Ten-maize inbred lines of maize （Zea mays L.） with high-induction rate and proliferation ability of embryonic calli were selected from 70-maize inbred lines by immature embryo culturing. Some of the embryonic calli ...Ten-maize inbred lines of maize （Zea mays L.） with high-induction rate and proliferation ability of embryonic calli were selected from 70-maize inbred lines by immature embryo culturing. Some of the embryonic calli were transferred onto regeneration medium to examine the ability of regeneration, some were transformed via Agrobacterium tumifaciens C58 carrying intron-β-glucuronidase （gus） gene, and GV3301 carrying the green fluorescent protein （gfp） gene to study the susceptibility of different genotypes in maize to A. tumifaciens. All embryonic calli initiated from 10-maize inbred lines were able to regenerate into plantlets, and the regeneration frequencies of inbred lines 6010, 6038, 6015, 6051, and 6060 were 61.11%, 31.94%, 45%, 33.33%, and 56.94%, respectively, which were higher than that of other lines. Analysis of variance indicated that the susceptibility of the various genotypes in maize to A. tumifacien C58 showed a significant difference among each other, and the inbred lines 6010, 6015, 6051, 6050, 6058, 6060, 6069, 6077 were susceptible to A. tumifacien C58, of which frequency of gus expression were over 70%. Expression of GFP was observed in six-inbred lines （6050, 6015, 6051, 6058, 6069, 6077）. The inbred lines 6051, 6010, 6015, 6060, and 6050 had the high regeneration and the susceptibility to A. tumifaciens C58; and the inbred lines 6051, 6015, and 6060 had the high regeneration and the susceptibility to Agrobacterium tumifaciens GV3301.展开更多
AIM: Dieulafoy's lesion (DL) accounts for 1-5.8% of cases of acute upper gastrointestinal bleeding (GIB). Its mortality is high, approaching 20%, despite recent advances in endoscopic therapy. We aimed to report o...AIM: Dieulafoy's lesion (DL) accounts for 1-5.8% of cases of acute upper gastrointestinal bleeding (GIB). Its mortality is high, approaching 20%, despite recent advances in endoscopic therapy. We aimed to report our experience in the treatment of DL.METHODS: A retrospective case study of all patients with DL between January 1993 and January 2003 was done. Characteristics, treatment methods, success rates and 30-d mortality of the patients were analyzed. RESULTS: Thirty-six patients were noted to have DL in the study period. Thirty-three records were available for assessment in which 35 DL were identified. The median age of the patients was 67 years with male to female ratio of 5.6:1. Significant comorbidities existed in 69% of the patients. Eighty-nine percent of the DL was found at first endoscopy, three DL at laparotomy. Significant coexistent endoscopic findings existed in 23%. Hemostasis was achieved in 88% by using adrenaline injection, or in combination with heater probe application at first endoscopy. Four cases had re-bleeding, all were successfully treated endoscopically. The 30-d mortality rate was 23%.CONCLUSION: Successful endoscopic hemostasis could be achieved in 100% of cases of DL. The overall mortality may still remain high, mainly due to the comorbidities and age of these patients.展开更多
In this case study,we analyzed the wound-healing process of a patient with a chronic wound who underwent fire needle treatment,and we tracked the coverage of granulation tissue and decrease of slough and exudate.An 85...In this case study,we analyzed the wound-healing process of a patient with a chronic wound who underwent fire needle treatment,and we tracked the coverage of granulation tissue and decrease of slough and exudate.An 85-year-old man had repeated right shoulder and back pain,itching,and skin festering for more than 1.5 years.A fire needle was administered combined with moist dressing once every 5 days to promote wound healing.After six rounds of fire needle treatment,granulation tissue formed over the surface of the wound base,the depth of the wound had become shallow,and the wound area was reduced.No complications occurred during the intervention.Fire needle therapy combined with a moist wound-healing dressing can be an effective alternative approach in managing chronic wounds.展开更多
Reactive lesions of bone and soft tissue can appear alarming on histologic examination because they are often cellular and have atypical cytologic features,such as distinct nucleoli,mild hyperchromasia,and mitotic act...Reactive lesions of bone and soft tissue can appear alarming on histologic examination because they are often cellular and have atypical cytologic features,such as distinct nucleoli,mild hyperchromasia,and mitotic activity.Reactive lesions of bone and periosteum also produce bone and cartilage matrix,resulting in confusion with osteosarcoma or chondrosarcoma.Careful attention to key cytomorphological features such as the pattern of bone formation,uniform appearance of cells,and absence of atypical mitoses should help identify the reactive nature of a lesion.Correlation with clinical and radiological findings is also imperative to avoid misclassification of the tumor because reactive lesions often arise at sites where osteosarcoma and chondrosarcoma are rare(eg,the hand)and lack aggressive radiological features.Here we present a case of exuberant callus formation after avulsion fracture of tibia in a three year-old Iranian girl which misdiagnosed as osteosarcoma.展开更多
