Anesthetic efficacy of topical dyclonine hydrochloride mucilage for preputial encircling in children / 临床麻醉学杂志

Objective To investigate the anesthetic efficacy of topical dyclonine hydrochloride mucilage for preputial encircling in children. Methods Sixty children under preputial encircling, 13 patients with redundant prepuce, 47 patients with phimosis, aged 4-12 years, weighing 14-38 kg, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups with 30 cases each: dyclonine group (group D) and control group (group C). Children with redundant prepuce in group D were smeared evenly 1％ dyclonine hydrochloride mucilage on the anterior 2/3 foreskins, glans and coronary sulcus by anesthesiologists who were assisted by the their parents 30 min before entering the operating room. Children with phimosis in group D were smeared evenly 1％ dyclonine hydrochloride mucilage on the anterior 2/3 foreskins, and then the tube was inserted near the coronary sulcus with the 18# straight indwelling needle. The syringe was injected into the 1％ dyclonine hydrochloride mucilage, and the glans and the coronary sulcus were squeezed repeatedly several times by anesthesiologists who were assisted by the their parents 30 min before entering the operating room. The dosage of dyclonine hydrochloride mucilage for each child was 0.2-0.3 ml/kg. Children in group C were smeared evenly isodose normal saline at the same time. All the children were treated with ketamine and propofol anesthesia after entering. The occurrence of intraoperative body reaction were observed and recorded, HR and MAP were recorded before anaesthesia induction (T0), at the beginning of surgery (T1), at the time of the coronary sulcus was exposed (T2), at the time of ligating (T3), at the time of the excess foreskin was cut (T4), the dosage of ketamine and propofol were recorded, and the occurrence of postoperative recovery time and emergence agitation during recovery period were observed. Results Body dynamic reaction rate in group D was significantly lower than that in group C (P ＜ 0.05), HR and MAP was significantly lower than that in group C at T3-T4 (P ＜ 0.05), the dosage of ketamine and propofol was significantly smaller than that in group C (P ＜ 0.05), the recovery time was significantly shorter than that in group C (P ＜ 0.05), the incidence of emergence agitation was significantly decreased compared with group C (P ＜ 0.05). Conclusion Topical dyclonine hydrochloride mucilage can effectively decrease body movement, lessen cyclic fluctuation, economize general anesthetics, shorten recovery time, reduce emergence agitation in children undergoing preputial encircling.

A Case of Silicone Band Migration Following an Encircling Procedure

PURPOSE: In the present study, a case of silicone band migration following an encircling procedure was reported. CASE SUMMARY: A seven-year-old male was admitted to our hospital after undergoing primary corneal suture and cataract extraction for traumatic corneal laceration and cataract in the left eye at another hospital. The cornea was well sutured, but due to vitreous bleeding and retinal detachment, we performed vitrectomy and silicone oil injection in combination with scleral buckling. The retina was well attached for 7 months following the procedure but the silicone oil was removed due to uncontrolled intraocular pressure elevation. Ten days later, the patient was readmitted for blurred vision in the left eye and vitreous bleeding as well as superotemporal retinal detachment were observed. During vitrectomy, we could not locate the indentation caused by scleral buckle, therefore extraocular area was closely examined. The scleral fixation sutures were well maintained in all 4 quadrants but the silicone band was not observed within the sutures. The band was located anterior to the fixation sutures and was displaced anterior to the medial rectus muscle insertion. The encircling silicone band was removed. The encircling procedure was again performed with a new silicone band combined with vitrectomy and silicone oil injection. Retinal attachment has been maintained and the silicone band well anchored since the operation. CONCLUSIONS: Anterior migration of the silicone band through the outer layer of the sclera or one or more tendons of recti muscles is a rare but potential complication of scleral buckling. Hence, clinicians must note the possibility of this complication when retinal detachment recurs and the encircling buckle is not observed.

