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@# Objective To explore the related factors of common postoperative complications after cranioplasty. Methods From November, 2009 to June, 2013, a total of 211 patients after cranioplasty were reviewed. The conventional two-dimensional titanium alloy was used. The incidence of scalp effusion, seizure and spontaneous intracerebral hemorrhage were recorded, and the related factors including gender, age, primary disease, skull defect site, attack time, concomitant hydrocephalus and intraoperative dural damage were analyzed. Results The incidence of these complications was 4.7% (10/211) in total. There were four cases with scalp effusion, five cases with seizures and one case with spontaneous intracerebral hemorrhage. The scalp effusion was related to hydrocephalus (χ2=4.804, P=0.028) and intraoperative dural damage (χ2=7.510, P=0.006). Seizure and spontaneous intracerebral hemorrhage were not related with any factors above (P>0.05). Conclusion The occurrence of postoperative scalp effusion can be reduced by repairing intraoperative dural damage, and dealing with extreme hydrocephalus timely.
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Objective To explore the factors associated with the complications of cranioplasty, infection and local epidural hematoma, such as age, sex, primary disease, skull defect and concomitant hydrocephalus. Methods 211 patients after cranioplasty were reviewed. Re-sults 8 cases (3.8%) complicated one of them, in which 6 cases with local epidural hematoma and 2 cases with infection. The infection was more likely related with the areas of skull defect (P=0.003). No factor was found related with the local epidural hematoma. Conclusion It is necessary to focus the size of the frontal sinus when repairing the the frontal bone, to avoid the screw into the frontal sinus caused infection.
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<p><b>OBJECTIVE</b>To investigate the effect of different nucleoside analogues on the long-term survival rate of patients with acute-on-chronic liver failure (ACLF) associated with hepatitis B virus (HBV) infection.</p><p><b>METHODS</b>One hundred and eighty patients with HBV-related ACLF were enrolled in this prospective cohort study and divided into a basic treatment group (n=30) and an antiviral treatment group, the latter of which was further subdivided into the lamivudine treatment group (n=66), telbivudine treatment group (n=38) and entecavir treatment group (n=46) according to voluntary choice by the patient.All study participants were followed-up for 24 months. The Kaplan-Meier method was applied for survival analysis.</p><p><b>RESULTS</b>The patients in the four antiviral treatment groups had statistically similar baseline clinical characteristics and 1-month survival rates (Breslow =4.475, P=0.215).However, the basic treatment group had a significantly lower survival rate than the antiviral treatment groups that received lamivudine, telbivudine, or entecavir (all P less than 0.05) at the treatment periods of 2, 3, 6, 12 and 18-months; however, these three treatment groups showed no significant differences in survival rates. At the time point of 24 months of treatment, the basic treatment group retained its lower rate of survival than the three antiviral treated groups (lamivudine:Breslow =5.604, P=0.018; telbivudine:Breslow =5.621, P=0.018; entecavir:Breslow =14.701, P less than 0.001); while the survival rates were similar for the lamivudine treatment group and the telbivudine treatment group at this time point, their survival rates were significantly lower than that of the entecavir treatment group (Breslow =4.010, P=0.045; Breslow =4.307, P=0.038).Stratification analysis showed that when the baseline was 30 less than PTA less than or equal to 40 or MELD less than or equal to 29 or HBV DNA more than or equal to 5 log10 IU/mL, the cumulative survival rates of the basic treatment group and antiviral treatment group were statistically similar even though the patients had completed 1 month of treatment After being treated for 2, 3, 6, 12, 18 and 24 months, the cumulative survival rates of the basic treatment group were consistently below those of the overall antiviral treatment group (P less than 0.05). The cumulative survival rate of the basic treatment group followed-up for 1 to 24 months, with PTA values between 20 and 30, was lower than that of the overall antiviral treatment group (P less than 0.05); two groups of patients with PTA less than or equal to 20 or MELD more than or equal to 30 were followed-up for 1 months to 24 months, and their cumulative survival rates showed no significant difference (P more than 0.05). Among the patients whose baseline was HBV DNA less than 5 log10 IU/mL, the comparison of survival rates between the basic treatment group and the overall antiviral treatment group showed no significant differences after treatment for 1, 2, 3, 6, 12 or 18 months, and the survival rate was lower than that of the overall antiviral treatment group (Breslow =4.055, P=0.044) after 24 months.</p><p><b>CONCLUSION</b>Nucleoside analogues can improve the long-term survival rate of HBV-related ACLF patients.Entecavir is preferred for the long-term treatment of these patients.Patients in the early and middle stages of this disease and HBV DNA-positive patients should adopt antiviral treatment as early as possible.</p>
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Humans , Acute-On-Chronic Liver Failure , Antiviral Agents , Cohort Studies , Guanine , Hepatitis B virus , Hepatitis B, Chronic , Lamivudine , Prospective Studies , Survival Analysis , Survival Rate , Thymidine , Time FactorsABSTRACT
Objective To investigate the related factors of infection post ventricle-peritoneal shunt and explore some preventive mea-sures. Methods 85 cases after ventricle-peritoneal shunt for normal pressure cranial hydrocephalus were analysed retrospectively. The effect of intensive prevention was observed. Results The overall infection rate was 7%after ventricle-peritoneal shunt. There was significant dif-ference between the patients with or without infection post-operation in some factors, such as preoperative infection (pneumonia, urinary tract infection, intracranial infection, biliary infection);the operator;activities of daily living. It was 9.8%(6/61) under routine aseptic opera-tion, and was 0 (0/24) under intensive management. Conclusion Infection after ventricle-peritoneal shunt is associated with many factors, es-pecially the susceptibility and contact to infection. Intensive management can significantly prevent the infection.