Objective: To assess the outcome of valve replacement under mild hypothermia on pump-beating heart and to discuss the risk factors of cardiac valve surgery. Methods: In the period from November 1997 to May 2003, a tot...Objective: To assess the outcome of valve replacement under mild hypothermia on pump-beating heart and to discuss the risk factors of cardiac valve surgery. Methods: In the period from November 1997 to May 2003, a total of 800 cases of valve replacement were carried out in our institute. The clinical data were reviewed and the technique of mild hypothermia and pump-beating heart to replace cardiac valve was described in detail. Results: 800 patients, 308 male and 492 female, with age range from 8 to 66 years, weighing 19 to 88 kg, underwent operation. The average cardiopulmonary bypass time was (109.38± 40.64) min, the average clamping time of the vena cava was (77.87±27.99) min and the average mechanical ventilation time was (17.78±12.21) h. There were 17 patients died in the early postoperative stage with an early mortality rate of 2.13%. The causes of death were failure in the weaning of extracorporeal circulation in 2 cases, severe low output syndrome in 3 cases, ventricular fibrillation in 3 cases, obstruction of coronary ostium of mechanical prosthetic valve in 1 case, hepatic failure in 2 cases, pulmonary failure in 1 case, multiorgan failure in 4 cases, and prosthetic valve dysfunction in 1 case. Severe postopertive complications occurred in 51 cases (6.375%), which included reexploration because of excessive bleeding in 16 cases (2.0%), lavage of poststernal infection in 2 cases (0.25%), postoperative strike in 7 cases (0.875%), pulmonary failure in 5 cases (0.625%), hepatic failure in 4 cases (0.5%), multiorgan failure in 11 cases (1.375%), ventricular arrhythmia in 5 cases (0.625%) and peripheral circulation failure in 1 case (0.125%). Conclusion: Mild hypothermia and pump-beating heart result in satisfying clinical outcome in patients undergoing valve replacement. The integrated sequenced deairing procedure ensures the avoidance of air embolism during operation. Pump-beating heart technique offers a safe and practical option especially in patients with severe critical valvular disorder.展开更多
One patient with wound surface sepsis caused by secondary pyocyanic infection after extensive burns associated with visceral injuries (peptic ulcer hemorrhage, renal insufficiency and hepatic dysfunction) and generali...One patient with wound surface sepsis caused by secondary pyocyanic infection after extensive burns associated with visceral injuries (peptic ulcer hemorrhage, renal insufficiency and hepatic dysfunction) and generalied candidiasis albicans was cured after anti-infection treatment with proper antibiotics, removal of the infected focus, and effective anti-fungal drugs.展开更多
Objective Summarizing the clinical experience of surgical treatment in 2 cases of blunt cardiactrauma and reviewing the relevant literatures. Methods A 6-year-old girl was diagnosed muscular ventricularseptal defect a...Objective Summarizing the clinical experience of surgical treatment in 2 cases of blunt cardiactrauma and reviewing the relevant literatures. Methods A 6-year-old girl was diagnosed muscular ventricularseptal defect and left ventricular aneurysm 2d after automobile accident and underwent ventricular septal defect re-pair 2 weeks after injury. Another 9-year-old boy was diagnosed severe mitral regurgitation resulted from rupture ofposterior papillary muscle 9d after automobile accident and underwent mitral valvuloplasty 2 weeks after injury.Results Heart function of the first patient was in New York Heart Association (NYHA) class echocardiographyshowed no residual septal defect and the size of left ventricular aneurysm reduced. Heart function of the second pa-tient is in NYHA class echocardiography showed mild mitral regurgitation. Conclusion Blunt traumaticheart disease occurs either because of heart compression between sternum and the spine and/or because of myocardi-al contusion; A more aggressive strategy with surgical treatment earlier before deterioration of heart function is ad-vocated; Earlier surgical correction of anatomic deformity will achieve a good result and a long time follow-up isnecessary.展开更多
Iatrogenic bile-duct injury post-laparoscopic cholecystectomy remains a major serious complication with unpredictable long-term results. We present a patient who underwent laparoscopic cholecystectomy for gallstones, ...Iatrogenic bile-duct injury post-laparoscopic cholecystectomy remains a major serious complication with unpredictable long-term results. We present a patient who underwent laparoscopic cholecystectomy for gallstones, in which the biliary injury was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was unrecognized. The patient was referred to our hospital for biliary leak. Ultrasound and cholangiography was repeated, which showed an unanatomical repair （right to left hepatic duct anastomosis over the T-tube）,with evidence of contrast medium coming out through the abdominal drain. Eventually the patient was subjected to a definitive surgical treatment. The biliary continuity was re-established by a Roux-en-Y hepaticojejunostomy, over transanastomotic external biliary stents. The patient is now doing well 4 years after the second surgical procedure. In reviewing the literature, we found a similar type of injury but we did not find a similar surgical real-repair. We propose an algorithm for the treatment of early and late biliary injuries.展开更多
