2023年 · 第61卷第03期

Femoral neck fracture is a common clinical hip fracture. Percutaneous cannulated nail internal fixation is the first choice for the treatment of undisplaced femoral neck fractures in the elderly and young adults^{［1, 2, 3］}。 The classical method of internal fixation of femoral neck fracture is closed reduction and percutaneous placement of three parallel cannulated screws^{［4, 5, 6］}。 Three cannulated screws were inserted into the femoral neck in an inverted "pin" shape, and the screws were as close to the femoral neck cortex as possible^{［7, 8, 9］}。 In order to accurately place the cannulated screw, the surgeon must first drill the cannulated screw guide pin into the femoral neck at the appropriate needle insertion point at the appropriate anteversion angle and neck stem angle. During the operation, the operator mainly depends on personal experience to complete this operation, and the accuracy of screw insertion and operation time are quite different.

A 14-year-old male patient went to the outpatient clinic of our hospital on January 5, 2022 due to "exertion chest tightness for more than 5 months after 9 years of percutaneous ventricular septal myocardial chemical ablation". Nine years ago, he was diagnosed with obstructive hypertrophic cardiomyopathy and mitral regurgitation (mild-moderate) in the cardiovascular pediatric department of our hospital because of "discovery of obstructive hypertrophic cardiomyopathy for more than 4 years". On November 13, 2013, he underwent percutaneous ventricular septal myocardial chemical ablation (absolute ethanol) + temporary pacemaker implantation. Intraoperative catheter manometry showed a decrease in left ventricular outflow tract pressure differential from 86 mmHg (1 mmHg =0.133 kPa) to 14 mmHg. However, postoperative echocardiography revealed that the thickness of the interventricular septum was 34 mm, the posterior wall of the left ventricle was 12 mm, the left ventricular outflow tract was narrowed, the inner diameter of the narrowest part was 8.1 mm, the maximum flow rate was 4.1 m/s, the pressure difference was 67 mmHg, and the mitral valve was mild regurgitation. Because the child's symptoms have improved significantly, he is instructed to review regularly. The differential pressure of left ventricular outflow tract fluctuated from 60 to 80 mmHg during follow-up. Five months ago, I began to experience decreased activity tolerance, and I was easily tired after climbing ladders or walking. I went to our hospital for treatment. On January 20, 2022, the echocardiogram in our hospital showed obvious thickening of the ventricular septum, 29 mm in diastole and 47 mm in systole, severe obstruction of the left ventricular outflow tract, flow rate of 4.3 m/s, pressure difference of 73 mmHg, and mild mitral regurgitation. Metoprolol (12.5 mg, twice/d) was given in the outpatient clinic, but the symptoms of the children did not improve significantly or even worsened after taking the drug. He was re-admitted on May 12, 2022, and was diagnosed with obstructive hypertrophic cardiomyopathy. After percutaneous ventricular septal myocardial chemical ablation, his cardiac function was classified as Class III by the New York College of Cardiology.

The patient, a 24-year-old male, was admitted to our hospital on June 20, 2020 due to "the liver was found to occupy space for 10 d". The patient experienced distension and pain in the left upper abdomen after eating 10 days ago, without nausea and vomiting, fever and other discomfort, and the pain persisted without relief. Local hospital laboratory tests revealed abnormal liver function, hepatitis B; The results of abdominal MRI showed that the left liver occupied space, and mixed liver cancer was considered, with involvement of the left hepatic vein, involvement of the left branch of the portal vein, and multiple calcifications in the liver. The symptoms were relieved after local analgesia and liver protection symptomatic treatment, and the patient went to our hospital for further diagnosis and treatment. Prior history of chronic hepatitis B is untreated, and there are no patients with digestive system malignancies in the family. Admission physical examination: weight 59 kg, body mass index 18.62 kg/m²There was no yellowing stain in the skin and sclera, flat and soft abdomen, tenderness in the left upper abdomen with rebound pain, no obvious mass palpable, no subcostal liver, negative Murphy sign, no moving void, and normal intestinal sounds. Laboratory tests: HBV surface antigen (+), e antibody (+), core antibody (+), alpha-fetoprotein 2 879 μ g/L, carcinoembryonic antigen 1.3 μ g/L, CA125 22.4 U/L, CA19-9 32.1 U/L, normal liver function. On 23 Jun 2020, an enhanced CT scan of the upper abdomen showed a 44 mm ×36 mm occupation at the junction of the 2 and 4 segments of the liver, considering primary liver cancer, left bile duct tumor thrombosis, and involvement of the left external branch of the portal vein (Figure 1). Preliminary diagnosis: primary liver cancer of the left lobe of the liver with invasion of the left branch of the portal vein (Chinese liver cancer stage IIIA) and chronic hepatitis B.

