Timing and safety of lung cancer surgery after SARS-CoV-2 infection: A multicenter retrospective study / 中国胸心血管外科临床杂志

@#Objective     To explore the timing and safety of limited-period lung cancer surgery in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods     Clinical data of of patients infected with COVID-19 undergoing lung cancer surgery (an observation group) in the Department of Thoracic Surgery of Guangdong Provincial People's Hospital, the Department of Thoracic Surgery of General Hospital of Southern Theater Command of PLA, and the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Guangdong Pharmaceutical University from December 2022 to January 2023 were retrospectively analyzed and compared with patients who underwent surgery during the same period but were not infected with COVID-19 (a control group), to explore the impact of COVID-19 infection on lung cancer surgery. Results     We finally included 110 patients with 73 patients in the observation group (28 males and 45 females at age of 52.62±12.80 years) and 37 patients in the control group (22 males and 15 females at age of 56.84±11.14 years). The average operation time of the observation group was longer than that of the control group, and the incidence of anhelation was higher than that of the control group (P<0.05). There were no statistcal differences in blood loss, length of hospital stay, moderate or above fever rate, degree of cough and chest pain, or blood routine between the two groups. Conclusion    It is safe and feasible to perform lung cancer surgery early after recovery for COVID-19 patients with lung cancer.

Surgical timing for acute traumatic central cord syndrome / 中华创伤骨科杂志

Objective:To investigate the effects of different surgical time points on the treatment efficacy of acute traumatic central cord syndrome (ATCCS).Methods:Retrospectively analyzed were the 84 ATCCS patients who had been treated at Department of Spinal Surgery, Henan Provincial People's Hospital from January 2013 to February 2021. According to the surgical timing, the patients were divided into 3 groups. In group A (surgery < 48 hours) of 16 cases, there were 11 males and 5 females, aged from 43 to 76 years; in group B (surgery within 3 to 7 days) of 41 cases, there were 31 males and 10 females, aged from 41 to 78 years; in group C (surgery within 8 to 14 days) of 27 cases, there were 15 males and 12 females, aged from 46 to 83 years. Anterior, posterior or combined anterior and posterior approaches were used according to their specific condition. The American Spinal Injury Association (ASIA) motor scores and Japanese Orthopaedic Association (JOA) scores at admission, 7 days and 12 months after operation, postoperative ICU duration, and complications were compared among the 3 groups.Results:There were no significant differences in the preoperative general information or surgical approaches among the 3 groups, showing they were comparable ( P> 0.05). In all patients, the ASIA motor scores and JOA scores at 7 days and 12 months after operation were significantly better than those at admission, and the ASIA motor scores and JOA scores at 12 months after operation were significantly better than those at 7 days after operation ( P<0.01). There was no significant difference in the ASIA motor score or JOA score between the 3 groups at 7 days or 12 months after operation ( P>0.05). The postoperative ICU duration in group A was 42 (26, 61) h, significantly longer than 23 (16, 35) h in group B and 24 (14, 38) h in group C ( P<0.05). There were no deaths in the 84 patients; there was no significant difference in the overall incidence of serious complications or in that of general complications among the 3 groups ( P>0.05). Conclusions:Surgery is safe and effective for ATCCS. However, decompression surgery within 2 weeks may achieve better outcomes.

Mortality Rate and Ten Years Survival of Elderly Patients Treated with Total Hip Arthroplasty for Femoral Neck Fractures

