[Clinical effect of compound internal fixations in treating extreme distal radial fractures]

Objective: To investigate the clinical character and treating strategy of extreme distal radial fractures. Methods: From June 2012 to May 2014, 12 patients who suffered from extreme distal radial fractures were treated in Department of Orthopedics, Tongji Hospital, Tongji University. According to AO/OTA classification, there were 4 cases of type 23B1, 3 cases of 23B2, 3 cases of 23C1 and 2 cases of 23C3.When classified by morphological features, there were 4 of simple styloid process fracture, 3 of simple extreme distal radial fracture without articular surface involved, 3 of styloid process fracture combined with distal radial articular fracture, and 2 of articular surface splintered or collapse fracture. According to the fracture features that radiographic exams showed, different surgical paths and fixation methods were chosen in order to protect soft tissues to the best advantage. To those patients with simple styloid process fracture, screw alone, Kirschner-wire or styloid plate were used for fixation. To the other types of fracture, open reduction and compound internal fixation with low-notch volar plate, dorsal or volar mini-plate, screw or Kirschner-wire was applied to ensure the stability of fixation, and maximally protect soft tissues like tendons, ligaments and neurovascular bundles, counting on the "stuffing-squeezing" effects after reduction or reconstruction of the articular surface. Situation of the wound and soft tissue were mainly checked in the first 2 weeks, and in the 3rd month post-operatively, fracture reduction and internal fixation were evaluated by radiographic methods like X-ray and CT scan. When 12 months post-operatively, not only radiographic follow-up such as fracture reduction, internal fixation and osteoarthritis were taken, but also some other evaluation, such as pain of wrist, rotation range of forearm, grip strength, and function of wrist according to DASH scores. Results: All of the 12 cases were followed up for at least 1 year. The wound healed well in all cases 2 weeks post-operatively, and no soft tissue infections, necrosis or neurovascular complications occurred. All fractures healed and no loss of reduction occurred 3 months post-operatively. Internal fixations were at good condition except in 2 cases, whose Kirschner-wire had been removed 2.5 and 2.8 months after the operation due to loosening and partly backing out on dorsal side. When followed up at 12 months post-operatively, one from these 2 patients suffered from a mild pain of wrist, and grip strength together with the function of the affected wrist dramatic declined when compared to the unaffected side. With the help of radiograph, local collapse on the articular surface was found, which meant to be traumatic arthritis. There were no pain in the rest 11 cases, and flexion-extension range of the wrist, rotation range of forearm and grip strength of the affected side recovered to over 80% of the unaffected side, with a DASH score was from 7 to 15 points(average 11.9 points)below 15 points. Conclusions: Traditional volar plates can not be used for extreme distal radial fractures. It may be an effective way to treat extreme distal radial fractures with compound internal fixation on the basis of morphological feature of fractures and the situation of soft tissue because of vivid of the fixation, reducing damage of soft tissue and early functional training.

The fluxes of CO2 from grazed and fenced temperate steppe during two drought years on the Inner Mongolia Plateau, China

The CO(2) flux was measured by the eddy covariance method on a temperate Leymus chinensis steppe over a period of 17 months spanning two consecutive growing seasons. The amount of precipitation was nearly normal, but it was low in the early and high in the late growing period in 2006. In the 2007 growing season, the amount of precipitation was about 45% less than the multi-year average and more evenly distributed. Comparisons were made between a moderately grazed site and a 28-year-old fenced site. The maximum instantaneous CO(2) release and uptake rates were 0.12 (May) and -0.11mg CO(2)m(-2)s(-1) (July) at the fenced site, and 0.11 and -0.16mg CO(2)m(-2)s(-1) (both in July) at the grazed site. In both growing seasons, the grazed site always had a higher daily uptake rate or lower release rate than the fenced site. The grazed site was a CO(2) sink during the growing season of 2007 and a CO(2) source in the growing season of 2006, whereas the fenced site was a CO(2) source in both seasons. Lower precipitation decreased CO(2) loss during the growing season more in the grazed site than in the fenced site, mainly because of depression of total ecosystem respiration (R(e)) in the former and stimulation in the latter. During the dormant season (from October to April), the fenced and grazed sites released 60.0 and 32.4g of C per m(2), respectively. Path analysis showed that temperature had the greatest effect on daily variation of ecosystem CO(2) exchange during the growing seasons at the two study sites. The results suggest that decrease of precipitation and/or increase of temperature will likely promote C loss from L. chinensis steppes, whether fenced or grazed, and that a grazed site is more sensitive.

