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Stevens-Johnson syndrome and toxic epidermal necrolysis induced by methazolamide: a systematic review

Objective To summarize the genotypes associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) induced by methazolamide and to provide references for the diagnosis and treatment of SJS and TEN induced by methazolamide. Methods Databases including PubMed, EMbase, CNKI, and WanFang Data were electronically searched from database inception to September 2021. Two reviewers independently screened literature and extracted data, and then a systematic review was performed. Results A total of 18 studies involving 49 patients were included. HLA genetic testing was performed on 37 patients. HLA-B*59:01 was detected in 27 patients, HLA-C*01:02 was detected in 15 patients, and 14 patients carried both genes. Statistical analysis showed that the positive rate of HLA-B*59:01 was 73% (95% CI 0.58 to 0.88) and that of HLA-C*01:02 was 40.5% (95%CI 0.24 to 0.57). The latent time until the symptoms were observed was 14.08 ± 8.77 days, and the mean dosage of methazolamide administered was 88.95±39.45 mg/d. Glucocorticoid and immunoglobulin were the main treatments prescribed. Conclusion Methazolamide can cause SJS and TEN. As the presence of HLA-B*59:01 or HLA-C*01:02 has been reported as a genetic risk factor for these adverse drug reactions, the implementation of genetic screening can effectively reduce their occurrence. Glucocorticoid and immunoglobulin, anti-infectives, should be administered to control the symptoms.

Treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis by transintervertebral release, bone impaction grafting, and posterior column compressed-closing

ObjectiveTo explore the safety and preliminary effectiveness of transintervertebral release, bone impaction grafting, and posterior column compressed-closing in the treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis.MethodsThe clinical data of 21 elderly patients with osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis were retrospectively analyzed between March 2016 and November 2017. There were 1 male and 20 females, aged 55-75 years, with an average of 64.8 years. The disease duration was 8-24 months, with an average of 13.1 months. The bone density T value ranged from −3.4 to −2.1, with an average of −2.3. Lesion segments: T11 in 2 cases, T12 in 6 cases, L1 in 8 cases, L2 in 1 case, T11, 12 in 1 case, T12, L1 in 2 cases, and T12, L2 in 1 case. Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA): 5 cases of grade D and 16 cases of grade E. All patients underwent transintervertebral release, bone impaction grafting, and posterior column compressed-closing. The effectiveness was evaluated by visual analogue scale (VAS) score and Oswestry dysfunction index (ODI) score before operation, at 3 months after operation, and at last follow-up. The neurological function was assessed by ASIA at last follow-up. Local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertebral axis (SVA) were measured on the X-ray films of the full-length lateral spine of the patient before operation, at 1 week after operation, and at last follow-up.ResultsNo complication such as fracture of internal fixator or nerve injury occurred. LKCA, TK, and SVA were significantly improved at 1 week after operation and at last follow-up (P<0.05). There was no significant difference between at 1 week after operation and at last follow-up (P>0.05). There was no significant difference in LL before and after operation (F=3.013, P=0.057). The VAS and ODI scores were significantly improved at 3 months after operation and at last follow-up, and further improved at last follow-up when compared with the scores at 3 months after operation, showing significant differences between time points (P<0.05). Five patients with ASIA grade D neurological function recovered to grade E at 6 months after operation.ConclusionTransintervertebral release, bone impaction grafting, and posterior column compressed-closing for treating osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis has definite effectiveness, strong orthopaedic ability, and minimal trauma, which can effectively restore the sagittal balance of the spine, alleviate pain, and improve the patients’ quality of life.

