Objective To analyze and explain how to treat 1 patient with post-ERCP hemobilia based on best clinical evidence. Methods We used EST and EPBD, ENBD, Hemobilia as key words to search MEDLINE （1978 ～ 2004） and CBMdisc（1978 ～ 2004） to find the best clinical evidence and evaluated the quality of evidence. Results According to the evidence, we found that endoscopic papillary balloon dilation （EPBD） or endoscopic nasobiliary drainage （ ENBD ） may be more effective and better tolerated in the treatment ofpost-ERCP hemobilia. Our patient did not receive sufficient medical treatment after hemobilia. He was not given a general assessment before surgery including liver function tests. As a result, the patient died of liver failure and its complications. Conclusions We should treat such patients promptly and efficiendy after hemobilia. We should also evaluate their general condition properly before the operation.
【摘要】目的探討重癥急性胰腺炎(SAP)時胰腺組織的誘導型一氧化氮合成酶(iNOS)、內皮素（ET1） mRNA表達狀態, 以及與血漿中NO、ET1濃度和腸道損傷的關系及丹參治療的影響。方法Wistar大鼠45只隨機分為3組:SAP模型組(A組),SAP丹參治療組(B組),假手術 組(C組),進行不同治療和觀察分析。結果A組血中淀粉酶(AML)、ET1、NO、內毒素(LPS)含量、125 I白蛋白累積指數及腹水量均顯著高于C組(Plt;0.01);與A組比較,B組胰腺ET1和iNOS mRNA表達較弱,血中AML、ET1、NO、LPS及腹水量顯著下降(Plt;0.01),125 I白蛋白累積指數較A組也有下降,但無差異(Pgt;0.05)。結論SAP時存在腸道損傷,胰腺組織ET1、iNOS mRNA的過度表達,使血中ET1、NO濃度升高,造成腸道屏障功能受損,腸通透性增加,引起內毒素血癥。丹參注射液通過減輕SAP時胰腺的病理損害程度,下調胰腺ET1和iNOS mRNA的表達,使血中ET1、NO濃度下降,對SAP及其腸道損傷有一定治療作用。
Objective To investigate the operative indication and clinical efficacy of combination of external fixator and volar approach fixation in treatingdistal radius fracture. Methods From March 2000 to March 2005, 28 patients with distal radius fracture were treated with combination of external fixator and volar approach fixation. Dorsal external fixator was used to maintain wrist in functional position, combinated volar plate or Kirschner wire fixation after reduction was achieved. Bone graft was necessary if there were severe comminuted cortical bone or compress of cancellous bone. Of 28 patients, there were 21 males and 7 females, aging from 1854 years with a median age of 41 years. The locations were the left side in 4 cases and the right side in 24 cases. According to typing criterion for AO, 18 cases were classified as C2 and 10 cases as C3. One case wasaccompanied with dislocation of lunate bone. Results Among 28 patients, 24 were followed up for an average of 8.5 months. The anatomical relationship of their wristjoint were reestablished and retained. Overall good to excellent results were achieved in 87%, excellent in 16 cases, good in 5 cases and fair in 3 cases. Conclusion A combination of external fixator and volar approach fixation is an effective method of treating fractures of the distal radius，because distal radius fracture is unstable or difficult to close reduction. Volarfixation can avoid operative complication, and external fixator can obtain satisfactory reduction and function.
