The optimal surgical time of laparoscopic appendicectomy after conservative treatment of appendiceal abscess in children / 中华实用儿科临床杂志

Objective:To explore the optimal surgical time of laparoscopic appendectomy after conservative treatment of appendiceal abscess in children.Methods:Clinical data of 86 children with appendiceal abscess diagnosed in the Department of General Surgery, Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2016 to June 2020 were retrospectively analyzed.According to the delayed laparoscopic appendectomy interval after the appendiceal abscess was cured, 86 children were divided into group A, B and C. Briefly, patients in the 3 groups were treated with laparoscopic appendectomy 4 weeks, 8 weeks and over 12 weeks after the appendiceal abscess was cured, respectively.Children with recurrent appendicitis during delayed operation were not included.The incidence of appendicitis recurrence during delayed operation, the incidences of intraoperative complications, conversion to laparotomy, and postoperative complications, operation time, the time of postoperative intestinal function recovery, and postoperative hospital stay were compared among 3 groups.Results:There were 10, 31 and 45 cases in group A, B and C, respectively.Among them 10, 30 and 39 patients received laparoscopic appendectomy, and 0, 1 and 6 cases had appendicitis recurrence in group A, B and C, respectively.There were no significant differences in the age, gender, diameter of appendiceal abscess, inflammatory indexes at diagnosis of diagnosing appendiceal abscess, cure time of conservative treatment of abscess, and inflammatory indexes at laparoscopic appendectomy among the 3 groups (all P>0.05). The incidence of appendicitis recurrence in group C(13.33%) was significantly higher than that in group A (0) and group B (3.22%)( P<0.05). There was no significant difference in the incidence of appendicitis recurrence between group A and group B( P>0.05). The incidences of intraoperative(group A, B, C was 40.00%, 10.00%, 10.26%, respectively) and postoperative complications (group A, B, C was 40.00%, 6.70%, 5.10%, respectively), and conversion to laparotomy(group A, B, C was 20.00%, 0, 0), operation time [group A, B, C was (106.70±7.42) d, 41.40±10.44) d, (39.60±11.27) d, respectively], postoperative intestinal function recovery time [group A, B, C was(5.80±2.15) d, (0.93±0.17) d, (0.83±0.11) d], and postoperative hospital stay[group A, B, C was(12.40±4.15) d, (1.67±0.31) d, (1.58±0.44) d] in group A were significantly higher than those in group B and group C(all P<0.05), but no significant differences were found between group B and group C(all P>0.05). Conclusions:Eight weeks are the best time for laparoscopic appendectomy after conservative treatment of appendiceal abscess in children.

Preoperative Incidence of Deep Vein Thrombosis after Hip Fractures in Korean

BACKGROUND: The purpose of the current study was to investigate the incidence of preoperative deep vein thrombosis (DVT) after hip fractures in Korea. METHODS: In this prospective study, we enrolled 152 Korean geriatric patients who had suffered hip fractures due to a simple fall and were hospitalized between January 2013 and December 2013. There were 52 male and 100 female patients, and their mean age was 78.2 years. There were 96 trochanteric fractures and 56 femoral neck fractures. All patients were examined for DVT: 26 by ultrasonography and 126 by computed tomography venography. The patients having DVT underwent inferior vena cava filter insertion before the surgical intervention. RESULTS: Preoperatively, none of the patients had any signs or symptoms of DVT; however, 4 patients were identified as having asymptomatic DVT. The overall incidence of DVT was 2.6% (4/152). The mean time to arrival at emergency room after injury was 32.6 hours. Mean time elapsed to undergo surgery after hospitalization was 24.9 hours. The average time to hospitalization after injury was 237 hours for patients with DVT versus 27.5 hours for patients without DVT. DVT developed within 72 hours in two of the 137 patients (1.4%) and after 72 hours in two of the remaining 15 patients (13.3%) hospitalized. CONCLUSIONS: While the preoperative incidence of DVT after hip fractures was relatively low (2.6%) in the Korean geriatric population, we confirmed that getting no treatment within 72 hours after injury increased the incidence of DVT. Thus, we conclude from this study that a workup for DVT should be considered in cases where admission or surgery has been delayed for more than 72 hours after injury.

Best Surgical Time for 79 Cases of Elderly Patients with Acute Cholecystitis / 实用医学杂志

Objective To compare the effects of different surgical time for the recovery of elderly patients with acute cholecystitis and provide reference for its clinical treatment. Methods Clinic data of 79 elderly patients with acute cholecystitis from January 2008 to September 2013 were analyzed retrospectively. Patients were divided into two groups according to different surgical time, 42 cases having surgery within 72 h as early surgery group, and 37 cases having surgery later than 72h as delayed surgery group then the curative effects of two groups were compared and analyzed. Results The success rate of early surgery group reached 97.6%, and that of delayed surgery group 91.9%, which showed no statistically significant difference (P > 0.05); with shorter operative time, less blood loss, shorter length of hospital stay and less medical cost, patients recovered better in early surgery group than those in delayed surgery group and there were statistically significant differences between two groups (P0.05).The complication rate of early surgery group was 2.4%, and that of delayed surgery group 18.9%, which indicated statistically significant difference (P<0.05). Conclusions Early surgical treatment for elderly patients with acute cholecystitis has a good therapeutic effect and is beneficial to the early rehabilitation of patients.