By peripheral nerve injury, we mean theloss of neurosensory and neuromotor functionsinduced by various causative factors,manifesting paralysis of the limbs andmuscular atrophy. It falls into the category ofinjury of t...By peripheral nerve injury, we mean theloss of neurosensory and neuromotor functionsinduced by various causative factors,manifesting paralysis of the limbs andmuscular atrophy. It falls into the category ofinjury of the muscle and tendon, and flacciditysyndrome in TCM. The following is asummary of documents in the recent 20展开更多
Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous anastamoses between the carotid artery and the cavernous sinus. These fistulas may be classified by cause (spontaneous or traumatic), flow velocity (high or...Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous anastamoses between the carotid artery and the cavernous sinus. These fistulas may be classified by cause (spontaneous or traumatic), flow velocity (high or low), or pathogenesis (direct or indirect). The most commonly adopted classification is that described by Barrow based on arterial supply. Traumatic CCFs are almost always direct shunts between the internal carotid artery (ICA) and the cavernous sinus. General features of CCFs, which may be apparent with any lesion, including bruit, headache, loss of vision, altered mental status and neurological deficits. Some fistulae may present primarily with hemorrhage before any evaluation can be performed. However, hemiparesis has been rarely observed. Only a literature review of Murata et al reported a case of hemiparesis caused by posttraumatic CCF, in which the fistula resulted in venous hypertension and subsequent brainstem congestion. While in our case, cerebral infarction was caused by total steal of the blood flow. The patient recovered after occlusion of the fistula with a detachable balloon.展开更多
Traumatic posterior hip dislocation is an uncommon injury in children, constituting less than 5% of paediatric dislocations. In a younger child （〈5 years）, minor trauma such as a slip or fall from a low height may ...Traumatic posterior hip dislocation is an uncommon injury in children, constituting less than 5% of paediatric dislocations. In a younger child （〈5 years）, minor trauma such as a slip or fall from a low height may cause a hip dislocation, whereas in an adolescent a dislocation is usually caused by a major trauma such as motor vehicle accident. In this case report we present a rare case of trau- matic hip dislocation in a 16-month-old girl. Early detectionand closed reduction ensured good outcome in our case. A high index of suspicion is necessary to achieve satisfactory reduction within six hours of dislocation because reduction after this period will greatly increase the risk of complications.展开更多
Objective：To evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury（TBI）mentioned in Cochrane Systematic Reviews published in the Cochrane Database of Systematic Re...Objective：To evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury（TBI）mentioned in Cochrane Systematic Reviews published in the Cochrane Database of Systematic Reviews（CDSR）.Methods：An exhausted literature search for all published Cochrane Systematic Reviews discussing therapeutic rather than prevention or rehabilitative interventions of TBI was conducted.We retrieved such databases as CDSR and Cochrane Injury Group,excluded the duplications,and eventually obtained 20 results,which stand for critical appraisal for as many as 20 different measures for TBI patients.The important data of each systematic review,including total population,intervention,outcome,etc,were collected and presented in a designed table.Besides,we also tried to find out the possible weakness of these clinical trials included in each review.Results：Analysis of these reviews yielded meanfuling observations：（1）The effectiveness of most ordinary treatments in TBI is inconclusive except that corticosteroids are likely to be ineffective or harmful,and tranexamic acid,nimodipine and progesterone show a promising effect in bleeding trauma,traumatic subarachnoid hemorrhage,TBI or severe TBI.（2）A majority of the systematic reviews include a small number of clinical trials and the modest numbers of patients,largely due to the uncertainty of the effectiveness.（3）The quality of most trials reported in the systematic reviews is more or less questionable.（4）In addition,lots of other complex factors together may lead to the inconclusive results demonstrated in the Cochrane Systematic Reviews.Conclusions：For clinical physicians,to translate these conclusions into practice with caution is essential.Basic medication and nursing care deserve additional attention as well and can be beneficial.For researchers,high quality trials with perfect design and comprehensive consideration of various factors are urgently required.展开更多
