Fractures of the humeral paddle, common to young adults, are most often complex, linked to violence and an increase in road accidents. The objective of our work is to evaluate our functional results, in the medium ter...Fractures of the humeral paddle, common to young adults, are most often complex, linked to violence and an increase in road accidents. The objective of our work is to evaluate our functional results, in the medium term, correlated with a review of the literature. This is a retrospective study of 63 patients, carried out in the traumatology-orthopedics department 1 of the IBN EL JAZZAR hospital in KAIROUAN, over a period of 7 years from January 2015 to December 2021. The average age of patients was 39 years (17 - 68 years). Predominantly male. The etiologies are dominated by falls and accidents on public roads. Fractures are classified according to the Müller and Allgöwer classification where type C is found in 51% of cases. All our patients undergo an olecranon osteotomy in 71% of cases. Osteosynthesis using a Lecestre plate combined with screwing or plugging is used in 84% of cases. The evolution is marked by complications observed in eight patients (16%), including two cases of sepsis, four cases of elbow stiffness (8%), one case of joint callus and one case of pseudarthrosis. Our results are evaluated according to the Mayo Elbow Performance Score, they are excellent and good in 71% of cases, average in 18% of cases and poor in 11% of cases. Fractures of the humeral paddle are fractures with a satisfactory functional prognosis, requiring ad integrum anatomical restoration and solid osteosynthesis allowing early rehabilitation of the elbow. One case of joint callus and one case of pseudarthrosis.展开更多
Tumour rupture of gastrointestinal stromal tumours(GISTs)has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological outcome.Although tumour rupture has not yet been includ...Tumour rupture of gastrointestinal stromal tumours(GISTs)has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological outcome.Although tumour rupture has not yet been included in the current tumor-node-metastasis classification of GISTs as a prognostic factor,it may change the natural history of a low-risk GIST to a high-risk GIST.Originally,tumour rupture was defined as the spillage or fracture of a tumour into a body cavity,but recently,new definitions have been proposed.These definitions distinguished from the prognostic point of view between the major defects of tumour integrity,which are considered tumour rupture,and the minor defects of tumour integrity,which are not considered tumour rupture.Moreover,it has been demonstrated that the risk of disease recurrence in R1 patients is largely modulated by the presence of tumour rupture.Therefore,after excluding tumour rupture,R1 may not be an unfavourable prognostic factor for GISTs.Additionally,after the standard adjuvant treatment of imatinib for GIST with rupture,a high recurrence rate persists.This review highlights the prognostic value of tumour rupture in GISTs and emphasizes the need to carefully take into account and minimize the risk of tumour rupture when choosing surgical strategies for GISTs.展开更多
BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.He...BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.Here,we review the literature and describe the surgical treatment of a 70-year-old woman who presented with a CSF leak due to a cervical spine spur.CASE SUMMARY A 70-year-old female patient who was treated for a cerebral infarction,presented with complains of weakness in the right lower extremity and a feeling of stepping on cotton.The patient underwent regular neck massage and presented with neck and right shoulder pain radiating to the right upper extremity one-month ago.Magnetic resonance imaging showed a strip of leaking cerebrospinal fluid posterior to the C1-4 vertebrae,and computed tomography showed a“sickleshaped”disc prolapse with calcification in C4/5.We chose to perform an anterior cervical discectomy.When the prolapsed C4/5 disc was scraped,clear fluid leakage was observed,and exploration revealed a 1 mm diameter rupture in the anterior aspect of the dura mater,which was compressed continuously with cotton patties,with no significant cerebrospinal fluid leakage after 1 h.CONCLUSION Three months after surgery,the patient was asymptomatic and follow-up imaging demonstrated complete resolution.展开更多
BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompan...BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction,leading to further deterioration of the nutritional status.Early enteral nutrition support is hypothesized to be helpful in improving this situation,but the exact effects have yet to be studied in depth.AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors,with the expectation that by improving the nutritional status of patients,the recovery process would be accelerated and the incidence of complications would be reduced,thus improving the quality of life.METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed.Fifty-three of these patients received complete parenteral nutrition support as the control group for this study.The other 68 patients received early enteral nutritional support as the observation group of this study.The clinical indicators comparing the two groups included time to fever,time to recovery of postoperative bowel function,time to postoperative exhaustion,and length of hospital stay.The changes in immune function and nutritional indexes in the two groups were compared.Furthermore,we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients.Finally,the occurrence of postoperative complications between the two patient groups was also compared.RESULTS The postoperative fever time,postoperative bowel function recovery time,postoperative exhaustion time,and hospitalization time were all higher in the control group than in the observation group(P<0.05).The levels of CD3+,CD4+,immunoglobulin(Ig)A,IgM,and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively,while CD8+was lower than in the control group(P<0.05).Total protein,albumin,prealbumin,and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively(P<0.05).The SF-36 scores of patients in the observation group were significantly higher than those in the control group(P<0.0001).The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group(P=0.021).CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable,and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery.This program can not only improve the immune function of the patient and protect the intestinal function,but it can also help to improve the quality of life of the patient.However,this program will increase the incidence of complications in patients.Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer.The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.展开更多