目的:探討顱腦損傷合并視神經損傷的發病機制及治療.方法:對23例顱腦損傷合并視神經損傷患者的臨床資料做回顧性分析。結果:經過積極治療部分患者視力有不同程度改善。結論:治療顱腦損傷合并視神經損傷,強調神經外科和眼科協同處理,掌握治療時機。
ObjectiveTo investigate the effectiveness of minimally invasive plate and medial supporting cannulated screw fixation via tarsal sinus approach in treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures. Methods A clinical data of 46 patients with Sanders type Ⅱand Ⅲ calcaneal fractures met the selective criteria between March 2016 and March 2021 was retrospectively analyzed. The factures were fixed with minimally invasive plate and medial supporting cannulated screws via tarsal sinus approach in 20 cases (group A) and with minimally invasive plate in 26 cases (group B). There was no significant difference between groups in term of the gender, age, injury causes, fracture type and side, the time from injury to operation, and preoperative calcaneal length and width, B?hler angle, Gissane angle, and visual analogue scale (VAS) score (P>0.05). The operation time, intraoperative blood loss, hospital stay, and the interval between operation and full weight-bearing were recorded. The pain improvement of patients was evaluated by VAS scores before operation and at 48 hours after operation. The ankle joint function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score at 3 and 12 months after operation. Besides, the calcaneal length and width, B?hler angle, and Gissane angle were measured by X-ray films before and after operation. Furthermore, the difference (loss value) between 3, 12 months and 1 day after operation was calculated. Moreover, the fracture healing and healing time was observed. ResultsAll operations of two groups were successfully completed. The incisions healed by first intention, and no vascular/nerve injury or incision infection occurred. The operation time of group A was significantly longer than that of group B (P<0.05). There was no significant difference in the intraoperative blood loss, hospital stay, and the interval between operation and full weight-bearing (P>0.05). All patients were followed up 12-36 months (mean, 14.8 months). The VAS scores at 48 hours after operation were significantly lower than those before operation in the two groups (P<0.05); there was no significant difference in the difference of pre- and post-operative VAS score between groups (P>0.05). The AOFAS scores at 12 months after operation were significantly higher than those at 3 months after operation in the two groups (P<0.05); and there was no significant difference between groups at 3 and 12 months (P>0.05). X-ray films showed that the fractures of the two groups healed and there was no significant difference in healing time (P>0.05). There was no significant difference in calcaneal length and width and Gissane angle between groups at each time point (P>0.05), but there was significant difference in B?hler angle between groups at 12 months (P<0.05). The imaging indexes of the two groups significantly improved at each time point after operation when compared with those before operation (P<0.05). There was no significant difference between different time points after operation (P>0.05) in the imaging indexes of group A. There were significant differences in the calcaneal length, calcaneal width, and Gissane angle of group B between 12 months and 1 day, 3 months after operation (P<0.05), and there was no significant difference between 1 day and 3 months after operation (P>0.05). The differences in B?hler angle of group B between different time points after operation were significant (P<0.05). There was no significant difference between groups in the loss of all imaging indexes at 3 months after operation (P>0.05). The losses of calcaneal width, B?hler angle, and Gissane angle in group A at 12 months after operation were significantly smaller than those in group B (P<0.05), and there was no significant difference in the loss of calcaneus length between groups (P>0.05). ConclusionCompared with only minimally invasive plate fixation, the combination of minimally invasive plate and medial supporting cannulated screw fixation via tarsal sinus approach for Sanders type Ⅱ and Ⅲ calcaneal fractures has the advantages of less trauma, less incision complications, reliable fracture reduction and fixation, and good long-term stability.
ObjectiveTo explore the clinical characteristics and long term mortality of patients with eosinophilic and neutrophilic chronic obstructive pulmonary disease (COPD) exacerbations requiring hospital admission.MethodsA retrospective review of the clinical data and long-term follow up was performed for 510 patients with first diagnosis of acute exacerbation of COPD (AECOPD) requiring hospital admission between January 2015 and December 2016. The follow-up was completed in January 1, 2020. These patients were divided into three groups according to routine blood test: an eosinophilic exacerbation group, with peripheral blood eosinophils >2%; a neutrophilic exacerbation group, with peripheral blood neutrophils >65% or leukocytes >11×109/L; a paucigranulocytic exacerbation group, any case did not belong to the above two groups. The differences of clinical characteristics were compared among three groups. Cox regression model was used for analysis of independent risk factors of all-cause mortality of AECOPD patients.ResultsA total of 510 AECOPD patients were enrolled (180 eosinophilic, 273 neutrophilic and 57 paucigranulocytic, respectively). Compared with the neutrophilic exacerbation group, the eosinophilic exacerbation group had shorter time since onset of symptoms, the lower proportion of comorbid heart failure, the lower proportion of mechanical ventilation, dual antibiotics and systematic corticosteroid treatment, the shorter length of hospitalization and lower hospital mortality (all P<0.05). The average follow-up duration was 41 months for 485 AECOPD patients who completed long term follow-up. Compared with the eosinophilic exacerbation group, the neutrophilic exacerbation group was associated with a higher long-term mortality of AECOPD (HR=1.691, 95%CI 1.205 - 2.373, P=0.002).ConclusionCOPD patients with neutrophilic exacerbations have more serious clinical features and higher mortality than those with eosinophilic exacerbations.
