Capsular Healing in Interportal and Periportal Capsulotomy Methods of Hip Arthroscopy.

OBJECTIVE: To evaluate the midterm outcomes and the capsular healing in patients who had interportal capsulotomy versus periportal capsulotomy of hip arthroscopy. METHODS: Retrospectively reviewed 33 patients with labral tear received hip arthroscopy, with an average age of 41 (27-67) years, including 13 cases of Cam deformity and three cases of Pincer deformity. All patients had positive sign of flexion adduction internal rotation or flexion abduction external rotation. With MRI and radiographic (CT, X plain) imageological examination. MRI showed that all patients had labral tear. Radiographic finding (CT, X plain) showed the pathological changes of acetabular and femoral neck osteophyte. One group with 23 patients were treated with periportal capsulotomy. Another group with 10 patients were treated with interportal capsulotomy. All patients did not close the capsule. Clinical outcomes were measured with the Hip Outcome Score Activities of Daily Living (HOS-ADL) and the modified Harris Hip Score (mHHS), patient satisfaction measured with visual analogue scale (VAS). The healing of the capsule was evaluated by MRI. MRI showed continuous capsular indicated healing, discontinuous capsular indicated unhealing. Postoperatively 6 months, mHHS and HOS-ADL were obtained. Randomized controlled trials were used in this study for analysis. RESULTS: All patients were followed up with average time of 9.3 months(3-29 months). The postoperative symptoms were obviously relieved, the VAS decreased from (4.9 ± 0.6) to (1.2 ± 0.2) after 3 months postoperative. Follow up 6 months post-operation, patients in the interportal group, the mHHS and HOS-ADL scores improvement were respectively 69.4 ± 9.3 & 70 ± 8.8 pre-operation, and 92.5 ± 5.0 & 86.6 ± 5.4 post-operation (P < 0.05); Patients in the periportal group, the mHHS and HOS-ADL scores improvement were respectively 69.9 ± 15.8, 68.1 ± 15.0 pre-operation, and 90.1 ± 9.3 & 86.7 ± 7.9 post-operation (P < 0.05).The differences were statistically significant. Six months after operation, MRI showed that 23 patients with periportal capsulotomy, the capsule have healed, without other complications. Three of the ten patients with interportal capsulotomy were healed and seven were not. CONCLUSION: Interportal and periportal capsulotomy had good outcomes. The technique of periportal capsulotomy had little damage to the joint capsule. Although the capsule did not close, the capsule healed well in postoperative follow-up. The nonunion rate of the joint capsule was high in the interportal capsulotomy without close the capsule.

Hepatocellular carcinoma with tumor thrombus in bile duct: A proposal of new classification according to resectability of primary lesion.

BACKGROUND: Hepatocellular carcinoma (HCC) with tumor thrombus in the bile duct (BDTT) is easily misdiagnosed or mistreated due to the clinicopathological diversity of the thrombus and its relationship with primary lesions. AIM: To propose a new classification for HCC with BDTT in order to guide its diagnosis and treatment. METHODS: A retrospective review of the diagnosis and treatment experience regarding seven typical HCC patients with BDTT between January 2010 and December 2019 was conducted. RESULTS: BDTT was preoperatively confirmed by computed tomography/magnetic resonance imaging in only four patients. Three patients with recurrent HCC and one patient with first-occurring HCC had no visible intrahepatic tumors; of these, misdiagnosis occurred in two patients, and three patients died. One patient was mistreated as having common bile duct stones, and another patient with a history of multiple recurrent HCC was misdiagnosed until obvious biliary dilation could be detected. Only one patient who received hepatectomy accompanied by BDTT extraction exhibited disease-free survival during the follow-up period. A new classification was proposed for HCC with BDTT as follows: HCC with microscopic BDTT (Type I); resectable primary or recurrent HCC mass in the liver with BDTT (Type II); BDTT without an obvious HCC mass in the liver (Type III) and BDTT accompanied with unresectable intra- or extrahepatic HCC lesions (Type IV). CONCLUSION: We herein propose a new classification system for HCC with BDTT to reflect its pathological characteristics and emphasize the significance of primary tumor resectability in its treatment.

Propyl isothiocyanate induces apoptosis in gastric cancer cells by oxidative stress via glutathione depletion.

Isothiocyanates are a group of compounds that exist in the majority of cruciferous plants. A number of isothiocyanates have been demonstrated to exhibit anticancer effects; however, antitumor properties of propyl isothiocyanate (PITC) have not been evaluated previously. In this study, the possible effects of PITC on gastric cancer (GC) cells were investigated, and the potential underlying mechanisms were explored. The results demonstrated that PITC inhibited cell viability of two GC cell lines and induced cell cycle arrest and apoptosis. Treatment with PITC promoted total glutathione depletion in GC cell lines, leading to reactive oxygen species accumulation and DNA damage, which activated the mitochondria-dependent and p53 signaling pathways to trigger apoptosis in GC cells. The effects of PITC were reversed by N-Acetyl-L-cysteine. The results of the present study revealed the potential mechanisms of PITC on apoptosis induction in GC cells, which may be mediated by mitochondria-dependent apoptosis and DNA damage.

