Current Issue : January - March Volume : 2018 Issue Number : 1 Articles : 5 Articles
Background: Burr hole craniostomy is a widely used method for the evacuation of CSDH. However it is not clear\nwhether the irrigation during operation improves the prognosis or gives rise to additional complications instead.\nThis retrospective cohort study was conducted to determine this issue.\nMethods: Patients attending two medical centers in China who underwent burr hole drainage with irrigation (BHDI)\nor burr hole drainage without irrigation (BHD) for unilateral CSDH during January 2013 to December 2016\nwere included in this study. The patients� clinical information and follow-up data were retrospectively reviewed, and\nthe radiologic findings were processed using the 3D Slicer software. The differences in outcomes were identified using\nt-test, chi-square test, or Fisher�s exact test.\nResults: A total of 151 patients comprising 63 patients in the BHD group and 88 patients in the BHDI group were\nincluded. Patients in the BHDI group had a higher volume of pneumocrania on the first postoperative day than that of\npatients in the BHD group (p < 0.05). No significant differences were observed between the two approaches in rates of\nrebleeding, recurrence and other complications (p > 0.05).\nConclusions: Irrigation had no improvement in the long-term curative effect on CSDH, but it increased the risk of\nshort-term complication in terms of pneumocrania. Therefore, this study suggests that irrigation is not an obligatory\nprocedure during burr hole drainage....
Background: Case cancellation (CC) has significant impact on the efficiency of operating room (OR) management,\nwhich can be mitigated by taking preventive measures. In this study, using the data of the West China Hospital (WCH),\nwe identified the effect of contributing factors and recommended hospital interventions to facilitate CC prevention.\nMethod: We conducted a retrospective review of 11,331 elective surgical cases from January 1 to December 31, 2014.\nCC reasons were grouped into six categories. The methods of descriptive statistics and hypothesis test were used to\nidentify the effect of factors.\nResults: CC reasons (746) were divided into six broad categories: workup related (preoperative diagnostic assessment\nissues or sudden medical condition changes) (25.8%), non-specified reasons (25.8%), coordination issues (15.1%),\npatient related (13.0%), support system issues (11.8%), and doctor related (8.5%). The types of the most frequently\nperformed operations are identified, as well as their CRs. The cancellation rate (CR) of males was lower than that of\nfemales (16.7% to 18.3%). A large difference in the CRs existed among doctors. The CR on Monday was significantly\nhigher than the other four weekdays.\nConclusions: Workup related issues, the types of procedures, the menstrual cycle of females, highly imbalanced CRs\namong doctors, and tendency of cancellation on Monday are the major identified factors, which account for a\nsignificant amount of preventable cancellations. It is suggested that corresponding hospital interventions can reduce\nCR and improve OR efficiency, including maintaining effective coordination, good communication and well-designed\npreoperative assessment processes, focusing on the type of procedures which are more time-consuming and complex,\npaying special attention to the physiology of females during surgery planning, taking measures to reduce CR of top\neight doctors, and improving surgery scheduling on Monday....
Background: In nearly 30% of patients with myeloma, pathological fractures are found to occur in the spine.\nIf the patients are not treated promptly and satisfactorily, the quality of their lives diminishes. Currently, the\nstandard treatment for metastatic lesions of the spine is radiotherapy, but surgical intervention is becoming\nmore frequent. It is very important to quickly identify metastases and implement surgical treatment before\nany fracture/s occur.\nMethods: Over the period of 2010ââ?¬â??2014 in our department, a total of 129 patients were treated for metastatic spinal\nmyeloma. 73 patients underwent vertebroplasty and 56 patients were operated on through various methods. Indications\nfor the surgery, its course, technique and outcome were subsequently evaluated. The majority of patients (76%) admitted\nfor treatment, exhibited vertebral fractures. Most lesions were multiplace and involved the vertebral bodies. In 42% of the\npatients, radiological examinations showed symptoms of compression of the nervous structures, while clinical signs were\nobserved in only 16% of the patients. The functional status of the patients was assessed using the Karnofsky scale, while\npain intensity was measured in a VAS score, before and after the surgery. The oncological results were assessed as a\nsurvival rate and local recurrence rate.\nResults: The average follow-up was conducted within 31 months (min 18, max 48). The patients after vertebroplasty\nsurvived 42 months, and the patients after surgery 23 months. Local recurrence of the disease was observed in 12\npatients. In 10 patients, among a group of 21 with paresis, their neurological conditions improved. The average results of\nboth their VAS score and Karnofsky performance score in patients after surgery was seen to have improved. Only sporadic\npostoperative complications after vertebroplasty and surgery were reported.\nConclusions: Early diagnosis of myeloma spine metastasis is essential to achieve the desired results of\ntreatment. Vertebroplasty, as advised, should be performed as early as possible. Both the functional and\noncological results after vertebroplasty are beneficial and the complication rates are low. Three relevant\nfactors were found in our study: patientââ?¬â?¢s age over 65 years, initial diagnosis over 3 years and stage III of\ndisease were related, significantly and statistically to survival....