Abstract: Objective To summarize the immediate effects and the near and midterm followup results of transthoracic balloon valvuloplasty for newborns and infants with severe and critical pulmonary valve stenosis to find out an effective plan for onestop balloon valvuloplasty. Methods From March 2006 to March 2010, 32 patients including 23 males and 9 females with severe and critical pulmonary valve stenosis were treated in Fu Wai Hospital. Their age ranged from 5 days to 11 months (4.59±3.21 months). Weight of the patients ranged from 2.3 to 10.5 kg (6.48±2.05 kg). Dilatation was performed under general anesthesia with intubation and the guidance of echocardiography. During the follow-up period, all survivors had serial echocardiographic assessment to measure the transpulmonary pressure gradient (TPG) and the degree of pulmonary regurgitation. Results All operations were successful with no severe postoperative complications. Hemodynamic indexes were stable after operation with TPG lowered from from 82±27 mm Hg preoperatively to 23±12 mm Hg postoperatively (t=15.28, Plt;0.05). Only 4 patients had a TPG of more than 40 mm Hg on echocardiography before leaving the hospital. Tricuspid regurgitation was decreased significantly with 17 cases of nonregurgitation, 13 cases of light regurgitation and 2 cases of moderate regurgitation. Saturation of peripheral oxygen in all the patients increased to higher than 95%. Followup time ranged from 1 month to 4 years (16±11 months). The results of the follow-up were satisfying for all the patients. The average TPG was 17±10 mm Hg with only one above 40 mm Hg. Pulmonary valve regurgitation was found in 24 patients including 23 with light pulmonary regurgitation and 1 with moderate regurgitation. Conclusion Transthoracic balloon valvuloplasty for newborns and infants with severe and critical pulmonary valve stenosis is safe and effective.
Objective To discuss the main points of technique and the range of fusion in posterior operation of spinal stenosis associated with lumbar degenerative kyphosis (LDK). Methods The cl inical data were retrospectively analysedfrom 20 cases of spinal stenosis associated with LDK which were performed posterior operation from February 2001 to February 2008. There were 1 male and 19 females, aged 52-81 years old with an average of 64 years old. The course of disease was 6-10 years. All patients had severe low back pain. According to Frankel’s neurologic function classification, there were 18 cases of grade E and 2 cases of grade D before operation. The apex of LDK included L1 in 3 cases, L2 in 10 and L3 in 7. The operational method was decided according to different characteristics of LDK. All patients were divided into three groups. Group 1 included 6 cases of sciatica and intermittent claudication with worse physical status, the segmental decompression of spinal canal, posterior intervertebral fusion and short transpedical instrument fixation were performed. Group 2 included 8 cases whose Cobb angle of LDK was less than 20°, the segmental decompression of spinal canal, posterior intervertebral fusion and one-level or multilevel lamina osteotomy were performed, instrumentation-assisted correction was used. Group 3 included 6 cases whose Cobb angle of LDK was more than 20°, the canal decompression and one-level transvertebral wedge osteotomy were performed, instrumentation-assisted correction, intervertebral fusion and posterior-lateral fusion were used. Results Incision healedby first intention in all patients. One patient suffered from superior mesenteric artery syndrome at 6 hours after operationand healed after symptomatic management. The neurologic function was improved to grade E at 2 weeks after opeartion. All patients were followed-up 24-54 months (average 26 months). At last follow-up，the Oswestry Disabil ity Index of all patients was 30.5% ± 9.6%; showing significant difference when compared with preoperation (55.9% ± 11.8%, P lt; 0.05). The back pain scoring and leg pain scoring were 2.8 ± 1.6 and 2.4 ± 1.6, respectively according to the Numeric Rating Scale score; showing significant differences when compared with preoperation (7.5 ± 0.5 and 7.3 ± 0.7, P lt; 0.05). The Numeric Rating Scale score and Oswestry Disabil ity Index in all patients were improved obviously when compared with before operation (P lt; 0.05). During the follow-up period, there was no instrumentation failure or correction loss and the fusion rate was up to 100%. Conclusion For spinal stenosis associated with LDK patients, the most important therapic purpose is to improve cl inical symptom through reconstruction lumbar stabil ization and spinal biomechanics l ine in sagittal plane. Overall estimate of the cl inical appearance and imageology character is necessary when making decision of which segments needed to be fixation and fusion. Individual ized treatment strategy may be the best choice.