BACKGROUND Spondyloepiphyseal dysplasia congenita(SEDC)is a rare autosomal dominant hereditary disease caused by COL2A1 mutations.SEDC primarily involves the skeletal system,with typical clinical manifestations,includ...BACKGROUND Spondyloepiphyseal dysplasia congenita(SEDC)is a rare autosomal dominant hereditary disease caused by COL2A1 mutations.SEDC primarily involves the skeletal system,with typical clinical manifestations,including short stature,hip dysplasia,and spinal deformity.Due to the low incidence of SEDC,there are only a few case reports regarding the surgical treatment of SEDC complicated with spinal deformities.CASE SUMMARY We report a case of a 16-year-old male patient with SEDC.He presented with typical short stature,atlantoaxial dysplasia,scoliosis,and hip dysplasia.Cervical magnetic resonance imaging showed spinal canal stenosis at the atlas level and cervical spinal cord compression with myelopathy.The scoliosis was a right thoracic curve with a Cobb angle of 65°.He underwent atlantoaxial reduction,decompression,and internal fixation from C1–C2 to relieve cervical myelopathy.Three months after cervical surgery,posterior correction surgery for scoliosis was performed from T3 to L4.Scoliosis was corrected from 66°to 8°and remained stable at 2-year follow-up.CONCLUSION This is the first case report of a patient with SEDC who successfully underwent surgery for atlantoaxial dysplasia and scoliosis.The study provides an important reference for the surgical treatment of SEDC complicated with spinal deformities.展开更多
Portal hypertension is a group of syndrome characterized by splenic hyperfunction, esophageal and gastric varices and ascites caused by abnormal portal vein hemodynamics. Among them, upper gastrointestinal bleeding ca...Portal hypertension is a group of syndrome characterized by splenic hyperfunction, esophageal and gastric varices and ascites caused by abnormal portal vein hemodynamics. Among them, upper gastrointestinal bleeding caused by esophageal and gastric varices is the most dangerous complication, which often threatens the lives of patients. After half a century of development, the treatment of portal hypertension is divided into two categories: medical drug therapy, endoscopic therapy and surgical treatment. With the understanding of portal hypertension and the continuous development of medical technology, the surgical operation of portal hypertension has also been greatly improved, reducing postoperative complications and improving the quality of life of patients after operation. However, at present, there is no surgical method that can completely cure portal hypertension. This article reviews the progress of surgical treatment of portal hypertension in recent years, in order to provide reference for the surgical treatment of portal hypertension.展开更多
Objective: To explore the related factors of surgical treatment of patients with corpus luteum rupture and establish a risk prediction model of surgical treatment of corpus luteum rupture. Methods: 222 patients with c...Objective: To explore the related factors of surgical treatment of patients with corpus luteum rupture and establish a risk prediction model of surgical treatment of corpus luteum rupture. Methods: 222 patients with corpus luteum rupture treated in Jingzhou First People’s Hospital from January 2015 to March 2022 were analyzed retrospectively, including 45 cases of surgery and 177 cases of conservative treatment. The training set and validation set were randomly assigned according to 7:3. We collected the basic information, laboratory and ultrasonic examination data of 222 patients. Logistic regression analysis was used to determine the independent risk factors and combined predictors of surgical treatment of corpus luteum rupture. The risk prediction model was established and the nomogram was drawn. The discrimination and calibration of the prediction model were verified and evaluated by receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow goodness of fit test;Decision curve analysis (DCA) was used to evaluate the clinical effectiveness of the prediction model. Results: Univariate logistic regression showed that whole abdominal pain (OR: 2.314, 95% CI: 1.090 - 4.912), abdominal muscle tension (OR: 2.379, 95% CI: 1.112 - 5.089), adnexal mass ≥ 4 cm (OR: 3.926, 95% CI: 1.771 - 8.266), hemoglobin Conclusion: The nomogram prediction model containing three predictive variables (hemoglobin, depth of pelvic effusion under ultrasound and cervical lifting pain) can be used to predict the risk of surgical treatment in patients with corpus luteum rupture.展开更多
Surgery is the most important and effective method for the treatment of gastric cancer.Since the first gastrectomy in the early 19th century,surgical treatment of gastric cancer has undergone more than 100 years of de...Surgery is the most important and effective method for the treatment of gastric cancer.Since the first gastrectomy in the early 19th century,surgical treatment of gastric cancer has undergone more than 100 years of development.With the increasing understanding of gastric cancer and the promotion of a series of clinical trials,the concept of gastric cancer surgery has evolved from the initial"bigger is better"to today’s"standardized surgery"and is developing towards individualized surgery focusing on accurate resection and quality of life.This trend has had a tremendous impact on the development of surgical treatments,such as minimally invasive surgeries,functionpreserving surgeries,and the optimal extent of lymph node dissection.Understanding the development and current status of gastric cancer surgery and exploring the remaining academic controversies are goals that every gastric surgeon should constantly pursue.However,how should gastric cancer surgery develop in the future?What opportunities and challenges will we encounter?In this review,we elaborate on the development and current status of gastric cancer surgery based on a series of clinical studies and discuss the controversy in the development of gastric cancer surgery.展开更多