The Blood Blister Like-aneurysm: Usefulness of Sundt Clip

OBJECTIVE: Blood blister-like aneurysm (BBA) is a kind of dorsal wall aneurysm and it is small, sessile, fragile and hazardous because of its high mortality and morbidity. Many challenges tried to establish the management or strategy. But so far, there is no optimal treatment of choice for the BBA. In this article, 17 cases of the ruptured BBA in one institute were analyzed retrospectively. The operative options were correlated with surgical and clinical outcomes. MATERIALS AND METHODS: During 14 years between October, 2002 and October, 2016, 23 patients were treated for subarachnoid hemorrhage with ruptured dorsal wall aneurysms. There were various strategies for treatment and different outcomes revealed. BBA were 17 (74%) cases and 6 (26%) cases were saccular aneurysm. By excluding saccular aneurysm, BBA was sorted and classified with its morphological characteristics, and the outcome of treatment in each case investigated retrospectively. RESULTS: Among 17 BBA-cases, 8 cases get microsurgical operation by Sundt clip. 5 cases get operation by conventional Yasargil clip, 1 case treated by Yasargil clip with wrapping, and 2 cases underwent endovascular management with coiling, and 1 case was managed by endovascular trapping of involved internal cerebral artery. Clinical outcomes were analyzed with modified Rankin Scale, Glasgow outcome scale and post-operative complications. CONCLUSION: As the optimal management, operation using Sundt clip had much significance in treatment BBA. And, a thorough analysis of the angiography is essential to prepare for the treatment of BBA.

Significance of vaginal cervical double cerclage for cervical incompetence after pregnancy / 中国基层医药

Objective To observe the pregnancy by transvaginal double slit cervical pregnancy outcome after ligation,and evaluate its clinical application value.Methods The clinical data of 80 cases with cervical incompe-tence were analyzed.All patients had pregnant metaphase inevitable abortion history,the average abortion pregnant was 21.7 week.According to different treatment methods,80 cases were divided into two groups,treatment group (40 cases)in non pregnant women with silk thread woven tape by double vagina and cervix cerclage,another group of 40 cases in 15 -20 weeks of pregnancy by using polypropylene McDonald method with cerclage.The operation,preg-nancy cervical tube length and pregnancy outcome were observed.Results The average operation time and bleeding volume between the two groups had no statistically significant differences.The pregnancy cervical average length of the treatment group was 4.6(4.8 ±0.5)cm,which was significantly longer than 3.9(3.1 ±0.8)cm of the control group (t =2.732,P <0.05).In the treatment group,the full -term delivery rate,preterm delivery rate,mean gestational age at delivery were 55.0%(22 /40),40.0%(16 /40),35.8 weeks,the average abortion was extended 14.1 weeks com-pared with preoperation,fetal survival rate was 90.0%(36 /40),neonatal birth weight was (3 100.0 ±200.0)g;28 gestational weeks following the inevitable abortion rate was 2.5%(1 /40).In the control group,the term delivery rate was 35.0%(14 /40),the rate of premature birth was 50.0%(20 /40),and the rate of abortion was 15.0%(6 /40)in 28 weeks.Mean gestational age at delivery was 33.2 weeks,which was extended 11.5 weeks compared with preoperative average abortion,fetal survival rate was 85.0% (34 /40),neonatal body mass was (2 900.0 ±300.0)g. The term delivery rate,fetal survival rate and neonatal weight in the treatment group were higher than those in the con-trol group.Conclusion Pregnant by double vagina and cervix cerclage treatment cervical function can maintain preg-nancy,cervical length,prolong the time of pregnancy and improve the perinatal survival rate,simple operation,take out stitches convenient,it is worthy of clinical application.

Vitrectomy with Perfluorocarbon Liquid versus Combined Encircling for Retinal Detachment with Giant Retinal Tear

