6361例儿童腹股沟疝:35年回顾

Purpose: This study, by its mere size and uniformity (1 pediatric surgeon), aims to corroborate or refute the teachings and myths of the pediatric inguinal hernia. Methods: From July 1969 to January 2004, 6361 infants and children with inguinal hernias were seen, operated on, and followed by the senior author. A retrospective survey of their charts was carried out to evaluate the demographics and clinical aspects of these patients. The hospital’ s research ethics board approved of this study. Results: The ages ranged from premature to 18 years (mean age, 3.3 years) with a male- to female ratio of 5:1. There were 59% right, 29% left, and 12% bilateral hernias (almost all indirect). Hydroceles were found in 19% . Incarceration occurred in 12% . A modified Ferguson repair was used. An opposite- side hernia developed in 5% , 95% within the first 5 years, and was not sex or age specific. There were 1.2% recurrences, 96% within 5 years. Thirteen percent had ventriculo- peritoneal shunts, 1.2% wound infections, and 0.3% testicular atrophy. There were no postoperative deaths. One percent had a documented hernia disappearance. Conclusions: Three of our results have not corresponded with previous teachings and myths: (1) a hernia of a premature baby should be fixed sooner than later; (2) routine contralateral groin exploration is not indicated in any situation; and (3) teenage recurrence rate is 4 times greater than the overall series.

Severe acute pancreatitis: Pathogenetic aspects and prognostic factors

Approximately 20% of patients with acute pancreatitis develop a severe disease associated with complications and high risk of mortality. The purpose of this study is to review pathogenesis and prognostic factors of severe acute pancreatitis （SAP）. An extensive medline search was undertaken with focusing on pathogenesis, complications and prognostic evaluation of SAP. Cytokines and other inflammatory markers play a major role in the pathogenesis and course of SAP and can be used as prognostic markers in its early phase. Other markers such as simple prognostic scores have been found to be as e^ective as multifactorial scoring systems （MFSS） at 48 h with the advantage of simplicity, efficacy, low cost, accuracy and early prediction of SAP. Recently, several laboratory markers including hematocrit, blood urea nitrogen （BUN）, creatinine, matrix metalloproteinase-9 （MMP-9） and serum amyloid A （SAA） have been used as early predictors of severity within the first 24 h. The last few years have witnessed a tremendous progress in understanding the pathogenesis and predicting the outcome of SAP. In this review we classified the prognostic markers into predictors of severity, pancreatic necrosis （PN）, infected PN （IPN） and mortality.

Effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients infected with hepatitis B virus

AIM: To observe the effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients with hepatitis B virus (HBV) infection, and to compare the differences of liver function by two treatments of antituberculosis.METHODS: Forty-seven TB patients with HBV infection and 170 TB patients without HBV infection were divided into HPBE(S) and HLAMKO treatment groups. Liver function tests before and after the treatments were performed once in 2 wk or monthly, and their clinical manifestations were recorded.RESULTS: The rate of hepatotoxicity occurred in 26 (59%)TB patients with HBV during anti-TB treatment, higher than that in 40 (24%) TB patients without HBV. Hepatotoxicity occurred in 66 out of 217 patients, and the incidence of liver dysfunction was 46.1% in HPBE(S) group, significantly higher than that in HLAMKO group (12.7%) (P＜0.01).CONCLUSION: TB patients with HBV should choose HLAMKO treatment because of fewer hepatotoxicity.

Expression of cytokeratins in Helicobacter pylori-associated chronic gastritis of adult patients infected with cagA+strains:An immunohistochemical study