@#Introduction: Mortality following traumatic femoral neck fractures in the elderly (age >60 years) is influenced by many factors. Addressing some of them may reduce the mortality rate thus improving patient survival and quality of life. Materials and methods: This study was a retrospective research using data collected from Hospital Sultanah Bahiyah, Kedah between the years 2008-2018. We measured outcomes such as age, gender, hospital stay, default rate, ambulation post-surgery, American Society of Anaesthesiologists score (ASA) and surgical timing in correlation with mortality rate and 10-year survival of elderly patients treated with Total Hip Arthroplasty for femoral neck fractures in this centre. Results: A total of 291 traumatic femoral neck fractures aged above 60 years post total hip arthroplasty performed were included. There was higher number of female (n =233) compared to male (n=53) Estimated 10 years survival from Kaplan Meier was 42.88% (95% CI: 33.15, 52.54). One year mortality rate in our study was found to be 18.9%. The average time to event was 7.1 years (95% CI:33.15, 52.24) with a mean age group of 75. Discussion: Total hip arthroplasty patients not ambulating after surgery had a 4.2 times higher hazard ratio compared to ambulators. Those with pre-existing systemic disease (ASA III and IV) were found to have the highest hazard ratio, almost five times that of healthy patients, after adjusting for confounding factors. Delay of more than seven days to surgery was found to be a significant factor in 10-year survival with a hazard ratio of 3.8, compared to surgery performed earlier. Conclusion: Delay of more than 7 days to surgery in 10 years survival was significant with high hazard ratio. It is a predictor factor for survival in 10 years. A larger sample size with a prospective design is required to confirm our findings regarding “unacceptable surgical timing” for femoral neck fractures in patients above 60 years of age.

A preliminary study on the surgical timing of spinal tuberculosis / 中国骨伤

OBJECTIVE@#To observe the changes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and nerve function in patients with spinal tuberculosis before and after surgery, explore the timing of surgical intervention, and evaluate its influence on surgical safety.@*METHODS@#A retrospective analysis was conducted on 387 patients with spinal tuberculosis who received surgical treatment from March 2012 to March 2017, including 278 males and 109 females, aged 12 to 86 years old with an average of (49.9±19.1) years. There were 64 cases of cervical tuberculosis, 86 cases of thoracic tuberculosis, 76 cases of thoracolumbar tuberculosis and 161 cases of lumbar tuberculosis. There were 297 patients with single segmental involvementand 90 patients with multiple segmental involvement. Among them, 62 cases presented neurological damage, and preoperative spinal cord neurological function depended on ASIA grade, 5 cases of grade A, 8 cases of grade B, 39 cases of grade C, and 10 cases of grade D. According to the duration of preoperative antituberculosis treatment, the patients were divided into group A (256 cases, receiving conventional quadruple antituberculosis treatment for 2-4 weeks before surgery) and group B (131 cases, receiving conventional quadruple antituberculosis treatment for more than 4 weeks before surgery). The two groups were compared in terms of gender, age, preoperative complicated pulmonary tuberculosis, lesion site, lesion scope, surgical approach, drug resistance and other general clinical characteristics. ESR, CRP, visual analogue scale(VAS), Oswestry Disability Index (ODI), Frankel grade and postoperative complications were observed.@*RESULTS@#All 387 patients were followed up for 12 to 36 (18.3±4.5) months. There were no significant differences in gender, age, preoperative pulmonary tuberculosis, lesion site, lesion range, surgical approach, preoperative drug resistance and other characteristics between two groups. A total of 32 patients in two groups did not heal after surgery, with an incidence rate of 8.27%. The VAS and spinal cord dysfunction index of the two groups were significantly improved after surgery (@*CONCLUSION@#After 2-4 weeks of anti tuberculosis treatment before operation, patients with spinal tuberculosis could be operated upon with ESR and CRP in a descending or stable period. In principle, patients with spinal tuberculosis and paraplegia should be treated as soon as possible after active preoperative management of the complication without emergency surgery.

Efficacy of early arthroscopic shoulder treatment of moderate full-thickness tear of the supraspinatus tendon / 中华创伤杂志

