A single-center retrospective study on influence factors on surgical methods in DCIS patients / 中华内分泌外科杂志

Objective To evaluate the influence factors on surgical methods in DCIS (Ductal carcinoma in situ) patients,and the prognosis of different surgical methods in a 10-year single-center retrospective study.Methods We retrospectively included 1557 DCIS patients who received treatments in our center from Jan.2006 to Nov.2016.T tests,Chi-square analysis and logistic regression analysis were used to analyze influence factors on surgical methods.Kaplan-Meier and Log-rank analysis were used to evaluate recurrence-free survival(RFS) and loco-regional recurrence-free survival (LRRFS) in patients with different surgical methods.Results Of the enrolled 1557 DCIS patients,surgical methods included modified radical mastectomy,simple mastectomy (with or without axillary evaluation) and breast conservation surgery (with or without axillary evaluation).The number of DCIS cases in our center increased (P＜0.001),so did the percentage of DCIS in annual malignant surgery cases (P=-0.026).Significant decrease was found in modified radical mastectomy (P=0.012).More than half of the patients received simple mastectomy after 2010,and more than one fifth of the patients received breast conservation surgery after 2008.About 13.99％ patients who received mastectomy had breast reconstruction.The independent influence factors of refusing breast conservation surgery were age ≥ 50(P＜0.001),medium nuclear grade (P=0.044),tumor size ＞ 15mm (P＜0.001) and spontaneous discharge (P＜0.001).Patients with smaller tumor size (≤ 15mm) and no spontaneous discharge had 4.18-fold and 7.04-fold greater preference for breast conservation surgery,respectively(OR=0.232,P＜0.001;OR=0.144,P＜0.001).There were no significant differences in RFS and LRRFS in patients with different surgical methods.Conclusion The evaluation in trends and influence factors of different surgical methods provides basis on surgical precision medicine in DCIS patients.

Steady spreading the performance of deep anterior lamellar keratoplasty in China / 中华实验眼科杂志

Keratoplasty is the main method for visual restoration once disease has affected corneal clarity.Because of its favorable surgical outcomes,deep anterior lamellar keratoplasty (DALK) has obtained popularity in ophthalmologist.It is of great importance to steadily spread the performance of DALK in China,which is otherwise prevented due to its high skill requirement and long learning curve.Therefore,this assessment reviewed the significance of spreading DALK in China,and discussed the indications,the learning curve and clinical research of DALK.

Manuseio da hipertensão em cirurgia e outros procedimentos / Management of hypertension in surgery and other procedures

A hipertensão arterial é uma condição clínica frequente no pré-, intra- e pós-operatório imediato ou no curso de procedimentos diagnósticos e terapêuticos. Elevações pressóricas no pós-operatório podem estar relacionadas com dor, hipóxia, hipercapnia e estresses físicos ou emocionais. Essas causas devem ser primariamente abordadas antes de se utilizar fármacos anti-hipertensivos. Quando o tratamento é necessário, a terapêutica deve ser individualizada, precedida por uma avaliação perioperatória. O objetivo é estabelecer o risco intrínseco associado ao tipo de procedimento. Os principais preditores da hipertensão perioperatória são história prévia de hipertensão, principalmente pressão arterial diastólica maior que 110 mmHg, e o tipo de cirurgia. O tratamento em longo prazo tende a restabelecer a reatividade vascular, a autorregulação da circulação encefálica, além de melhorar estabilidade hemodinâmica. Elevações pressóricas agudas (> 20%) no intraoperatório são tipicamente consideradas emergências hipertensivas e estão relacionadas com o aumento da atividade simpática e da resistência vascular periférica. Hipertensão no período pós-operatório (arbitrariamente defi nida como pressão arterial sistólica ≥ 190 mmHg e/ou diastólica ≥ 100 mmHg em duas medidas consecutivas) pode ter consequências adversas em cirurgias cardíacas ou não cardíacas. Urgências hipertensivas são comuns na prática clínica de cirurgiões e anestesistas, com aumento do risco de complicações no perioperatório de cirurgias gerais, enquanto as emergências hipertensivas são mais frequentes em cirurgias cardíacas e neurológicas. No entanto, o tratamento da hipertensão crônica é a melhor estratégia para reduzir a incidência dessas condições clínicas. Esta revisão abordou o conceito, incidência, fi siopatologia, diagnóstico clínico, agentes farmacológicos e as estratégias terapêuticas habitualmente utilizadas no manejo da hipertensão em cirurgia e outros procedimentos.

