Dr. Renji: These misconceptions need to be noted. After the last bone fracture in her life, the centenarian grandmother made a big comeback

Release time:Apr 16, 2024 04:26 AM

A hundred year old grandmother accidentally fell at home and was diagnosed with a intertrochanteric fracture of the femur. After a fracture, the elderly person is unable to turn over and experiences severe pain as soon as they do so. They cannot sleep at night and are unable to take care of themselves when urinating or defecating. And this type of fracture is known as the "last fracture in life" in the medical industry, which can cause various serious complications throughout the patient's body, and even lead to the patient's death.

However, can centenarians tolerate anesthesia and overcome various difficulties such as postoperative extubation and rehabilitation? The Department of Traumatology and Orthopedics at Renji Hospital affiliated with Shanghai Jiao Tong University bravely entered the age restricted area and performed intramedullary nail fixation surgery for intertrochanteric fractures of the femur. The centenarian grandmother's postoperative recovery was good, and she started a new quality of life.

Surgical Challenge for Centenarians After Fractures

Intertrochanteric fracture of the femur has always been known as the "last fracture in life" for elderly patients. Conservative treatment of this type of fracture can cause serious complications such as persistent occult blood loss, deep vein thrombosis in the lower limbs, pulmonary infection, urinary tract infection, pulmonary embolism, etc. The mortality rate is very high, with a mortality rate of over 20% within one month. Timely evaluation and early surgery are the best means to reduce mortality. On the third day after the fracture, the centenary grandmother went to the emergency department of the trauma orthopedics department at Renji Hospital and strongly requested surgery, and was willing to bear all the risks during the perioperative period.

Having surgery after the age of one hundred can be considered a great challenge. After a comprehensive examination, experts found that the centenarian grandmother can walk and take care of herself, but she suffers from diseases such as hypertension and deafness. At the same time, the risk of anesthesia should not be underestimated. Zhao Yanhua, the deputy chief physician of the anesthesia department, arrived early in the ward for evaluation. In order to reduce the risks of intraoperative anesthesia and postoperative difficulty in extubation, a combination of spinal anesthesia and nerve block anesthesia was performed on the patient.

After the deputy chief physician of the trauma orthopedics department, Li Zhanyu, and the attending physician, Zhou Chun, closed the fracture site of the centenary grandmother and completed the intramedullary nail fixation in just 40 minutes. The intraoperative bleeding was only about 50 milliliters, but due to this type of fracture, the preoperative occult blood loss may be 800 to 1200 milliliters. During the operation, 400 milliliters of red blood cells were infused and the patient was successfully returned to the hospital room.

$Dr. Renji: These misconceptions need to be noted. After the last bone fracture in her life, the centenarian grandmother made a big comeback$

The next day, the doctors injected 400 milliliters of red blood cells into the centenarian grandmother. The elderly woman was already able to eat and turn over on her own, sit by the bed for half an hour with the company of her family, and sleep comfortably at night. The centenarian grandmother finally showed a smile and was transferred to a medical consortium hospital for further rehabilitation treatment 5 days after surgery.

Li Zhanyu said that there are many misunderstandings among the public regarding elderly patients with intertrochanteric fractures of the femur. Many elderly people are afraid of surgical risks and choose conservative treatment. In fact, conservative treatment does not necessarily mean safety. Elderly people will face various problems, such as severe limb pain, reluctance to turn over or even move, causing deep vein thrombosis in the lower limbs, and easily leading to pulmonary embolism, cerebral infarction, and myocardial infarction. Long term bed rest can cause bedsores, lung infections, and urinary system infections, which are fatal complications. In addition, continuous blood loss at the fracture end can cause severe anemia and exacerbate pre-existing heart, lung, and brain diseases.

Conservatism also carries risks, and rehabilitation and calcium supplementation are both important

For elderly or even centenarians, as long as they can tolerate anesthesia, it is still recommended to undergo surgery as early as possible. After early surgery, patients can turn over and sit straight, which is easy to care for. For stable fractures, they can walk on the ground as soon as possible, and their quality of life is significantly improved. During and after surgery, timely blood transfusion can be performed to correct anemia.