PURPOSE: To evaluate the clinical usefulness of additional encircling in patients treated for retinal detachment with giant retinal tear and without proliferative vitreoretinopathy, compared to single vitrectomy using perfluorocarbon liquid. METHODS: Patients who underwent surgery for retinal detachment with giant retinal tear were divided into either the vitrectomy alone group or combined vitrectomy and encircling group. We reviewed the primary anatomical success rate, final anatomical success rate and best corrected visual acuity (BCVA) at the last follow-up (log MAR). Additionally, BCVA at the first visit, intraocular pressure, lens status, history of intraocular surgery, high myopia, trauma history, time from symptom onset to surgery, location and size of the giant retinal tear, extent of retinal detachment and foveal detachment were reviewed. RESULTS: Among a total of 29 eyes, the vitrectomy alone group included 8 eyes and the combined group 21 eyes. Location and size of the giant retinal tear, extent of retinal detachment and foveal detachment, intraocular pressure, history of intraocular surgery, lens status, high myopia, trauma history and time from symptom onset to surgery were not different between the 2 groups. The primary success rate was 87.5% in the vitrectomy group and 85.7% in the combined group; the final surgery success rate was 100.0% and 95.2%, respectively. There was no significant difference in the anatomical success rate between the 2 groups. The postoperative BCVA was similar in both groups (0.80 vs. 0.92). CONCLUSIONS: When vitrectomy using perfluorocarbon liquid was performed for the treatment of giant retinal tear without proliferative vitreoretinopathy, an encircling provided no additional benefit for the anatomical success rate and visual recovery. Only intensive vitrectomy of peripheral retina was considered capable of achieving a successful retinal attachment in patients without proliferative vitreoretinopathy.

Clinical analysis of 16 cases with complete rectal prolapse undergoing Gant-Miwa and anal encircling procedure with Xiaozhiling injection / 国际外科学杂志

Objective To evaluate the efficacy of Gant-Miwa and anal encircling procedure with Xiaozhiling injection for complete rectal prolapse.Methods Clinical data of 16 patients with complete rectal prolapse undergoing Gant-Miwa and anal encircling procedure with Xiaozhiling injection between Feb.2011 and Nov.2014 were retrospectively analyzed.Results All patients were operated successufully and theirs prolapse symptons disappeared.Urinary retention was found in 3 cases,2 cases were observed a replase who were infected in the area of the anal operation,1 cases was found delayed healing of perianal incision,and 2 cases were happened constipation duing to the rectal stenosis.Complications wasn't happened such as bleeding,perianal abscess,anal fistula,and so on.Thirteen cases were followed-up of average 2.2 years and 2 cases were observed postoperative recurrance.Conclusions Gant-Miwa and anal encircling procedure with Xiaozhiling injection for the treatment of complete rectal prolapse is a procedure with minimally trauma,fewer complications and low recurrence rate,which is worth promoting after innovation and improvement.

Ahmed glaucoma valve in eyes with preexisting episcleral encircling element.

Background: To describe the use of Ahmed glaucoma valve (AGV) in the management of intractable glaucoma in eyes with a preexisting episcleral encircling element. Materials and Methods: This is a retrospective, consecutive, noncomparative study. The study included 12 eyes of 12 patients with a preexisting episcleral encircling element that underwent implantation of silicone AGV to treat intractable glaucoma during January 2009 to September 2010. Results: The mean patient age was 25.6 (standard deviation 17.1) years. Five (41.6%) patients were monocular. The indications for AGV were varied. The mean duration between placement of episcleral encircling element and implantation of AGV was 30.5 (33.8) months. The mean follow-up was 37.4 (22.9) weeks. Preoperatively, the mean intraocular pressure (IOP) was 31.4 (7.9) mmHg and the mean antiglaucoma medications were 2.8. At the fi nal postoperative follow-up, the mean IOP was 12.5 (3.5) mmHg and the mean number of antiglaucoma medications was 0.8 (P < 0.001). The complications observed over the follow-up period did include corneal graft failure in three eyes, tube erosion in two eyes and rhegmatogenous retinal detachment in one eye. Conclusion: AGV is an eff ective option in the management of intractable glaucoma in eyes with a preexisting episcleral encircling element keeping in mind the possibility of signifi cant postoperative complications.

Salvage Surgical Treatment for Failed Endovascular Procedure of a Blood Blister-Like Aneurysm

The blood blister-like aneurysm (BBA) of the internal carotid artery (ICA) is a rare but clinically important cause of subarachnoid hemorrhage (SAH), which accounts for 0.5% of incidences of ruptured intracranial aneurysms. BBA is a thin-walled, broad-based aneurysm that lacks an identifiable neck and is one of the most difficult lesions to treat. In this paper, a case is presented of a 57-year-old woman with SAH. Her cerebral angiography demonstrated a small BBA on the dorsal wall of her right ICA. Endovascular treatment that consisted of a stent-within-a-stent was attempted, but the replacement of the second stent failed, and the aneurysm became bigger. Surgery was performed by clipping the BBA with a Sundt slim-line encircling graft clip. The patient completely recovered with no complications. This treatment may be a salvageable option for BBA, especially when endovascular treatment has failed.