AIM： To investigate the expression of different cytokeratins （CKs） in gastric epithelium of adult patients with chronic gastritis infected with Helicobacter pylori （H pylon） cagA ＋ strains. METHODS： The expression of CK 7, 8, 18, 19 and 20 was studied immunohistochemically in antral gastric biopsies of 84 patients. All the CKs were immunostained in cagA＋Hpylori gastritis （57 cases）, non-Hpylori gastritis （17 cases） and normal gastric mucosa （10 cases）. RESULTS： In cagA＋ H pylori gastritis, CK8 was expressed comparably to the normal antral mucosa from surface epithelium to deep glands. Distribution of CK18 and CK 19 was unchanged, i.e. transmucosal, but intensity of the expression was different in foveolar region in comparison to normal gastric mucosa. Cytokeratin 18 immunoreactivity was significantly higher in the foveolar epithelium of H pylori-positive gastritis compared to both Hpylori-negative gastritis and controls. On the contrary, decrease in CK19 immunoreactivity occurred in foveolar epithelium of H pylori-positive gastritis. In both normal and inflamed antral mucosa without Hpyloriinfection, CK20 was expressed stronglyl moderately and homogenously in surface epithelium and upper foveolar region, but in H pylod -induced gastritis significant decrease of expression in foveolar region was noted. Generally, in both normal antral mucosa and H pylori-negative gastritis, expression of CK7 was not observed, while in about half cagA＋ H pylori-infected patients, moderate focal CK7 immunoreactivity of the neck and coiled gland areas was registered, especially in areas with more severe inflammatory infiltrate. CONCLUSION： Alterations in expression of CK 7, 18, 19 and 20 together with normal expression of CK8 occur in antral mucosa of H pylori-associated chronic gastritis in adult patients infected with cagA＋ strains. Alterations in different cytokeratins expression might contribute to weakening of epithelial tight junctions observed in H pylori-infected gastric mucosa.

IRRIGATION AND TRACTION THERAPY FOR OPEN FRACTURE WITH LARGE－SIZED FULL－THICKNESS SKIN－DEFICIT AND SEVERELY INFECTED WOUND

In this paper the results of skeletal traction and irrigation therapy (STIT) used for open fracture complicated with large-sized full-thickness skin-deficit and infection wounds (OFIW) were presented. Fourteen patients of OFIW were treated by the plaster cast and wound dressing (PCWD), and 30 patients of OFIW were treated by STIT. The results indicated that after one week of treatment, the white blood cell count in the STIT group, compared to 17. 6±l. 0×109/L from before treatment, returned to 8. 8±0. 8×109/L,and in contrast, the cell count of the PCWD group was about 13. 0±1. 4×109/L. All of wound exudate culture in the STIT group was negative, and those of 7 cases (7/14) in PCWD group were positive (P<0. 0l). The symptoms and signs such as pain, fever and septic exudate on the wound in the STIT group were much milder than those in the PCWD group. There were 5 cases (35. 7%) of toxicemia and septicemia, 2 cases (14. 3%) of osteomyelitis, 2 cases (14. 3 %) of amputation, 1 case (7. 1%) of delayed union and 3 cases (21. 4 %) of malunion in the PCWD group, and no complications in the STIT group.

WOUND INFECTION AFTER SCOLIOSIS SURGERY:AN ANALYSIS OF 15 CASES

OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.

Expression of Helicobacter pyloriAlpA protein and its immunogenicity

AIM:To construct a recombinant strain which expresses adhesin AlpA of Helicobacter pylori (H pylori) and to study the immunogenicity of adhesin AlpA. METHODS: Gene Ab, which was amplified from H pylori chromosomal DNA by PCR technique, was sequenced and the biological information was analyzed, and inserted into the Nco I and Not I restriction fragments of the expression vector pET-22b(+) using T4 DNA ligase. The resulting plasmid pET-AlpA was transformed into competent E.coli BL21(DE3) cells using ampicillin resistance for selection. Recombinant strains were incubated in 5 mL LB with 100 μg/mL ampicillin overnight at 37 ℃. Sonication of BL21(DE3)pET-22b(+)/AlpA was analyzed by Western blot to detect AlpA immunogenicity. RESULTS: The gene encoding AlpA protein was amplified by PCR with chromosomal DNA of H pylori Sydney strain (SS1) as templates. It revealed that AlpA DNA fragment amplified by PCR had approximately 1 500 nucleotides, compatible with the previous reports. The recombinant plasmid pET-22b(+)/AB was successfully constructed. DNA sequencing showed one open reading frame with the length of 588 bp. It encoded seven conservative regions that showed good antigenicity and hydrophobicity by Parker and Welling method. Furthermore, INTERNET EXPASY, NNPREDICT and ISREC predicted that it was a porin-like structure consisting of β-pleated sheets that were embedded in the outer membrane. BLAST analyzed 836 767 protein sequences and found that the similar sequences were all belonging to H pylori OMP sequences. SDS-PAGE and scan analysis showed that the molecular weight of AB was 22.5 ku and recombinant protein amounted to 29% of the total bacterial protein, among which dissolved expression amounted to 21.9% of sonicated supernatant. The rAB purity amounted to 96% through affinity chromatography. Western blot analysis of rAB confirmed that it could be specially recognized by serum form rabbit immunized with AlpA and H pylori infected. CONCLUSION: Adhesin AlpA recombinant protein may be a potential vaccine for control and treatment of H pylori infection.