[Repair of humeral fracture and non-union with transfer of vascularized periosteal flap]

OBJECTIVE

To study the results of humeral fracture and non-union repaired by vascularized periosteal flap transfer.

METHODS

The clinical data of humeral fracture and non-union in 23 cases were analysized retrospectively since 1995. Among them, minuted or several segmental fracture in 12 cases, non-union in 11 cases, and following injury of radial nerve in 7 cases. The operative method was open reduction, inner or external fixation with vascularized periosteal flap transfer.

RESULTS

The period of follow-up was 6 months to 2 years. The repair result of all patients was excellent and good, but elbow joint motion in 2 cases of non-union was not satisfactory. The periosteal flap had good osteogenic ability. The period of bone union was 2 to 5 months in humeral fracture and non-union. And function of radial nerve was recovery.

CONCLUSION

Transfer of distal humeral periosteal flap pedicled with radial collateral vessels is a better method for humeral fracture and non-union.

[Clinical application of the medial multiplex flap pedicled with the posterior tibial vessel]

OBJECTIVE

To investigate the clinical results of the medial multiplex flap pedicled with the posterior tibial vessel.

METHODS

Twelve cases with soft tissue defects and bone defects of limbs were treated with the medial multiplex flap pedicled with the posterior tibial vessel from September 1992 to May 1999. Among them, bone and soft tissue defects following opened fracture in 7 cases, chronic ulcer following chronic osteomyelitis in 2 cases, melanoepithelioma in 2 cases, bone and soft tissue defects following osteoma resection in 1 case. The bone defect area was from 2.5 cm x 5.0 cm to 4.5 cm x 11.0 cm. Free graft was performed in 5 cases, bridged transposition in 3 cases and reversal transposition in 4 cases, among them, periosteal myocutaneous flap with autogenous or allogeneic bone grafting in 8 cases, myocutaneous flap in 4 cases. The area of the flaps from 6 cm x 8 cm to 12 cm x 25 cm.

RESULTS

All flaps were healed by first intention, but in the distal fragments of bigger flaps were partially necrosed in 2 cases. In 10 cases bone healing were obtained after 16 weeks of operation according to the X-ray photos. All cases were followed up from 6 to 18 months. All cases achieved satisfactory result but 1 case died because of lung metastasis of osteoma.

CONCLUSION

The multiplex graft pedicled with the posterior tibial vessel is an ideal graft for repairing the large soft tissue defects and bone defects, because it has such advantages as adequate blood supply, big vascular diameter, long pedicle and big dermatomic area.

[The applied anatomy of transposition of the distal dorsal ulna bone flap pedicled with dorsal metacarpal artery]

OBJECTIVE

To investigate the anatomic basis for transposition of the distal dorsal ulna bone flap pedicled with dorsal metacarpal artery to repair the defect of the 3rd or 4th and 5th metacarpal bone head.

METHODS

In 30 adult cadaveric upper limbs, the branches and constitutions of the dorsal carpal arterial networks were observed.

RESULTS

The dorsal carpal arterial networks were consisted of the dorsal carpal branches of ulnar and radial arteries, the terminal branches of posterior interosseous artery and the dorsal carpal branch of anterior interosseous artery, and then the 2nd, 3rd, 4th dorsal metacarpal branches were originated from the networks. The dorsal metacarpal branches were anastomosed with the deep branches of deep palmar arch to constitute the dorsal metacarpal artery.

CONCLUSION

Transposition of the distal dorsal ulna bone flap pedicled with the 3rd, 4th dorsal metacarpal arteries can be used in repairing the defect of 3rd, 4th and 5th metacarpal bone head.

[Transposing the great trochanter bone flap pedicaled with the deep branch of the medial circumflex artery in repair of necrotic femoral head]

The transposition of the greater trochanter bone flap pedicled with the deep branch of the medial circumflex artery was designed as a new therapeutic method for the treatment of early ischemic necrosis of the femoral head in adults. Bone flap was successfully used in 15 limbs of 13 patients. Applied anatomy, operative indications and procedure of the bone flap was introduced.