Delayed open reduction and internal fixation for the Cotton's fracture / 中国矫形外科杂志

0.05).The activities degrees of ankle joint also had no statistical difference.[Conclusion]According to the extent of the displacement of Cotton's fracture,we should make the right operative order and the incision,thus we can get results with anatomic reduction and shorten the operative time,which can help the patients make early exercises and get satisfactory effect.

A Case of Delayed Operated Huge Mature Cystic Teratoma of the Ovary / 대한산부인과학회잡지

Mature cystic teratoma of the ovary are often diagnosed in women of reproductive age and account for 5-25% of all ovarian tumors. Due to continuous growth and possible complications, namely rupture, torsion, infection and malignancy, teratoma should be removed surgically. More complications are occurred in huge teratoma. We present here a case of a delayed operated huge mature cystic teratoma without any complication with a brief review of the literature.

A Clinical Study in 226 Cases of Intestinal Obstruction

BACKGROUND : There is so different between Doctors at managing the patient with intestinal obstruction. Some prefer conservative management and prefer to delay the operation. But others prefer the early operation. So, we have studied in order to compare the clinical difference between early operation and delayed operation for intestinal obstruction. METHODS : This clinical report is based on a review of the records of 226 patients with intestinal obstruction that have been managed at the Department of General Surgery, Seventh Adventist Hospital in Seoul, during about 4 years from January, 1994 to October, 1997. RESULTS : 1) Male to female ratio was 2.32 : 1. The most frequent age group was within 1 year. 2) The common causes of intestinal obstruction were postoperative adhesion (35.8%), intussusception (19.1%), hernia (16.6%) and neoplasm (8.6%). 3) The chief complaints on admission were abdominal pain in 142 cases (62.8%), nausea and vomiting in 110 cases (48.7%), bloody stool in 43 cases (19.0%) and fever in 27 cases (11.9%). The physical findings were abdominal tenderness in 117 cases (51.8%), increased peristalsis in 98 cases (43.4%) and abdominal distension in 64 cases (28.3%). 4) The previous abdominal operation leading to intestinal obstruction were appendectomy in 16 cases (27.6%), small bowel operation in 13 cases (23.4%), gastro-duodenal operation in 9 cases (15.5%) and gynecologic operation in 7 cases (12.1%). 5) In patients who admit because of intestinal obstruction due to previous operation, most of them entered in hospital within 6months after previous operation. 6) Among 226 cases, 46 cases (20.4%) had emergency operation, 64 cases (28.3%) had only conservative treatment and 116 cases (51.3%) had elective delayed operation 7) In patients who was cured with only conservative management, 12 cases (18.8%) of them stayed for 1day on hospital and 32 cases (50%) of them stayed for 1 or 2 days. 8) Exploratory laparotomy was performed in 162 cases. The types of obstruction were composed of 36 cases (22.2%) of strangulated obstruction and 126 cases (77.8%) of simple obstruction. The frequency of strangulated obstruction was 14 cases (38.9%) when the early operation were done, and that ofstrangulated obstruction was 22 cases (61.1%) when the delayed operation were done. There was significant difference between early operation group and delayed operation. 9) As for operative procedure, adhesiolysis was done in 38 cases (23.5%), bandlysis was done in 30 cases (26.1%), manual reduction and incidental appendectomy was done in 28 cases (17.3%). 10) The incidence of postoperative complication was 46 cases (28.4%) and the most cause of death was septic shock. CONCLUSIONS : The early operation for the patient who suffered from intestinal obstruction due to previous operation is better than delayed operation.

A Clinical Study of Acute suppurative Cholangitis with Conservative Treatment and Delayed Operation

The classic clinical manifestations of acute suppurative cholangitis were first described by Charcot in 1877 as a triad of fever(and chill),jaundice and right upper quadrant pain. In 1959,Reynolds and Dargan characterized acute suppurative cholangitis as a distinct clinical entity manifested by a clinical pentad of Charcot,s three signs plus shock and central nervous system depression.We have clinical analysis of acute suppurative cholangitis,218 cases who were admitted in Chonnam Hospital from Jan.1989 to Dec.1995.All cases were treated conservatively initially,and then delayed operation was performed when the patients were improved from the septic condition by cholangitis.

Clinical Study of Conservative Management of the Acute Epidural Hematoma

The authors present 31 patient with acute epidural hematoma who had been admitted from January, 1987 to June. 1989 managed by consevative treatment. The results were as follows ; 1) The age of patients was distributed evenly, most patients were male (26 cases) and the most common mechanism of injury was traffic accidents(14 cases). 2) Sites of hematoma were mostly the temporal and parietal area and the maximum thickness of hematoma was not different from each site. 3) On admission, all patients presented GCS score above 13 except 2 cases. 4) All patients did not undergo delayed up, due to the enlargement of the hematoma or neurological deterioration. 5) The maximum thickness of hematoma was under 20 mm in all patients. 6) The hematoma was resolved within 30 days in all cases. This was confirmed with brain CT scan.