[Experience of wound treatment on extremely severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident].

Objective: To explore experience of wound treatment of extremely severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident. Methods: On August 2nd, 2014, 98 extremely severe burn mass patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to 20 hospitals in China. The patients with complete medical record were enrolled in the study and divided into microskin graft group with 56 patients and Meek skin graft group with 42 patients. Split-thickness skin in area of residual skin were resected to repair wounds of patients in microskin graft group and Meek skin graft group by microskin grafting and Meek miniature skin grafting, respectively. The residual wound size on 28 days post injury and wound infection after skin grafting of patients in the two groups, and position of donor site of all patients were retrospectively analyzed. Data were processed with t test and chi-square test. Results: The size of residual wound of patients in Meek skin graft group on 28 days post injury was (59±13)% total body surface area (TBSA), which was obviously smaller than that in microskin graft group [(70±14)%TBSA, t=4.379, P<0.05]. Twenty-nine patients in microskin graft group and 11 patients in Meek skin graft group suffered from obvious wound infection after skin grafting. Wounds of patients in two groups were repaired with residual skin around wound in head, trunk, groin, armpit, and uncommon donor sites of scrotum (4 patients), vola (10 patients), and toe or finger web (8 patients). Conclusions: Meek skin graft is the first choice for wound repair of extremely severe burn mass patients, with faster wound healing, less wound infection. Uncommon donor sites of scrotum, vola, and toe or finger web can also be used for wound repair in case of lack of skin.

[A preliminary study on the correlation between obstructive sleep apnea hypopnea syndrome and chronic tinnitus].

Objective:To investigate and analyze the chronic tinnitus prevalence and its related factors in OSAHS patients.Method:We studied 115 patients who were diagnosed with OSAHS by polysomnography.All patients BMI were calculated. The amount of patients accompanying tinnitus was calculated by investigating the history of tinnitus. Univariate and multivariate logistic analyzes were used to calculate the association between gender, age, hearing loss, BMI, and the lowest SPO2 with tinnitus. The differences in tinnitus prevalence among different age groups and gender were compared using chi-square test.Result:①The prevalence of tinnitus in 115 OSAHS patients was 38.26% (44/115). ②Between the ages of 31-80 years, the prevalence of tinnitus in every 10-year-old group was 9.09%,6.82%,11.36%,38.64%,and 29.55%,respectively.There was a significant difference between the age groups (χ²=14.55,P<0.01). The prevalence of female was 44.12%(15/34) which was higher than the male 35.80%(29/81), there was no significant difference (χ²=0.70,P>0.05). ③The results of univariate and multivariate logistic regression analysis showed that sex, BMI and lowest SPO2 had no correlation with tinnitus in patients with OSAHS, while age and hearing loss were independent correlates of tinnitus(P<0.05).Conclusion:More than 1/3 of patients with OSAHS had chronic tinnitus, both age and hearing loss maybe the risk factors of tinnitus in patients with OSAHS, but neither BMI nor the lowest SPO2 was clearly related to chronic tinnitus.

Survival outcome of weak estrogen/progesterone receptor expression in HER2 negative breast cancer is similar to triple negative breast cancer.

BACKGROUND: Recent publications have suggested that human epidermal growth factor receptor 2 (HER2)-negative breast cancers with "weak" estrogen receptor (ER)/progesterone receptor (PR) expression levels by immunohistochemical (IHC) analysis were considered as the triple-negative (TN) subtype. This study aimed to evaluate the overall survival (OS), disease-free survival rates (DFS), and disease-specific survival (DSS) based on ER and PR expression levels into one of three groups, ER and PR <1%, ER and PR 1%-20%, and ER or PR >20% by hormone therapy. METHODS: Medical records of 3353 breast cancer patients treated from 2006 to 2013 were retrospectively reviewed. Tumor characteristics, type of treatment, OS, DFS and DSS were evaluated among the three patient groups. RESULTS: Regarding OS, there were significant differences according to the received hormone therapy in the different groups: ER and PR <1% (P = 0.972), ER and PR 1%-20% (P = 0.264), and ER or PR >20% (P = 0.014). Regarding DFS and DSS, there were also significant differences in the different groups: ER and PR <1% (P = 0.611, 0.766), ER and PR 1%-20% (P = 0.847, 0.629), and ER or PR >20% (P = 0.031, 0.002). CONCLUSIONS: In HER2 negative breast cancer patient with hormone therapy, ER and PR expression level of 1%-20% has similar survival outcome to the ER and PR expression level of <1% by IHC analysis.