A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from su- prasternal notch to mediastinum. Exploratory operation via medi...A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from su- prasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years fol- low-up.展开更多
Central venous catheters （CVCs） are widely used in various puncture and drainage operations in intensive care units （ICUs） in recent years. Compared to conventional operating devices, CVC was welcomed by clinician...Central venous catheters （CVCs） are widely used in various puncture and drainage operations in intensive care units （ICUs） in recent years. Compared to conventional operating devices, CVC was welcomed by clinicians because of the advantages of easy use, less damage to the body and convenient fixation pro- cess. We came across a patient with severe acute pancreatitis （SAP） who developed cardiac arrest due to thoracic cavity massive bleeding 24 h after thoracoceotesis with CVC. Thoracotomy surgery was carried out immediately, which confirmed an intercostal artery injury. The patient was discharged from hospital without any neurological complications two months later. Here we report this case to remind all the emergency department and ICU physicians to pay more attention to the complication of thoracic cavity bleeding following thoracocentesis conducted by CVC.展开更多
High-velocity penetrating pelvic injury is one of the most difficult challenges to trauma surgeons. The injury sites frequently include soft tissue, pelvis, geni- tourinary tract, vascular structures and intraabdomina...High-velocity penetrating pelvic injury is one of the most difficult challenges to trauma surgeons. The injury sites frequently include soft tissue, pelvis, geni- tourinary tract, vascular structures and intraabdominal viscera. We present an unusual case of a male patient suf- fering a collision at night with a deformed steel bar penetrat- ing into his right groin. Careful planning of the surgical approach is important before extracting the foreign body. The possibility ofmultiorgan damage to intrapelvic struc-tures such as colon, urinary bladder, vessels and nerves, frequently necessitates a multidisciplinary involvement and systematic approach. Besides, limited incision as well as modification should be considered, and debridement and perioperative antibiotics can be used to reduce the risk of serious wound infection.展开更多
The treatment of extensive severe burn injury is very difficult, especially when some complications are involved. A burned patient sustained 98% total body surface area (TBSA) with 95% full thickness burn and severe i...The treatment of extensive severe burn injury is very difficult, especially when some complications are involved. A burned patient sustained 98% total body surface area (TBSA) with 95% full thickness burn and severe inhalation injury was admitted to our hospital in 08- 2000. After aggressive treatment, the patient recovered fully. This paper reports the treatment of the patient.展开更多
基金This work was supported by the National Natural Sciences Foundation of China (No. 30370889)the Program for Changjiang Scholars and Innovative Research Team in University of China (No. IRT0453)+3 种基金Beijing Agricultural Innovative Platform-Beijing Natural Science Fund Programthe National High-tech R&D Program of China (No. 2006 AA100103)the National Key Technolo-gies R&D Program (No. 2006 BAD01A03)the Program of the National Ministry of Agriculture (No. 2003-Q03)
文摘Ten-maize inbred lines of maize （Zea mays L.） with high-induction rate and proliferation ability of embryonic calli were selected from 70-maize inbred lines by immature embryo culturing. Some of the embryonic calli were transferred onto regeneration medium to examine the ability of regeneration, some were transformed via Agrobacterium tumifaciens C58 carrying intron-β-glucuronidase （gus） gene, and GV3301 carrying the green fluorescent protein （gfp） gene to study the susceptibility of different genotypes in maize to A. tumifaciens. All embryonic calli initiated from 10-maize inbred lines were able to regenerate into plantlets, and the regeneration frequencies of inbred lines 6010, 6038, 6015, 6051, and 6060 were 61.11%, 31.94%, 45%, 33.33%, and 56.94%, respectively, which were higher than that of other lines. Analysis of variance indicated that the susceptibility of the various genotypes in maize to A. tumifacien C58 showed a significant difference among each other, and the inbred lines 6010, 6015, 6051, 6050, 6058, 6060, 6069, 6077 were susceptible to A. tumifacien C58, of which frequency of gus expression were over 70%. Expression of GFP was observed in six-inbred lines （6050, 6015, 6051, 6058, 6069, 6077）. The inbred lines 6051, 6010, 6015, 6060, and 6050 had the high regeneration and the susceptibility to A. tumifaciens C58; and the inbred lines 6051, 6015, and 6060 had the high regeneration and the susceptibility to Agrobacterium tumifaciens GV3301.
