Early Decompression of Acute Subdural Hematoma for Postoperative Neurological Improvement: A Single Center Retrospective Review of 10 Years / 대한신경손상학회지

OBJECTIVE: This study was conducted to investigate survival related factors, as well as to evaluate the effects of early decompression on acute subdural hematoma (ASDH). METHODS: We retrospectively reviewed cases of decompressive craniectomy (DC) for decade. In total, 198 cases of DC involved ASDH were available for review, and 65 cases were excluded due to missing data on onset time and a delayed operation after closed observation with medical care. Finally, 133 cases of DC with ASDH were included in this study, and various factors including the time interval between trauma onset and operation were evaluated. RESULTS: In the present study, survival rate after DC in patients with ASDH was shown to be related to patient age (50 years old, p=0.012), brain compression ratio (p=0.042) and brain stem compression (p=0.020). Sex, preoperative mental status, and time interval between trauma onset and operation were not related with survival rate. Among those that survived (n=78), improvements in Glasgow Coma Scale (GCS) score of more than three points, compared to preoperative measurement, were more frequently observed among the early (less than 3 hours between trauma onset and operation) decompressed cases (p=0.013). However, improvements of more than 4 or 5 points on the GCS were not affected by early decompression. CONCLUSION: Early decompression of ASDH was not correlated with survival rate, but was related with neurological improvement (more than three points on the GCS). Accordingly, early decompression in ASDH, if indicated, may be of particular benefit.

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.

Early operation treatment of filter channel obstruction after trabeculectomy of glaucoma / 局解手术学杂志

Objective To probe into the treatment method of filter channel obstruction after trabeculectomy. Methods Filter channel obstruction occurred in 25 eyes within one month after trabeculectomy,and they were retrospectively analyzed. According to different parts of obstruction,they were divided into three types namely inner obstruction, middle obstruction and outer obstruction. Patients with inner ob-struction were given miosis, separation of the anterior synechia, and expansion of peripheral iris incision when necessary. Patienrts with mid-dle obstruction were given reconstruction of the trabecular incision. Patienrts with outer obstruction were given conjunctiva or sclera flap dis-section within 1 month afer trabeculectomy. Results Postoperative IOP ( intraocular pressure) decreased significantly compared with preop-erative IOP. The IOP stabilized at 13~21 mmHg in the fallowing 6~12 months after operation. Conclusion Taking appropriate measures could restore the filtration function within one month after trabeculectomy when the incision adhesion was not very close.

Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures

PURPOSE: To find out the effect of early closed reduction and internal fixation (within 24 hours after admission to hospital) on the morbidity and mortality in the elderly with intertrochanteric fractures of the femur. MATERIALS AND METHODS: Retrospectively, we analyzed 99 patients with intertrochanteric fracture of the femur who underwent surgery from January, 2009 to December, 2010. We reviewed 89 of the 99 patients and checked for early complications and reviewed the mortality rates 3 months, 6 months and 1 year after surgery. There were 24 males and 65 females. The average age was 79.8 years (61-99 years). According to the American Society of Anesthesiologists classification, 25 patients were class 1, 37 patients were class 2, 26 patients were class 3, and 1 patient was class 4. All patients were operated on by one surgeon, who was skilled in inserting intramedullary nail. RESULTS: The average surgical time was 43 minutes and the average intraoperative blood loss was 165 ml. Sixteen patients experienced delirium but all of them recovered. One patient had pneumonia at one month after surgery. Pressure sores developed in one patient but improved with conservative treatment. Pulmonary thromboembolism developed in some patients one month after surgery. Three patients (3.4%) died within three months and one patient (1.1%) died between three and six months after surgery, but no patient died between six months and one year after surgery. CONCLUSION: If patients are optimized for the operation, early internal fixation of trochanteric fracture in elderly patients after arrival at the hospital should be considered to reduce early complications and mortality.