BACKGROUND Chronic pancreatitis(CP)is a long-lasting disease frequently associated with complications for which there is no comprehensive pathophysiological classification.AIM The aims of this study were to:Propose a ...BACKGROUND Chronic pancreatitis(CP)is a long-lasting disease frequently associated with complications for which there is no comprehensive pathophysiological classification.AIM The aims of this study were to:Propose a pathophysiological classification of the complications of CP;evaluate their prevalence in a surgical cohort prior to,and following surgical management;and assess the impact of the surgical treatment on the occurrence of new complications of CP during follow-up.We hypothesized that optimal surgical treatment can resolve existing complications and reduce the risk of new complications,with the exclusion of pancreatic insufficiency.The primary outcomes were prevalence of complications of CP at baseline(prior to surgical treatment)and occurrence of new complications during follow-up.METHODS After institutional review board approval,a prospective observational cohort study with long-term follow-up(up to 20.4 years)was conducted.All consecutive single-center adult patients(≥18 years of age)with CP according to the criteria of the American Pancreas Association subjected to surgical management between 1997 and 2021,were included.The prevalence of CP complications evaluated,according to the proposed classification,in a surgical cohort of 166 patients.Development of the pathophysiological classification was based on a literature review on the clinical presentation,course,and complications of CP,as well a review of previous classification systems of CP.RESULTS We distinguished four groups of complications:Pancreatic duct complications peripancreatic complications,pancreatic hemorrhages,and pancreatic insufficiency(exocrine and endocrine).Their baseline prevalence was 20.5%,23.5%,10.2%,31.3%,and 27.1%,respectively.Surgical treatment was highly effective in avoiding new complications in the first and third groups.In the group of peripancreatic complications,the 15-year Kaplan-Meier prevalence of new complications was 12.1%.The prevalence of pancreatic exocrine and endocrine insufficiency increased during follow-up,being 66.4%and 47.1%,respectively,at 15 years following surgery.Pancreatoduodenal resection resulted optimal results in avoiding new peripancreatic complications,but was associated with the highest rate of pancreatic exocrine insufficiency.CONCLUSION The proposed complication classification improves the understanding of CP.It could be beneficial for clinical decision making,as it provides an opportunity for more comprehensive judgement on patient’s needs on the one hand,and on the pros and cons of the treatment under consideration,on the other.The presence of complications of CP and the risk of development of new ones should be among the main determinants of surgical choice.展开更多
Dir Sir, I am doctor Guo-Yuan Yang,from the Department of Ophthalmology of West China Hospital of Sichuan University in Chengdu,Sichuan Province,China.I write to present a case report of posterior lentiglobus with cat...Dir Sir, I am doctor Guo-Yuan Yang,from the Department of Ophthalmology of West China Hospital of Sichuan University in Chengdu,Sichuan Province,China.I write to present a case report of posterior lentiglobus with cataract.展开更多
We read the article titled,“Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification,”by Schuhbaur J with great interest.However,we found some worthwhile iss...We read the article titled,“Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification,”by Schuhbaur J with great interest.However,we found some worthwhile issues that we believe should be discussed with the authors,and have provided our comments in this letter.It would be valuable if the authors could provide further information about the clinical stages,follow-up time,and clinical outcomes of the patients.展开更多
BACKGROUND Septic arthritis of the hand,which is the second most common after damage of the knee joint,remains one of the leading causes of temporary disability.An inflammation can cause dysfunction of the joint,and i...BACKGROUND Septic arthritis of the hand,which is the second most common after damage of the knee joint,remains one of the leading causes of temporary disability.An inflammation can cause dysfunction of the joint,and in the most severe cases,the need for amputation of the finger may arise.The results of their treatment today,especially from a functional point of view,cannot be considered satisfactory.Urgent surgical treatment is extremely important in septic arthritis of the hand,as it helps to prevent cartilage destruction and the development of osteomyelitis.AIM To explore the features of the course of septic arthritis of the hand as well as approaches to surgical treatment and its results,depending on the nature of the damage to the articular structures.METHODS The results of the treatment of 170 patients with septic arthritis of the hand,which were treated in the period of 2020-2021,were analyzed.Inflammation of the interphalangeal and metacarpophalangeal joints(MCP)of fingers 1,2,and 3 was more often noted in 147(81.6%)joints.The most common cause of arthritis was a penetrating injury as a result of household trauma(101,59.4%),animal bite(30,17.6%),and clenched fist injury(15,8.8%).Septic arthritis with contiguous osteomyelitis was observed in 98(54.4%)cases.Surgical treatment was completed with drainage and irrigation of the joint.Early mobilization was used to restore function.In patients with osteomyelitis,it was aimed at the formation of neoarthrosis.Arthrodesis was not applied.Long-term results of treatment were assessed in 142(83.5%)patients within 1 mo to 12 mo after discharge from the hospital[the median was 7 mo(IQR:4-9)].RESULTS The most commonly isolated organism was Staphylococcus aureus(35.3%).The median treatment delay in patients without osteomyelitis was 5 d(IQR:4-7);for septic arthritis with contiguous osteomyelitis,it was 14 d(IQR:5-21).Radiography for osteomyelitis within 2 wk was uninformative:41.2%of diagnoses.A single surgical treatment was required in 138(81.2%)patients,two treatments in 22(12.9%),and three or more in 10(5.9%).Total elimination of the infection was achieved in 163(95.9%)patients.The best functional results of treatment were noted in patients without osteomyelitis.After septic arthritis,Total Active Motion(TAM)for the MCP was 96.2%(IQR:85.1-98.0),for the proximal interphalangeal joint(PIP)82.4%(IQR:54.5-98.5),and for the distal interphalangeal joint(DIP)69.4%(IQR:65.4-74.1).In cases with osteomyelitis,it was possible to achieve the formation of neoarthrosis with TAM for MCP-64.2%(IQR:45.3-90.1),for PIP-62.5%(IQR:41.8-68.9),and for DIP-59.4%(IQR:50-62.1).Additionally,the severity of pain during movements did not exceed 1 point.CONCLUSION The delay in treatment of patients with septic arthritis of the hand was accompanied by a high incidence of osteomyelitis,especially in the presence of diabetes mellitus.Urgent surgical treatment,along with continued irrigation of the joint and antibiotic therapy,made it possible to eliminate the infection,and early rehabilitation restored the range of motion.The best results were noted in patients without osteomyelitis.With the development of osteomyelitis,a complex of early rehabilitation measures also made it possible to partially restore the range of motion due to the formation of neoarthrosis,without resorting to arthrodesis.展开更多
