Ten cases of neurotmesis of posterior interosseous nerve of the forearm were treated with mierosurgical technique from Aug, 1988 to Oct. 1990, of which, 4 cases by autogenous nerve graft and 6 cases by direct neurosuture. Eight cases have been followed-up from 4 months to 1 year after operation concerning with satisfactory results. Some questions the diagnosis, the points for attention in operation, and the relation of the results and the time when the operation done were discussed. The comparison of the results and the recovery time between the autogenous-nerve graft and direct neurosuture was made.
OBJECTIVE: To investigate a treatment method for overtime avulsion of scalp. METHODS: Form October 1992 to July 2001, we treated 7 cases of avulsed scalp, which had been wounded more than 12 hours and accompanied with shock and head wound, with split thickness scalp skin grafting. RESULTS: Except for partial necrosis of scalp in center of bare area of skull, more than 90% of grafting split thickness scalp skin survived in 4 cases and more than 80% in 3 cases, and presented satisfactory appearance during following up. The bare area had no periosteum above 4 cm in diameter needed to graft split thickness skin after skull was covered granulation tissue. CONCLUSION: The limits of time of scalp skin grafting will be prolonged as long as the processes are settled properly to maintain the skin of body.
ObjectiveTo explain the advantage of laparoscopic endoscopic rendezvous procedures used to treat rectal carcinoma, and predict the future direction of the surgery methods for rectal carcinoma.
MethodsA review and summary based on the clinical experience of our hospital and the published researches about the laparoscopic endoscopic rendezvous procedures over the past years in home and abroad were performed.
ResultsLaparoscopy can monitor the situation of the abdominal cavity.Endoscopy can detect the location of rectal carcinoma.Laparoscopic endoscopic rendezvous procedures used to treat rectal carcinoma can combine the advantage of each other.And the purpose of "less invasion, less pain, and faster recovery" will be achieved.The effect of "1+1 > 2" will be realized.
ConclusionLaparoscopy and transanal endoscopic microsurgery hybrid could be a naive form of nature orifice transluminal endoscopic surgery to treat rectal carcinoma.
The ulcer resulting from snake-bite injury was characterized by deep and wide tissue necrosis and secondary infection. The patient was at high risk of loss of function of his extremity. From 1989 to 1996, 16 cases with deep ulcer of the upper extremity resulting from snake-bite injury were treated with different types of axial thoraco-abdominal skin flaps, depending on the location of the ulcer. Thoraco-umbilical skin flap was used in 2 cases, lateral thoracoabdominal skin flap in 1 case, iliolumbar skin flaps in 5 cases, lower abdominal skin flaps in 6 cases, lower abdominal divided foliated skin flap in 1 case and Y-shaped hypogastric skin flap in 1 case. Reparative operation was carried out within 3 weeks after injury and primary repair were undertaken in 6 of them. The pedicles were divided in 17 to 24 days after operation. Twelve flaps survived. Three of the 6 flaps had mild signs of inflammation which disappeared after administration of antibiotics. One had necrosis of the distal part of the flap, and was healed with split skin graft. This type of skin flap was an ideal method for the treatment of snake-bite injury of the upper extremity.
Objective To study the effectiveness of substitute valve at the popliteal vein in treatment of deep venous valve insufficiency of lower extremities. Methods From January 1996 to August 2002, 27 patients were diagnosed having deep venous valve insufficiency of lower extremities by color Doppler and radiography with an average disease course of 17.4 years.All 27 patients had varicose vein, 25 pain, 22 swelling,25 pigmentation in ankle area and 19 chronic ulcerations.Two cases had been treated with great saphenous vein ligation and striping.Averagevein pressure in resting position was (11.00±0.73)kPa,and the ambulatory venous pressure was (9.14±0.68)kPa.All patients were treated with substitute valve at the popliteal vein,and great saphenous vein ligation and stripping, some were treated with subfascial endoscopic perforating veins ablation. Results The average ambulatory venous pressure after operation was (5.94±0.82)kPa,were significantly different from that before operation(P＜0.01). The curative results were satisfactory,and all symptom and physical sign disappeared.After a mean follow-up period of2-6 years,21 cases had satifactory results. Conclusion Substitute valve at the popliteal vein have the value of widespread application.
Objective To study the therapeutic effect of Roux-en-Y gastric bypass （RYGB） on type 2 diabetes mellitus （T2DM） rats and explore the possible mechanism of vaspin in RYGB on T2DM. Methods Twenty SD rats with T2DM and 20 age- and sex-matched normal SD rats were randomly divided into 4 groups according to the random digits table：T2DM-RYGB group， T2DM-sham operation （SO） group，RYGB group，and SO group，10 rats in each group. Fasting plasma glucose （FPG） level，serum insulin （INS） level，vaspin level，and homeostasis model of insulin resistance （HOMA-IR） were determined before operation and on week 4，8 after operation，respectively．At the same time，the correlation between vaspin and the indicators （FPG，INS，or HOMA-IR） was analyzed．Results Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not significantly different between the T2DM-RYGB group and T2DM-SO group （P＞0.05） or between the RYGB group and SO group （P＞0.05），but the FPG level，INS level，vaspin level，and HOMA-IR in the T2DM-RYGB group and T2DM-SO group were significantly higher than those in the RYGB group （P＜0.05） and SO group （P＜0.05），respectively. On week 4 after operation，the FPG level，INS level，vaspin level，and HOMA-IR decreased in the T2DM-RYGB group，except for the FPG level，the other indexes had no significant differences as compared with the values before operation. On week 8 after operation，the FPG level，INS level，vaspin level，and HOMA-IR further decreased in the T2DM-RYGB group，there were significant differences of these indicators between before operation and on week 8 after operation. Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not statistically significant （P＞0.05） in the T2DM-SO group，RYGB group，or SO group. The changes in serum vaspin level correlated positively with those in INS and HOMA-IR before operaion and on week 4，8 after operaion in the T2DM-RYGB group and T2DM SO group rats （P＜0.05），respectively. Conclusions RYGB surgery has a therapeutic effect on T2DM rats，and serum vaspin level decreases and insulin resistance is improved after RYGB surgery，which may be one of the mechanisms of the treatment for T2DM.