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<p><b>BACKGROUND</b>The operating microscopes have been applied to modern surgery for nearly a century. However, generations of microsurgeons have to flex their necks and fix their eyes on the eyepieces of a microscope continually that leads to physical and mental fatigue during a long operation. Stereoscopic three-dimensional (3D) media provides more ergonomic working environment, subsequently, resulting better performance in tasks and more accurate judgment. In this study, an alternative method of magnification was analyzed using a three-dimensional microsurgical video system and compared with the traditional method under microscopy to evaluate the availability and feasibility of a 3D microsurgical video system for microvascular anastomosis.</p><p><b>METHODS</b>Forty Sprague-Dawley rats were randomly divided into four groups with each of 10. In 20 rats, 10 femoral artery anastomoses with a conventional microscope (arterial microscope group) were compared with that of 10 femoral artery anastomoses with a 3D microsurgical video system (arterial 3D group). For the other 20 rats, 10 femoral vein anastomoses using a conventional microscope (venous microscope group) were compared with that of 10 femoral vein anastomoses using a 3D microsurgical video system (venous 3D group). The arterial and venous microscope groups were considered to be the control groups. The arterial and venous 3D groups were the experimental groups. The examined criteria were as follows: anastomotic time, patency right after the procedure and 10 days later, number of sutures, vessel caliber, and pathological features.</p><p><b>RESULTS</b>There were no differences between the operating equipment with respect to vessel caliber, anastomotic time, patency rate, number of sutures, and pathological changes in either the small arteries or veins. The average arterial anastomotic time of the arterial microscope group and arterial 3D group was 34.21 and 33.87 minutes, respectively (P > 0.05). The average venous anastomotic time of the venous microscope group and venous 3D group was 29.95 and 31.50 minutes, respectively (P > 0.05).</p><p><b>CONCLUSIONS</b>A small vessel anastomosis can be performed successfully with the help of a 3D display system. Although the vascular anastomotic time did not demonstrate a significant difference between the groups, the 3D microsurgical video system offers another option to improve the working environment for surgeons. Further development of our 3D monitoring system should focus on a higher resolution and better flexibility.</p>
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Animals , Female , Rats , Anastomosis, Surgical , Methods , Femoral Artery , General Surgery , Femoral Vein , General Surgery , Microscopy, Video , Methods , Rats, Sprague-DawleyABSTRACT
Objective To investigate the diagnosis and operation treatment of primary intrahepatic cholangiocelhlar carcinoma (PICC), for improving the level of diagnosis and treament of PICC. Methods The clinical data of 18 cases with PICC confirmed by operation were analyzed retrospectively. Results In the early stage, no specific symptoms was found in all the 18 cases, the positive cases of AFP, CEA, CA199 and live cirrhosis were 2, 4, 3 and 4. The diagnostic rates of ultrasound examination, CT and MRI were 11.1%(2/18), 42.9%(6/14) and 45.5% (5/11 ). Seven cases were diagnosed as suffering from PICC and the others were misdiagnosed. Of all the 18 patients, 8 cases underwent radical resection and 10 cases received palliative excision. Conclusions PICC patients lack clinical features and serum tumor marker,the rato of misdiagnosis is high, but that of radical resection is low. Knowing its clinicopathological features well. Radicalresection is the best way for treatment of PICC.
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Objective To evaluate the feasibility of Selective Portal Vein Embolization(SPVE)in rabbits with the mixture of ZT glue and Lipiodol.Methods Sixteen white New Zealand rabbits were randomly divided into 2 groups:Group A,ZT glue:Lipiodol(1:2)mixture and Group B Lipiodol group.SPVE of left branch was performed in each group under digital subtraction angiography.The distribution feature of the embolic agents and the histopathology of liver in each group were observed.The weight ratio of the right lobe to the whole liver at the 30th day after SPVE were recorded and analyzed.Results Permanent embolization were occurred in group A.Recanalization was appeared in group B.Atrophy of the embolized lobes and compensatory hypertrophy of none-embolized lohes was,observed..The weight ratio of the right lobe to the whole liver Was 69.41±5.10% in group A.There was statistical difference between these two groups(P＜0.05).Conclusion There were permanent embolization after SPVE with the mixture of ZT glue and lipiodol.SPVE induced atrophy of the embolized lobes of liver and compensatory hypertrophy of none-embolized lobes.