Treatment of large avulsion injury in perianal, sacral, and perineal regions by island flaps or skin graft combined with vacuum assisted closure.

BACKGROUND: Traumatic avulsion injuries to the anus, although uncommon, can result in serious complications and even death. Management of anal avulsion injuries remains controversial and challenging. This study aimed to investigate the clinical effects of treating large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal regions with island flaps or skin graft combined with vacuum assisted closure. METHODS: Island flaps or skin graft combined with vacuum assisted closure, diverting ileostomy, the rectum packed with double-lumen tubes around Vaseline gauze, negative pressure drainage with continuous distal washing, wounds with skin grafting as well as specialized treatment were performed. RESULTS: The injuries healed in all patients. Six cases had incomplete perianal avulsion without wound infection. Wound infection was seen in four cases with annular perianal avulsion and was controlled, and the separated prowl lacuna was closed. The survival rate in 10 patients who underwent skin grafting was higher than 90%. No anal stenosis was observed after surgery, and ileostomy closure was performed at 3 months (six cases) and 6 months (four cases) after surgery, respectively. CONCLUSIONS: Covering a wound with an island flap or skin graft combined with vacuum assisted closure is successful in solving technical problems, protects the function of the anus and rapidly seals the wound at the same time.

Diagnostic value of contrast-enhanced ultrasound in thyroid nodules with calcification.

The aim of this study was to investigate the diagnostic values of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in benign and malignant thyroid nodules with calcification. Conventional ultrasound and CEUS were performed in 122 patients with thyroid nodules with calcification. The thyroid nodules were characterized as benign or malignant by pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accordance rate of the two imaging methods were determined. The area under the receiver operating characteristics curve (AUC) was used to assess the diagnostic values of the two imaging methods. In 122 cases of thyroid nodules with calcification, 73 benign nodules and 49 malignant nodules were verified by pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accordance rate of conventional ultrasound were 50%, 77%, 59%, 69%, and 66%, respectively, and those of CEUS were 90%, 92%, 88%, 93%, and 91%, respectively. There were significant differences between the two imaging methods. AUCs of conventional ultrasound and CEUS were 0.628 ± 0.052 and 0.908 ± 0.031, suggesting low and high diagnostic values, respectively. CEUS has high diagnostic values, being significantly greater than those of conventional ultrasound, in differential diagnosis of benign and malignant thyroid nodules with calcification.

Assessment of immune cells and function of the residual spleen after subtotal splenectomy due to splenomegaly in cirrhotic patients.

BACKGROUND: The spleen is thought to be central in regulating the immune system, a metabolic asset involved in endocrine function. Overwhelming postsplenectomy infection leads to a mortality rate of up to 50%. However, there is still controversy on performing subtotal splenectomy as treatment of splenomegaly due to portal hypertension in cirrhotic patients. In the present study, immunocytes and the indexes of splenic size, hemodynamics, hematology and immunology in the residual spleen were analyzed to support subtotal splenectomy due to splenomegaly. RESULTS: In residual spleen, T lymphocytes mainly were focal aggregation in the periarterial lymphatic sheath. While B lymphocytes densely distributed in splenic corpuscle. In red pulp, macrophages were equally distributed in the xsplenic cord and adhered to the wall of splenic sinus with high density. The number of unit area T and B lymphocytes of splenic corpuscle and marginal zone as well as macrophages of red pulp were obviously increased in the residual spleen, while the number of macrophages didn't be changed among the three groups in white pulp. While there were some beneficial changes (i.e., Counts of platelet and leucocyte as well as serum proportion of CD3+ T cells, CD4+ T cells, CD8+ T cells were increased markedly; serum levels of M-CSF and GM-CSF were decreased significantly; The proportion of granulocyte, erythrocyte, megakaryocyte in bone marrow were changed obviously; But serum IgA, IgM, IgG, Tuftsin level, there was no significant difference; splenic artery flow volume, portal venous diameter and portal venous flow volume, a significant difference was observed in residual spleen) in the clinical indices. CONCLUSION: After subtotal splenectomy with splenomegaly due to portal hypertension in cirrhotic patients, the number of unit area T and B lymphocytes, and MØ in red pulp of residual spleen increased significantly. However, whether increase of T, B lymphocytes and MØs in residual splenic tissue can enhance the immune function of the spleen, still need further research to confirm.