Objective To discuss clinical features and surgical treatment of the coexistence of cervical,thoracic and lumber degenerative disease. Methods From January 2004 to December 2008,79 cases with the coexistence of cervic...Objective To discuss clinical features and surgical treatment of the coexistence of cervical,thoracic and lumber degenerative disease. Methods From January 2004 to December 2008,79 cases with the coexistence of cervical,thoracic展开更多
A 25-year-old woman presented a unilateral mandibular swelling, after laboratory analysis, radiological studies and aspiration puncture biopsy, the pathological diagnosis of Central Giant Cell Granuloma was made. Radi...A 25-year-old woman presented a unilateral mandibular swelling, after laboratory analysis, radiological studies and aspiration puncture biopsy, the pathological diagnosis of Central Giant Cell Granuloma was made. Radiographically, the multilocular lesion involved the left lower first molar and was 30 mm long by 20 mm high. Dental extraction of the molar involved with forceps and exeresis in toto of the tumor were performed using a Volkmann cutting curette. The tumor made up of 90% vascular tissue produced intra-surgical bleeding that made visibility difficult. The bone bed curettage was aggressive except for its base in direct contact with the inferior dental nerve. Subsequently, to avoid recurrence, the surgical protocol includes a double irrigation with Carnoy’s solution, (fixative composed of 60% ethanol, 30% chloroform and 10% glacial acetic acid 98%) for 5 minutes that produces chemical cauterization. Finally, it was washed with physiological solution and the cavity was filled with iodoformed gauze. The gauze was exchanged and removed gradually over three weeks for second intention healing. This case is presented to demonstrate that inexpensive chemical treatment can be safely used for outpatient surgery under local anesthesia. Because Carnoy’s solution achieved control of intraoperative bleeding, allowed bone healing and prevented recurrence of the lesion in clinical radiographic follow-up for 15 years.展开更多
Introduction: Patella tendon rupture (PTR) is a cause of handicap in athletic patients. Surgery remains the actual therapeutic modality with a variety of techniques that permits a return to sport. Our objective was to...Introduction: Patella tendon rupture (PTR) is a cause of handicap in athletic patients. Surgery remains the actual therapeutic modality with a variety of techniques that permits a return to sport. Our objective was to evaluate the return to sporting activities after surgical repair of a PTR. Method: We conducted a retrospective cohort study over five years from January 2016 to April 2021. We included athletes from 18 to 65 years of operating for a PTR. We evaluated: the knee functional score, the level of satisfaction, Lysholm score, VISA-P questionnaire, and return to sports. Results: A total of twenty-one cases of PTR were identified. The median age was 36 years (18 - 63). After surgery, the median follow-up was 17 months (12 - 55). All patients were able to walk at 3 months. A total of 17 patients (85%) returned to sports. The median return to sports was 6 months (5 - 11). Patients who return to a similar sport with a similar initial level of sporting activity were 45% (9 patients). The median time to return to sports for patients at a similar level of sport was 7.5 months (6 - 13). Functional scores were satisfactory;with a VISA-P score of 90/100 (25 - 100) and a Lysholm score of 98/100 (40 - 100). Conclusion: Surgical repair of PTR in athletes offers good results regarding return to sports in terms of proportion and timing whatsoever the technique. The use of protection band wires is reserved for patients with relative satisfaction during suture repair.展开更多
Objective To evaluate the clinical significance of intraoperative indocyanine green (ICG) videoangiography in surgical management of spinal dural ateriovenots fistulae (dAVFs) . Methods In this retrospective analysis ...Objective To evaluate the clinical significance of intraoperative indocyanine green (ICG) videoangiography in surgical management of spinal dural ateriovenots fistulae (dAVFs) . Methods In this retrospective analysis we examined nine cases of dAVFs,diagnosed by complete spinal angiography,in which laminoplasty were performed through posterior approach. An operating microscope-integrated light展开更多
Objective To study the diagnosis and treatment of lower thoracic ossification of ligamentum flavum(OLF) combined with lumbar spinal stenosis.Methods Retrospective analysis was carried out on 11 cases of lower thoracic...Objective To study the diagnosis and treatment of lower thoracic ossification of ligamentum flavum(OLF) combined with lumbar spinal stenosis.Methods Retrospective analysis was carried out on 11 cases of lower thoracic OLF combined with展开更多
Objective The aim of this study was to evaluate the long term results of treatment and prognositic factors in patients with recurrent hepatocellular carcinoma after curative resection of hepatocellular carcinoma. Meth...Objective The aim of this study was to evaluate the long term results of treatment and prognositic factors in patients with recurrent hepatocellular carcinoma after curative resection of hepatocellular carcinoma. Methods 112 patients of recurrent hepatocellular carcinoma who underwent surgical treatment were studied. Survival results after recurrence and from first hepatectomy were analyzed, and prognostic factors were determined by analyzing the clinicopathological variables.Results The mean survival of 112 patients was 26 months (4 to 76 months). 30 patients with tumor free state were still living. 1 year, 3 year and 5 year survival rates were 81.0%, 43.3% and 32 0%, respectively, and the 58 patients with hepatic resection were 87%, 59% and 38%, respectively. Among the 9 patients with secondary re resection, 6 had lived for over 3 years, and two for over 5 years. There were no operative death in this series, and few complications were found.Conclusion Early detection of recurrence depends on AFP measurements and ultrasonography follow up monitoring after resection. Re resection for recurrent hepatocellular carcinoma has been proved to be the most effective treatment modality. Aggressive treatment with a multimodality strategy is an option to improve long term survival in some patients with unresectable recurrent hepatocellular carcinoma.\;展开更多