ObjectiveTo evaluate the effectiveness of a new type of sutured titanium wire combined with titanium nail internal fixation in correction of serious old medial canthus deformity.MethodsBetween March 2012 and June 2015, 18 patients with unilateral serious old medial canthus deformity were treated. There were 14 males and 4 females. The patient’s age ranged from 23 to 62 years (mean, 42 years). The causes of deformity included accident injury in 10 cases, boxing injury in 4 cases, sharp device scratching in 3 cases, and animal bite in 1 case. All patients had been treated with suture or steel wire fixation in other hospitals to correct the medial canthus deformity and the deformity recurred. The interval between this operation and the first operation was 6 months to 2 years (mean, 16 months). The nasal root or medial canthus skin scar incision was used as the operative approach, and the adhesion of the medial canthus ligament to the adjacent tissues was fully loosened, then the tail end of the new type sutured titanium wire was fixed to the residual end of the medial canthus ligament. After passing through the scar tissue, the needle end of wire was fixed on the titanium nail in the bone wall of anterior lacrimal crest. The position and shape of the medial canthus angle was determined by adjusting the tightness of titanium wire.ResultsAll incisions healed by first intention. All patients were followed up 6-12 months (mean, 10 months). In 16 cases, the medial canthus deformity was obviously corrected, and the appearances of bilateral eyes were basically symmetrical, without exposure of titanium nail and titanium wire. The medial canthus was retreated at 2 mm after 6 months in 2 cases, who were satisfied with their appearance without reoperation.ConclusionApplication of the new type of suture titanium wire combined with titanium nail in the correction of serious old medial canthus deformity can achieve good effectiveness with the low recurrence rate.
Objective To assess the quality of the published randomized controlled trials published in Journal of Beijing University of Traditional Chinese Medicine (JBUTCM), Acta Universitatis Traditionis Medicalis Sinensis Pharmacologiaeque Shanghai (AUTMSPS), Journal of Guangdong University of Traditional Chinese Medicine (JGUTCM), and Journal of Chengdu University of Traditional Chinese Medicine (JCUTCM) from 2000 to 2005. Method Guided by the Cochrane Center hand-searching guidelines, we searched 24 volumes (111 issues) of the four journals. The data were extracted according to the principles of clinical epidemiology and consolidated standards of reporting trials (CONSORT), as well as an evaluation scale for randomized controlled trials (RCTs). The data were managed by descriptive analysis and uniformity test. Results There were 365 RCTs. The diagnostic criteria were reported in 297 trials (81.37%). The inclusion and exclusion criteria were reported in 143 trials (39.18%) and 132 trials (36.16%), perspectively, None mentioned the estimation of sample size. The randomization and allocation concealment were reported in 70 trials (19.18%) and 9 trials, perspectively. The baseline data were described in 292 trials (80.00%). Blinding was mentioned in 35 trials (9.59%).Withdrawal occurred in 20 trials (5.48%). Informed consent was acquired in 2 trials. Adverse drug reactions were described in 97 trails (26.58%). Conclusion There are deficiencies in the reporting of these RCTs, Most of the trials do not describe the randomization, only a few trials use the allocation concealment and blinded method, no description of comparability of baseline data, most of the trials do not report the inclusion and exclusion criteria, and none estimate the sample size. These problems indicate that it is necessary to improve the quality of clinical research in Chinese medicine and pharmacology.