Objective:To investigate the clinical effect of early arthroscopic shoulder treatment of moderate full-thickness tear of the supraspinatus tendon.Methods:A retrospective case control study was conducted to analyze the clinical data of 43 patients with moderate full-thickness supraspinatus tendon tear admitted to First Affiliated Hospital of Xi 'an Jiaotong University from January 2018 to June 2020，including 17 males and 26 females，aged from 41 to 68 years［（55.9±8.2）years］. All patients had arthroscopic shoulder supraspinatus tendon suture and acromioplasty，including 22 patients underwent surgery within 1 month after persistent shoulder pain and motion limitation in early group and 21 patients between 1 month and 3 months in late group. The duration of operation and intraoperative blood loss were recorded. The visual analogue scale（VAS），American Shoulder and Elbow Society（ASES）score and Constant-Murley score were assessed before operation and at postoperative 3 weeks，6 weeks，3 months and 6 months. The complications were detected with 6 months after operation. Results:All patients were followed up for 6-7 months［（6.4±0.4）months］. There was no statistical significance in operation duration and intraoperative blood loss between the two groups（ P>0.05）. At 3 weeks，6 weeks，3 months and 6 months after operation，there showed significant decrease of VAS but significant increase of ASES and Constant-Murley scores compared to preoperation（ P<0.05）. At 3 weeks and 6 weeks after operation，the VAS in early group［（4.4±0.9）points，（3.7±0.8）points］was lower than that in late group［（5.5±1.0）points，（4.8±1.1）points］；while the ASES score［（49.1±4.6）points，（56.8±4.1）points］and Constant-Murley score［（54.1±4.8）points，（64.1±4.4）points］in early group were higher than those in late group［ASES score：（45.2±5.4）points，（50.3±5.4）points；Constant-Murley score：（50.5±3.3）points，（58.2±3.9）points］（ P<0.05）. At 3 months and 6 months after operation，the two groups showed no statistical significance in these scores. There were no postoperative complications such as infection or nerve injury in both group within 6 months. Conclusion:For moderate full-thickness tear of the supraspinatus tendon，arthroscopic shoulder surgery performed within 1 month after persistent shoulder pain and motion limitation can achieve better pain relief and faster functional rehabilitation in the short term compared with surgery performed 1-3 months later.

Analysis of the effectiveness and surgical timing for the treatment of lacrimal duct obstruction secondary to chemotherapy by bicanalicular stent intubation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the effectiveness and surgical timing for the treatment of lacrimal duct obstruction secondary to chemotherapy by bicanalicular stent intubation.<p>METHODS:A retrospective analysis was performed on 50 patients of 100 eyes who underwent bicanalicular stent intubation from July 2015 to April 2018 in our hospital, all the patients were suffered from lacrimal duct obstruction secondary to chemotherapy. They were divided into three groups according to the length of time between the date of surgery and the date of first chemotherapy. All patients were followed for at least 12mo post-operation. Ophthalmic physical examinations and lacrimal duct irrigations were recorded.<p>RESULTS: Evaluating the effectiveness 12mo after surgery. The efficiency of group 1, group 2 and group 3 were 83.3%, 61.1%, 30.0%, respectively. With the delay of surgical intervention, the efficiency decreased significantly, and the difference was statistically significant(χ2=18.322, <i>P</i><0.01).<p>CONCLUSION: Early diagnosis and surgical intervention of lacrimal duct obstruction secondary to chemotherapy with 5-FU, S-1 or docetaxel in patients with malignant tumors are of great significance to improve the success rate of surgery.

Research progress in effect of surgical timing on postoperative mortality in elderly patients with hip fracture / 中华创伤杂志

Hip fracture is a common type of fracture in the elderly. Complications such as pulmonary infection, pressure sore, deep vein thrombosis or pulmonary embolism often occurred after hip fracture, which may threaten the lives of patients. At present, surgery is the main measure for hip fracture, including joint replacement and internal fixation. The impact of surgical timing on postoperative mortality is the focus of attention of many scholars. However, there is still no consistent conclusion, and clinicians are often confused. The authors review the definition of surgical timing, the impact of surgical timing on mortality and process improvement in surgical timing in order to better guide clinical practice and provide new ideas for clinical research.

Timing of Hip-fracture Surgery in Elderly Patients: Literature Review and Recommendations / 대한고관절학회지

The incidence of hip fractures is rapidly increasing with an aging population and is now one of the most important health concerns worldwide due to a high mortality rate. The effect of delayed surgery on postoperative outcomes has been widely discussed. Although various treatment guidelines for hip fractures in the elderly exist, most institutions recommend that operations are conducted as soon as possible to help achieve the most favorable outcomes. While opinions differ on the relationship between delayed surgery and postoperative mortality, a strong association between earlier surgery and improvement in postoperative outcomes (e.g., length of hospital stay, bedsore occurrence, return to an independent lifestyle), has been reported. Taken together, performing operations for hip fractures in the elderly within 48 hours of admission appears to be best practice. Importantly, however, existing evidence is based primarily on observational studies which are susceptible to inherent bias. Here, we share the results of a literature search to summarize data that helps inform the most appropriate surgical timing for hip fractures in the elderly and the effects of delayed surgery on postoperative outcome. In addition, we expect to be able to provide a more accurate basis for these correlations through a large-scale randomized controlled trial in the future and to present data supporting recommendations for appropriate surgical timing.