[The investigation and analysis of the tinnitus in 1 596 cases of physical examinees].

Objective:To investigate and analyze the tinnitus' prevalence and its related systemic factors in health examination population in Dalian City. Method:The 1 596 people were chosen from the Physical Examination Center of our hospital from February 1, 2015 to April 1, 2015, the tinnitus questionnaire was performed, as well as Otolaryngology examination，the whole body check and blood test. We calculated the prevalence of tinnitus and analyzed the relationship of tinnitus with the gender,age,hypertension,hyperlipidemia, overweight, diabetes, renal dysfunction, anemia and other factors. Result:①The total prevalence of tinnitus is about 18.8%(300/1 596) in Dalian's health examination population, and it is increased gradually with age(P<0.01). The prevalence of female is 20.6% (175/848), which is higher than the male(16.7%,125/748)(P<0.05).②Analyzed with the single factor Logistic regression analysis：female(OR=1.30), age(OR=1.04), hypertension(OR=2.30),hyperlipidemia(OR=1.49), overweight(OR=1.45), and diabetes(OR=1.75) were independent related factors for tinnitus(P<0.05); and analyzed with multi factor Logistic regression analysis: female(OR=1.27,P＝0.085), age(OR=1.05,P＜0.01),overweight(OR=1.46,P＝0.007) were the main related factors.Conclusion:The prevalence of tinnitus is high in health examination population of Dalian；hypertension, hyperlipidemia and diabetes may be associated with tinnitus, all of female, overweight and age may be the mainly systemic factors.

Intralesional copper wire retention and pingyangmycin injection: an effective combinational therapy for complex venous malformation in soft tissue.

OBJECTIVES: Complex venous malformations (VMs) may extensively involve the soft tissue. The treatment remains a challenge till now. Here we introduce a combinational therapy of copper wires and pingyangmycin (bleomycin A5,PYM). METHODS: Copper wires were retained in VMs by repeated penetration with a straight needle. Subsequently, PYM solution was injected into the lesion. Eight to 10 days later, copper wires were removed. The dressing was changed every day until the puncture pores healed. Magnetic resonance imaging scanning was performed to observe the change of VMs. RESULTS: From January 2001 to December 2011, 56 patients were treated. During the follow-up period, most of the VMs shrunk obviously. The symptoms were relieved or disappeared. The complications included local pain, temporary paraesthesia and moderate fever, which disappeared quickly after the removal of copper wires. CONCLUSIONS: This combinational therapy is a safe and effective approach for the complex VMs in soft tissue.

Papillary breast lesions diagnosed by core biopsy require complete excision.