In addition, the selection of surgical timing is also important. The guidelines recommend surgery within 24 hours as much as possible, which can significantly reduce the incidence of postoperative complications and mortality; After 36 to 48 hours, the risk of death significantly increases, and surgery cannot be performed until all examinations are completed and all indicators are close to normal. "After the adjustment is completed, lung infection may have already occurred and the opportunity for surgery has been lost." Li Zhanyu said that if the overall condition is poor and there are many internal medicine diseases, surgery should also be performed within 72 hours at the latest after adjusting the state. "This type of surgery is a life-saving surgery, and the earlier the preparation before surgery is complete, the better. It requires not only the courage and attention of doctors, but also the understanding and support of family members."

Why is "Cancer King" immunotherapy ineffective? Fudan Cancer Hospital Reveals New Mechanisms of Immunosuppressive Environment for pancreatic cancer CRIP1 | Tumor | pancreatic cancer

Immunotherapy has been proven to achieve significant therapeutic effects in various solid tumors. However, for pancreatic cancer, known as the "king of cancer", immunotherapy has been ineffective. On August 4, Professor Yu Xianjun, Dean of the Cancer Hospital Affiliated to Fudan University, and Shi Si, Associate Professor of Pancreatic Surgery released a research achievement, which first found the key role of cysteine rich protein 1 in shaping the immunosuppressive microenvironment of pancreatic cancer, filled the gap in the research field of immunosuppressive microenvironment of pancreatic cancer, and provided a theoretical basis for precise immunotherapy of pancreatic cancer patients. Ductal adenocarcinoma of the pancreas is the main type of pancreatic cancer, accounting for about 90% of all pancreatic cancer. Due to its high malignancy and poor treatment effectiveness, pancreatic ductal adenocarcinoma has always been one of the most malignant tumors. In recent years, the level of surgical techniques and comprehensive treatment has been achieved

A 14-year-old girl suffers from a rare eye disease and receives support from a public welfare fund. Symptoms of "I haven't looked in the mirror for a long time" | Patient | Public welfare

A 14-year-old girl has been experiencing symptoms such as protruding pupils, incomplete eye closure, corneal injury, restricted eye movement, and overall fatigue for several years. The physical discomfort and facial abnormalities caused by eye diseases have made her increasingly reticent, and her temperament is vastly different from before. At the Ophthalmology Department of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, the pupil has been diagnosed with a rare thyroid ophthalmopathy combined with myasthenia gravis, which requires prompt treatment. However, considering the young age of the pupil, conventional hormone and radiation therapy cannot be used. Therefore, Zhou Huifang, Deputy Director of Ophthalmology and thyroid ophthalmology expert, has developed a targeted drug combined with surgical treatment plan for it, and targeted drug treatment will be performed first. Three months ago, I was hospitalized for one week with mydriasis and received intravenous targeted drug treatment. Afterwards, I went home for observation and followed up on time

The municipal eye disease prevention and treatment center launched the dry eye diagnosis and treatment studio, and the incidence rate of dry eye in China is about 21% to 30% of the meibomian gland | dry eye | eye disease

According to the Statistics of Chinese Dry Eye Expert Consensus, the incidence rate of dry eye in China is about 21%~30%, and it is estimated that there are at least 300 million patients nationwide. The Dry Eye Diagnosis and Treatment Studio of Shanghai Eye Disease Prevention and Treatment Center was officially launched today. In the future, the studio will continuously improve the dry eye diagnosis and treatment standards, and form standardized diagnosis and treatment concepts and service models. Suitable technologies will be promoted to the community, allowing residents to enjoy convenient dry eye diagnosis and treatment services at their doorstep. Executive Dean and Party Secretary Gao Wei stated that this is also one of the livelihood service measures recently launched by the hospital around high-quality development and meeting the needs of the people. It is reported that dry eye syndrome is a chronic ocular surface disease caused by multiple factors. The instability of the tear film or imbalance of the ocular surface microenvironment caused by abnormal quality, quantity, and dynamics of tears can be accompanied by ocular surface inflammatory reactions, tissue damage, and nerve abnormalities, resulting in various discomforts in the eyes