Correlation of contrast-enhanced ultrasonographic features with microvessel density in papillary thyroid carcinomas.

BACKGROUND: The purpose of this study was to investigate the correlation of contrast-enhanced ultrasonographic (CEUS) features with microvessel density (MVD) in papillary thyroid carcinomas (PTCs). MATERIALS AND METHODS: Contrast-enhanced ultrasonography (CEUS) was performed in 62 patients (17 men and 45 women) with PTC. Tomtec software was applied to analyze the time intensity curve of CEUS. Immunohistochemistry was performed to evaluate the level of MVD in papillary thyroid carcinoma. Then the relationship between quantitative feature and the level of MVD was analyzed using SPSS 16.0 software. RESULTS: The mean peak intensity of PTC tissues was lower than that of peripheral thyroid parenchyma (61.9 ± 11.8% vs 100%, p < 0.05). The MVDs of CD34 and CD31 antibodies staining were 38.0 ± 6.1 and 37.9 ± 5.1 respectively in 62 PTC samples. A significantly positive correlation was observed between peak intensity and MVD in PTC tissues (PCD34 < 0.01, rCD34 = 0.838, PCD31 < 0.01, rCD31 = 0.837). CONCLUSIONS: The peak intensity in CEUS could reflect the MVD in PTC tissues. Therefore, quantification of CEUS seems to be helpful for assessment of MVD in PTC tissues.

[Differential diagnostic value of contrast-enhanced ultrasound in calcified thyroid nodules].

OBJECTIVE: To evaluate the diagnostic value of contrast-enhanced ultrasound(CEUS) in calcified thyroid nodules. METHODS: A total of 179 cases with calcified thyroid nodules between February 2009 and September 2012 underwent CEUS by injection of microbubbles via superficial vein was included in the study. Pathological diagnosis as a gold standard, the sensitivity, specificity, positive predictive, negative predictive and diagnostic coincidence rate of CEUS were evaluated. RESULTS: Among 110 cases of benign nodules, 62 cases were nodular goiter (46 cases with macrocalcification and 16 cases with microcalcification); 29 cases were adenoma (28 cases with macrocalcification and 1 case with microcalcification); 17 cases were Hashimoto's thyroid (13 cases with macrocalcification and 4 cases with microcalcification); and 2 cases were granuloma with microcalcification. Among 69 cases of malignant nodules (t = 14.33, P < 0.05), 68 cases were papillary carcinoma (60 cases with microcalcification and 8 cases with macrocalcification), and 1 case of medullary carcinoma with microcalcification. Malignant nodules mainly showed weak inhomogeneous enhancement, with the mean; peak intensity (51.38 ± 14.33)dB that was lower than that (92.37 ± 33.36)dB in benign nodules, and benign nodules showed isoenhancement or hyperenhancement, with significant differences compared to malignant nodules (t = 14.33, P < 0.05) , however, there were significant differences in the enhanced time and the time to peak between benign and malignant nodules. The sensitivity, specificity, positive predictive, negative predictive and diagnostic coincidence rate of CEUS for the diagnoses of thyroid nodules were 92.75%, 90.91%, 86.49%, 95.24% and 91.62%, respectively. CONCLUSION: CEUS has high value in differential diagnosis of benign and malignant calcified thyroid nodules.

[Logistic regression analysis of contrast-enhanced ultrasound and ultrasonic elastography in differential diagnosis of thyroid nodules].