Clinical efficient of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency on a report of 187 cases / 中国综合临床

ObjectiveTo evaluate the therapeutic effect of encircling constriction of superficial femoral vein in the treatment of primary deep venous insuficiency(PDVI).MethodsFrom Jan.2004 to Jun.2011,187 patients( 196 lower extremities)with primary deep venous insufficiency were treated with encircling constriction of venous wall at the first pair of superficial femoral venous valve pulse superficial varicose stripping.Results The 183 limbs in 176 patients were followed-up from 7 months to 8 years,with a mean period for 63.5 months.Ninety-four point one percent of the patients were followed up (176/187).Clinical symptomatic improvement achieved in 87.4％ ( 160/183 ) of the lower extremities.There was 2.2％ ( 4/183 ) of recurrence of the varicose vein,9.3％ ( 17/183 ) of light edema,8％ ( 2/25 ) of recurrence of ulcer.ConclusionEncircling constriction of superficial femoral vein is an effective method in the treatment of primary deep venous valve insufficiency.

Clinical research on encircling constriction of superficial femoral vein with electrocoagulation in the varicose veins of lower extremity / 中国综合临床

Objective To observe the effect of the operation and application value of encircling constriction of superficial femoral vein with electrocoagulation in the varicose veins of lower extremity.Methods 271 cases were divided into the research group(n=166)with encircling constriction of superficial femoral vein with electro-coagulation and the control group(n=105)with traditional encircling constriction of superficial femoral vein with electrocoagulation.The degrees of the venous reflux,velocities of blood flow,CEAP classification and clinical scoring of the two groups were compared.Results The research group was better than the control group on decrease in de- grees of the venous reflux.increase in velocities of blood flow and decrease in clinical scores(P<0.01).Conclu- sions The encircling constriction of superficial femoral vein with electrocoagulation is the desirable method in the treatment of varicose veins of the lower extremity.

Two Cases of Ocular Ischemia following Scleral Encircling

PURPOSE: To report two cases of ocular ischemia following scleral encircling. METHODS: A 21-year-old man with glaucoma and a 76-year-old woman without any medical problem were transferred to our department for surgery to treat retinal detachment. After retrobulbar anesthesia and limbal peritomy of conjunctiva, the 4-rectus muscles were isolated. Scleral encircling was performed with No. a 42 band (4.0 mm in width) after cryotherapy done completely around retinal tear. RESULTS: Following surgery, One patient experienced ophthalmic artery occlusion and while the other patient experienced central retinal artery occlusion. Vision was not restored in either cases despite IV injection of 250 ml of 15% mannitol solution and anterior chamber paracentesis. CONCLUSIONS: In the cases where patients are of old age or suffer from glaucoma, we strongly recommend that the surgeons perform the scleral encircling carefully.

Combined Surgery of Retinal Reattachment Surgery and Cataract Extraction for Retinal Detachment

PURPOSE: To report the anatomical and functional outcomes of combined surgery-pars planar vitrectomy, scleral encircling and phacoemulsification and posterior chamber intraocular lens implantation. METHODS: We retrospectively studied the anatomical success, functional success and complications in 12 patients who had undergone combined surgery due to retinal detachment with cataract and vitreous opacity from March 2001 to August 2003. RESULTS: Twelve eyes were included in this study. Anatomical success was achieved after the initial operation in 10 (83.3%) eyes, and functional success in 6 (50%). Intraoperative complications included posterior capsule rupture in 1 eye, postoperative complications including hyphema in 3 eyes, and increased intraocular pressure in 3. CONCLUSIONS: The results of this study suggest that combined surgery is a safe and effective procedure for patients with rhegmatogenous retinal detachment, concomitant cataract, and vitreoretinal diseases.