BACKGROUND: Surgical excision of papillary breast lesions with atypia diagnosed using core needle biopsy (CNB) has been accepted; however, the management of benign papillary lesions (without atypia) has been controversial. The purpose of this study was to evaluate the surgical outcome of nonmalignant papillary lesions diagnosed by ultrasound-guided 14-gauge CNB, and to establish clear guidelines on management of these lesions. METHODS: We retrospectively identified 268 nonmalignant papillary breast lesions, including 203 benign lesions and 65 atypical lesions, diagnosed by CNB and subsequently surgically excised in 250 women at our institution between July 2004 and October 2010. For each lesion, medical records and radiologic and pathologic reports were reviewed and coded. We compared the histological upgrade among the collected variables. RESULTS: On histological examination after surgical excision, 15.4% atypical papillary lesions and 5.9% benign lesions were upgraded to malignant, and 20.2% benign lesions were upgraded to atypical. Atypia (P = 0.015) was significantly associated with malignant upgrade at excision. No clinical or radiologic variable was helpful in predicting the possibility of histological upgrade of CNB-diagnosed nonmalignant papillary lesions. CONCLUSIONS: Nonmalignant papillary lesions diagnosed with CNB showed an unacceptable pathological upgrade rate after excision. Therefore, surgical excision should be performed for all papillary lesions of the breast for definitive diagnosis.

Factors predictive of breast cancer in open biopsy in cases with atypical ductal hyperplasia diagnosed by ultrasound-guided core needle biopsy.

AIMS: The purpose of the study was to explore factors predictive of breast cancer as diagnosed by excision biopsy in cases with a diagnosis of atypical ductal hyperplasia (ADH) on ultrasound-guided core needle biopsy (CNB). PATIENTS AND METHODS: We carried out diagnosis of breast lesions by ultrasound-guided CNB in a single hospital in Taiwan from November 2003 to October 2009. Patients who were diagnosed with ADH and subsequently underwent excision biopsy were included in this study (n = 124). RESULTS: Fifty-six of the 124 patients who were included (45.2%) had cancer, and the remaining 68 had benign lesions. By multivariate analysis of all clinical characteristics and on the basis of the imaging features in these cases, older patient age (≥50 y/o, OR: 3.910, p = 0.005), larger tumour size (≥15 mm, OR: 3.398, p = 0.013), and the presence of architectural distortion by mammography (OR: 10.7, p = 0.036) were found likely to be associated with breast cancer. CONCLUSIONS: Open biopsy is necessary in patients who were diagnosed with ADH on CNB. Older patients (≥50 y/o), with a larger tumour size (≥15 mm) and an abnormal mammography are especially likely to have breast cancer.

A progesterone-receptor-positive huge retroperitoneal tumour mimics metastasis in a breast cancer patient: sarcomatoid renal cell carcinoma.

We report a rare case of breast cancer concomitant with progesterone-receptor-positive renal cell carcinoma. A 48-year-old woman was diagnosed as having infiltrating ductal carcinoma of the breast and underwent modified radical mastectomy. A synchronous retroperitoneal tumour was detected by sonography of the abdomen in a routine cancer staging. Initially, the tumour was diagnosed as a synchronous retroperitoneal metastasis by needle biopsy; further tests revealed that it was progesterone receptor-positive. The retroperitoneal tumour showed poor response to full courses of adjuvant chemotherapy for breast cancer. Subsequently, the patient underwent a radical operation that included nephrectomy. The final pathology confirmed a sarcomatoid renal cell carcinoma. The post-operative course was uneventful. The patient had no recurrence at the 1-year follow-up. In this report, accurate diagnosis and adequate treatment were discussed. An intra-abdominal tumour with progesterone receptor- (PR) positive features is usually considered to be metastatic in breast cancer patients. For breast cancer patients with a PR-positive retroperitoneal tumour, renal cell carcinoma should be differentiated from a metastatic lesion of breast cancer, even if PR-expression is rare in renal cell carcinoma. To the best of our knowledge, this is the first case of PR-positive expression in breast cancer concomitant with renal carcinoma. In clinical settings, it is challenging for the surgeon to make an accurate diagnosis and to provide prompt treatment in such cases.

The relationship between acid-suppressing drugs and phytobezoar formation: a retrospective analysis and discussion of phytobezoar formation.