[Experimental study on cellular electrophysiology of Viscum coloratum flavonoid in treating tachyarrhythmias]

Viscum Coloratum Flavonoid (VCF) is one of the dihydro-flavonoids isolated and purified from the stem and leaf of Viscum Coloratum. It was proved both experimentally and clinically to have the effects of anti-tachyarrhythmias. The mechanism of this effect, however, was unclear. In this study, the effects of the drug on the fast response action potentials (FAP) in canine Purkinje fibers and guinea pig ventricular myocardial cells were investigated by glass-microelectrode technique. The results indicated that 0.1 mg/ml VCF accelerated the repolarizations of 2nd and 3rd phase of FAP, shortened action potential duration (APD), and slightly shortened effective refractory period (ERP) (canine) or unchanged (guinea pig). delta ERP/delta APD ratio was increased, therefore, ERP was relatively prolonged. All effects appeared after using the drug for 2 minutes, reached stable status after 10 minutes, and disappeared after washing off the drug for 15 minutes. It was suggested that VCF was the drug which exerted effects rapidly, maintained effects shortly, and had effects reversibly. The cellular electrophysiologic mechanisms of VCF on anti-tachyarrhythmias should be attributed to prolong the ERP relatively and abolish the reentry. This drug is particularly applicable to the tachyarrhythmias due to reentry.

[Effects of Viscum coloratum flavonoids on fast response action potentials of hearts]

The effects of the total flavonoids of Viscum coloratum (VCF) on the fast response action potentials (FAP) of canine Purkinje fibers and guinea pig ventricular papillary muscles were studied by glass-microelectrode technique. The effects of VCF on the ionic currents through cellular membrane were analysed with selective ion blockers (CsCl, verapamil, and TEA+), respectively. VCF (100 micrograms.ml-1) accelerated the repolarization of FAP and increased delta ERP/delta APD ratio, which were related to decreasing Isi and increasing Ix. It was suggested that the anti-tachyarrhythmic mechanism of VCF was attributed to prolonging ERP relatively and to abolishing reentrant excitation.

Assessment of Nd:YAG laser via metal cap and sapphire tip delivery system. An experimental and clinical investigation

Sixteen segments of normal human aorta were irradiated by Nd:YAG laser beam delivered via domestically made metal cap and sapphire tip fibre systems. It was found that the metal tip fibre caused more target tissue damage and adhesion than the sapphire tip fibre. The sapphire tip fibre caused an ablation crater with a smoother edge, less carbonization layer and smaller thermal necrotic zone than the metal tip did. The metal cap and sapphire tip fibre were applied to 2 cases of iliac artery stenosis and 5 cases of coronary stenosis, all showing an immediate ablation.

[Changes in the deformability of erythrocytes and 2,3-DPG in coronary artery stenosis]

The changes of deformability of RBC and 2,3-DPG in RBC in patients with coronary artery stenosis and the influence of some factors on them were studied. The results showed that: (1) the deformability index was inversely proportional to the degree of lesions of coronary vessels (P less than 0.01); (2) the 2,3-DPG was inversely proportional to the degree of lesions of coronary vessels (P less than 0.01); (3) there was a significant decrease in deformability index after using contrast medium; (4) Saliva may increase deformability of RBC and 2,3-DPG; (5) Nifedipine may increase deformability of RBC. These results showed: (1) the possible existence of microcirculatory dysfunction in coronary artery disease and in parallel of impaired deformability of RBC; (2) the possibility of normalization of the decreased deformability of 2,3-DPG in RBC by Salvia; (3) the possibility of increase of velocity of blood flow in microcirculation in coronary artery disease by Salvia.

[Extent of treatment of early carcinoma of the uterine cervix--local treatment of 198 stage I patients]

The extent of treatment of early carcinoma of the uterine cervix is still controversial. 198 patients with Stage I carcinoma of the uterine cervix who received local treatment for the primary tumor are summarized, 107 with early invasive carcinoma and 91 with invasive cancer. Microscopic examination showed that 62.2% of the patients had lesions less than 1 cm in diameter. In 82.8% of the patients, the invasion was confined to the cervical ring by pathological examination. The accuracy of multiple biopsies was 79.3%. Of 198 patients, 124 received intracavitary radiotherapy only, 73 hysterectomy and 1 cone resection of the uterine cervix. All of them were followed for 5 years or more. The 5-year survival rate was 98% and none of them died of cancer. The author considers that the extent of treatment of early invasive carcinoma can be localized. For localized invasive carcinoma (stage Ib) with lesion less than 1 cm and extent of invasion less than half of the uterine cervix ring as confirmed by biopsy, the treatment of regional lymph nodes can be omitted. Multiple biopsies may replace diagnostic cone resection in most instances.

