Objective To compare the curative effect of procedure for prolapse and hemorrhoids (PPH) with MilliganMorgan hemorrhoidectomy (MMH) for acute incarcerated hemorrhoids. Methods A retrospective study of 103 patients with acute incarcerated hemorrhoids treated by surgery was performed. The patients were divided into PPH group (n=58) and MMH group (n=45) according to the different operation program who underwent. Operative time, pain score of VAS, time required for anodyne, postoperative complications, hospital stay, and hospital charges were compared. Results The symptoms were both relieved in two groups patients. Although the hospital charges of patients in MMH group were fewer, the patients in PPH group had advantages of shorter operative time, less postoperative pain, lower requirement for anodyne, fewer complications (edema of anal edge), and shorter hospital stay (Plt;0.01). Conclusion PPH is as safe and effective as MMH, and furthermore its short-term therapeutic effect is better than MMH.
Objective To explore the influence factors for the functional improvement after the fetal olfactory ensheathing cell (OEC) transplantation for chronic spinal cord injury(SCI). Methods The olfactory bulbs were harvested and trypsinized down to single fetal OEC. They were cultured for 12-17 days prepared for use. From November 2001 to December 2003, a total of 300 patients volunteered for the fetal OEC transplantation, among whom 222 suffered from complete chronicSCI and 78 suffered from incomplete chronic SCI. The procedures were performed on the patients with a disease course ranging from 6 months to 31 years (average 3.1 years) after their injuries. The fetal OEC was transplanted by the form of injections into the spinal cord at the upper and lower ends of the injury site. All the patients were assessed by the ASIA standard before the transplantation and 2-8 weeks after the transplantation. The influence factors including age, sex, duration after the injury, and injury degreesand levels were compared with those in the functional improvement after fetal OEC transplantation. Results The partially-improved neurological functions assessed by the ASIA standard were indicated by the motor scores increasing from 39.1±20.6 to 45.9±20.3 (Plt;0.001), the light touch scores from 51.7±24.9 to 63.4±23.0 (Plt;0.001), and the pin prick scores from 53.0±24.2 to 65.3±22.7(Plt;0.001). There was no significant difference in the functional improvement of the motor, light touch, and pin brick when compared with the age, sex, duration after theinjury, and the injury degrees and levels. The motor scores and light touch scores at the cervical level were higher than the scores at the thoracic level. Conclusion The fetal OEC transplantation can partially improve the neurological functions quickly in treatment of the chronic spinal cord injury. All the influence factors except the motor scores and light touch scores, which were higher at the cervical level than at thoracic level, have no impact on the functional improvement after the fetal OEC transplantation.
Objective To evaluate the efficacy of Gefitinib for patients with non-small-cell lung cancer (NSCLC). Methods We searched several databases, including MEDLINE (1991 to June 2008), The Cochrane Library (Issue 4, 2008) and CBMDisc (1978 to Feb. 2008). Randomized controlled trials (RCTs) were included in the meta-analyses, which were done using The Cochrane Collaboration’s RevMan 4.2 software. We also included retrospective case reports published in Chinese journals. Results Eight RCTs and 36 uncontrolled case reports were analyzed. The results of the RCTs showed that 250 mg/d Gefitinib had similar efficacy to 500 mg/d, but the side effect was significantly less for the lower dose. When used as a combined first-line treatment or a third-line treatment, Gefitinib was not superior to placebo on response rate, survival rate and life span. When used as second-line treatment, it did not prolong median survival, though it gave a higher response rate than placebo. Gefitinib caused many more side effects than placebo. Gefitinib exhibited similar efficacy to docetaxel in objective response rate [OR 1.18, 95%CI (0.84, 1.67), P=0.35], but was better for symptom and quality-of-life improvement [OR 1.58, 95%CI (1.33, 1.89), Plt;0.00001]. The overall uncontrolled clinical studies showed the following results: complete response rate was 2.2%, partial response rate was 25.8%, disease stable rate was 40.0% and progressive disease rate was 32.0%. The average median survival time was 8.9 months; the average time to progressive disease was 5.2 months, and the 1-year survival rate was 44.2%. The average median survival from EAP studies (6.9 months) was shorter than that for all the studies as well as the registered clinical trials (10.0 months). The average periods to progressive disease for registered clinical trials (3.2 months) and EAP studies (4.4 months) were somewhat shorter than that found for all studies combined, though response rate and 1-year survival rate were similar. Since there was no controlled clinical study, it was hard to conclude from the results whether Gefitinib brought any clinical benefit to NSCLC patients in China. Conclusion Gifitinib is not suitable as a combined first-line treatment or a third-line treatment for NSCLC. The clinical favor from gefitinib in the second-line treatment remains uncertain. There is not enough evidence to show whether Chinese people are more sensitive to Gefitinib, and its use in the second-line treatment of NSCLC needs to be tested further.
