2016年 · 第54卷第10期

The development of clinical diagnosis and treatment technology is changing with each passing day, and clinical research in related fields is constantly innovating. In order to provide Chinese orthopedic Surgeons with the most effective information on the treatment of axial fractures, the Spinal Trauma Working Group of the Orthopedic Surgeons Branch of the Chinese Medical Physicians Association organized experts to study the Guidelines for the Management of Acute Axial Fractures in Adults issued by the Congress of Neurological Surgeons (CNS) in 2002 for 11 months^[1]and the 2013 revised Guidelines for the Management of Acute Axis Fractures in Adults^[2]This guideline was developed based on the systematic review and analysis of published Chinese and English literature on the treatment of adult axial fractures.

Chemotherapy is the most effective method to treat acute leukemia, but the vast majority of patients will develop agranulocytic deficiency during chemotherapy, forming a severe immunosuppressive state, which may be secondary to severe infection or even life-threatening^[1]。 The incidence of acute appendicitis in patients with acute leukemia is significantly increased due to the destruction of gastrointestinal mucosa and low immune function caused by chemotherapy drugs^[2]。 Such patients are often complicated with agranulocytosis, severe anemia and thrombocytopenia, etc. The surgical risk is extremely high, and the treatment choice is controversial^[3]。 We retrospectively analyzed the clinical data of patients with acute appendicitis during the treatment of acute leukemia admitted to our hospital from January 2003 to December 2015, and analyzed the efficacy of different treatment methods and the factors affecting the prognosis of patients.

PatientFemale, 47 years old, was admitted to the cardiovascular surgery department of our hospital on July 9, 2015 due to "echocardiography during physical examination found space-occupying lesions of right atrium for 1 week". The patient usually has no chest tightness, chest pain, palpitations and other symptoms, and his activities are not limited. No obvious abnormalities were found in physical examination, and no obvious murmur was found in each valve area of the heart auscultation. Echocardiography revealed an abnormal mass-like echo in the right atrium, about 48 mm ×47 mm in size, and CT examination revealed a huge, slightly lower density, round space-occupying lesion in the right atrium, attached to the middle and lower part of the atrial septum with a wide base, extending to the level of the entrance of the inferior vena cava (Figure 1)。 In order to prevent the tumor from further enlarging and affecting right ventricular function, the patient was subjected to right atrial mass resection on July 9, 2015. The operation used superior and inferior vena cava and aorta cannulation to establish cardiopulmonary bypass, perfusion of arrest fluid through the root of the aorta, incision of the right atrium, a spherical huge space-occupying lesion with intact and smooth capsule, and the base of the tumor fixed to the atrial septum near the inferior vena cava (Figure 2), compressing the coronary sinus and invading the lower left atrium. The tumor was completely cut off along the tumor envelope, the endocardium was sutured with 5-0 non-absorbable suture, the lower part of the left and right atrium was reconstructed, the atrial septal defect was repaired with polyester sheets of corresponding size, the right atrium was sutured, the chest was closed to stop bleeding, and the tumor was sent to pathological examination. The operation was smooth, and the patient recovered well after operation.

PatientA 51-year-old female presented to a local hospital on March 10, 2014 due to right lower back and leg pain with mobility restriction for 1 week after a lumbar sprain. Physical examination showed positive signs of lumbar disc herniation, and CT examination of lumbar spine showed L_4-5Right-central disc herniation, right L₅nerve root compression, L₅A partial endplate defect can be seen on the right side of the upper endplate (Figure 1), diagnosed as L_4-5Endplate rupture disc herniation^[1]。 Conservative treatment (rest, oral analgesics, neurotrophic drugs, etc.) is administered. After 2 weeks, the pain in the right lower limb was relieved, but there was still a numbness. On April 14, 2014, I visited the local hospital again, and the CT reexamination findings were the same as the CT examination at the first visit (Figure 2)。 In view of the effectiveness of conservative treatment, no prominent intervertebral disc changes were found on CT review, so conservative treatment continued. After one month, the patient's low back pain symptoms basically disappeared, and only occasionally had slight discomfort in his right lower limb after bending or sitting for a long time. After continued observation for 2 months, the original symptoms completely disappeared. On August 4, 2014, a lumbar MRI examination was performed in a local hospital. The results showed that the lumbar spine was normal, and no intervertebral disc herniation was found (Figure 3)。 For further examination, the patient came to our hospital on August 14, 2014, and there were no positive signs of disc herniation in the physical examination. Lumbar spine CT examination showed that the CT examination at the first visit to the local hospital showed L_4-5The disc herniation has completely disappeared and is still visible L₅Remnants of partial defects in the upper endplate (Figure 4), diagnosed as disc herniation of endplate rupture type with complete spontaneous absorption, which was not treated. After 1 year of follow-up, the patient had no clinical symptom recurrence, and his daily life was normal. The patient was not recommended for imaging examination.

The patient was a 57-year-old male. He was seen for "painless macroscopic hematuria for 1 month". CT examination suggested that the right lower ureter may occupy space, and the right hydronephrosis. Ureteroscopy showed multiple cauliflower-like and lichen-like neoplasms in the lower right ureter, and the boundaries were unclear under ordinary white light observation (Figure 1), the new organism boundary was clearer after observation with narrow-band light (Figure 2)； Biopsy confirmed high grade urothelial carcinoma.

Question 11What are the precautions or experiences when doing left and right hepatic duct plastic surgery, and what is the difference between classic pelvic anastomosis?

Comrade Wu Weiran, an outstanding member of the Communist Party of China, a famous medical scientist in China, an outstanding surgical expert, a national model worker, a winner of the Bethune Medal, a member of the 12th and 13th Central Committee of the Communist Party of China, a member of the Standing Committee of the 8th, 9th, 10th and 11th National Committee of the Chinese People's Political Consultative Conference, a former member of the Central Health Care Committee, a deputy leader of the first, second and third expert groups of the Central Health Care Committee, a model of central cadre medical and health care workers, an editorial member of the 5th editorial committee of Chinese Journal of Surgery, and an honorary president of Beijing Hospital, died in Beijing at 0: 40 on August 8, 2016 at the age of 96 due to illness.