Investigation of early appendectomy in appendicular abscess / 局解手术学杂志

Objective To evaluate the feasibility and safety of early appendectomy in appendicular abscess. Methods Fifty patients with appendicular abscess who received early appendectomy in our hospital from January 2009 to June 2012 were considered as the abscess group,50 cases patients received acute appendicitis surgery were regarded as the control group. The postoperative hospital stay,cost of hospi-talization,operative time,the amount of bleeding in operation and complications were retrospectively analyzed. Results The operative time of abscess group was (68±23) min,and the control group was (49±14) min (P0. 05). All patients were cured. Conclusion Early treatment of appendiceal abscess is safe and alternate to conventional conservative treatment followed by interval appendectomy. It is not only to avoid the secondary hospitalization and treatment fail-ure,but also save the cost of hospitalization and minimize the medical expenses.

Efficacy of early versus late reconstruction for anterior cruciate ligament rupture:a systematic review / 中国矫形外科杂志

[Objective]To determine the efficacy of early versus late reconstruction for anterior cruciate ligament rupture.[Method]The author searched MEDLINE(1950-2007.4),OVID(1950-2007.6),PUBMED(1950-2007.7),the CBM(1978-2007.6),WanFang(1981-2007.6),and hand-searched several related journals for randomized controlled trials(RCTs)and quasi-randomized controlled trials(quasi-RCTs)involving the efficacy of early versus late reconstruction for anterior cruciate ligament rupture,the quality of the included trials was assessed.RevMan 4.2.8 software was used for statistical analysis.[Result]Ten studies were included(1RCT,9 CCT).The results of meta-analysis indicated that the huge heterogeneity consist in as follows:intraarticular meniscus tears of the knee,extension deficit of the knee,comparison of lysholm of the knee after the operation.No statistically significant differences between the two operative procedures were observed as follows:including the result of incidence of intraarticular chondral damage of the knee,comparison of Lachman test of the knee found after the operation as well as the result of incidence of comparison of Pivot test of the knee found after the operation.Statistically significant differences were more observed in the late reconstruction in the clinical outcome of both intraarticular arthofibrosis and flexion deficit of the knee found after the operation than that of early reconstruction.[Conclusion]Although result obtained on the basis of CCT with a lager bias and one RCT,the author still conclude that statistically significant differences are more observed in the late reconstruction in the clinical outcome of both intraarticular arthofibrosis and flexion deficit of the knee found after the operation than that of early reconstruction.More high quality,large-scale randomized controlled trials are required for the accurate conclusion in treating it.

Effectiveness of Early Surgery in Children with Traumatic Subdural Hygroma

OBJECTIVE: This study was performed to evaluate the usefulness of early operation in children with traumatic subdural hygroma. METHODS: The subjects were nine patients (Glasgow coma scale (GCS) score was below 10 and age was below 10 years old) who developed subdural hygroma after trauma between January 2000 to December 2002. Subduroperitoneal shunt was performed in one group and not performed in the other group. We analyzed the GCS score on admission and at 1 year after operation. Overall clinical results were evaluated retrospectively. RESULTS: Patients who underwent operation exhibited higher GCS scores at 1 year after trauma compared to those in the patients who were treated by conservative therapy(p<0.05). CONCLUSION: The early operation could be an effective treatment to children with subdural hygroma who showed delayed improvement of consciousness and to patients with hygroma that didn't decrease or was above moderate amount.

3-Dimensional Computed Tomography Angiography in Early Operation for Poor Grade Aneurysms

OBJECTIVE: The authors studied the feasibility of 3-Dimensional computed tomographic angiography(3-D CTA) in early surgery for poor grade patients with aneurysmal subarachnoid hemorrhage(SAH), therefore intended to verify the eligibility of this diagnostic tool in these special clinical settings. METHODS: During the period between July 1997 and December 2000, we studied 31 patients diagnosed as aneurysmal SAH that were classified as the Hunt-Hess grade IV or V and Fisher group III or IV. As the conventional angiography could not be conducted because of the patients' poor clinical conditions, we carried out early surgery on the same day of SAH solely based on the 3-D CTA. We compared the 3-D CTA features with intraoperative findings. RESULTS: Total of 33 aneurysms were found in preoperative 3-D CTA and, of them, all 31 ruptured aneurysms and additional another two unruptured ones were also. Undetected three aneurysms were found in the operative field(2 cases) and postoperative digital subtraction angiography(1 case). The sensitivity of 3-D CTA was 94.7% and specificity was 100%. CONCLUSION: According to our results, 3-D CTA might be sufficient for early surgery of intracranial aneurysms in poor grade SAH patients in urgent conditions.