Objective To study the clinical features, surgical treatments and the prognosis of the 103 patients with the metastatic tumors in the spine. Methods From Jan. 1996 to Dec. 2001,103 cases were treated by operation in o...Objective To study the clinical features, surgical treatments and the prognosis of the 103 patients with the metastatic tumors in the spine. Methods From Jan. 1996 to Dec. 2001,103 cases were treated by operation in our department, there were 62 males and 41 females, aging from 33 to 79 years old (average,59 years). The lesions were located at cervical spines in 34 cases, thoracic spines in 39,lumbar spines in 25 and sacrum in 5. The patients underwnet anterior, prosterior,combined or staged antero-posterior operations based on the location of lesions in the spine. Most of the patients were adopted vertebral reconstruction and internal fixation depending on the conditions. Preoperative clinical evaluation included of general conditions,X-ray films,CT scan.MRI and ECT in odrer to decide the endurance of the patient to the surgical treatment. The operation was only considered when the patient could have the expected survival time more than 6 months. Operative indications, surgical methods and prognosis展开更多
Objective To summarize clinical experience for treating anterior mitral leaflet prolapse with an artificial chordal loop. Methods From January 2008 to August 2009,pre-measured ePTFE loops were used to treat anterior l...Objective To summarize clinical experience for treating anterior mitral leaflet prolapse with an artificial chordal loop. Methods From January 2008 to August 2009,pre-measured ePTFE loops were used to treat anterior leaflet prolapse in 8 patients,5 males and 3 females, aged from 28 to 68 (average 56.0±8.9) years. The heart展开更多
文摘Fractures of the humeral paddle, common to young adults, are most often complex, linked to violence and an increase in road accidents. The objective of our work is to evaluate our functional results, in the medium term, correlated with a review of the literature. This is a retrospective study of 63 patients, carried out in the traumatology-orthopedics department 1 of the IBN EL JAZZAR hospital in KAIROUAN, over a period of 7 years from January 2015 to December 2021. The average age of patients was 39 years (17 - 68 years). Predominantly male. The etiologies are dominated by falls and accidents on public roads. Fractures are classified according to the Müller and Allgöwer classification where type C is found in 51% of cases. All our patients undergo an olecranon osteotomy in 71% of cases. Osteosynthesis using a Lecestre plate combined with screwing or plugging is used in 84% of cases. The evolution is marked by complications observed in eight patients (16%), including two cases of sepsis, four cases of elbow stiffness (8%), one case of joint callus and one case of pseudarthrosis. Our results are evaluated according to the Mayo Elbow Performance Score, they are excellent and good in 71% of cases, average in 18% of cases and poor in 11% of cases. Fractures of the humeral paddle are fractures with a satisfactory functional prognosis, requiring ad integrum anatomical restoration and solid osteosynthesis allowing early rehabilitation of the elbow. One case of joint callus and one case of pseudarthrosis.
文摘Tumour rupture of gastrointestinal stromal tumours(GISTs)has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological outcome.Although tumour rupture has not yet been included in the current tumor-node-metastasis classification of GISTs as a prognostic factor,it may change the natural history of a low-risk GIST to a high-risk GIST.Originally,tumour rupture was defined as the spillage or fracture of a tumour into a body cavity,but recently,new definitions have been proposed.These definitions distinguished from the prognostic point of view between the major defects of tumour integrity,which are considered tumour rupture,and the minor defects of tumour integrity,which are not considered tumour rupture.Moreover,it has been demonstrated that the risk of disease recurrence in R1 patients is largely modulated by the presence of tumour rupture.Therefore,after excluding tumour rupture,R1 may not be an unfavourable prognostic factor for GISTs.Additionally,after the standard adjuvant treatment of imatinib for GIST with rupture,a high recurrence rate persists.This review highlights the prognostic value of tumour rupture in GISTs and emphasizes the need to carefully take into account and minimize the risk of tumour rupture when choosing surgical strategies for GISTs.
文摘BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.Here,we review the literature and describe the surgical treatment of a 70-year-old woman who presented with a CSF leak due to a cervical spine spur.CASE SUMMARY A 70-year-old female patient who was treated for a cerebral infarction,presented with complains of weakness in the right lower extremity and a feeling of stepping on cotton.The patient underwent regular neck massage and presented with neck and right shoulder pain radiating to the right upper extremity one-month ago.Magnetic resonance imaging showed a strip of leaking cerebrospinal fluid posterior to the C1-4 vertebrae,and computed tomography showed a“sickleshaped”disc prolapse with calcification in C4/5.We chose to perform an anterior cervical discectomy.When the prolapsed C4/5 disc was scraped,clear fluid leakage was observed,and exploration revealed a 1 mm diameter rupture in the anterior aspect of the dura mater,which was compressed continuously with cotton patties,with no significant cerebrospinal fluid leakage after 1 h.CONCLUSION Three months after surgery,the patient was asymptomatic and follow-up imaging demonstrated complete resolution.
基金the Xiangshan County Science and Technology Bureau,Project Name Regional Quality Control on the Impact and Value of Endoscopic Screening for Intestinal Adenomas,No.2022C6018.