Objective To evaluate and compare the prognosis of idiopathic macular holes (IMH) and traumatic macular holes (TMH) treated by pars plana vitrectomy (PPV).Methods The clinical data of 72 IMH eyes and 55 TMH eyes, which were treated by PPV between November 2001 and December 2007, were retrospectively reviewed. The visual outcomes and macular anatomic closure were evaluated, and their relationships with prognostic factors including the size of macular hole (MH), preoperative visual acuity (VA) and duration of disease were analyzed.Results The closure rate of IMH (100.0%) was significant higher than that of TMH (85.5%) (P=0.001). The postoperative VA of IMH and TMH were (0.25plusmn;0.02) and (0.21plusmn;0.21) respectively,both significantly increased compare to their preoperative VA (t=-6.841,-4.093; P=0.000). VAincreased IMH and TMH eyes had same VA （chi;2=3.651，P=0.07）. PrePPV VAge;0.1 IMH eyes had better outcomes than PrePPV VA＜0.1 IMH eyes （chi;2=12.04, P=0.001）, while PrePPV VA had no effects on TMH outcomes （chi;2=0.371，P=0.486）. IMH eyes with small holes had better outcomes （t=2.476，P=0.016）, and TMH eyes with small holes had better closure （t=-4.042, P＜0.001）. The duration of disease had no significant influence on TMH visual （chi;2=0.704, P=0.401） and anatomic （chi;2=0.166, P=0.684） outcomes. Conclusions PPV is an effective treatment for MH. The closure rate of IMH is higher than that of TMH. The diameter of MH and preoperative VA are major factors for IMH outcomes, and the duration of disease and preoperative VA have no effects on postoperative VA in TMH.
Objective To improve the accuracy of the acetabular component placement using the nonimage based surgical navigation system. Methods Twenty-three patients (14 males, 9 females; age, 28-55 years;26 hips）with hip disease underwent the total hip arthroplasty (THA) using the nonimage based surgicalnavigation system from February 2004 to April 2006. Rheumatoid arthritis was found in 3 patients (3 hips), necrosis of the femoral head in 6 patients (6 hips), and osteoarthritis in 14 patients (16 hips). All the patients were randomly divided into the following 2 groups: the navigated group (11 patients, 13 hips), treated by THA using the nonimage based surgical navigation system; and the control group (12 patients, 13 hips), treated by the traditional THA. According to thedesign of the study, the acetabular component was placed in the best inclination angle (45°) and the anteversion angle (15°). The postoperative component position was examined. Results No fracture, dislocation, infection or injury to the sciatic nerve was found. In the navigated group, the inclination and the anteversion reached 15.4±1.4° and 45.5±1.3°, respectively. In the control group,the inclination and the anteversion were 13.9±7.6° and 43.7±6.4°, respectively. The inclination difference was considered statistically significant (Plt;0.01). All the patients were followed up for 10-40 months,averaged 26 months. In the navigated group, the postoperative average Harris hip score was 95 (range,85-110), with an excellent result in 11 hips and a good result in 2 hips. In the control group, the postoperative average Harris hip score was 92 (range,75-110), with an excellent result in 9 hips, a good result in 3 hips, and a fair result in 1 hip. The Harris hip score difference was considered statistically significant (Plt;0.05). There was a significantly better result obtained in the navigated group than in the control group. Conclusion The acetabular component can be implanted accurately by the nonimage based surgical navigation system, which can reduce the incidence of the loosening of the prostheses and has an important value in clinical practice.
In order to rise the efficiency of combined therapy and evaluate the value and status of cryosurgery in advancedstage liver cancer, liquid nitrogen was employed in treating 90 patients with hepatic carcinoma in our department from Nov. 1994 to Dec. 1997. The results revealed that cryotherapy could induce unrecoverable coagulation necrosis of the tumors. The levels of serum AFP decreased after cryosurgery and one patient has been surviving for three years. The authors believe that cryosurgery is an effective method for unresectable lesions of hepatic carcinoma and has a probability in decreasing its postoperative recurrent rate.
OBJECTIVE:To investigate the treatment of retinal redetachment after vitrectomy and silicone oil tamponade.
METHODS:Investigating retrospectively on the treatment effect of 8 cases of redetachment of retina with proliferative vitreoretinopathy(PVR) in which the retinas had been attached formerly after vetrectomy and silicone oil tamponade operation.The reoperative procedures included pars plana vitrectomy,membranes peeling,retinotomy,inner exchange of the fluid and silicone oil tampnade and subretinal membranes were removed out in 2 eyes.
RESULTS:Six eyes had anatomical reattachment postoperatively and another 2 eyes still had inferior shallow retinal detachment.Visual acuity was improved in 6 patients and remained unchange in 2 patients.
CONCLUSIONS:The cause of recurrent retinal detachment might be the formation of the proliferative epiretinal and subretinal membranes,and vitrectomy to release the traction of proliferative membranes and full fluid silicone oil exchange should do good to reattachment.
（Chin J Ocul Fundus Dis,1996,12: 13-15 ）