Conservative Therapy Compared with Operations in Early Severe Acute Pancreatitis / 中国医师杂志

Objective To explore indications of the conservative therapy an early operative treatment for severe acute pancreatitis and researching comprehensive therapeutic rule.Methods Retrospective analyze the clinical feature and the result as making a diagnosis and giving treatment of 82 cases of SAP admitted from Aug.1986 to dec.2000.Results Among them,28 cases underwent conservative treatment,with the cure rate of 85.7%,54 cases underwent conservative treatment,with the cure rate of 81.5%,the total cure rate was 82.9%.Conclusions The conservative therapy or early operation of SAP is determined by the patients' clinica feature,while the supportive conservative therapy being on,we should carefully observe the changes of the patient's condition and the response to therapy,when once surgical indication being discovered,early operation should be performed ,the emergency surgery should be performed as soon as possible for the biliary obstruction of SAP.

Analysis of Outcome in Relation to the Timing of Surgery in Aneurysmal Subarachnoid Hemorrhagic Patients

The purpose of this study was to investigate whether early surgery benefits in the treatment of the patients with ruptured aneurysm by comparing the outcome in relation to the timing of surgery. The autho rs analyzed 81 patients with ruptured aneurysm who underwent operation during one year from January 1996 through December 1996. Among these, sixty patients(74%) underwent operation within 72 hours after first bleeding, and 21 patients (26%) after 72 hours following first bleeding. Thirtysix patients(82%) recovered without se rious neurological deficits in 44 patients with initial Hunt and Hess g rade I to III who were operated upon in early period, and four out of 16 patients with initial Hunt and Hess grade IV to V. Sixteen patients (84%) recovered without serious neurological deficits in 19 patients with initial Hunt and Hess grade I to III who received late operation but none in 2 patients in Hunt and Hess grade IV to V. Seven out of 60 (12%) patients died after early operation, one of 21(5%) patient died after late operation. The causes of morbidity were vasospasm (19 cases), rebleeding (5 cases), hydrocephalus (1 case) in early operation and vasospasm (2 cases), hydrocephalus (1 case) in late operation. It is concluded that early operation is mandatory even in the patients with poor clinical status prior to surgery since early aneurysmal surgery can minimize the chance of rebleeding, permit more aggressive treatment against vaso-spasm and improve the clinical outcome.

Management of Cerebral Aneurysms in Elderly Patientsc / 대한뇌혈관학회지

In many countries, the percentage of seninor citizens is expanding. Direct operation for ruptured aneurysm should be the choice of treatment in elderly patients of Hunt-Hess grade I through III, but should not be performed in cases of grade V. To evaluate the risk of early operation of elderly patients with ruptured cerebral aneurysm, conducted a retrospective analysis 464 elderly patients with ruptured aneurysms who were over aged 60 years between Jan 1980 to June 1999. Of these, 334 cases were performed early operation in which the direct intracranial operation was carried out within 3 days after last subarachnoid hemorrhage. The female: male ratio is 4.87: 1. The location of aneurysms are 144 anterior communicating artery aneurysms, 139 internal carotid artery aneurysms, 117 middle cerebral artery aneurysms, 35 multiple aneurysms, etc. Associated conditions are hypertension, diabetes mellitus, pulmonary problem, etc. Operation methods are 404 clippings, 53 coatings, 1 endovascular treatment, etc. Problems during operation are 29 broad aneurysms, 22 giant aneurysms, 21 tight brains, etc. In early operative group(within 3 days), 79% had favorable outcome, 11% unfavorable outcome and 10% died. The early operation is an effective and reliable method to reduce the occurrence of rebleeding, vasospasm, ischemic complication, medical complication and to shorten lengths of hospitalization.

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.