The Ninth Hospital has taken the lead in formulating the world's first consensus on core indicators for clinical evaluation of dental implants, which has been officially published in clinical practice

The International Dental Implant Consensus Report, jointly written by the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine and renowned universities in the field of dentistry such as Harvard University, University of Zurich, University of Gothenburg, Columbia University, and University of Frankfurt, has recently been jointly published in top journals in the field of dentistry, including Clinical Periodontology and Clinical Dental Implant Research. This consensus has for the first time established an internationally unified core set of indicators for evaluating the clinical effectiveness of dental implants, covering the five key areas of the field of dental implants. It is of milestone significance for carrying out standardized clinical diagnosis, treatment, and research on dental implants. The core evaluation indicators determined by this consensus will become an important benchmark for scholars in the field of dental implants worldwide to conduct high-quality research. The consensus is composed of 8 top international experts in the field of oral implantation

Recently, autologous hematopoietic stem cell therapy was completed in Shanghai, and British girls born in the 1990s have suffered from multiple relapses of blood diseases, including stem cells, peripheral blood, and diseases

Recently, Catherine, a British girl born in the 1990s, received autologous peripheral blood hematopoietic stem cell transfusion at the Cancer Center of Shanghai Jiahui International Hospital, and was successfully discharged from the warehouse. She is now on her way back to China after being discharged from the hospital. She is also the first patient at Shanghai Jiahui International Hospital to complete relevant treatments. In 2019, Catherine was diagnosed with Hodgkin's lymphoma in the UK, and after treatment, the disease completely improved. During her work and life in China in 2021, she went to seek medical attention due to multiple enlarged lymph nodes. Pathological biopsy confirmed a recurrence of Hodgkin's lymphoma, and through combined targeted drug treatment, her condition was temporarily under control. Last year in the second half of the year, when the disease recurred, the girl began to use immunotherapy combined with targeted drugs for treatment. Expert evaluation suggests that for young patients with hematological tumors, the risk of recurrence is high and treatment difficulty is increasing in the future. Autologous hematopoietic stem cell therapy is recommended

Important news

The boundless scenery is always new-General Secretary Xi Jinping guides the construction of digital society, review and development | education | society Unswervingly Promote and Improve the Comprehensive and Strict Party Governance System Xi Jinping | Strict Party Governance | System "Seeking Truth" magazine published an important article by General Secretary Xi Jinping "Improving the Comprehensive and Strict Party Governance System and Promoting the New Great Project of Party Building in the New Era to Develop in Depth" State | President | Xi Jinping General Secretary's thoughts are still in my mind, learning from the season | building a modern marine ranching power | developing | the ocean Leading the way with a heavy load | More vitality in opening up to the outside world, stronger momentum in science and technology innovation - Strong development momentum in the ancient capital of Xi'an Automotive | New energy | Opening up to the outside world Chinese Stars | 210 Seconds Review of the Victory of Aerospace Heroes on their Way Home! Flying | Divine Boat | Hero

Political situation

What are the remaining obstacles in the investigation and undercover investigation by the law enforcement inspection team of the Municipal People's Congress? This work evaluates that Shanghai has always been at the forefront of garbage classification | garbage | law enforcement Looking forward to the global high-quality engineering enterprise layout in Shanghai, Mayor Gong Zheng meets with the President elect of the World Federation of Engineering Organizations | Global | Quality To jointly discuss and deepen cooperation and exchange in counterpart support, Chen Jining and Nie Zhuang led a discussion on the work of the party and government delegation in Kashgar, Xinjiang Chen Jining and Gong Zheng jointly inspected and discussed, jointly serving the overall development of the country! Yin Li and Yin Yong led a Beijing delegation to Shanghai to inspect the delegation's development and overall situation Contributed about 1/4 of the GDP of Shanghai, currently with 70000 foreign-funded enterprises in Shanghai. The Youth Association of Shanghai Foreign Countries has helped each other in terms of membership and GDP The representative group of Yangpu Street helps to alleviate public concerns, with garbage belts turning back into green belts and street lights lighting up again in residential areas | Representative | Yangpu