Laparoscopic surgery in endometrial carcinoma staging operation:analysis of 39 cases

Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endometrial carcinoma in PLA general hospital between 2006 and 2009 retrospectively.Thirty-nine patients were performed laparoscopic modified radical hysterectomy plus systemic retroperitoneal lymphadenectomy.Forty-seven patients received traditional abdominal radical hysterectomy plus systemic retroperitoneal lymphadenectomy.We compared the operation time,blood loss,number of lymph nodes retrieved,time for restoration of gastrointestinal function,postoperative complications and morbidity,the incidence of wound infection,the length of hospital stay,and hospital charges.Results:There was no significant deviation between the two groups in age,clinical stage,and pathology.We found that there was no significant deviation between the two groups in the number of lymph nodes retrieved,postoperative complications,the rate of wound infection or hospital charge(P > 0.05).The laparoscopic group had an advantage in blood loss,time for restoration of gastrointestinal function,time for postoperative hospital stay(P < 0.05).Conclusion:Laparoscopic surgery,as a primary surgical intervention,seems to be a safe and feasible option especially in patients with early endometrial cancer.

The Influence of Anaerobic Bacteria on Human Urinary System

The anaerobic bacteria can cause infections in different parts of the body, including appendicitis, cholecystitis, otitis media, oral infections, endocarditis, endometritis, brain abscess, myocardial necrosis, osteomyelitis, peritonitis, empyema, salpingitis, septic arthritis, liver abscess, sinusitis, intestinal surgery or post-traumatic wound infections, and bacteremia, such as pelvic inflammatory disease. This paper analyzes the experimental method of anaerobic bacteria to human urinary system through the influence of literature.

Canine Extremity Wound Treatment with Chitosan Extracted from Shrimp Shells： A Case Report

The aim of this case report was to demonstrate the effectivity of chitosan as topical agent on the treatment of severely infected canine extremity wound. The dog was hit by a bus and presented severe friction wounds accompanying with bilateral hip and extremity fractures. Local and generalized infections were observed on the post operational period. The dog was unresponsive to the standard therapeutic protocols and health status was getting worsened. The regenerative sutures did not hold the tissues because of the infection and the tissue eruption. Chitosan samples were extracted from shrimp shell wastes. The milled form of chitosan was topically used to treat the open and heavily mix infected wound areas located at skin and rear extremities accompanying with fever and Canine coronavirus diarrhea. It was decided to use the chitosan as a bio barrier and anti-bio affect over the damaged and erupted tissues. Macroscopic fmdings indicated chitosan promoted the natural blood clotting and absorbed the inflammation fluid. Microscopic findings indicated the infiltration of polymorph nuclear leukocytes （PMN） accelerated with the topical use of chitosan in the early phase of wound healing. The wound healing was observed daily. This veterinary practice wound treatment result indicated that chitosan is effective to medicate topically the canine open and mix infected wounds with bacteria and viruses and promotes the granulomatosis in four weeks period.

THE DEVELOPMENT OF MONOCLONAL ANTIBODY AGAINST rhTNF AND ITS CURATIVE EFFECTSON E.Coli INFECTED MICE

Fifteen hybridoma cell lines producing monoclonal antiboclies (McAb) against recombinant human tu-mor necrosis factor a (rhTNFa) have been established by fusing SP 2/0 cells with spleen cells from aBALB/c mouse immunized with rhTNFa. Following J M Davis’s Works, semi-solid medium was usedfor initial cloning. Five of them were studied further. Their main chromosome- numbers range were 96 to105, all of them were IgG1 subclass. The affinities of these McAbs were estimated to be 1. 25 ×108 mol/L, 1. 12×108 mol/L, 2. 34×108 mol/L, 8. 55 × 107 mol/L, 1. 04×108 mol/L, respectively.Two groups of mice challenging with E Coli (107 organisms), one group treated with 2mg/kg anti-TNF monoclonal antibody, the other did not. There was a higher survival rate in treated group, the serumTNF level was significantly lower too, and the untreated mice had severe pathologic changes in vlscera.

