurrence were showed in all patients. Conclusion Laparoscopy is a safe technology in resetting and repairing of inguinal incarcerated hernia
Objective To investigate the advance in the management of skeletal trauma of the extremities. Methods The literature at home and abroad was reviewed, and the research findings withclinical experience in the therapeutic methods for fracture of the extremities were summarized.Results The concept on fracture management was renewed, the minimally invasive surgery (MIS) was developed and popularized, the implantation was improved, the navigation technique with computerassisted surgery was applied, and the tissue engineering was developed. The fracture mana gement was changed from the anatomical reduction with absolutely rigid fixation to the biological osteosynthesis with protection of the fracture environment. The minimally invasive surgical techniques included the minimally invasive plate osteosynthesis, intramedullary nailing, external fixation, arthroscopic surgery,and computer-assisted surgery. In concordance with the MIS principles, the newimplants, such as the locking compression plate, and the less invasive stabilization system were well designed and put into clinical practice so as to provide effective therapeutic results in treating osteoporotic fractures and complicated articular and/or metaphyseal fractures. In treatment of the delayed union or nonunion offractures, more effective techniques were employed, including the application of bone substitutes, which are degradable and have properties of bone conduction and induction. In the repair of segmental defects of the long tubular bone, the bonetransport and the vascularized bone grafts could work well. The investigation of the bone engineering revealed its great potentiality.Conclusion Fracture of the extremities is a common problem and its management should emphasize the recovery of the extremity function of the patient in addition to emphasis on the replacement and fixation of the biological structures. The combination of bone engineering and microsurgery represents the development tendency inthis field.
Purpose
To evaluate the surgical effect of idiopathic macular hole (IMH)，with optical coherence tomography (OCT)．
Methods
To measure the diameter of holes and hole halos，the thickness of hole in edge，the changes of hole pattern in 19 cases (19 eyes) with IMH using OCT．
Results
By quantitatively measuring，OCT showed that after surgery the mean hole diameter lessened from （570．95plusmn;264．59 ）mu;m to （337．05plusmn;335．95）mu;m．The mean diameter of hole halo lessened from （1043．53plusmn;278．80）mu;m to （695．00plusmn;483．00）mu;m and the mean thickness of the hole edge thinned from （389．78plusmn;60．58）mu;m to （298．78plusmn;109．80）mu;m．In 17 eyes the holes become closed or reduced in size or the hole halo，and thinned in hole edge．The anatomic successful rate of the surgery is 89%．
Conclusion
OCT can objectively，accurately and effectively judge the anatomic effect of IMH surgery．
(Chin J Ocul Fundus Dis，2000，16：71-138)
OBJECTIVE: To study the effect of subcutaneous implant of peripheral nerve allograft on sciatic nerve regeneration in rats. METHODS: Out of 30 male Wistar rats, 6 were donors and 24 were divided randomly into 2 groups. In experimental group (group A, n = 12), a 15 mm segment of sciatic nerve harvested from donors was separately inserted into subcutaneous compartment on the right thigh; two weeks later, the segment of sciatic nerve in subcutaneous compartment was removed and transplanted into a 10 mm sciatic nerve defect of left, which was made immediately. In the control group (group B, n = 12), a 10 mm sciatic nerve defect was made and immediately repaired in situ on the left thigh. The regeneration of sciatic nerve was examined histologically (after 2, 4, 8, and 14 weeks) and electrophysiologically (after 14 weeks of operation). RESULTS: After 2 weeks of operation, the inflammatory reaction was a little ber in group A than in group B. After 4 weeks, the intensity of the inflammatory reaction was similar between two groups; some collagen fibers proliferated. After 8 weeks, the inflammatory reaction ended and the collagen fibers proliferated obviously. After 14 weeks of operation, the structure of epineurium was in integrity and there was no obvious difference in perineurium and endonurium between two groups. A large number of myelinated nerve fibers and a small number of unmyelinated nerve fibers regenerated. The structure of myelin sheath was in integrity. The number and size of regenerated axon had no significant difference between two groups(P gt; 0.05). The conduction velocity, the peak value and the latent period of motor nerve were no significant difference between two groups (P gt; 0.05). CONCLUSION: The allograft of sciatic nerve inserted into subcutaneous compartment can promote nerve regeneration.
Objective To summarize the therapeutic effectinevess of incorporating pedicled retrograde flap of forearm transplantation for reconstructing severe contracture of the first web space and wrist. Methods Between November 2005 and February 2010, 26 patients with severe contracture of the first web and wrist were treated. There were 18 males and 8 females with an average age of 27 years (range, 12-45 years). The locations were the right sides in 15 cases and the left sides in 11cases. The injury reason included hot water scald in 7 cases, explosion hurt in 5 cases, traffic accident in 3 cases, hot pressing in 5 cases, and flame burns in 6 cases. The duration of scar contracture ranged from 6 to 26 months with an average of 11 months. According to the evaluation standard by GU Yudong et al., all had severe contracture of the first web space, and concomitant injuries included adduction deformity thumb, l imitation of the thumb extension and opposition function, and carpometacarpal flexion joint deformity. After scar contracture was released, the defect size ranged from 5.8 cm × 4.5 cm to 11.3 cm × 7.2 cm, which were repaired by the incorporating pedicled retrograde flap of forearm of 6.5 cm × 5.0 cm to 12.5 cm × 8.0 cm at size. The donor sites were directly sutured or repaired with skin graft. Results Bl ister and partial necrosis occurred at the distal end of the flaps in 2 cases, which were cured after dressing change. The other flaps survived and wounds healed by first intention. Incisions at donor sites healed by first intention. Twenty-six patients were followed up 6 to 24 months (mean, 15 months). The patients had functional recovery in thumb adduction and opposition at different degrees. At 6 months after operation, according to the Swanson et al. AMA system for total thumb activity, the total thumb function was improved significantly, and according to Jensen et al. measurement, the width and angle of the first web space were significantly increased, all showing significant differences (P lt; 0.05). Conclusion Incorporating pedicled retrograde flap of forearm transplantation for repairing severe contracture of the first web space and wrist could augment the first web space and improve the wrist flexible function.
