[A case of high-pressure injection injury of hand complicated with deep chemical burn caused by industrial cement].

This article reports a patient with extensive high-pressure injection injury of the hand combined with deep chemical burn caused by high-pressure injection of industrial cement materials was diagnosed and treated in the Department of Hand Surgery, Xiaolan Hospital Affiliated to Southern Medical University in 2022. The nerves, tendons and blood vessels of the left hand were involved, and the ulnar skin of the left thumb was extensively necrosis, and a large number of extensive cement foreign bodies remained under the skin. Part of the cement was inserted into the joint capsule of the interphalangeal joint. After emergency surgical treatment, the patient was saved successfully, and the wound healed well without chemical poisoning and other related complications, which created conditions for the second stage of flap repair.

[Late reoperations after repaired Stanford type A aortic dissection].

Objective: To summarize the experience of reoperations on patients who had late complications related to previous aortic surgery for Stanford type A dissection. Methods: From August 2008 to October 2016, 14 patients (10 male and 4 female patients) who underwent previous cardiac surgery for Stanford type A aortic dissection accepted reoperations on the late complications at Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University. The range of age was from 41 to 76 years, the mean age was (57±12) years. In these patients, first time operations were ascending aorta replacement procedure in 3 patients, ascending aorta combined with partial aortic arch replacement in 4 patients, aortic root replacement (Bentall) associated with Marfan syndrome in 3 patients, aortic valve combined with ascending aorta replacement (Wheat) in 1 patient, ascending aorta combined with Sun's procedure in 1 patient, Wheat combined with Sun's procedure in 1 patient, Bentall combined with Sun's procedure in 1 patient. The interval between two operations averaged 0.3 to 10.0 years with a mean of (4.8±3.1) years. The reasons for reoperations included part anastomotic split, aortic valve insufficiency, false aneurysm formation, enlargement of remant aortal and false cavity. The selection of reoperation included anastomotic repair, aortic valve replacement, total arch replacement and Sun's procedure. Results: Of the 14 patients, the cardiopulmonary bypass times were 107 to 409 minutes with a mean of (204±51) minutes, cross clamp times were 60 to 212 minutes with a mean of (108±35) minutes, selective cerebral perfusion times were 16 to 38 minutes with a mean of (21±11) minutes. All patients survived from the operation, one patient died from severe pulmonary infection 50 days after operation. Three patients had postoperative complications, including acute renal failure of 2 patients and pulmonary infection of 1 patient, and these patients were recovered after treatment. Thirteen patients were finally recovered from hospital. The patients were followed up for 16 to 45 months, and no aortic rupture, paraplegia and death were observed in the follow-up. Conclusions: Patients for residual aortic dissection after initial operations on Stanford type A aortic dissection should be attached great importance and always need emergency surgery, but the technique is demanding and risk is great for surgeons and patients, which need enough specification and accurate on aortic operation. More importantly, the Sun's procedure also should be performed on the treatment of residual aortic dissection or distal arch expansion, and obtains the short- and long-term results in the future.

[The expressions of intercellular adhesion molecule-1 in renal tissue of rats with paraquat poisoning and the effect of melatonin].

OBJECTIVE: To study the mechanism of paraquat (PQ) -induced renal injury in rats, the expression changes of ICAM-1 to assess the protective effect of Melatonin in PQ poisoning. METHODS: Ninety adult healthy Sprague-Dawley (SD) rats were divided into three groups at random. CONTROL GROUP: 30 rats; Poisoned group: 30 rats; Melatonin group: 30 rats. Control group and Poisoned group were treated intragastrically with 1 ml of PQ (50 mg/kg) diluted with normal saline. Control groupwere treated with the same dose of normal saline as Poisoned group and Melatonin group. Melatonin group were given 1 ml of Melatonin at a dose of 10 mg/kg diluted with normal saline (once daily, intraperitoneally) Control and Poisoned group were treated with the same dose of normal saline (once daily, intraperitoneally) as Melatonin group. Pathology of renal tissue were oberserved by HE staining, and electron microscope. The histopathological changes and the expression of ICAM-1 were observed with mmunohistochemistry (IHC). RESULTS: (1) There were no obvious pathological changes in Control group. Poisoned group Renal glomerulus had hyperemia and distension.Renal tubule epith elial cell had edema and vacuolar degeneration and renal tubule lumina was narrowing on day 1, There were serious edema exudation and necrosis on day 5,which gradually lessened furthermore; Compared with Poisoned group, the aforementioned pathological lesion was more palliative in Melatonin group. (2) No obvious abnomal changes in ultrastructure of renal tissues in Control group. There were swelling of mitochondrion and rupture of renal tubule epithelial cell and endoplasmic reticulum had extension, lysosome was mult and had much phagocytosis in Poisoned group. (3) There was a very weak expression of ICAM-1 in Control group. while in Poisoned group, there was already a significant higher expression of ICAM-1 of renal tubule on day 1 after PQ poisoning, Immunohistochemistry score (IHS) of Poisoned group on day 1, 3, 5, 7, 14 were (0.1561±0.0295、0.2572±0.0259、0.3028±0.0153、0.2083±0.0227、0.9309±0.0059) , compared with Control group (P<0.01) ; Melatonin group were (0.1259±0.0061、0.2109±0.0280、0.2679±0.0233、0.1771±0.0186、0.0791±0.0135) , compared with Control group (P<0.01) , compared with Poisoned group (P<0.05) ; CONCLUSION: ICAM-1 was involved in the procedures of renal injury; MT surely had a protective effect, which might be mediated by ICAM-1 in the paraquat-induced renal injury, but its regulation path still need a further exploration.