Economics

What else can I rely on for growing vegetables?, Agricultural Experiment of a Group of Young People: Lettuce without Heaven or Earth | Physical Strength | Agriculture Very few have been rejected at once... Shanghai Automotive Engine Factory has presented 49 automotive grade chips to solicit domestic alternatives to SAIC | Netherlands | United States | Lingang Pujiang International Science and Technology City | Substitution | Import | Localization | Automotive grade chips Is there still a "flower head" in domestic blockchain?, No Bitcoin, First Blockchain Technology National Standard Released Web3.0 | Blockchain | Domestic These top domestic and international beverage cold drink brands have rolled up like this, in order to welcome the overall recovery of the consumer market as a brand | Sugar Tea | International Making a dojo inside a snail shell allows the city's scraps to make a comeback. This European style garden in Shanghai used to be a "stone" on the road. Shanghai Pocket Park | Sparrow Little Dirty | Making a dojo inside a snail shell 23 industry associations (business and academic) in the Yangtze River Delta have established alliances to provide trade adjustment assistance, and the foreign trade situation is complex and severe. | Trade | Alliance

Regional situation

Shanghai Charity Foundation Successfully Issued First Electronic Donation Receipt Community | Activity | Shanghai Charity Foundation Carry out normalized social theater performance activities, and the "hometown of drama" Songjiang Xinbang will resume stage and social theater | Drama | Songjiang Xinbang How to promote and replicate the "near rail model"? Changfeng Xincun Street Building Party Building 4.0 Model | Building Committee | Jintie The largest single scale near zero energy consumption building in Shanghai will be built, and the construction area of the first batch of "Jiabao Smart Bay" in Jiading New City will start | plot | first batch Jing'an creates "one park, one theme", and the art exhibition "Painting Life and Coloring" opens at Jing'an Sculpture Park to experience | Art | Jing'an The highlights of the Xuhui exhibition area at the first Carbon Expo are frequent, including waste plastic recycling and environmental protection roads, Shanghai's first near zero carbon community, low-carbon | green | community

Viewpoint

"White carbon" is on the rise, and there are many colors of carbon? This is definitely not sensationalism, carbon dioxide emissions, color Where does the trend go: "China-Chic" cultural and creative market status, development trend and innovation path Cultural and creative | Chinese goods | China-Chic He demonstrated the essence of the revolutionary ideology and spiritual qualities of communists, and during his brief 40 years of life, Secretary Yu Xiusong's ideology What is the relationship between the "four major functions" and the "five centers"? Accurately grasp these two key elements | functions | relationships Why mention "Clean Your Plate Campaign" again?, Today's life | leftovers | CDs To find the balance between digitization and greening, experts say that excessive digitization may increase energy consumption. Digital | Green | Digitization

Vision

Celebrating the Second Anniversary of the US Army's Withdrawal, [Looking at the World] Afghan Taliban Armed Security Personnel March Typhoon | Taliban | Afghanistan It's more convenient to buy book exhibition tickets offline today, including ID card, cash, and old-fashioned mobile phones. Lu Xun | Book Exhibition | Mobile Phone These spaces create multiple interactive viewing experiences for citizens and tourists, playing with weekend aesthetics | Design | Citizens The opening ceremony will continue as usual. [Looking at the World] The opening match of the Women's World Cup. A shooting occurred in Auckland City, resulting in three deaths. The World Cup | Event | Opening match World Blood Donor Day: Oriental Pearl TV Tower, Shanghai center and other city landmarks light up Life Red World Blood Donor Day Take the artwork home for a thousand yuan? Many people come to this exhibition for their "treasure hunting" works | gallery | to take home