Clinical Outcomes of Scleral Buckle Encircling for the Retinal Detachment of Retinopathy of Prematurity

PURPOSE: To investigate the clinical outcomes of scleral buckle encircling surgery for the retinal detachment of retinopathy of prematurity (ROP). METHODS: The medical records of the patients who had undergone primary scleral buckle encircling for the retinal detachment of ROP (4A, 4B, 5) between January 1989 and March 2002 were retrospectively reviewed. RESULTS: Of the 59 patients (M:F ratio= 32:27, 83 eyes), the mean gestational age, birth weight, and follow-up period were 29.2 weeks, 1244gm, and 52.8 months respectively. Just before scleral buckle encircling surgery there were 48 eyes of stage 4A, 19 of stage 4B, and 16 of stage 5. Attachment of posterior pole retina was achieved in 66.7%, 63.2%, and 25% of eyes, respectively. Final best corrected visual acuity in eyes with attached posterior pole retina was generally poor, and the rate of vision over 20/1000 was 30.3% (10/33) in the verbal group and the rate of vision with moderate fix and follow was 75% (9/12) in the nonverbal group. The mean induced anisometropia after scleral buckle encircling surgery was -12.1 D. The mean reduced myopia after removal of scleral buckling material was 3.4 D. CONCLUSIONS: An anatomic success after scleral buckle encircling surgery in infant with retinal detachment of ROP was fairly achieved, but the final results depended on the extent of retinal detachment. Although the retina was attached after surgery, a severe degree of myopia developed and resulted in low vision. Therefore once retinal detachment develops in infants with ROP, early surgery is required. Furthermore, to maximize the vision, efforts for correcting refractive errors should be made intensively.

Evaluation of encircling scleral buckling surgery in rhegmatogenous retinal detachment with vitrectomy / 中华眼底病杂志

Objective To evaluate the therapeutic effect of encircling scleral buckling surgery in rhegmatogenous retinal detachement (RRD) with vitrectomy. Methods The records of a series of 118 consecutive patients with RRD undergone encircling scleral buckling surgery and vitrectomy between 1995 1999 were reviewed. All of the patients underwent an onece vitrectomy, and they consisted of with encircling scleral buckling group and without encircling scleral buckling group. The difference of rate of retinal reattachment, and the relationship between the reattachment rate and the grade of PVR, position of retinal tear and the different intraocular tamponade substitute in both groups were analysed and compared. The average follow up period was 6.5 mons (1.5 mons 3 ys). Results The rate of retinal reattachment in this series of 118 cases was 81 4% (96/118) in which the encircling scleral buckling group accounted for 44 7% and the group without encircling scleral buckling accounted for 55.3%. There was no statistical difference of rate of retinal reattachment between both groups with PVR C, different intraocular tamponade and various positions of retinal tears, while the rate of retinal reattachment in cases of PVR D and retinal tears posterior to equator in group without encircling scleral buckling was significanthy higher than that in encircling scleral buckling group ( P

Scleral Encircling for Complex Types of Rhegmatogenous Retinal Detachment

We performed treat the 41 eyes of rhegmatogenous retinal detachment to scleral encircling.The causes of retinal detachment were unidentifiable breaks (10 eyes), high myopia (8 eyes), pseudophakia or aphakia (8 eyes), giant tear (8 eyes)and multiple holes (7 eyes). Overall the reattachment ratewas 80.5% (33/41 eyes). The anatomic success rate was relatively high (85.7%)in eyes with giant tear, high myopia and multiple hole but relatively low in eyes with breaks unidentified (60%) or pseudophakic and aphakic retinal detachment (75%). Among those 33 eyes, functional success was achived in 27 eyes (81.8%). We achieved higher functional success rate in pseudophakia or aphakia, multiple hole and high myopia (over 83.3%) but low functional success rate in unidentifiable breaks (66.7%)and giant tear (71.4%). Our results suggest other treatments such as pars plana vitrectomy should be considered to treat eyes with retinal detachment of breaks unidentified, although scleral encircling has been used conventially.