文摘BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction,leading to further deterioration of the nutritional status.Early enteral nutrition support is hypothesized to be helpful in improving this situation,but the exact effects have yet to be studied in depth.AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors,with the expectation that by improving the nutritional status of patients,the recovery process would be accelerated and the incidence of complications would be reduced,thus improving the quality of life.METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed.Fifty-three of these patients received complete parenteral nutrition support as the control group for this study.The other 68 patients received early enteral nutritional support as the observation group of this study.The clinical indicators comparing the two groups included time to fever,time to recovery of postoperative bowel function,time to postoperative exhaustion,and length of hospital stay.The changes in immune function and nutritional indexes in the two groups were compared.Furthermore,we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients.Finally,the occurrence of postoperative complications between the two patient groups was also compared.RESULTS The postoperative fever time,postoperative bowel function recovery time,postoperative exhaustion time,and hospitalization time were all higher in the control group than in the observation group(P<0.05).The levels of CD3+,CD4+,immunoglobulin(Ig)A,IgM,and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively,while CD8+was lower than in the control group(P<0.05).Total protein,albumin,prealbumin,and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively(P<0.05).The SF-36 scores of patients in the observation group were significantly higher than those in the control group(P<0.0001).The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group(P=0.021).CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable,and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery.This program can not only improve the immune function of the patient and protect the intestinal function,but it can also help to improve the quality of life of the patient.However,this program will increase the incidence of complications in patients.Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer.The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.
基金National Natural Science Foundation of China,No.81974354 and No.82230083.
文摘BACKGROUND Spondyloepiphyseal dysplasia congenita(SEDC)is a rare autosomal dominant hereditary disease caused by COL2A1 mutations.SEDC primarily involves the skeletal system,with typical clinical manifestations,including short stature,hip dysplasia,and spinal deformity.Due to the low incidence of SEDC,there are only a few case reports regarding the surgical treatment of SEDC complicated with spinal deformities.CASE SUMMARY We report a case of a 16-year-old male patient with SEDC.He presented with typical short stature,atlantoaxial dysplasia,scoliosis,and hip dysplasia.Cervical magnetic resonance imaging showed spinal canal stenosis at the atlas level and cervical spinal cord compression with myelopathy.The scoliosis was a right thoracic curve with a Cobb angle of 65°.He underwent atlantoaxial reduction,decompression,and internal fixation from C1–C2 to relieve cervical myelopathy.Three months after cervical surgery,posterior correction surgery for scoliosis was performed from T3 to L4.Scoliosis was corrected from 66°to 8°and remained stable at 2-year follow-up.CONCLUSION This is the first case report of a patient with SEDC who successfully underwent surgery for atlantoaxial dysplasia and scoliosis.The study provides an important reference for the surgical treatment of SEDC complicated with spinal deformities.
文摘Portal hypertension is a group of syndrome characterized by splenic hyperfunction, esophageal and gastric varices and ascites caused by abnormal portal vein hemodynamics. Among them, upper gastrointestinal bleeding caused by esophageal and gastric varices is the most dangerous complication, which often threatens the lives of patients. After half a century of development, the treatment of portal hypertension is divided into two categories: medical drug therapy, endoscopic therapy and surgical treatment. With the understanding of portal hypertension and the continuous development of medical technology, the surgical operation of portal hypertension has also been greatly improved, reducing postoperative complications and improving the quality of life of patients after operation. However, at present, there is no surgical method that can completely cure portal hypertension. This article reviews the progress of surgical treatment of portal hypertension in recent years, in order to provide reference for the surgical treatment of portal hypertension.
文摘Objective: To explore the related factors of surgical treatment of patients with corpus luteum rupture and establish a risk prediction model of surgical treatment of corpus luteum rupture. Methods: 222 patients with corpus luteum rupture treated in Jingzhou First People’s Hospital from January 2015 to March 2022 were analyzed retrospectively, including 45 cases of surgery and 177 cases of conservative treatment. The training set and validation set were randomly assigned according to 7:3. We collected the basic information, laboratory and ultrasonic examination data of 222 patients. Logistic regression analysis was used to determine the independent risk factors and combined predictors of surgical treatment of corpus luteum rupture. The risk prediction model was established and the nomogram was drawn. The discrimination and calibration of the prediction model were verified and evaluated by receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow goodness of fit test;Decision curve analysis (DCA) was used to evaluate the clinical effectiveness of the prediction model. Results: Univariate logistic regression showed that whole abdominal pain (OR: 2.314, 95% CI: 1.090 - 4.912), abdominal muscle tension (OR: 2.379, 95% CI: 1.112 - 5.089), adnexal mass ≥ 4 cm (OR: 3.926, 95% CI: 1.771 - 8.266), hemoglobin Conclusion: The nomogram prediction model containing three predictive variables (hemoglobin, depth of pelvic effusion under ultrasound and cervical lifting pain) can be used to predict the risk of surgical treatment in patients with corpus luteum rupture.
文摘Surgery is the most important and effective method for the treatment of gastric cancer.Since the first gastrectomy in the early 19th century,surgical treatment of gastric cancer has undergone more than 100 years of development.With the increasing understanding of gastric cancer and the promotion of a series of clinical trials,the concept of gastric cancer surgery has evolved from the initial"bigger is better"to today’s"standardized surgery"and is developing towards individualized surgery focusing on accurate resection and quality of life.This trend has had a tremendous impact on the development of surgical treatments,such as minimally invasive surgeries,functionpreserving surgeries,and the optimal extent of lymph node dissection.Understanding the development and current status of gastric cancer surgery and exploring the remaining academic controversies are goals that every gastric surgeon should constantly pursue.However,how should gastric cancer surgery develop in the future?What opportunities and challenges will we encounter?In this review,we elaborate on the development and current status of gastric cancer surgery based on a series of clinical studies and discuss the controversy in the development of gastric cancer surgery.
