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Objective:To investigate clinical application of preoperative "second eye" ultrosound guided orientation in non-palpable breast lesions surgery.Methods:100 patients were involved in the present study, with 136 impalpable breast lesions. Patients were divided into treatment group and control group by using random number table method. Patients of the control group were operated according to the preoperative ultrasonic location alone, while lesions of patients from the treatment group were located not only by preoperative surface location, but also by the "second eye" ultrasonic examination performed by surgeons. Volume of resected specimen and the operation time and the average length of incision were observed and compared between the two groups.Results:All lesions were completely resected. The average operation time of the treatment and control groups was 20 minutes vs 28 minutes ( P<0.05) , the average volume of resected specimens was 3.0 ml vs 4.1 ml ( P<0.05) , and the average length of incision was 25 mm vs 30 mm ( P=0.21) . Conclusions:It is an accurate, safe and effective method to remove clinical non-palpable breast lesions by the "second eye" ultrasound operated immediately before the surgery. It can obviously shorten the operation time, precisely remove the specimen, and reduce damage to normal tissues. In clinical practice, breast ultrasonic characteristics are recommended to be mastered by surgeons so that it could be helpful to the surgery.
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OBJECTIVE:To provide reference for imipenem-resistant Pseudomonas aeruginosa infection control. METHODS:114 patients infected with imipenem-resistant P. aeruginosa were selected from 3 tertiary hospitals in Zhoushan during Feb. 2013 to Feb. 2014. 114 strains of P. aeruginosa were isolated from clinical specimens,and drug resistance characteristics and carbapene-mase-producing gene diversity were analyzed. 101 inpatients with imipenem-resistant P. aeruginosa infection were included in con-trol group;univariate and multivariate Logistic regression analysis were adopted to explore the risk factors of imipenem-resistant P. aeruginosa infection. RESULTS:114 strains were sensitive to polymyxin B,and had different levels of resistance to other 9 kinds of antibiotics. Carbapenemase-producing gene were mainly IMP and VIM type gene. Long-term hospitalization,mechanical ventila-tion,used imipenem and early combined use of antibiotics were risk factors of imipenem-resistant P. aeruginosa infection. CON-CLUSIONS:In Zhoushan area,imipenem-resistant P. aeruginosa shows serious drug resistance. To avoid long-term hospitalization and early combined use of antibiotics can reduce imipenem-resistant P. aeruginosa infection.
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A child case of acute myocardial ischemia induced by symptomatic myocardial bridge (SMB)was reported and relevant literatures were reviewed in this article.The case and literatures indicate that myocardial bridge is a rare congenital coronary artery anomaly in children.The pathogenesis may be related to stenosis,spasm,arteriosclerosis of coronary artery because of myocardial bridge compression during systole.Clinical manifestations include chest pain,malignant arrhythmia,syncope,cardiac arrest and myocardial infarction.The diagnosis of myocardial bridge is based on cardiac imaging.SMB patients should be first treated with β-adrenergic; if ineffective,surgical treatment or implantable automated cardiac defibrillator shonld be chosen.The patients complicated with hypertrophic cardiomyopathy have worse conditions with high mortality.
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Objective To evaluate intra-operative radiotherapy after breast conservative surgery in early breast cancer patients in terms of postoperative complications,cosmetic outcome and recurrence events.Methods From June 2007 to Dec 2010,115 early breast cancer patients received breast conserving surgery.Fifty-nine patients (study group) received intra-operative radiotherapy,compared with 56 patients (control group) receiving routine postoperative radiotherapy.Postoperative complications were evaluated 1 month after surgery; cosmetic outcome was evaluated 1 year postoperatively; recurrence and death events were followed up.Results The average wound healing time was 13 -22 days in study group and 9 - 14days in control group.In the study group,2 patients developed fat deliquescence,16 patients showed wound edema while no such side effects were found in control group.No infection or hematoma were found in either group.Overall cosmetic outcome was rated 1 year post operation.In the study group (41 cases),36 patients were graded as excellent or good,5 patients were as fair or poor.Meanwhile in the control group (37 cases),wounds in 25 patients were graded as excellent or good,that in 12 patients were as fair or poor (P =0.031).After a follow-up from 3 to 42 months(median:24 months),two patients (3.39％) in study group developed local cancer relapses,one of them( 1.7％ ) died.In control group,one patient ( 1.8％ )developed local relapse,and no one died.Conclusions Intra-operative radiotherapy is safe and reliable with good cosmetic outcome.
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Objective To evaluate the feasibility of hand-assisted laparoscopic colorectal resection. Methods Clinical data of 21 cases of hand-assisted laparoscopic colorectal resection in this hospital from October 2003 to August 2004 were retrospectively reviewed. Results The hand-assisted laparoscopic resection was accomplished in 20 cases. The mean operation time was 144 min, the mean blood loss was 120 ml, the mean number of dissected lymph nodes was 8.5, and the mean time to intestinal function recovery, 69 h. Postoperative abdominal bleeding was found in 1 case, which was cured with conservative therapy. A conversion to open surgery was needed in 1 case. Conclusions Hand-assisted laparoscopic colorectal resection safe, feasible, and radical, with advantages of fewer complications and simplicity of performance.
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Objective To explore the method and result of endoscopic thyroidectomy. Methods Thyroidectomy was performed endoscopically in 4 cases of thyroidoma. Results 4 patients underwent endoscopic thyroidectomy, whose operation time was 52,63,70,75 minutes respectively. An average blood loss during operation was 35ml and no complication occurred. They were discharged 4 days～5 days after operation. Conclusions The endoscopic thyroidectomy has the advantages of minimal invasion, less bleeding, less complication and quicker recovery.
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Objective To study the feasibility of endoscopic thyroidectomy with bipolar electrocoagulation. Methods Endoscopic partial thyroidectomy via precordial approach, mainly by using bipolar electrocoagulation and scissors, was accomplished in 21 patients with thyroid tumors with a diameter of 0.7～5.5 cm. Results The operation was accomplished endoscopically in 20 patients, whereas a conversion to open thyroidectomy was conducted in 1 patient. The mean incision length was 22 mm, the operation time was 69?47 min, and the blood loss was 55?41 ml. Postoperative analgesic treatment was required in 2 patients and no serious complications happened. Conclusions Endoscopic thyroidectomy with bipolar electrocoagulation is feasible in the absence of ultrasonic scalpel.
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Objective To access the clinical value of interstitial brachytherpay in patients with advanced carcinoma. Methods 6 patients(1 case of hepatic cancer,3 cases of prostate cancer,2 cases of local recurrence of rectal cancer)received interstitial high dose rate(Ir-192)brachytherpay with afterloading technique(6.0 Gy/day in 4 days) Tubes were inserted with laparoscopic guidance to minimize the risk of tube misplacement. Results The size of the tumors was reduced and the local control rate was encouraging(6/6). one patient with local recurrence of rectal cancer aquired CR,the ofher five cases acquired PR. Conclusions Interstitial tube insertion with laparoscopic guidance to treat advanced carcinoma in afterloading technique is a simple,minimally invasive,safe and economical method,especially fit for elder patients who intolerate or disagree to operation.