Clinical Significance of Rebleeding and Risk Factors Affecting Rebleeding in Patients with Spontaneous Subarachnoid Hemorrhages

To investigate the clinical significance of and risk factors for rebleeding in patients with spontaneous subarachnoid hemorrhages(SAH), the authors reviewed the consecutive cases of 527 patients admitted in the 7-year period from 1988 to 1995. Of these patients, 75(14.2%) rebled. Rebleeding occurred within 24 hours in 45 patients, among whom 32 cases rebled within 12-24 hours after initial SAH, within 1-3 days in 19, within 4-7 days in 9, and after 1 week in 2. These patients had an overall mortality of 82.9% compared to 28.4% for patients without rebleeding. The patients with rebleeding within 24 hours after the initial attack had an operative rate of 34.9% and a postoperative mortality of 53.3% compared to 26.8%, 37.5%, respectively, for patients with rebleeding after 24 hours. The significant factors affecting rebleeding were as follows;Over 70 years in age, association with intracerebral hematoma(10-20cc), sizure before operation, aneurysms on the vertebrobasilar system, poor neurological condition on admission, and angiography within 6 hours of initial SAH. Ultra-early operation within 24 hours following intentional delay in angiography of at least 6 hours from the initial rupture is recommended if the associated hematoma is not large enough to show mass effect.

Two Cases of Posterior Communicating Artery Aneurysm Complicated by Massive Subdural Hematoma

We experienced 2 cases of caute subdural hematoma with tentorial herniation due to ruptured posterior communicating artery aneurysm. Based on a review of the literature and the clinical course in the present cases, recommend therapy consist of early evacuation of hematoma and clipping of aneurysm because of the not infrequent development of rapid deterioration.

Clinical Analysis of Early Operation for Elderly Patients with Ruptured Aneurysm

Direct operation for ruptured aneurysm should be the choice of treatment in elderly patients same as in younger cases. The early operation is an effective and reliable method to reduce the occurrence of rebleeding, vasospasm, ischemic complication, medical complication & to shorten lengths of hospitalization. To evaluate the risk of early operation of elderly patients with ruptured cerebral aneurysm. conducted a retrospective analysis 81 elderly patients with ruptured aneurysms who were over aged 60 years between Jan 1985 to June 1988. Of these, 47 case were performed early operation in which the direct intracranial operation was carried out within 3 days after last subarachnoid hemorrage. 77 % had favorable outcome and 13% died.

A Clinical Analysis of Spontaneous Intracerebral Hemorrhages at the Basal Ganglia and Thalamus

The author analyzed 169 cases of spontaneous intracerebral hemorrhages at the basal ganglia and thalamus, who had been admitted to Jeonju Presbyterian Medical Center from 1975 to 1979. Intracerebral hematoma was confirmed by angiography and the amount of hematoma was divided as small, medium or large according to the angiographic evidence. Among the 169 cases, 145 cases underwent appropriate medical or surgical treatment. 63 cases were treated conservatively and 82 cases were operated ; 22 cases of frontal approach, 51 cases of temporal approach, and 9 cases of extraventricula diainage of clot. Results obtained are as follows : 1. The common pridiection age group was from the fifth to the seventh decades, which was 90.5% of all cases. The ratio of male to female was about 2 to 1. 2. putaminal hemorrhage was 65.1%, and thalamic hemorrhage was 16.6%. 3. Angiographic evidence of arteriosclerosis was seen in 86.4%. 4. The worse prognostic factors were related to age(over 65), site and size of hematoma, and mental state on admission. 5. With conservative management 49.2% were improved, 6.3% not improved, 44.4% moribund or dead. 6. With surgical treatment 58.5% were improved, 3.7% not improved, 37.8% moribund or dead. 7. Microsurgical temporal approach proved to have the following advantages over frontal approach. (1) Better outcome was found in this approach(64.7% vs 54.4%). (2) The distance to the hematoma was closer in temporal approach, and so total removal of hematoma and complete control of bleeding sources with less surrounding structural damages were possible. 8. Early operation seems to be more effective than delayed operation in the cases of large hematoma with deteriorating neurological signs.