A 55-year-old male patient was seen in our department on November 10, 2021 due to "skin and sclera yellowing with epigastric pain for 5 days". The patient reported fatigue, no fever, chills, abdominal distension, vomiting and other manifestations, yellowish urine for more than 1 month, and no significant change in weight was seen. Past history: 1 year ago, he was diagnosed with anti-N-methyl-D-aspartate receptor (NMDAR) autoimmune encephalitis, and was given methylprednisolone shock combined with gamma globule immunotherapy. The disease was controlled regularly, and he did not complain of headache and abnormal behavior. Small cell lung cancer in the upper lobe of the right lung (extensive stage) was confirmed 10 months ago: mediastinal lymph node metastasis and bone metastasis. Six cycles of etoposide combined with loblatin regimen chemotherapy and 33 times of involved field and contracted field push-volume radiotherapy were sequentially performed. After imaging evaluation, the condition was stable and then the condition was reviewed regularly. Had hypertension for more than 30 years, blood sugar was found to rise for more than 7 months, and tuberculosis infection was found for more than 1 year (all without regular monitoring and treatment). Physical examination: clear consciousness, obvious yellowing of skin and sclera, mild tenderness in the upper abdomen, and no obvious abnormalities. Laboratory tests: blood routine and erythrocyte sedimentation rate were normal, and tuberculin test was positive; Serum total bilirubin 238.8 μ mol/L, direct bilirubin 202.2 μ mol/L, albumin 39.2 g/L; Blood coagulation index and immunoglobulin G typing were normal; Serum amylase 437.0 U/L, lipase 2 002.0 U/L; Serum CA19-9 304.1 U/mL, CA125 39.5 U/mL, carcinoembryonic antigen 5.3 μ g/L, neurogenic specific enolase 45.1 μ g/L, gastrin releasing peptide precursor 741.2 ng/L; Glycosylated hemoglobin 7.1%. CT examination of the upper abdomen showed low-density, mildly enhanced lesions in the pancreatic head area, protruding into the duodenal lumen (Figure 1), combined with intrahepatic and extrahepatic bile duct and pancreatic duct dilatation, and soft tissue density shadow in the pancreatic cervical-gastric space, considering malignant tumor and lymph node metastasis; Chest CT showed that the maximum diameter of the lesion in the apical segment of the upper lobe of the right lung was about 10.0 mm (larger than the previous 6.2 mm), and the multiple enlarged lymph nodes in the mediastinum were larger than the previous; MRI of the head showed no obvious abnormalities. Main diagnostic considerations: pancreatic metastasis, retroperitoneal lymph node metastasis, obstructive jaundice; Secondary diagnoses were: small cell lung cancer (extensive stage), autoimmune encephalitis (anti-Namdar type), hypertension grade 3 (very high risk), and type 2 diabetes.

Professor Zhang Shengdao, a famous surgeon and medical educator in China, tenured professor and chief physician of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, non-partisan celebrity, former director of surgery at Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, honorary director of Shanghai Institute of Digestive Surgery, former leader of pancreatic surgery group of surgical branch of Chinese Medical Association, former deputy leader of biliary surgery group of surgical branch of Chinese Medical Association, editorial member of the 8th and 9th editorial committee of Chinese Journal of Surgery, and recipient of special government allowance from the State Council, died at 12: 58 on January 14, 2023 at the age of 96 at Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine.

An outstanding member of the Communist Party of China, an academician of the Chinese Academy of Engineering, an internationally renowned general surgery expert and medical educator, a member of the Chinese Academy of Medical Sciences, former vice president of Nanjing General Hospital of Nanjing Military Region, honorary director of the General Surgery Research Institute of the Eastern Theatre Command General Hospital, and academician Li Jieshou, a professor and doctoral supervisor of Nanjing University, died in Nanjing at 18: 59 on January 30, 2023 at the age of 98 due to ineffective treatment.

Professor Tan Yuquan, a famous medical educator and surgeon in China, and Professor Tan Yuquan of the First Bethune Hospital of Jilin University, died in Changchun at 11: 15 on January 12, 2023 at the age of 96 due to ineffective treatment.