[Pyometra and radiotherapy of cancer of the uterine cervix--analysis of 282 patients]

From March 1958 to December 1980, 11284 patients with cancer of uterine cervix were treated with radiotherapy in our hospital. Among them, 282 were complicated with pyometra with an incidence of 2.5%. The incidence of pyometra was higher in patients treated by combined intracavitary with external irradiation than by other radiation methods. 74.1% was diagnosed during the manipulation of intracavitary therapy. Escherichia coli comprised 46.5% by culture. The 5 year survival rate was lower in patients with pyometra than without it. The patients who had a temperature over 38 degrees C and uterus enlarged to more than 6 weeks of pregnancy had a bad prognosis. It was even worse for patients whose pyometra did not heal or developed at the end of radiation. Endometrial biopsy was done in 36 patients with pyometra and cancer cells were seen in 55.6% of them. Endometrial biopsy positive rate reached to 77.8% in the patients whose pyometra was not cured or occurred after radiotherapy. This is the main reason of the poor prognosis. The authors believe that endometrial and cervical biopsy should be taken for cancer of uterine cervix complicated with pyometra; for biopsy positive patients during the treatment, the intracavitary dose should be increased; for positive patients after radiotherapy, operation is strongly indicated.

[192Ir afterloading machine for intracavitary radiotherapy--first unit installed in China]

This paper presents the source, applicators and treatment results of the first 192Ir afterloading machine manufactured at home. The intrauterine source can effect pendulous displacements in linear or non-linear patterns without preparatory dilatation. The vagina source can assume palisade and erect position. Satisfactory dose distributions are possible by various arrangements of the vaginal applicators as required clinically. From Oct. 1984 to Dec. 1985, 82 patients with cervical malignancies were treated by this machine. The tumor mass in all patients disappeared before the conclusion of treatment. There was no local recurrence with the longest follow-up of one year as compared to the tumor inhibition rate of 91.9% by the traditional method during the same period. These results suggest that this facility be satisfactory and that the traditional intracavitary treatment could be replaced.

[Malignancy of the uterine body after radiotherapy for carcinoma of uterine cervix--report of 12 cases]

Twelve cases of malignancy of the uterine body occurred 5-19 years after radiotherapy for 8,704 cases of carcinoma of cervix-an incidence of 0.14%. 10 cases were malignant mixed mesodermal tumor and 2 endometrial carcinoma. The radiation dose varied from 5,500 to 12,000 rad to the area of uterine body. Eight patients had vaginal discharge and 4 were asymptomatic in the follow-up examination in which enlarged uterus was found in all except one. The tumor had extented out of the uterus in 6 patients. 6 of the 12 patients were diagnosed by endometrial biopsy before treatment. Eight patients were treated by operation, 3 by radiation and 1 was untreated. Eleven patients died within 3 years, one recurred in 4.5 years after treatment. It is believed that the malignant tumor of the uterine body is closely related to radiotherapy and the prognosis is poor. Therefore, in the follow-up examination, if vaginal discharge and enlarged uterus are found, endometrial biopsy should be done to ensure correct diagnosis and early operation in order to obtain a better result.

Effect of higenamine on action potential of ventricular myocardial cells

Action potentials of isolated ventricular myocardial fibers of pigs and the electrophysiological actions of dl-demethylcoclaurine (DMC) or higenamine on the porcine myocardial cells were studied by glass microelectrodes. The action potentials of porcine ventricular myocardial fibers were similar to those of other mammalian hearts. Amplitude of the action potential was 115 +/- 9 mV, duration of action potential 242 +/- 30 ms, resting membrane potential -85 +/- 5 mV and the maximum rise of depolarization of action potential 151 +/- 27 V/s. After perfusion with normal Tyrode's solution containing DMC 5 micrograms/ml, the amplitude of action potential was increased and the duration of action potential was prolonged, the amplitude and duration of the plateau of action potential were increased and the slope of phase 2 of action potential was reduced (p less than 0.05). The resting potential, the slope of phase 3 and the maximum depolarization rate of phase 0 of action potential did not change. In Tyrode's solution containing Mn++ 3 mM, these electrophysiological actions of DMC disappeared. DMC may abolish the conduction block induced by K+-rich solution. In Tyrode's solution containing K+ 32 mM, the upstroke of action potential showed 2 phases under influence of DMC. The second phase disappeared when Mn++ was added. All findings indicate that DMC can be considered as an activator of the slow channel. The electrophysiological mechanism and clinical significance of DMC were discussed.