Role of locking plates in treatment of difficult ununited fractures： a clinical study

Objective： To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods： Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture （3 patients）, supracondylar fracture of femur （gap nonunion）, fracture of clavicle, fracture of both forearm bones （radius and ulna） fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar frac- ture of humerus （one patient each）. Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients. Results： Minimum follow-up was 6 months （range, 6 months to 2.5 years）. Average time for union was 3.4 months （range 2.5 to 6 months）. None of the patients had plate- related complications or postoperative wound infections. Conclusion： Along with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.

Anti-infective reconstituted bone xenograft used for primary bone grafting to repair contaminated defect in the radius in dogs

Objective: To investigate the effect of anti-infective reconstituted bone xenograft as a primary graft to repair a segmental with severe contamination. Methods: A canine model of contaminated defect of 1.5 cm in size in the radius was used, in which anti-infective reconstituted bone xenograft or reconstituted bone xenograft was implanted as a primary graft followed by internal fixation. The effectiveness of the two grafting materials in repairing a contaminated segmental defect was compared. Results: The animals which had received implant of anti-infective reconstituted bone xenograft should largely healed defects 6 months after operation while the defects implanted with reconstituted bone xenograft remained unrepaired with bone infection. Conclusions: Besides its strong osteoinductive and osteoconductive activity, anti-infective reconstituted bone xenograft is highly antibacterial and can be used as a primary graft to repair the severely contaminated segmental defect.

Infectious complications in patients with crush syndrome following the Wenchuan earthquake

Objective： To analyze the results of clinical and bacteriological examinations in patients with crush syndrome who suffered infectious complications after an earthquake in Sichuan, China. Methods： Atotal of 313 bacteriological samples among 147 patients with crush syndrome were collected. Infectious complications, results of microbiological examinations, potential risk factors of infection and mortality were analyzed statistically. Results： In the obtained database, 112 out of the 147 （75.7%） patients had infectious complications, in which, wound infection, pulmonary infection, and sepsis were most common. The time under the rubble and the time from injury to treatment were related to the occurrence of wound infec- tion （P=0.013, odds ratio 2.25;P=0.017, odds ratio 2.31）. Sep- sis and wound infection were more common in patients who underwent fasciotomy or amputation than in those who did not （P=O.O01 ）. Conclusion： Quick rescue and injury treatment can decrease the infection risk in crush syndrome patients. It is better to obtain microorganic proofs before applying antibiotics, and bacteriological and drug sensitivity data should be taken into account, especially considering that most of these infections are hospital-acquired and drug resistance. Emphasizing the accuracy and efficiency of wound management in emergency situations, cautiously assessing the indications for fasciotomy to avoid open wounds from unnecessary osteofascial compartment de- compression incisions may decrease the incidence of in- fection and ameliorate the prognosis.

Treatment for 332 cases of lower leg fracture in ＂5.12＂ Wenchuan earthquake

Objective： To retrospectively analyze the medical treatment of 332 patients with lower leg fracture in Wenchuan earthquake admitted in West China Hospital. Methods： From May 12, 2008 to June 15, 2008, 332 patients with lower leg fracture injured in Wenchuan earthquake were treated in our hospital. The data on trauma condition and clinical treatment were collected and analyzed. Results： Among the 332 cases of lower leg fracture, there were 179 eases of open fracture, accounting for 53.9%, in which 91% belonged to Gustilo Ⅱ or Ⅲ injury with serious pollution. Many patients had posttraumatic complications, vascular and nerve injury, wound infection or osteofascial compartment syndrome. After medical treatment, blood vessels were reconnected, wound surface was repaired and wound infection was under control. Conclusion： For the patients with lower leg fracture in earthquake, we followed the principle of ＂complete debridement - restoring the continuity of bone bracket - timely recovering blood supply of limbs and repairing nerve damage - repair the wound surface at stage Ⅰ or Ⅱ ＂ so as to reduce the incidence of amputation and infection.