Axial Length Change after Encircling Scleral Buckling Procedures

Pars plana vitrectomy with encircling scleral buckling was performed for 30 eyes of 30 patients with complicated retinal disorders, and the changes of axial length, refractive power, and corneal curvature were analyzed. Significant axial length elongations were observed after encircling procedures. Mean elongation was 0.93+/-0.48mm after 3 months and 0.91+/-0.54mm after 6 months. These spherical equivalent of refraction showed myopic shift of -2.26+/-1.51 diopters(D) after 3 months and -2.19+/-1.39D after 6 months. These changes seem to be less prominent in the eyes with preoperative axial length of 24.50mm or longer(0.68+/-0.46mm after 3 months, 0.60+/-0.49mm after 6 months) than in the eyes with axial length of 24.49mm or shorter(1.18+/-0.35mm 1.23+/-0.38mm). Slight increase in astigmatism was observed, 0.80+/-1.35D after 3 months and 0.64+/-1.01D after 6 months. The mean keratometric readings showed no significant changes, 0.00+/-0.95D after 3 months and 0.26+/-0.95D after 6 months. The result of this study may give an important information when combined procedure of encircling scleral buckling and IOL implantation be planned.

Effect of Encircling Silicone Sponge for Retinal Detachment

120 eyes of 119 patients with retinal detachment were treated with an encircling silicone sponge scleral buckling in the department of Ophthalmolgy, Severance Hospital, Yonsei University Medical Center from September 1, 1988, to January 31, 1991. Results were as follow 107 eyes among 120 eyes (89.2%) showed anatomical success, and 54 eyes of them (45%) showed functional success. As the preoperative factors, the case of over 20/70 vision (100%, p>0.05, 100%, p0.05, 57%, p0.05,61%, p0.05, 54%, p<0.05) showed favorable anatomical and functional success rate. The presence and degree of the proliferative vitreoretinaopathy affected the anatomical and functional success rate, but the age of patients did not affect the success of surgery.

Pefractive Changes After Encircling Scleral Buckling Surgery

Sixty rhegmatogenous retinal detachment patients who had received retinal detachment surgery by same surgeon at Yongdong Severance Hospital from Feb. 1990 to Feb. 1991 were evaluated prospectively to detect the refractive changes after operation. The authors studied the postoperative retinoscopic findings 3 months after retinal detachment surgery, and compared with preoperative refractive errors. The results were as follows; 1. The encircling scleral buckling with 3mm silicone sponge increased an average induced myopia of -1.63 diopter. 2. The segmental buckling increased an average induced myopia of -0.50 diopter. 3. The combined operation of encircling buckling and radial buckling increased an average induced myopia of -2.75 diopter. 4. The pneumatic retinopexy with SF6 gas caused never postoperative refractive changes.

Intraocular Pressure After Cataract Extraction in Silicone tube Implanted Glaucomatous eye

The functioning filtering bleb constructed after trabeculectomy in glaucomatous patient might be fail after cataract operation probably due to transient collapse during cataract extraction and inflammatiry reaction of the filtering bleb which result in unsuccessful intraocular pressure control. To compare if the results were identical in cases with the use of encircling band to enlarge the aqueous absorbing scar tissue to trabeculectomy, intraocular pressure was followed for more than 6 months after cataract extraction and posterior chamber lens implantation in 7 eyes that previously underwent silicone tube insertion with the use of encircling band. There were no cases with increased intraocular pressure needed to control postoperatively. Therefore it could be possible to concluded that inflammatory reaction of the filtering bleb or transient collapse during cataract extraction has no negative influences on intraocular pressure in silicone tube implanted eye using encircling band.

Anterior chamber tube shunt to an encircling band in the treatment of glaucoma

We performed a new technique described by Schocket et al. in 6 cases of advanred, uncontrolled glaucoma and 2 cases of neovascular glaucoma. A silicone tube was inserted into the anterior chamber and aqueous was shunted through the tube to a reservoir around the encircling band. After a mean follow up of 103 days, 8 eyes (100 %) had a sucoessful outcome with the intraocular pressure below 20 mm Hg. Thus we recommend this procedure rather than destructive surgery in the treatment of advanced, uncontrolled glaucoma and neovascular glaucoma.