文摘AIM: Dieulafoy's lesion (DL) accounts for 1-5.8% of cases of acute upper gastrointestinal bleeding (GIB). Its mortality is high, approaching 20%, despite recent advances in endoscopic therapy. We aimed to report our experience in the treatment of DL.METHODS: A retrospective case study of all patients with DL between January 1993 and January 2003 was done. Characteristics, treatment methods, success rates and 30-d mortality of the patients were analyzed. RESULTS: Thirty-six patients were noted to have DL in the study period. Thirty-three records were available for assessment in which 35 DL were identified. The median age of the patients was 67 years with male to female ratio of 5.6:1. Significant comorbidities existed in 69% of the patients. Eighty-nine percent of the DL was found at first endoscopy, three DL at laparotomy. Significant coexistent endoscopic findings existed in 23%. Hemostasis was achieved in 88% by using adrenaline injection, or in combination with heater probe application at first endoscopy. Four cases had re-bleeding, all were successfully treated endoscopically. The 30-d mortality rate was 23%.CONCLUSION: Successful endoscopic hemostasis could be achieved in 100% of cases of DL. The overall mortality may still remain high, mainly due to the comorbidities and age of these patients.
基金This research was funded by grants from The First Affiliated Hospital Project of Guangzhou University of Chinese Medicine(No.2017HL01)
文摘In this case study,we analyzed the wound-healing process of a patient with a chronic wound who underwent fire needle treatment,and we tracked the coverage of granulation tissue and decrease of slough and exudate.An 85-year-old man had repeated right shoulder and back pain,itching,and skin festering for more than 1.5 years.A fire needle was administered combined with moist dressing once every 5 days to promote wound healing.After six rounds of fire needle treatment,granulation tissue formed over the surface of the wound base,the depth of the wound had become shallow,and the wound area was reduced.No complications occurred during the intervention.Fire needle therapy combined with a moist wound-healing dressing can be an effective alternative approach in managing chronic wounds.
文摘Reactive lesions of bone and soft tissue can appear alarming on histologic examination because they are often cellular and have atypical cytologic features,such as distinct nucleoli,mild hyperchromasia,and mitotic activity.Reactive lesions of bone and periosteum also produce bone and cartilage matrix,resulting in confusion with osteosarcoma or chondrosarcoma.Careful attention to key cytomorphological features such as the pattern of bone formation,uniform appearance of cells,and absence of atypical mitoses should help identify the reactive nature of a lesion.Correlation with clinical and radiological findings is also imperative to avoid misclassification of the tumor because reactive lesions often arise at sites where osteosarcoma and chondrosarcoma are rare(eg,the hand)and lack aggressive radiological features.Here we present a case of exuberant callus formation after avulsion fracture of tibia in a three year-old Iranian girl which misdiagnosed as osteosarcoma.