文摘BACKGROUND Chronic pancreatitis(CP)is a long-lasting disease frequently associated with complications for which there is no comprehensive pathophysiological classification.AIM The aims of this study were to:Propose a pathophysiological classification of the complications of CP;evaluate their prevalence in a surgical cohort prior to,and following surgical management;and assess the impact of the surgical treatment on the occurrence of new complications of CP during follow-up.We hypothesized that optimal surgical treatment can resolve existing complications and reduce the risk of new complications,with the exclusion of pancreatic insufficiency.The primary outcomes were prevalence of complications of CP at baseline(prior to surgical treatment)and occurrence of new complications during follow-up.METHODS After institutional review board approval,a prospective observational cohort study with long-term follow-up(up to 20.4 years)was conducted.All consecutive single-center adult patients(≥18 years of age)with CP according to the criteria of the American Pancreas Association subjected to surgical management between 1997 and 2021,were included.The prevalence of CP complications evaluated,according to the proposed classification,in a surgical cohort of 166 patients.Development of the pathophysiological classification was based on a literature review on the clinical presentation,course,and complications of CP,as well a review of previous classification systems of CP.RESULTS We distinguished four groups of complications:Pancreatic duct complications peripancreatic complications,pancreatic hemorrhages,and pancreatic insufficiency(exocrine and endocrine).Their baseline prevalence was 20.5%,23.5%,10.2%,31.3%,and 27.1%,respectively.Surgical treatment was highly effective in avoiding new complications in the first and third groups.In the group of peripancreatic complications,the 15-year Kaplan-Meier prevalence of new complications was 12.1%.The prevalence of pancreatic exocrine and endocrine insufficiency increased during follow-up,being 66.4%and 47.1%,respectively,at 15 years following surgery.Pancreatoduodenal resection resulted optimal results in avoiding new peripancreatic complications,but was associated with the highest rate of pancreatic exocrine insufficiency.CONCLUSION The proposed complication classification improves the understanding of CP.It could be beneficial for clinical decision making,as it provides an opportunity for more comprehensive judgement on patient’s needs on the one hand,and on the pros and cons of the treatment under consideration,on the other.The presence of complications of CP and the risk of development of new ones should be among the main determinants of surgical choice.
文摘Dir Sir, I am doctor Guo-Yuan Yang,from the Department of Ophthalmology of West China Hospital of Sichuan University in Chengdu,Sichuan Province,China.I write to present a case report of posterior lentiglobus with cataract.
文摘We read the article titled,“Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification,”by Schuhbaur J with great interest.However,we found some worthwhile issues that we believe should be discussed with the authors,and have provided our comments in this letter.It would be valuable if the authors could provide further information about the clinical stages,follow-up time,and clinical outcomes of the patients.
基金The study was reviewed and approved by the I.M.Sechenov First Moscow State Medical University Institutional Review Board(Approval No.03-22).
文摘BACKGROUND Septic arthritis of the hand,which is the second most common after damage of the knee joint,remains one of the leading causes of temporary disability.An inflammation can cause dysfunction of the joint,and in the most severe cases,the need for amputation of the finger may arise.The results of their treatment today,especially from a functional point of view,cannot be considered satisfactory.Urgent surgical treatment is extremely important in septic arthritis of the hand,as it helps to prevent cartilage destruction and the development of osteomyelitis.AIM To explore the features of the course of septic arthritis of the hand as well as approaches to surgical treatment and its results,depending on the nature of the damage to the articular structures.METHODS The results of the treatment of 170 patients with septic arthritis of the hand,which were treated in the period of 2020-2021,were analyzed.Inflammation of the interphalangeal and metacarpophalangeal joints(MCP)of fingers 1,2,and 3 was more often noted in 147(81.6%)joints.The most common cause of arthritis was a penetrating injury as a result of household trauma(101,59.4%),animal bite(30,17.6%),and clenched fist injury(15,8.8%).Septic arthritis with contiguous osteomyelitis was observed in 98(54.4%)cases.Surgical treatment was completed with drainage and irrigation of the joint.Early mobilization was used to restore function.In patients with osteomyelitis,it was aimed at the formation of neoarthrosis.Arthrodesis was not applied.Long-term results of treatment were assessed in 142(83.5%)patients within 1 mo to 12 mo after discharge from the hospital[the median was 7 mo(IQR:4-9)].RESULTS The most commonly isolated organism was Staphylococcus aureus(35.3%).The median treatment delay in patients without osteomyelitis was 5 d(IQR:4-7);for septic arthritis with contiguous osteomyelitis,it was 14 d(IQR:5-21).Radiography for osteomyelitis within 2 wk was uninformative:41.2%of diagnoses.A single surgical treatment was required in 138(81.2%)patients,two treatments in 22(12.9%),and three or more in 10(5.9%).Total elimination of the infection was achieved in 163(95.9%)patients.The best functional results of treatment were noted in patients without osteomyelitis.After septic arthritis,Total Active Motion(TAM)for the MCP was 96.2%(IQR:85.1-98.0),for the proximal interphalangeal joint(PIP)82.4%(IQR:54.5-98.5),and for the distal interphalangeal joint(DIP)69.4%(IQR:65.4-74.1).In cases with osteomyelitis,it was possible to achieve the formation of neoarthrosis with TAM for MCP-64.2%(IQR:45.3-90.1),for PIP-62.5%(IQR:41.8-68.9),and for DIP-59.4%(IQR:50-62.1).Additionally,the severity of pain during movements did not exceed 1 point.CONCLUSION The delay in treatment of patients with septic arthritis of the hand was accompanied by a high incidence of osteomyelitis,especially in the presence of diabetes mellitus.Urgent surgical treatment,along with continued irrigation of the joint and antibiotic therapy,made it possible to eliminate the infection,and early rehabilitation restored the range of motion.The best results were noted in patients without osteomyelitis.With the development of osteomyelitis,a complex of early rehabilitation measures also made it possible to partially restore the range of motion due to the formation of neoarthrosis,without resorting to arthrodesis.