ObjectiveTo evaluate the efficacy of intra-arterial chemotherapy (IAC) for advanced retinoblastoma (RB) after failure of intravenous chemotherapy (IVC). MethodsFifteen eyes of 13 patients with advanced RB were treated with IAC (1-5 cycles) after failure of IVC (2-8 cycles). The patients included 10 boys and 3 girls, with the mean age of (15.67±8.16) months. Six patients had bilateral RB and 7 patients had unilateral RB. There were 14 eyes (93.33%) in stage D, 1 eye (6.67%) in stage E according to the International Classification of intraocular retinoblastoma. The main reasons for failure of IVC were recurrent primary tumor in 3 eyes (20.00%), subretinal seeds recurrence in 9 eyes (60.00%), viable vitreous seeds in 2 eyes (13.33%) and poor response of primary tumor in 1 eye (6.67%). The mean interval between IVC completion and IAC start was 3 months. The mean follow-up was 19 months (ranged from 3 to 52 months). ResultsAfter IVC and secondary IAC, the retinoblastoma and seeds were regressed in 12 eyes (80.00%). Three eyes required enucleation for severe vitreous seeds, subretinal seeds recurrence and primary tumor recurrence. There was no evidence of metastasis in any case. ConclusionIAC can achieve high global salvage rate (80.00%) for patients with advanced retinoblastoma after failure of IVC.
ObjectiveTo explore the pathogenesis of cervical spondylosis combined with cervicogenic vertigo, and to investigate the clinical results of anterior discectomy and fusion in treating the disease. MethodsA retrospective study was performed on 83 patients with cervical spondylosis myelopathy (n=60, 72%) or radiculopathy (n=23, 37.3%) accompanied by sympathetic symptoms such as dizziness between March 2008 and November 2012. The disease involved single segment in 29 cases, double segment in 50 cases, and triple in 4 cases. All the segments involved were treated with anterior discectomy and fusion. Vertigo alleviation was observed before surgery, 3 days after surgery, and during the final follow-up. Neurological status was evaluated by Japanese Orthopedic Association (JOA) score system and sympathetic symptoms were evaluated with vertigo symptom and function scoring system. ResultsThe average follow-up was 21 months (ranging from 12 to 30 months). Significant difference was observed between sympathetic symptom scores and JOA scores before surgery and 3 days after surgery or at the final follow-up (P<0.05), but no significant difference was found between the scores 3 days after surgery and during the final follow-up (P>0.05). ConclusionThe surgical effect for cervicogenic vertigo is often accompanied by the relief of spinal cord and nerve roots symptoms. Surgery is effective for cervical spondylosis combined with cervicogenic vertigo.
Objective To investigate the prophylaxes, diagnosis and treatment of pelvi-peritoneal hernia (PPH) after Miles operation for rectal carcinoma. Methods Three hundred and nine patients who underwent Miles operation from January 1986 to June 1999 were collected and analysed retrospectively, 11 of them were complicated with PPH. Results The morbidity of PPH after Miles operation was 3.6% (11/309). The main manifestations included abdominal distention to some extent (11 cases), pain (3 cases), vomiting (2 cases), gastric liquid more than 500 ml a day by gastric tube (3 cases), and non-exsufflation of the stoma of colostomy (11 cases). Two cases had pea green small intestinal liquid by perineal tube. The signs were slight abdominal tender (5 cases), active or excessive intestinal gurgling sound (7 cases), and diminished intestinal gurgling sound (4 cases). Abdominal plane films, showing the distant small intestinal obstruction, were taken in all 11 cases. Only 2 patients were correctly diagnosed before reoperation, and other patients were regarded as adhesive intestinal obstruction. The average observational time following appearance of the clinical manifestations after Miles operation was 7.4 days. All patients were diagnosed by laparotomy, 3 of them underwent adhesion lysis and reposition, and 8 patients partial ileum resection and anastomosis. The content of the hernias was ileum. The morbidity after reoperation was 27.3% (3 cases), and the complication was wound infection. All 11 patients were cured and left hospital. Conclusion The PPH after Miles operation is often lack of typical clinical manifestations. The early diagnosis and laparotomy in time is key to management. It is important to prevent the complication.