Research progress in effect of surgical timing on postoperative mortality in elderly patients with hip fracture / 中华创伤杂志

Hip fracture is a common type of fracture in the elderly.Complications such as pulmonary infection,pressure sore,deep vein thrombosis or pulmonary embolism often occurred after hip fracture,which may threaten the lives of patients.At present,surgery is the main measure for hip fracture,including joint replacement and internal fixation.The impact of surgical timing on postoperative mortality is the focus of attention of many scholars.However,there is still no consistent conclusion,and clinicians are often confused.The authors review the definition of surgical timing,the impact of surgical timing on mortality and process improvement in surgical timing in order to better guide clinical practice and provide new ideas for clinical research.

Changes of surgical interventions on necrotizing pancreatitis / 中华外科杂志

Objective@#To investigate the changes of surgical invitations on necrotizing pancreatitis in recent 14 years by reviewing single center data.@*Methods@#One thousand and eighty patients with necrotizing pancreatitis who received surgical invitation were involved in the study.All the patients were treated at Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to December 2018. Six hundred and seventy-eight were males and 402 were females. The median (range) age of the study patients was 45 (20-76) years.The etiology of the disease was related to cholelithiasis in 335 cases(31.02%), hyperlipemia in 302 cases(27.96%), alcohol in 226 cases(20.93%), endoscopic retrograde cholangiopancreatography in 28 cases(2.59%), pregnancy in 50 cases(4.63%), idiopathic factors in 72 cases(6.67%) and other causes in 67 cases(6.20%). The patients were divided into two groups according to the time of admission. Group 1 included 1 475 patients that admitted from January 2005 to December 2010, and group 2 included 1 539 patients that admitted from January 2011 to December 2018. The surgical interventions, morbidity and mortality of the two group were compared, and χ2 test was used for the statistical test.@*Results@#Two hundred and sixty-six among the 1 080 cases were treated with drainage procedures because of the pseudocyst.One hundred and seventy-five drainage procedures were performed between January 2005 and December 2018, which account for 11.87%(175/1 475) of all patients of necrotizing pancreatitis; 91 drainage procedures were performed between January 2011 and December 2018, which account for 5.91%(91/1 539) of all patients of necrotizing pancreatitis. Eight hundred and fourteen cases received surgical intervention for infection of necrotizing tissues. Of these cases, 410 cases received percutaneous catheter drainage(PCD) of retroperitoneal fluid or residual infection. Debridement of necrotic tissues was performed on 756 cases. Of these cases, 32 cases received minimal invasive retroperitoneal debridement with/without denotes video assistant, 4 cases received transluminal endoscopic debridement, 21 cases received laparoscopic debridement, and 709 cases received open laparotic debridement.Three hundred and sixty-five cases were admitted to our institute during January 2005 to December 2010, and the other 391 cases were admitted to our institute from January 2011 to December 2018. Of the first period, all debridement were performed with open laparotic procedures. Of the second period, debridement were performed with open laparotic procedures and minimal invasive procedures. The average times of surgical invasion, morbidity of principal local complications and mortality of the two periods were 1.27 and 1.34,28.22%(103/365) and 29.92%(117/346), and 6.03%(23/365) and 6.91%(27/346), respectively.@*Conclusions@#Minimal invasive procedures can be considered for debridement in patients with necrotizing pancreatitis in some selected conditions.The involvements of minimal invasive procedures in treatment of necrotizing pancreatitis don′t decrease the morbidity of principal local complications and mortality in recent years. Rational surgical procedures and appropriate surgical timing are the keys to improve the efficacy of necrotizing pancreatitis.