Background: Median arcuate ligament syndrome is a rare condition with abdominal symptoms. Accepted\ntreatment options are open release of median arcuate ligament, laparoscopic release of edian arcuate ligament,\nrobot-assisted release of median arcuate ligament and open vascular treatment. Here we aimed to evaluate the\ncentral priority of open vascular therapy in the treatment of median arcuate ligament syndrome.\nMethods: We conducted a monocentric retrospective study between January 1996 and June 2016. Thirty-one\npatients with median arcuate ligament syndrome underwent open vascular surgery, including division of median\narcuate ligament in 17 cases, and vascular reconstruction of the celiac artery in 14 cases.\nResults: In a 20-year period, 31 patients (n = 26 women, n = 5 men) were treated with division of median arcuate\nligament (n = 17) or vascular reconstruction in combination with division of median arcuate ligament (n = 14). The\nmean age of patients was 44.8 Ã?± 15.13 years. The complication rate was 16.1% (n = 5). Revisions were performed in\n4 cases. The 30-day mortality rate was 0%. The mean in-hospital stay was 10.7 days. Follow-up data were obtained\nfor 30 patients. The mean follow-up period was 52.2 months (range 2ââ?¬â??149 months). Patients were grouped into a\ndecompression group (n = 17) and revascularisation group (n = 13). The estimated Freedom From Symptoms rates\nwere 93.3, 77.8, and 69.1% for the decompression group and 100, 83.3, and 83.3% for the revascularisation group after\n12, 24 and 60 months respectively. We found no significant difference in the Freedom From Re-Intervention CA rates\nof the decompression (100% at 12, 24 and 60 months post-surgery) and revascularisation (100% at 12 months, and 91.\n7% at 24 and 60 months post-surgery) groups during follow-up (p = 0.26).\nConclusions: Open vascular treatment of median arcuate ligament syndrome is a safe, low mortality-risk procedure,\nwith low morbidity rate. Treatment choice depends on the clinical and morphological situation of each patient....
Background: Aortic dissection (AD) represents a clinically uncommon aortic pathology which predicts a dismal\nprognosis if not promptly treated. In acute Debakey type I AD (ADIAD), aortic lesion extends from aortic root to\neven distal abdominal aorta among which aortic arch and its three main branches still remain a great surgical\nchallenge for repair and reconstruction. Several decades have witnessed the painstaking efforts of cardiovascular\nsurgeons across the globe for optimizing the surgical procedures, from total or hemi-arch replacement, ââ?¬Å?elephant\ntrunkââ?¬Â technique to branched stent graft. However, operative mortality and morbidity still remain to be reduced\nand surgical strategy is to be advanced and simplified, particularly the repair and reconstruction of aortic arch and\nsupra-aortic vessels.\nMethods: In this paper, we reviewed the relevant literature concerning recent advances in surgical intervention of\naortic arch and summarized our opinions in the application of branched stent graft in ADIAD.\nResults: The operative strategy for acute Debakey type I aortic dissection still remain to be advanced and\nsimplified, especially the repair and reconstruction of aortic arch and supra-aortic vessels. For selection of branched\nstent grafts, the anatomic features and pathological changes of diseased arch are the crucial factors for clinical\ndecision making.\nConclusions: Branched stent graft is potentially an effective alternative for the treatment of type I AD with\ndiseased aortic arch and supra-aortic vessels. The selection of branched stent grafts still remains to be further\ndiscussed in large-scale studies in the future....
Loading....