文摘Objective: To assess the outcome of valve replacement under mild hypothermia on pump-beating heart and to discuss the risk factors of cardiac valve surgery. Methods: In the period from November 1997 to May 2003, a total of 800 cases of valve replacement were carried out in our institute. The clinical data were reviewed and the technique of mild hypothermia and pump-beating heart to replace cardiac valve was described in detail. Results: 800 patients, 308 male and 492 female, with age range from 8 to 66 years, weighing 19 to 88 kg, underwent operation. The average cardiopulmonary bypass time was (109.38± 40.64) min, the average clamping time of the vena cava was (77.87±27.99) min and the average mechanical ventilation time was (17.78±12.21) h. There were 17 patients died in the early postoperative stage with an early mortality rate of 2.13%. The causes of death were failure in the weaning of extracorporeal circulation in 2 cases, severe low output syndrome in 3 cases, ventricular fibrillation in 3 cases, obstruction of coronary ostium of mechanical prosthetic valve in 1 case, hepatic failure in 2 cases, pulmonary failure in 1 case, multiorgan failure in 4 cases, and prosthetic valve dysfunction in 1 case. Severe postopertive complications occurred in 51 cases (6.375%), which included reexploration because of excessive bleeding in 16 cases (2.0%), lavage of poststernal infection in 2 cases (0.25%), postoperative strike in 7 cases (0.875%), pulmonary failure in 5 cases (0.625%), hepatic failure in 4 cases (0.5%), multiorgan failure in 11 cases (1.375%), ventricular arrhythmia in 5 cases (0.625%) and peripheral circulation failure in 1 case (0.125%). Conclusion: Mild hypothermia and pump-beating heart result in satisfying clinical outcome in patients undergoing valve replacement. The integrated sequenced deairing procedure ensures the avoidance of air embolism during operation. Pump-beating heart technique offers a safe and practical option especially in patients with severe critical valvular disorder.
文摘One patient with wound surface sepsis caused by secondary pyocyanic infection after extensive burns associated with visceral injuries (peptic ulcer hemorrhage, renal insufficiency and hepatic dysfunction) and generalied candidiasis albicans was cured after anti-infection treatment with proper antibiotics, removal of the infected focus, and effective anti-fungal drugs.
文摘Objective Summarizing the clinical experience of surgical treatment in 2 cases of blunt cardiactrauma and reviewing the relevant literatures. Methods A 6-year-old girl was diagnosed muscular ventricularseptal defect and left ventricular aneurysm 2d after automobile accident and underwent ventricular septal defect re-pair 2 weeks after injury. Another 9-year-old boy was diagnosed severe mitral regurgitation resulted from rupture ofposterior papillary muscle 9d after automobile accident and underwent mitral valvuloplasty 2 weeks after injury.Results Heart function of the first patient was in New York Heart Association (NYHA) class echocardiographyshowed no residual septal defect and the size of left ventricular aneurysm reduced. Heart function of the second pa-tient is in NYHA class echocardiography showed mild mitral regurgitation. Conclusion Blunt traumaticheart disease occurs either because of heart compression between sternum and the spine and/or because of myocardi-al contusion; A more aggressive strategy with surgical treatment earlier before deterioration of heart function is ad-vocated; Earlier surgical correction of anatomic deformity will achieve a good result and a long time follow-up isnecessary.
文摘Iatrogenic bile-duct injury post-laparoscopic cholecystectomy remains a major serious complication with unpredictable long-term results. We present a patient who underwent laparoscopic cholecystectomy for gallstones, in which the biliary injury was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was unrecognized. The patient was referred to our hospital for biliary leak. Ultrasound and cholangiography was repeated, which showed an unanatomical repair （right to left hepatic duct anastomosis over the T-tube）,with evidence of contrast medium coming out through the abdominal drain. Eventually the patient was subjected to a definitive surgical treatment. The biliary continuity was re-established by a Roux-en-Y hepaticojejunostomy, over transanastomotic external biliary stents. The patient is now doing well 4 years after the second surgical procedure. In reviewing the literature, we found a similar type of injury but we did not find a similar surgical real-repair. We propose an algorithm for the treatment of early and late biliary injuries.
文摘By peripheral nerve injury, we mean theloss of neurosensory and neuromotor functionsinduced by various causative factors,manifesting paralysis of the limbs andmuscular atrophy. It falls into the category ofinjury of the muscle and tendon, and flacciditysyndrome in TCM. The following is asummary of documents in the recent 20
文摘Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous anastamoses between the carotid artery and the cavernous sinus. These fistulas may be classified by cause (spontaneous or traumatic), flow velocity (high or low), or pathogenesis (direct or indirect). The most commonly adopted classification is that described by Barrow based on arterial supply. Traumatic CCFs are almost always direct shunts between the internal carotid artery (ICA) and the cavernous sinus. General features of CCFs, which may be apparent with any lesion, including bruit, headache, loss of vision, altered mental status and neurological deficits. Some fistulae may present primarily with hemorrhage before any evaluation can be performed. However, hemiparesis has been rarely observed. Only a literature review of Murata et al reported a case of hemiparesis caused by posttraumatic CCF, in which the fistula resulted in venous hypertension and subsequent brainstem congestion. While in our case, cerebral infarction was caused by total steal of the blood flow. The patient recovered after occlusion of the fistula with a detachable balloon.