Study of clinical prognosis in the choice of operation time for calculus incarcerated cholecystitis patients / 国际外科学杂志

Objective To explore the difference between the curative effect and the prognosis under different time of surgery for calculus incarcerated cholecystitis patients.Methods Ninty-three cases of acute cholecystitis caused by stone inlay in the neck of the gallbladder patients in Xiaogan First People's Hospital from April 2013 to April 2015 were divided into group A and group B according to the duration.Group A:the course of disease was within 72 hours(n =43).Group B:the course of disease was over 72 hours (n =50).The observation indicators of the two groups included (1)operation condition:operation time,postoperative anal exhaust time,postoperative pain time,intraoperative blood loss and length of hospital stay;(2) conversion to laparotomy situation;(3) the postoperative complications of pulmonary infection,abdominal infection,incision infection,bile leakage.All the patients were followed up by outpatient or telephone,inquiried and recorded patient's health status.The deadline for follow-up was October 2015.The measurement data were expressed by ((x) ± s) and comparison between groups was analyzed by using t test.Count data were analyzed using x2 test.Results (1) The average operation time,postoperative anal exhaust time,postoperative pain time,intraoperative blood loss and hospitalization time of group Awere (56.4±12.7) minutes,(37.8±4.6) hours,(24.2±3.8) hours,(58.3± 14.3) ml,(4.8± 2.9) days respectively,the data of group B were (82.5 ± 15.8) minutes,(76.2 ±7.8) hours,(53.8 ± 7.8) hours,(71.4 ± 16.9) ml,(7.8 ± 2.5) days respectively,the difference between the two groups were statistically significant (all P ＜ 0.05);(2) The conversion rate of laparotomy in group A (4.65％,2/43) was significantly less than group B (18.00％,9/50),and the difference was statistically significant (P ＜ 0.05);(3)The complication rate in group A (4.65％,2/43) was significantly less than group B (16.00％,8/50),and the difference was statistically significant (P ＜ 0.05).Conclusion The prognosis of calculous incarcerated cholecystitis with different surgical time is significantly different,the prognosis of the patients duration within 72 hours surgery prognosis was significantly better than the duration more than 72 hours surgery.

Clopidogrel and surgical timing for senile hip fractures / 中华创伤骨科杂志

Hip fractures,with an increasing morbidity in the elderly patients,pose a serious threat to the health of the aged.At the moment,surgery is the preferred treatment for the vast majority of these patients.Early surgical intervention is strongly recommended by most guidelines and articles.It is still controversial,however,whether surgery should be postponed or performed and whether medication therapy should be withdrawn or continued in some of the elderly patients with hip fracture who are taking anticoagulant or antithrombotic drugs before they are injured.Clopidogrel is one of the anti-platelet drugs commonly used clinically.This article reviews the literature regarding the impact of clopidogrel on surgical timing for hip fractures in the aged,hoping to provide useful clues to the clinical study and practice.

Current concept in surgical timing and prognostic indicators of neonates with congenital diaphragmatic hernia / 中国小儿急救医学

Congenital diaphragmatic hernia( CDH) is a severe birth defect characterized by hernia-tion of abdominal viscera into thoracic cavity caused by a defect of the diaphragm. It presents with a wide range of severity,which mostly depends on degrees of pulmonary hypertension and pulmonary hypoplasia. The neonatal and surgical management of infants with CDH has evolved over years,and the practice of dela-ying surgery until patients achieve clinical stability is widely accepted. However,there is still little consensus on optimal timing of repair for the most severe CDH patients or who requires extracorporeal membrane oxy-genation. Numerous prenatal and postnatal factors may affect the prognosis in neonates with CDH, such as lung to head ratio,liver position,blood gases,echocardiographic indicators,clinical scoring system shortly af-ter birth. Stratifying the CDH infant population into high-and low-risk for mortality may help to develop tar-geted management strategies based on severity,and thus improve outcomes.