Phospholipid/protein co-mediated assembly of Cu_(2)O nanoparticles for specific inhibition of growth and biofilm formation of pathogenic fungi

As the increasing number of the individuals suffering from AIDs,chemotherapy,and radiotherapy,pathogenic fungi,which may rapidly grow and invade the host tissues in these immune-compromised patients,is becoming great threat to human health.In this study,we constructed a novel fungal pathogen-responsive assembly of cuprous oxide(Cu_(2)O)nanoparticles(NPs)for specific targeting and inhibiting growth and biofilm formation of the representative fungal pathogen,Candida albicans(C.albicans).This assembly was formed by coating the initial Cu_(2)O NPs with both phosphatidylethanolamine(PE)and bovine serum albumin(BSA),followed by hydrophobic/electrostatic interaction-driven formation of the Cu_(2)O-PE-BSA microaggregates.The formed microaggregates could be induced for disassembly by the fungal pathogen C.albicans,leading to close binding of the NPs to the cell wall of the pathogen.Both confocal microscopy and viability assays showed that the assembly strongly inhibited growth and biofilm formation of the pathogen,but had extreme low toxicity to mammalian cells.In vivo mouse wound model further revealed that the assembly had high capacity of healing the fungus-infected wounds and reduced the fungal burden of the wound tissues.This study sheds a novel light on facile development of pathogen-responsive nano-assemblies for efficient and safe antifungal therapy.

Surgical treatment of infected arterial injuries of the major limb

To analyze retrospectively the surgical treatment of 21 cases of infected arterial injuries of the major limb hospitalized from 1989 to 2003 in our department. Methods： After a radical debridement and drainage, an autologous vessel bypass reconstruction, simple vessel ligation or amputation were carried out respectively according to each patient＇s condition. In order to make a better milieu for the grafts, local musculo-cutaneous flaps were translocated to cover the wounds in 9 cases. Results ： 1 case （ 4.8 % ） died during the treatment. 5 cases （ 5/21, 23.8 % ） underwent amputations. Blood supply reconstruction was successful in 15 cases （15/21, 71.4%）. 93.3% （14/15） of the cases were successful in getting an unobstructed vessel at early stage. Thrombosis occurred in 1 case （ 1/15, 6.7 % ） and a sound result was obtained after a second operation. Conclusions： Radical debridement combined with bypass vessel reconstruction with autologous vein and with musculo-cutaneous flap translocation is an effective treatment for infective limb vascular injuries.

Maggot therapy for repairing serious infective wound in a severely burned patient

The larvae of musca domestica were put in use to discard the dead tissue of a case of severe burn. A total of 50 000 aseptic maggots were put onto the infective wound surface, and aseptic dressings overlaid the surface. Three days later, another 20 000 maggots were put onto the wound for the second therapy. After twice maggot debridement, most necrotic muscle tissues of the wound were cleaned up, and eventually fresh granulation tissuegrew and later the wound was covered and healed by 3 times of skin grafting. The result demonstrates that maggot therapy is safe and effective with no adverse complications except pain.

Retrospective analysis： the earthquake-injured patients in Barakott of Pakistan

Objective： To provide the experience on medical rescue and care for any giant earthquake by analysing the patients treated by the Chinese Medical Rescue Team in the Barakott earthquake of Pakistan. Methods： On October 8, 2005, a giant earthquake （7.8 Richter scale） earthquake occurred in the northwest Pakistan. We belonged to the Chinese Medical Rescue Team and worked in the earthquake-affected town-Barakott from October 28, 2005 to November 17, 2005. The patients were classifted into upper respiratory tract infection, diarrhea, trauma and other diseases. All the data of patients who were injured during the earthquake were analysed. The difference was analyzed by x^2 test. Results： Of the 2 194 patients treated by the Chinese Medical Rescue Team, trauma patients only accounted for 29%, diarrhea patients for 4%, upper respiratory infection patients for 14%, and other types of diseases for 52%.Among the 630 trauma patients, 426 patients were injured during the earthquake. Of the 426 patients, 291 （68%） patients were found having open wounds, 85 （20%） patients mainly complained of soft tissue pain without any wound or fracture, and 76 （18%） patients had fractures with or without open wound. The most frequent site of wound was lower extremity. Head injury in children was 30%, obviously higher than that in the adults. Wound infection was common among the injured patients, with the rates of 72%, 64% and 78% in male, female adult patients and children, respectively. Conclusions： Prevalence of common diseases, trauma, wound infection and fracture are main problems presented at late stage of the giant earthquake. Great attention should be paid to head and lower extremity injuries.