选择性松解膝内侧副韧带浅层在膝内翻全膝关节置换术中的应用

总结选择性松解膝内侧副韧带浅层在膝内翻全膝关节置换术中应用的效果。 方法 2006 年5 月－ 2007 年5 月，对60 例膝内翻患者行全膝关节置换术。男27 例，女33 例；年龄55 ～ 78 岁。骨性关节炎38 例，类风湿性关节炎15 例，创伤性关节炎7 例。膝内翻总角度为（13.8 ± 2.5）°，HSS 评分为（36.5 ± 2.9）分。术中选择性松解膝内侧副韧带浅层矫正膝内翻。 结果 术后患者切口均Ⅰ期愈合。获随访6 ～ 12 个月，平均9 个月。膝内翻总角度为（0.8 ± 1.5）°，HSS 评分为（86.0 ± 3.5）分，与术前比较差异均有统计学意义（P lt; 0.05）。 结论 在膝内翻全膝关节置换术中应用选择性松解膝内侧副韧带浅层疗效良好，具有损伤较小及操作简便的优点。

COMPARISON OF OPERATION MODE AND CLINICAL EFFECT OF DIFFERENT SURGICAL TREATMENTS OF GLUTEUS MUSCLE CONTRACTURE(with 98 cases reports)

OBJECTIVE: To explore a better surgical mode to treat gluteal muscle contracture. METHODS: In 98 cases, superior cross incision of large tuberosity was performed in 20 cases, posterosuperior curve incision of large tuberosity was performed in 20 cases, and exteroinferior cross incision of iliac spine in the other 58 cases. The patients were observed after operation and followed up. RESULTS: The patients who received exteroinferior cross incision of iliac spine recovered soon without bleeding and infection after operation, which indicated the lowest incidental rate of postoperative complication. CONCLUSION: Exteroinferior cross incision of iliac spine is a safe and effective surgical operation to loosen the gluteal muscle contracture.

Application of Ultrasonically Activated Scalpel in Laparoscopic Intestinal Adhesion Release

【Abstract】ObjectiveTo study the application of ultrasonically activated scalpel in laparoscopic intestinal adhesion release.MethodsIntestinal adhesion release with ultrasonically activated scalpel under laparoscope was performed in 29 patients suffered from intestinal adhesive obstruction after gynecological operation. ResultsAll operations were successfully performed, and none of them converted into open surgery. Intestinal disruption occurred durring operation in 2 patients with extensive intestinal denseadhesion which were mended successfully under laparoscope. The operative duration was 30-150 min (mean 45 min). Postoperative complications such as bowel leakage, bleeding, abdominal infection were not experienced. Postoperative hospital stay was 3-7 days (mean 4 days). No case had relapse symptom such as abdominal distention or pain after 1-24 months of followup. ConclusionCompared with electric scalpel, ultrasonically activated scalpel can improve the operative safety, lessen tissue damage, shorten operative time, and reduce the chance of relapse in laparoscopic operation in gynecology.

PERIPHERAL NERVE INJECTION IN JURY: A COMPARATIVE STUDY OF RESULTS BETWEEN EARLY INCISION OF EPINEURIUM WITH SALINE IRRI GATION AND LATE NEUROLYSIS

A controversy still exists in the management of nerve injection injury. The results of different timing of operation and methods in treating this type of nerve injury were analysed in limb s function, neuroelectrophysiology and histology. The results showed that the recovery of the injuried nerve in the group of operation, was considerably better than that in the group without operation. In the group of operation early incision of the epineurium with saline irrigation! was superior to late neurolysis. It was suggested that the early incision with saline irrigation could be used as an emergency management for this type of nerve injury.

大疱性表皮松解症手部瘢痕挛缩畸形手术松解全厚皮片植皮一例

Surgical Treatment of Myocardial Bridge

Objective To investigate the clinical characteristics, operative indications, operative methods and operative effect of myocardial bridge(MB). Methods From Oct.1996 to Feb.2007, 34 cases with MB underwent MB operation in Fu Wai Hospital. There were 10 cases with isolated myocardial bridge, 4 complicated with coronary artery heart disease, 15 complicated with heart valve diseases, 3 complicated with hypertrophic obstructive cardiomyopathy, 1 complicated with Marfan’s syndrome and 1 complicated with atrial septal defect. All the 34 cases were diagnosed definitely by coronary angiography. According to cardiac function classification（NYHA）, there were 30 cases in gradeⅡ and 4 cases in gradeⅢ. Thirtytwo cases involved left anterior descending(LAD), 1 involved posterior descending branch(PDB) and 1 involved circumflex(CX), with a length of 1-6 cm respectively. Fifteen cases underwent myotomy on myocardial bridge and 19 cases underwent coronary artery bypass grafting(CAGB). Results Among cases who underwent myotomy on myocardial bridge, there was 1 intraoperative right ventricle perforation which was cured after repair. Among cases who underwent myotomy on myocardial bridge with mitral valve replacement concomitantly, there was 1 death caused by left ventricular rupture. There was no other operative complication. Thirty cases were followed up for 15-124 months. Two cases with isolated MB had angina pectoris after myotomy on myocardial bridge and were controlled by drugs. Among 30 cases with MB, 25 in NYHA gradeⅠ, 2 in gradeⅡ and 3 in gradeⅢ. Conclusion The surgical treatments of myocardial bridge include myotomy on myocardial bridge and CABG, and can be properly chosen according to the length, position of myocardial bridge, and having or not having mural coronary artery proximal atherosclerosis. Both the two treatments can obtain satisfactory clinical outcome.