Effect of surgical timing of femoral intertrochanteric fractures on 1-year postoperative mortality in elderly / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effect of surgical timing of intertrochanteric fracture on 1-year postoperative mortality in elderly and analyze factors that influence 1-year postoperative mortality.</p><p><b>METHODS</b>A retrospective search had been conducted to analyze 350 patients of intertrochanteric fracture from December 2012 to December 2014. The studied patients were divided into three groups such as the group of <72 h and the group of 72-96 h and the group of >96 h, which depended on the time of injury to surgery. The postoperative mortality was compared among the groups and causes of death in patients were evaluated after surgery. Multiple logistic regression was then used to distinguish independent effects on mortality.</p><p><b>RESULTS</b>The one-year postoperative mortality of three groups(<72h, 72-96 h, >96 h)were significantly different and the rate of death was 1.8%, 8.1%, 10.3%. The one-year postoperative mortality of the group of <72 h was inferior to the group of 72-96 h and >96 h respectively(<0.05). Age, preoperative coexist disease and surgical timing were dependent risk factors to one-year postoperative mortality(<0.05, OR>1).</p><p><b>CONCLUSIONS</b>The early surgery can diminish one year postoperative mortality, the patient who is older and has too many preoperative coexist diseases and is delayed to surgery has higher risk to die in one year after surgery.</p>

Surgical timing for complex bile duct injury / 临床外科杂志

Complicated bile duct injury greatly affects quality of patients' life and even threatens their life safety because it is difficult to be recognized and reconstructed,also with the poor surgical effect.Regarding to the surgical timing of complicated bile duct injury,it still have a big controversy.Here we would discuss the timing of surgeries for bile duct injury.We consider that it should be reconstructed when it is recognized during operation,even converted to laparotomy for laparoscopic surgeries.About postoperative cases,we think that it should be operated to explore damage range and reconstruct for those cases found within 48 hours and without obvious infection.However,reconstruction should be performed after 6 weeks for those found after 48 hours or with biliary duct infection.

Relationship between different surgical methods, hemorrhage position, hemorrhage volume, surgical timing, and treatment outcome of hypertensive intracerebral hemorrhage / 世界急诊医学杂志（英文）

BACKGROUND: The present study aimed to explore the relationship between surgical methods, hemorrhage position, hemorrhage volume, surgical timing and treatment outcome of hypertensive intracerebral hemorrhage (HICH). METHODS: A total of 1310 patients, who had been admitted to six hospitals from January 2004 to January 2008, were divided into six groups according to different surgical methods: craniotomy through bone flap (group A), craniotomy through a small bone window (group B), stereotactic drilling drainage (group C1 and group C2), neuron-endoscopy operation (group D) and external ventricular drainage (group E) in consideration of hemorrhage position, hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods. RESULTS: The effectiveness rate of the methods was 74.12％ for 1310 patients after one-month follow-up. In this series, the disability rate was 44.82％ 3–6 months after the operation. Among the 1310 patients, 241 (18.40％) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours, the mortality rate of group A was significantly lower than that of groups B, C, D, and E (P<0.05). If hematoma volume was 50–80 mL and the operation was performed within 6–12 hours, the mortality rate of groups B and D was lower than that of groups A, C and E (P<0.05). If hematoma volume was 20–50 mL and the operation was performed within 6–24 hours, the mortality rate of group C was lower than that of groups A, B and D (P<0.05). CONCLUSIONS: Craniotomy through a bone flap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.

A study on the timing of liver transplantation and factors influencing prognosis in patients of acute liver failure / 中华普通外科杂志

Objective To explore the optimal timing of liver transplantation for acute liver failure,and analyze relative risk factors affecting patients' prognosis.Methods We retrospectively analyze perioperative clinical data of 50 patients suffering from acute liver failure who underwent liver transplantation between March 2005 and June 2010 in Organ Transplantation Center,the First Affiliated Hospital of Sun Yat-sen University.Patients were divided into survival group and death group.Clinical data before operation were collected and analyzed by univariate and multivariate analysis,respectively.Risk factors influencing the perioperative mortality were selected and were used to direct the operation time.Results There were 50 patients who underwent liver transplantation and 11 cases died during perioperative phase.Five patients died of respiratory infection,three of acute renal failure,one of digestive tract hemorrhage,one of primary allograft failure and one of multiple organ failure.The perioperative,one-year and three-year survival rate were 78％,74％ and 72％ respectively.In the univariate analysis,age,bilirubin level,prothrombin time,creatinine level,grade of encephalopathy and MELD score were found to be significantly different between survival group and death group.The multivariate analysis revealed that age≥65 y,INR ≥3.5,creatinine level ≥ 2.5 mg/dl and MELD score ≥ 40 were independent risk factors affecting survival.Conclusions Liver transplantation is an effective treatment of choice for acute liver failure.Appropriate timing of transplantation helps achieve a high survival rate.