Objective To systematically review the efficacy and adverse events of alendronate on bone mineral density and fractures in men with osteoporosis. Methods We electronically searched MEDLINE (1990 to 2005), EMBASE (1990 to 2005), The Cochrane Library (Issue 3, 2005), Controlled Trials Register and The National Research Register, CBM disc, VIP, and CNKI. We also handsearched some related journals. The search was conducted in Nov., 2005. The quality of included randomized controlled trials (RCTs) was evaluated and meta-analysis was conducted by RevMan 4.2.8. Results We identified 7 studies including 817 patients. Sufficient evidence showed that alendronate plus calcium was superior as preventive treatment to calcium in increasing the bone mineral density (SMD 0.59, 95% CI 0.15 to 1.03, P=0.009) of the lumbar spine. The incidence of withdrawal and lost to follow-up due to adverse events of the alendronate plus calcium was lower than that of calcium (RR 0.32, 95% CI 0.11 to 0.87). Two studies showed that alendronate was superior to placebo in increasing the bone mineral density in men with osteoporosis but with no significantly statistical difference in reducing fractures. Two studies showed alendronate was superior to alfacalcidol in increasing the bone mineral density and reducing the vertebral fractures in men with osteoporosis. One study showed alendronate was not superior to calcitonin or alfacalcidol in increasing the bone mineral density in men at high risk of osteoporosis. One study comparing anledronate or parathyroid hormone with combination of these drugs in men with osteoporosis suggested that anledronate wasn’t superior to parathyroid hormone in increasing the bone mineral density, and the combination did not show any difference compared to parathyroid hormone alone. Conclusions Alendronate is more effective in prevention and treatment of men with osteoporosis compared to placebo. Alendronate is more effective than alfacalcidol in increasing bone mineral density and reducingvertebral fractures in men with osteoporosis. Alendronate is not superior to alfacalcidol or calcitonin in increasing the bone mineral density in preventing men osteoporosis. Alendronate compared to combination of parathyroid hormone does not show more effectiveness in increasing the bone mineral density in men with osteoporosis. More RCTs of high quality, especially multiple center trials are needed to generate ber evidence.
Objective To explore the injury mechanism, clinical features and treatment methods of multiple-level noncontiguous spinal fractures(MNSF). Methods The clinical data of 23 patients with MNSF were analyzed retrospectively. Therewere 15 males and 8 females aging from 13 to 75 years. Five cases missed diagnosis. The locations of the primary injury were cervical region in 3 cases, thoracic region in 7 cases, and thoracolumbar region in 13 cases. The spinal fractures associated with spinal cord injury were 14 cases in the primary injury, and 3 cases in the secondary injury. According to Frankel grade, there were 7 cases ofgrade A, 1 case of grade B, 3 cases of grade C, 6 cases of grade D and 6 cases of grade E. Sixteen cases were treated by surgical stabilization while 7 cases were treated conservatively. Results Twenty patients were followed up from 3 months to 4 years with a mean of 11.5 months except three patients. No neurologic deterioration was observed in patients who were treated conservatively or operatively. No wound infection, no implant failure or bone graft nonunion occurred in patients who were treated operatively. Among 17 patients with neurologic deficit before operation, 12 got 1-3 grade improvement of the Frankel grading, 4 remained unchanged and 1 died. Conclusion The mechanism of MNSF injury is complex, it is easy to miss diagnosis. The patients with spinal injury must be examined carefully and completely. A whole spine radiographic survey should be accomplished if necessary and treatments should be based on the stability of spine fractures and the severity of spinal cord injury.