DIAGNOSIS AND TREATMENT OF UNILATERAL GLUTEAL MUSCLE CONTRACTURE

Objective? To investigate the pathogenesis, diagnosis, and treatment of unilateral gluteal muscle contracture. Methods Between January 1990 and September 2009, 41 patients with unilateral gluteal muscle contracture were treated and the cl inical data were retrospectively analysed. Among them, 24 were male and 17 were female with an age range from 6 to 29 years (mean, 12 years). Thirty-nine patients had a definite history of repeat intragluteal injection. The locations were the left side in 9 cases and the right side in 32 cases. The main cl inical manifestations included lameness and abnormal gait. The medical examination showed pelvic obl ique and relative inequal ity of lower l imbs with a mean difference of 2.1 cm (range, 1.2-3.8 cm) in the distance form navel to malleolus medials. The X-ray films of pelvis showed outpouching trochanter of femur and pelvic obl ique. The CT scans showed no abnormal finding except pelvic obl ique and gluteal muscle contracture. The arc longitudinal incision was made into the posterolateral area nearby the greater trochanter and then lysis of the gluteal muscles was performed, followed by the skin traction of both legs and rehabil itation exercise. Results All incisions healed by first intention. Forty-one patients were followed up 1-20 years (mean, 5 years), and the signs of gluteal muscle contracture disappeared. After 1 year of operation, 34 patients had equal leg length, 5 patients had mild pelvic obl ique, and 2 patients had obvious pelvic obl ique. According to LIU Guohui et al. evaluation standard, the results were excellent in 33 cases, good in 6 cases, and poor in 2 cases with an excellent and good rate of 95.12% at 1 year after operation. Conclusion Unilateral gluteal muscle contracture leads to pelvic obl ique and inequal ity of lower l imbs, and it can be cured with the surgical release of the gluteal muscle contracture by the arc longitudinal incision into the posterolateral area nearby the greater trochanter, combined with postoperative skin traction and rehabil itation exercises.

膝关节镜下松解术治疗膝关节功能障碍

【摘 要】 目的 总结膝关节功能障碍行关节镜下松解，以及术后康复方法及疗效。 方法 2002 年10 月－2006 年2 月，采用膝关节镜下松解术治疗膝关节功能障碍15 例，男11 例，女4 例；年龄25 ～ 56 岁。左侧9 例，右侧6 例。髌骨骨折7 例，胫骨平台骨折4 例，前交叉韧带断裂3 例，化脓性关节炎1 例。病程6 个月～ 3 年，平均1.5 年。膝关节功能障碍程度：伸膝0 ～ 10º，屈膝30 ～ 60 º；膝关节活动范围30 ～ 50 º。术后行关节腔冲洗，早期CPM 机功能锻炼，手法屈膝按摩。 结果 患者术后切口Ⅰ期愈合，无并发症。获随访1 ～ 3 年半，平均2 年。膝关节活动度: 屈110° ～伸0°者4 例，屈100° ～伸0° 者7 例，屈90° ～伸0° 者3 例，屈70° ～伸0° 者1 例。按KSS 评分标准，优11 例，良3 例，可1 例，优良率为93.3％。 结论 关节镜下行膝关节内松解，术后关节腔冲洗，为早期行膝关节功能锻炼创造了条件，有利于膝关节功能康复。