Surgical Timing of Degenerative Mitral Regurgitation: What to Consider

Severe primary mitral regurgitation (MR) is a progressive condition which engenders significant mortality and morbidity if left untreated. The optimal timing of surgery in patients with MR of degenerative origin continues to be debated, especially for those who are asymptomatic. Apart from symptoms, current authoritative guidelines recommend intervention when there is incipient left ventricular dysfunction, pulmonary hypertension or new onset atrial fibrillation. This review focuses on the asymptomatic subject with severe MR, and examines contemporary clinical decision-making and management strategies, including the 2012 European guidelines on valvular heart disease. We discuss the rationale for risk stratifying the asymptomatic individual, and highlight current and novel diagnostic tools that may have a useful role, with an emphasis on echocardiographic imaging.

Surgical Results of Anterior Proliferative Vitreoretinopathy

Proliferative vitreoretinopathy is the principal cause of failure in rhegmatogenous retinal detachment surgery. The final cause of anatomic failure is anterior proliferative vitreoretinopathy. Surgical outcome of anterior proliferative vitreoretinopathy is poorer than that of posterior proliferative vitreoretinopathy. Of 147 cases which underwent vitreoretinal surgery from January through December 1993, 16 eyes(l6 patients) had anterior proliferative vitreoretinopathy. Seven eyes had anterior proliferative vitreoretinopathy at initial surgery(group 1). Remaining 9 eyes developed anterior proliferative vitreoretinopathy after primary vitrectomy(group 2). Of 16 eyes, 3 were aphakic, 2 were pseudophakic, and remaining 11 were phakic. Lens was removed in 11 phakic eyes. Meticulous vitreous base dissection and removal of anterior epiretinal membrane were performed. After minimal follow-up of 6 months, retina reattached in 11 eyes(69%) including all nine eyes of group 2. Nine eyes(56%) had postoperative visual acuity of 0.025 or better. These results suggest that both vitreous base dissection and meticulous removal of anterior and posterior epiretinal membrane should be crucial in improving surgical success rate of anterior proliferative vitreoretinopathy.

Outcome of Poor Grade Subarachnoid Hemorrhage Patients:Relationship to Timing of Surgery

In order to define the hospital course and the best surgical timing for the poor grade subarachnoid hemorrhage(SAH) patients, 131 patients(from 1989 to 1991) whose clinical grade on admission were Hunt and Hess grade III to V were analyzed. Their admission grades was III(90 patients), IV(30 patients), and V(11 patients). Patients were grouped into the early surgery group(within 3 days of the last hemorrhage), the intermediate group(4 to 14 days), the late surgery group(14 days after the last hemorrhage), and non-surgical group. Early surgery was performed on 17 patients, intermediate on 31 patients, and late on 54 paients. Twenty-nine patients did not undergo surgery. This non-surgical group had a high mortality rate(72.4%). During the waiting period for a delayed surgery(later than 3 days), 21% improved their clinical state, 53.5% were stationary and 25.5% became worse. Morbidity and mortality were compated among these three surgical groups and the non-surgical group, with sratistical analysis using chi square test and Fisher's exact test. No statistical differences were noted between the management groups in terms of associated disease, location of aneurysms, Fisher's grade, occurrence of hydrocephalus or symptomatic vasospasm. The mortality rate was significantly lower in the combined surgical groups than in the non-surgical group(p<0.05). Mortality was related to the timing of surgery. It was higher after early surgery than in the other two gorups, but it was not different between the intermediate and late surgery groups. Morbidity was not different among the three surgery groups. The major cause of morbidity and mortality in the early surgery group was brain swelling, while rebleeding, hydrocephalus, and vasospasm, were the main causes in the intermediate and delayed surgery groups. It is concluded that it is not recommended that early surgery must be done in all the poor grade SAH patients. However three days after the last hemorrhage, it is better to perform surgery as soon as possible, because there were no statistically significant differences between the intermediate group and the late surgery groups in the mortality and the morbidity rates.