Arterial hypertension is a common clinical condition in the preoperative, intraoperative and immediate postoperative period, or in the course of diagnostic or therapeutic procedures. Elevated postoperative readings can be related to pain, hypoxia and hypercapnia, and physical or emotional stress. These causes should be primarily managed rather than treating the elevated blood pressure with antihypertensives. When treatment is necessary, therapy should be carefully individualized, preceded by a perioperative evaluation. The goal is to establish the intrinsic risk associated with the type of procedure. The main predictors of perioperative hypertension are previous history of hypertension, especially diastolic blood pressure greater than 110 mmHg, and type of surgery. The long-term treatment tends to restore vascular reactivity, self-regulation of brain circulation and improve hemodynamic stability. Acute pressure elevations in blood pressure (> 20%) in the intraoperative period are tipically considered hypertensive emergencies and related to increased sympathetic activity and peripheral vascular resistance. Postoperative hypertension (arbitrarily defi ned as systolic ≥ 190 mm Hg and/or diastolic blood pressure ≥ 100 mmHg on 2 consecutive readings following surgery) may have signifi cant adverse sequelae in both cardiac and noncardiac patients. Hypertensive urgencies are common in clinical practice of surgeons and anesthesists, with increased risk of perioperative complications in general surgery. Hypertensive emergencies are more frequent in cardiac and neurological surgeries. Nevertheless, treatment of chronic hypertension is the best strategy to reduce the incidence of these clinical conditions. This revision described the defi nition, incidence, physiopatology, clinical diagnosis, pharmacological agents and therapeutic strategies commonly used in the management of perioperative hypertension and other procedures.

Vitrectomy and Silicone Oil Tamponade to Prevent Retinal Detachment in Severe Acute Retinal Necrosis Syndrome

PURPOSE: We report the results in two patients received prophylactic surgery to prevent retinal detachment in the severe acute retinal necrosis. CASE SUMMARY: Two patients in whom the presumptive diagnosis of the severe acute retinal necrosis were concomitantly treated with antiviral agents, systemic steroids and anti platelet therapy. We performed vitrectomy and silicone oil tamponade as the prophylactic surgical procedure for retinal detachments. The retinas remained attached in all patients over a follow up periods. CONCLUSIONS: Retinal detachment secondary to acute retinal necrosis has a complex nature and usually results in severe visual loss. A combination of vitrectomy and silicone oil tamponade may be effective prophylaxes against retinal detachment in acute retinal necrosis.

Early Enteral Nutrition after Abdominal Surgery / 中国普外基础与临床杂志

Objective To generally analyze the current situations of clinical research and applications in early enteral nutrition (EEN) after abdominal surgery. Methods The published papers about the current situations of clinical research and applications in EEN after abdominal surgery were reviewed. Results EEN after abdominal surgery seems to be safe and effective, produces a positive nitrogen balance, keeps the integrality of structure and function of the apparatus, protects gut barrier, and reduces or prevents septic complications. Conclusion EEN may be of more benefits and will be one of the best methods of nutrition support after abdominal surgery.

Minimally invasive treatment of lung cancer / 中国癌症杂志

Being one of the main choices for treatment of lung cancer, surgery has developed enormously. Minimally invasive treatment of lung cancer includes video-assisted thoracoscopic surgery(VATS) and Muscle-sparing thoracotomy (MST) which are both feasible and safe for lobectomy, and both with less bleeding, less impairment of pulmonary and heart function, quicker return to full preoperative activities with less pain, fewer complications, and shorter length of stay mhospital than full postero-lateral thoracotomy. Muscle-sparing thoracotomy is simple and safe, providing adequate exposure,satisfying radical resection. So it could be the routine incision in resection of carcinoma and benign tumors in lung. Lacking prospective randomized study data, and with difficulties in dissecting mediastinal lymph nodes, and no difference in postoperative complications, length of stay in hospital, and survival rate, VATS could only be applied to selected patients for ‘easy’ lobectomies; but MST could be used in almost all the cases of lung cancer surgery.

Surgery combined with intraoperative radiotherapy compared with surgery alone for rectal carcinoma / 中国癌症杂志

Purpose:To assess the effect of surgery combined with intraoperative radiotherapy (IORT) in the treatment of rectal carcinoma.Methods:97 patients with rectal carcinoma underwent IORT with 10～30Gy by 9～16MeV elect ro n beam to the tumor bed and local lymphatic regions. Another 122 patients treate d by surgery alone served as control.Results:Surgery combined w ith IORT did not improve the 5-year survival rate and local recurrence rate in the stage Dukes A patients. IORT have increased the 3-year and the 5-year surv ival rates in the stage Dukes B patients to 19.9%?27.2%, decreased their local recurrence rates to 19%?20.2%(P