文摘Objective To discuss clinical features and surgical treatment of the coexistence of cervical,thoracic and lumber degenerative disease. Methods From January 2004 to December 2008,79 cases with the coexistence of cervical,thoracic
文摘A 25-year-old woman presented a unilateral mandibular swelling, after laboratory analysis, radiological studies and aspiration puncture biopsy, the pathological diagnosis of Central Giant Cell Granuloma was made. Radiographically, the multilocular lesion involved the left lower first molar and was 30 mm long by 20 mm high. Dental extraction of the molar involved with forceps and exeresis in toto of the tumor were performed using a Volkmann cutting curette. The tumor made up of 90% vascular tissue produced intra-surgical bleeding that made visibility difficult. The bone bed curettage was aggressive except for its base in direct contact with the inferior dental nerve. Subsequently, to avoid recurrence, the surgical protocol includes a double irrigation with Carnoy’s solution, (fixative composed of 60% ethanol, 30% chloroform and 10% glacial acetic acid 98%) for 5 minutes that produces chemical cauterization. Finally, it was washed with physiological solution and the cavity was filled with iodoformed gauze. The gauze was exchanged and removed gradually over three weeks for second intention healing. This case is presented to demonstrate that inexpensive chemical treatment can be safely used for outpatient surgery under local anesthesia. Because Carnoy’s solution achieved control of intraoperative bleeding, allowed bone healing and prevented recurrence of the lesion in clinical radiographic follow-up for 15 years.
文摘Introduction: Patella tendon rupture (PTR) is a cause of handicap in athletic patients. Surgery remains the actual therapeutic modality with a variety of techniques that permits a return to sport. Our objective was to evaluate the return to sporting activities after surgical repair of a PTR. Method: We conducted a retrospective cohort study over five years from January 2016 to April 2021. We included athletes from 18 to 65 years of operating for a PTR. We evaluated: the knee functional score, the level of satisfaction, Lysholm score, VISA-P questionnaire, and return to sports. Results: A total of twenty-one cases of PTR were identified. The median age was 36 years (18 - 63). After surgery, the median follow-up was 17 months (12 - 55). All patients were able to walk at 3 months. A total of 17 patients (85%) returned to sports. The median return to sports was 6 months (5 - 11). Patients who return to a similar sport with a similar initial level of sporting activity were 45% (9 patients). The median time to return to sports for patients at a similar level of sport was 7.5 months (6 - 13). Functional scores were satisfactory;with a VISA-P score of 90/100 (25 - 100) and a Lysholm score of 98/100 (40 - 100). Conclusion: Surgical repair of PTR in athletes offers good results regarding return to sports in terms of proportion and timing whatsoever the technique. The use of protection band wires is reserved for patients with relative satisfaction during suture repair.
文摘Objective To evaluate the clinical significance of intraoperative indocyanine green (ICG) videoangiography in surgical management of spinal dural ateriovenots fistulae (dAVFs) . Methods In this retrospective analysis we examined nine cases of dAVFs,diagnosed by complete spinal angiography,in which laminoplasty were performed through posterior approach. An operating microscope-integrated light
文摘Objective To study the diagnosis and treatment of lower thoracic ossification of ligamentum flavum(OLF) combined with lumbar spinal stenosis.Methods Retrospective analysis was carried out on 11 cases of lower thoracic OLF combined with
文摘Objective The aim of this study was to evaluate the long term results of treatment and prognositic factors in patients with recurrent hepatocellular carcinoma after curative resection of hepatocellular carcinoma. Methods 112 patients of recurrent hepatocellular carcinoma who underwent surgical treatment were studied. Survival results after recurrence and from first hepatectomy were analyzed, and prognostic factors were determined by analyzing the clinicopathological variables.Results The mean survival of 112 patients was 26 months (4 to 76 months). 30 patients with tumor free state were still living. 1 year, 3 year and 5 year survival rates were 81.0%, 43.3% and 32 0%, respectively, and the 58 patients with hepatic resection were 87%, 59% and 38%, respectively. Among the 9 patients with secondary re resection, 6 had lived for over 3 years, and two for over 5 years. There were no operative death in this series, and few complications were found.Conclusion Early detection of recurrence depends on AFP measurements and ultrasonography follow up monitoring after resection. Re resection for recurrent hepatocellular carcinoma has been proved to be the most effective treatment modality. Aggressive treatment with a multimodality strategy is an option to improve long term survival in some patients with unresectable recurrent hepatocellular carcinoma.\;
文摘Objective To study the clinical features, surgical treatments and the prognosis of the 103 patients with the metastatic tumors in the spine. Methods From Jan. 1996 to Dec. 2001,103 cases were treated by operation in our department, there were 62 males and 41 females, aging from 33 to 79 years old (average,59 years). The lesions were located at cervical spines in 34 cases, thoracic spines in 39,lumbar spines in 25 and sacrum in 5. The patients underwnet anterior, prosterior,combined or staged antero-posterior operations based on the location of lesions in the spine. Most of the patients were adopted vertebral reconstruction and internal fixation depending on the conditions. Preoperative clinical evaluation included of general conditions,X-ray films,CT scan.MRI and ECT in odrer to decide the endurance of the patient to the surgical treatment. The operation was only considered when the patient could have the expected survival time more than 6 months. Operative indications, surgical methods and prognosis
文摘Objective To summarize clinical experience for treating anterior mitral leaflet prolapse with an artificial chordal loop. Methods From January 2008 to August 2009,pre-measured ePTFE loops were used to treat anterior leaflet prolapse in 8 patients,5 males and 3 females, aged from 28 to 68 (average 56.0±8.9) years. The heart
