Retinopathy of prematurity (ROP) has become the leading blinding eye disease in children worldwide. In recent years, the recognition and treatment of acute stage lesions have achieved remarkable results. Fundus lesions could spontaneously regress in most of children with ROP, while the understanding of the law of spontaneous regression is still very limited. Although the fundus morphology is significantly improved after spontaneous regression, the long-term prognosis of visual function is not optimistic. The introduction of new technologies such as fundus fluorescence angiography and optical coherence tomography and angiography will help further understanding the nature of the spontaneous regression. To increase the study about spontaneous regression of ROP, which has significance for rationally arranging an economical and efficient screening time, formulating a scientific and individual treatment and follow-up plan, and improving the prognosis of visual function.
ObjectiveTo analyze the causes and characteristics of massive hemorrhage secondary to percutaneous nephrolithotomy (PCNL) and assess the value of superselective renal artery embolization in the management of this condition. MethodsThe imaging data and prognosis of 28 patients who developed repeated massive hemorrhage secondary to PCNL and underwent superselective renal artery embolization between April 2005 and June 2013 were reviewed. ResultsFollowing superselective renal artery embolization, hemorrhage was effectively controlled in all the 28 patients. Follow-up lasted from 6 to 62 months, averaging 41.6 months. No hematuria or other complications occurred during the follow-up period. ConclusionSuperselective renal artery embolization is safe and effective in managing massive hemorrhage secondary to PCNL, and it may be used as a preferred treatment for patients who are refractory to expectant treatments.
目的 研究鞏膜外墊壓手術聯合視網膜激光光凝對硅油眼視網膜脫離的治療效果。 方法 回顧性分析2009年1月－2012年1月，用鞏膜外墊壓聯合視網膜光凝手術治療36例硅油眼視網膜脫離的視網膜復位效果。 結果 全部患者均順利完成鞏膜外墊壓手術及隨后的視網膜激光光凝，行鞏膜外放液5只眼，手術中未發生視網膜嵌頓、眼內出血和眼壓顯著升高等并發癥；手術后1周視網膜復位21只眼（58.33%），剩下15只眼1個月后復位7只眼（19.44%），視網膜脫離總復位率為28只眼（77.77%）；未復位8只眼（22.23%），改用玻璃體切割手術方式，視網膜成功復位；6個月后取出硅油，隨訪6個月視網膜無脫離或者脫離范圍增加；手術后眼壓≥30 mm Hg （1 mm Hg=0.133 kPa）3只眼，≥20 mm Hg 7只眼，對癥治療1周后眼壓均恢復到正常范圍。 結論 鞏膜外墊壓聯合視網膜激光光凝治療硅油眼視網膜脫離，手術簡單，復位率高，可為硅油眼視網膜脫離首選手術方式，對于鞏膜外墊壓手術失敗和復雜的硅油眼視網膜脫離，應當選擇玻璃體切割手術方式。
Objective To summarize our clinical experience of endovascular repair of aortic pseudoaneurysms，andexplore the etiology of the disease，treatment indications，and early and midterm results of the procedure. Methods From November 2009 to May 2012，52 patients with aortic pseudoaneurysms received endovascular aortic repair （EVAR） in FuWai Hospital. There were 44 male and 8 female patients with their age of （53.8±13.5 ） years. Their onset syndromes includedchest or back pain in 46 patients and hoarseness in 5 patients. There were 23 acute patients and 29 chronic patients. Aortic pseudoaneurysms located at the descending thoracic aorta in 51 patients and the abdominal aorta in 1 patient. The meandiameter of the aortic pseudoaneurysms was （45.1±33.8） mm. All the patients were diagnosed using enhanced CT scan of the aorta. Three patients received emergency EVAR. All the patients received EVAR through the femoral arteries under general anesthesia. Forty-six patients underwent isolated EVAR，5 patients received hybrid technique for EVAR via the neck，and 1 patient received hybrid technique including EVAR and total arch replacement via median sternotomy under normothermia. The average diameter of stent-grafts was （34.2±3.3） mm and the average length was （157.7±20.3） mm. Enhanced CT scan of the aorta was performed before discharge，3 months and 1 year after EVAR during follow-up. Results There was no in-hospital death and EVAR was 100% successful. All the patients （100%） were followed up for 1-31 （12.6±7.9）months after discharge. Their chest or back pain symptoms all significantly improved. Their hoarseness improved too duringfollow-up. One patient’s hoarseness disappeared early after EVAR but recurred 5 months after EVAR. Enhanced CT scan showed enlargement of the stent-graft without endoleak. One patient underwent emergency EVAR for sudden onset of massivehemoptysis，recovered well before discharge，and was readmitted to hospital 5 months after EVAR because of fetid sputum and hemoptysis，who was diagnosed as Behcet’s disease and cured after anti-infection and immunosuppressive therapy. One patient had recurrent fever before and 6 months after EVAR and was cured by antibiotic therapy. Intraoperative angiographyshowed trivial typeⅠendoleak in 4 patients right after stent-graft deployment，which disappeared in enhanced CT scan 3-6 months after EVAR. Intraoperative angiography showed no endoleak in all the other patients，and their enhanced CT scans 3 months and 1 year after EVAR showed complete sealing between the stent-grafts and the aortic wall，thrombus in the pseudoaneurysm sac and decreased diameters of the pseudoaneurysms without endoleak. Two patients had hemiplegia 1 dayand 6 days after EVAR respectively，1 patient was cured and discharged and the other patient survived with hemiplegicsequelae. One patient with an abdominal aortic pseudoaneurysm died of sudden onset of cerebral infarction at home 3 monthsafter EVAR. Conclusions Endovascular repair of descending aortic pseudoaneurysms is safe and effective with good early and midterm results，and longer follow-up is needed for its long-term outcomes. Individualized treatment plan is basedon the location of the pseudoaneurysms. Preoperative meticulous medical history and physical examination are both importantfor the differentiation of the etiology of aortic pseudoaneurysms. Postoperative treatment based on the etiology and close follow-up are also needed to ensure long-term results.