文摘Traumatic posterior hip dislocation is an uncommon injury in children, constituting less than 5% of paediatric dislocations. In a younger child （〈5 years）, minor trauma such as a slip or fall from a low height may cause a hip dislocation, whereas in an adolescent a dislocation is usually caused by a major trauma such as motor vehicle accident. In this case report we present a rare case of trau- matic hip dislocation in a 16-month-old girl. Early detectionand closed reduction ensured good outcome in our case. A high index of suspicion is necessary to achieve satisfactory reduction within six hours of dislocation because reduction after this period will greatly increase the risk of complications.
文摘Objective：To evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury（TBI）mentioned in Cochrane Systematic Reviews published in the Cochrane Database of Systematic Reviews（CDSR）.Methods：An exhausted literature search for all published Cochrane Systematic Reviews discussing therapeutic rather than prevention or rehabilitative interventions of TBI was conducted.We retrieved such databases as CDSR and Cochrane Injury Group,excluded the duplications,and eventually obtained 20 results,which stand for critical appraisal for as many as 20 different measures for TBI patients.The important data of each systematic review,including total population,intervention,outcome,etc,were collected and presented in a designed table.Besides,we also tried to find out the possible weakness of these clinical trials included in each review.Results：Analysis of these reviews yielded meanfuling observations：（1）The effectiveness of most ordinary treatments in TBI is inconclusive except that corticosteroids are likely to be ineffective or harmful,and tranexamic acid,nimodipine and progesterone show a promising effect in bleeding trauma,traumatic subarachnoid hemorrhage,TBI or severe TBI.（2）A majority of the systematic reviews include a small number of clinical trials and the modest numbers of patients,largely due to the uncertainty of the effectiveness.（3）The quality of most trials reported in the systematic reviews is more or less questionable.（4）In addition,lots of other complex factors together may lead to the inconclusive results demonstrated in the Cochrane Systematic Reviews.Conclusions：For clinical physicians,to translate these conclusions into practice with caution is essential.Basic medication and nursing care deserve additional attention as well and can be beneficial.For researchers,high quality trials with perfect design and comprehensive consideration of various factors are urgently required.
文摘A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from su- prasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years fol- low-up.
文摘Central venous catheters （CVCs） are widely used in various puncture and drainage operations in intensive care units （ICUs） in recent years. Compared to conventional operating devices, CVC was welcomed by clinicians because of the advantages of easy use, less damage to the body and convenient fixation pro- cess. We came across a patient with severe acute pancreatitis （SAP） who developed cardiac arrest due to thoracic cavity massive bleeding 24 h after thoracoceotesis with CVC. Thoracotomy surgery was carried out immediately, which confirmed an intercostal artery injury. The patient was discharged from hospital without any neurological complications two months later. Here we report this case to remind all the emergency department and ICU physicians to pay more attention to the complication of thoracic cavity bleeding following thoracocentesis conducted by CVC.
文摘High-velocity penetrating pelvic injury is one of the most difficult challenges to trauma surgeons. The injury sites frequently include soft tissue, pelvis, geni- tourinary tract, vascular structures and intraabdominal viscera. We present an unusual case of a male patient suf- fering a collision at night with a deformed steel bar penetrat- ing into his right groin. Careful planning of the surgical approach is important before extracting the foreign body. The possibility ofmultiorgan damage to intrapelvic struc-tures such as colon, urinary bladder, vessels and nerves, frequently necessitates a multidisciplinary involvement and systematic approach. Besides, limited incision as well as modification should be considered, and debridement and perioperative antibiotics can be used to reduce the risk of serious wound infection.
文摘The treatment of extensive severe burn injury is very difficult, especially when some complications are involved. A burned patient sustained 98% total body surface area (TBSA) with 95% full thickness burn and severe inhalation injury was admitted to our hospital in 08- 2000. After aggressive treatment, the patient recovered fully. This paper reports the treatment of the patient.