OBJECTIVES: Although phytobezoars are a rare cause of gastrointestinal obstruction, they are most commonly found in patients with previous gastric surgery. It is well known that predisposing factors of phytobezoar formation are ingestion of fruits containing soluble tannin, presence of dilute hydrochloric acid in the stomach, and gastric stasis or delayed emptying. We investigated whether intake of acid-suppressing drugs that neutralize gastric acidity or inhibit gastric acid secretion to constitute a hypo-acidic condition, increases the risk of phytobezoar formation. MATERIALS AND METHODS: Between September 1992 and October 2008, 32 patients (24 male and 8 female) with gastrointestinal phytobezoars were diagnosed either surgically or endoscopically at the Tri-Service General Hospital, Taipei, Republic of China. The data were collected from hospital records and analyzed retrospectively. RESULTS: Eighteen (56.25%) of all patients had previous gastric surgery and 6 (42.9%) of the 14 patients who had not undergone surgery had diabetes mellitus. The majority of admissions were during winter and spring (between October and March) (P < 0.01) and none of the patients had taken acid-suppressing drugs during the 6 months before detection of gastrointestinal phytobezoars. CONCLUSIONS: In our study, intake of acid-suppressing drugs did not increase the risk of phytobezoar formation in patients with normal gastric motility. Moreover, we believe that the major factor in phytobezoar formation is gastric stasis or delayed emptying, which sufficiently prolongs the retention period of materials in the stomach, while dilute hydrochloric acid is a minor factor.

Volvulus of small intestine: rare complication of mesenteric pseudocyst.

OBJECTIVE: Mesenteric cyst is a rare intra-abdominal lesion. Most patients with mesenteric cysts are asymptomatic. Symptomatic mesenteric cysts are associated with cyst size, cyst location, and complications, including infection, rupture, hemorrhage, and intestinal obstruction. Volvulus is a rare complication of mesenteric cyst. SUBJECT: We report a 50-year-old woman with colicky epigastric pain for three days. The symptoms exacerbated in the supine position and were relieved in the sitting position. Computed tomography of her abdomen revealed a huge cystic lesion with a whirl sign of mesentery vessels. She had the history of gastro-esophageal reflux disease. RESULT: Segmental resection of the small intestine with end-to-end anastomosis was performed. Histology indicated a hemorrhagic pseudocyst. The patient recovered well after surgery. CONCLUSION: Mesenteric pseudocyst rarely results in volvulus of small intestine. Our case is the eleventh case reported in the English literature. Atypical presentation of epigastric pain while lying down may lead to mis-diagnosis. This case reminds the clinicians this rare complication.

[Design of Z-shaped Achilles tendon scar composite flaps to correct the tendon-scar contracture].

OBJECTIVE: To modify the design of the Achilles tendon-scar composite flap into the Z-shape and to apply it into clinic situations to correct the tendon-scar contracture after burn and other injures. METHODS: According to degree of contracture and strephenopedia, the central limb of Z-shaped design lay in contracture line of posterior ankle area just over the Achilles tendon and extended 8 to 12 cm in length. Lateral limbs extended 5 to 8 cm and usual angles of the Z-shape was 60 degrees. The two tendon-scar composite flaps were made and slipped along the central limb between them. From March 1994 to August 1999, seven patients with Achilles tendon scar contracture were operated with this method. RESULTS: Excellent relieving of the Achilles tendon-scar contractue was achieved. No such complications happened as ischemia and necrosis of the flaps. CONCLUSION: The Z-shaped tendon-scar composite flap is practical in clinics. It is characterized by abundant blood supply, easily procedure and reliable result.

[Allogeneic auricular cartilage framework for total reconstruction of the ear in 8 patients].

This paper reports our experience in total reconstruction of the ear using allogeneic auricular cartilage framework in 8 patients. The allogeneic auricular cartilage framework has natural appearance, and no carving or fabrication is needed. The cartilage treated with glutaraldehyde firmly adhered to its surrounding tissue of the host in a short time. Good results were observed in 6-month to 2-year follow-up, and no complications such as rejection, distortion and absorption occurred.