OBJECTIVE: To evaluate the contrast-enhanced ultrasound(CEUS) and ultrasonic elastography (UE) in diagnosis of thyroid nodules by a binary Logistic regression model. METHODS: A total 149 cases with thyroid nodules were examed by CEUS and UE and were confirmed by surgical pathology. A Logistic model was obtained on the basis of ultrasonographic features. Receiver operator characteris(ROC) curve was constructed to assess the performance of the Logistic model. RESULTS: Four ultrasonographic features including calcification, enhancement degree, biggest perfusion strength and elastic score were finally entered into the Logistic model. The percentage of correct prediction was 91.90%. CONCLUSION: Both CEUS and UE have high value in differential diagnosis of thyroid nodules and the Logistic regression model has high diagnostic rate.

Assessment of the infiltration of inflammatory cells in the walls of thrombotic varicose veins.

The purpose of this study is to describe the infiltration of mast cells as well as T and B cells in the walls of thrombotic varicose great saphenous veins. Sections were obtained from venous segments of patients with varicose veins and stained with toluidine blue for mast cells, while immunohistochemistry for T cells (using CD45RO antibody) and B cells (CD20) was analyzed using light microscopy after staining. The number of mast cells, T, and B cells observed in thrombotic varicose veins was 1.925 ± 1.203, 72.038 ± 34.707, and 19.519 ± 9.899, respectively. In varicose veins, the corresponding values were 0.265 ± 0.099, 0.600 ± 0.432, and 0.488 ± 0.400. Significantly higher number of mast cells, T cells, and B cells were observed in thrombotic varicose veins compared with control veins. A significant difference was not observed between the varicose group and control group. Thrombi in varicose veins can induce infiltration of mast cells, T cells, and B cells, which may be involved in the remodeling of venous walls.

Thin steel plate with thumbtack fixation in the treatment of massive presacral venous plexus hemorrhage.

BACKGROUND: Massive presacral venous plexus hemorrhage during radical resection of rectal carcinoma is rare, but when it occurs, bleeding can be uncontrollable, leading to death in some cases. Medical adhesive gauze sticking and packing and thumbtack compressive fixation are often used for hemostasis, but these methods are not effective in cases of uncontrollable massive hemorrhage. Therefore, identifying a practical, accurate, and reliable method of hemostasis in these cases is essential. METHODS: Between January 2004 and December 2009, we treated 3 patients with massive presacral venous plexus hemorrhage during resection of rectal carcinoma by placing small, trimmed thin steel plates at the bleeding sites. The plates were fixed with a saddle-type application of thumbtacks. RESULTS: Bleeding was successfully controlled in all 3 patients, and intestinal anastomosis was carried out after hemostasis. No complications were observed. CONCLUSIONS: Application of a small, thin steel plate to the bleeding site with thumbtack fixation is a simple and effective method of hemostasis in patients with massive presacral venous plexus hemorrhage during resection of rectal carcinoma.

[Effect of NO3(-)-N on CH4 emission during denitrification in subtropical soils].

Methane production and emission were investigated in 45 subtropical soil samples, collected from different land use and derived from different soil parent materials in Jiangxi province, by incubating flooded soil slurries in a closed system under N2 gas in the headspace after treatment with or without NO3(-)-N (200 mg x kg(-1)) for 28 days at 30 degrees C. The results indicated that the content and availability of soil organic C were the dominant factors influencing CH4 production and emission whether NO3(-)-N was added or not under this anaerobic incubation condition. Methane emission was higher in the soils derived from granite in the unamended soils and used for rice cultivation in the amended soils. During the anaerobic incubation, the NO3(-)-N added significantly inhibited the production and emission of CH4. The inhibitory effect of NO3(-)-N on CH4 emission might be stronger than that of N2O. The amount and rate of NO3(-)-N denitrified in the first 7 days of incubation determined the CH4 emission amount in the soils with NO3(-)-N. The Fe2+ content increased exponentially with the CH4 emission in 73% of the control soils without NO3(-)-N, which indicated that Fe3+ reduction processed simultaneously with CO2 reduction. Nitrate nitrogen inhibits not only the production and emission of CH4 but also the reduction of Fe3+.