[Choices of the internal fixation and approaches on unstable pelvic ring fractures].

OBJECTIVE: To discuss the suitable surgical approach and the internal fixation of unstable pelvic pelvic fractures. METHODS: From May 2010 to May 2015, 45 patients with unstable pelvic fractures were treated with different approaches and fixations, including 38 males and 7 females with an average age of 45 years ranging from 21 to 61 years. The course was within 2 weeks. According to Young-Burg classification, 23 patients were lateral compression injuries, 6 patients were vertical shearing injuries, 16 patients were anterior-posterior compression injuries. All patients had hip pain and limitation of motion, the X-rays showed the pelvic ring fracture. RESULTS: All wounds healed well without complications, 45 cases were followed up for a mean period of 13 months (ranged 9 to 21 months). Patients with hip pain had a good postoperative pain relief. The post-operative X-rays showed the reduction was satisfied and the pelvic ring shaped well. According to Majeed standards, the final follow-up score was 93.5±11.6, 35 cases got excellent results, 8 were good, 2 were fare. CONCLUSIONS: The unstable pelvic and acetabular fractures are always with compound injury. Beside the reduction, to decrease the second surgery trauma should take into consideration as well, the intra-articular reduction and the stability of the pelvic were especially valued, so combined the different approach with minimal invasive technique can get good clinical result.

[Anatomical study on the treatment of complex acetabular fractures with self-designed 3-dimensional anatoimical locking plate].

OBJECTIVE: To design a new 3-dimensional anatomical locking plate internal fixation on the basis of anatomic character of acetabulum for treating complex acetabular fractures except the posterior wall and posterior column fracture, and to investigate its advantages and disadvantages. METHODS: Five fresh adult cadavers and 40 biopsy specimens of pelvic cavity were collected. The length and radian of iliopectineal crest and pecten pubis,the distance from acetabular index to iliopectineal crest were measured to guide the research and development of the 3-dimensional anatomical locking plate internal fixation for complex acetabular fractures through the ilioinguinal approach or combined with Stoppa approach. RESULTS: The average lengths of iliopectineal crest of male and female were (54.12+/-5.42) mm and (58.24+/-6.60) mm;and the radians were (64.26+/10.28)degrees and(60.32+/-12.26)degrees. The lengths of bow pubic were(122.21+/-8.02) mm and(126.52+/-7.84) mm;and the radians were (66.24+/-13.10)degrees and(63.25+/-12.10) degrees. The distance from acetabular index to iliopectineal crest of male and female were (18.6 + 2.2) mm and (18.9+/-2.5) mm. The 3-dimensional anatomical locking plate was used to treat compound acetabular fractures through ilio-inguinal groove incision or combined with Stoppa incision,including dislocated acetabular fractures at quadratic district,but not including paries posterior and columma posterior fractures. CONCLUSION: The self-designed 3-dimensional anatomical locking plate internal fixation has the characteristics of operational convenience, accurate fixation, mini operational trauma,short operational time and low operational risk,therefore it is especially suit for the complex acetabular fractures except the posterior wall and posterior column fracture which is difficult to be solved by contentional internal fixation.

[Choice of operative approaches for complex fractures of the quadrilateral area of acetabular].

OBJECTIVE: To compare different surgical approaches in order to obtain better surgical exposure and more reliable reset fixation according to the different types of quadrilateral area fractures of acetabular. METHODS: From January 2006 to January 2011, 58 patients with the quadrilateral area fractures of acetabular were treated by surgical operation through the simple Kocher-Langenbeck (KL) approach, ilioinguinal approach, modified Stoppa approach, or combined surgical approach, or a combination of anterior column screw fixation percutaneously and modify Stoppa approach. RESULTS: Forty-nine patients were followed up for an average time of 32 months ranging from 2 to 6 years. One patient with deep infection cured after treatment of effective antibiotics and drainage, 2 patients had a sciatic nerve injury, 2 cases of avascular necrosis of the femoral head. Among them, 36 cases were anatomical reducted, 8 were good and 5 were poor according to Matta's radiographic assessment system. According to the mean Merle d'Aubigne and Postel Score,32 patients got excellent result, 12 good,4 fair and 1 bad,the average score was (15.3 +/- 2.5). CONCLUSION: Single classic surgical approach can only use for some types of the complex quadrilateral area fractures of acetabular while combination approach may need for some fractures. Modified Stoppa approach combined with ilioinguinal approach or a combination of anterior column acetabular screw fixation are the most effective surgical approaches for complex quadrilateral area fractures of acetabular.