【Abstract】 Objective To introduce a new method using calcium phosphate cement/Danshen drug del ivery systemfor avascular necrosis of femoral head and to evaluate its cl inical outcome. Methods From May 2000 to June 2005, 48 patients (54 hips) with avascular necrosis of femoral head were treated with calcium phosphate cement/Danshen drug del ivery system implantation in the involved femoral head. There were 32 males(36 hips) and 16 females(18 hips) with an average age of 38.7 years (26-62 years). Twenty-one cases had the history of drinking or smoking, 15 cases had the history of receiving hormonotherapy and 2 had the history of injury in hip joint. The disease course was 2-32 months. According to standard of Association Research Circulation Osseous (ARCO) staging, 9 hips were classified as stage I, 31 as stage II and 14 as stage III. The operation consisted of removal of necrotic bone under weight-loading cartilage and the implantation of calcium phosphate cement/Danshen drug del ivery system, all mani pulations were done through a bone tunnel in trochanter. The function of hi p joint were evaluated and X-ray films were taken pre- and post-operatively. Results No phlebothrombosis of leg and foreign body action occurred in all cases, and incision healed by first intention. The postoperative follow-up averaged 42.5 months, ranging from 22 to 73 months. According to the evaluation criterion of Dandong 1995 for adult avascular necrosis of femoral head, the results were excellent in 33 hi ps, good in 17, fair in 3 and poor in 1, the excellent and good rate was92.6 %. Conclusion This method is relatively simple with less invasion, it not only improves the microcirculation of femoral head by local appl ication of traditional Chinese medicine, but also provide mechanic buttress in the weight-loaded area, which is beneficial to repair and reconstruction of femoral head. It may be a choice of minimally invasion surgery for femoral head necrosis.
Objective To investigate the perioperative management and the results of surgical treatment of spinal tuberculosis associated with diabetes mellitus. Methods The cl inical data were analysed retrospectively from 42 patients with spinal tuberculosis associated with type 2 diabetes mell itus who were surgically treated between July 2001 and January 2009.There were 22 males and 20 females with an average age of 56.5 years (range, 41-78 years). The disease duration was 4-18 months (mean, 7.5 months). The involved vertebrae included 2 cervical vertebrae, 13 thoracic vertebrae, 17 thoracolumbar vertebrae, and 10 lumbar vertebrae. Of them, 18 patients compl icated by paraplegia, and 25 patients had more than one of concomitant diseases. Anterior debridement and bony grafting with anterior instrumentation fixation were performed in 16 patients; anterior debridement and bony grafting with posterior instrumentation fixation in 4 patients; posterolateral costotransversectomy debridement and interbody fusion with posterior instrumentation fixation in 8 patients; posterior debridement and bony grafting with posterior fixation in 7 patients; sinus resectomy and focus debridement in 2 patients; anterior debridement and bony grafting in 3 patients; and CT guided percutaneous catheter drainage in 2 patients. Postoperative anti-tuberculosis treatment was given for 12-24 months. Results The patients were followed up 1.5-5.0 years, with a mean period of 3.5 years. One patient died of pulmonary infection after 1 week of operation; 1 patient died of myocardial infarction after 2 years of operation; and other patients survived without tuberculosis recurrence. Among 38 patients who received bony grafting, 34 patients achieved bony fusion, 3 suffered bony grafting failure without kyphotic deformity or instabil ity except 1 patient who died from pulmonary infection. Among 18 cases compl icated by paraplegia, nerve function improved to a certain extent. The intraoperative and postoperativecompl ications occured in 28 cases. The systemic compl ications mainly included heart insufficiency in 5, heart rrhythmia in 3, pulmonary infection in 2, urinary tract infection in 2, and stree ulcer in 1; they were cured after medical treatment. The local complications mainly included sinus tract formation in 5, pleural tear in 2, neurologic injury in 2, intraoperative tear of inferior vena cava in 2, and the loosening of transpedicular screws in 4; they all were cured effectively. Conclusion Surgical treatment of spinal tuberculosis associated with diabetes mell itus appears to be a beneficial procedure on the condition that the blood glucose is controlled and the associated disorders and postoperative complications are properly handled, and reasonably selection of surgical procedures is very important. Instrumentation fixation provides adequate stabil ity to allow early mobilization.