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Objective To investigate the timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute pyogenic cholecystitis in the advanced age.Methods The clinical data for 56 advanced age patients with acute pyogenic cholecystitis in the Department of Hepatobiliary Surgery,the 900th Hospital of the Joint Logistics Support Force of People's Liberation Army from January 2018 to February 2019 were retrospectively analyzed.There were 31 males and 25 females,aged from 70 to 86 years,with average age was (75.52±3.57) years.According to the percutaneous transhepatic gallbladder drainage(PTGD) after laparoscopic cholecystectomy(LC) time interval,all patients were divided into three groups.Patients in the group A(n =12),B (n =21),and C (n =23) performed LC were within 2 months,during 2-4 months,and during 4-6 months,retrospectively.Observation indicators:(1) Surgical situations.The operation and postoperative basic condition of the three groups were compared.(2) Follow-up situations.Patients were followed-up by outpatient examination or telephone interview to detect the postoperative complication in the postoperative three months up to June 2019.Measurement data with normal distribution were represented as (Mean ± SD),and comparison multiple groups was done using single factor analysis of variance (AVONA test),and comparison between groups was done using the t test,and comparison of multiple groups in pairs was done using the SNK-q test,and hierarchical data were analyzed using Kruskal-wallis H test.Count data were analyzed using the chi-square test or Fisher exact probability.Results (1) Surgical situations:the thickness of gallbladder wall before LC,the rates of converting to laparotomy,the volume of intraoperative blood loss,the operation duration,and the duration of postoperative hospital stay were (0.57±:0.04) cm,50.0％,(95.83 ±11.45) ml,(107.50±21.90) min,(5.67±3.40) d in the group A,and (0.43 ±0.03) cm,9.5％,(69.52±24.59) ml,(71.43 ±12.16) min,(3.76±2.61) d in the group B,and (0.43 ± 0.05) cm,39.1％,(68.64 ±21.89) ml,(77.95 ±12.88) min,(5.05 ±2.95) d in the group C,respectively,showing significant differences in the above indicators between the three groups (P ＜ 0.05).The thickness of gallbladder wall before LC,the volume of intraoperative blood loss,the operation duration,those in group A were higher than the group B and C (P ＜0.05),and with no statistically significant different between the group B and C (P ＞ 0.05).The rates of converting to laparotomy,the duration of postoperative hospital stay in group B were better than the group A and C (P ＜ 0.05),and with no statistically significant different between the group A and C (P ＞0.05).The thickness of gallbladder wall before LC,the volume of intraoperative blood loss,the operation duration,and the duration of postoperative hospital stay were (0.43 ± 0.03) cm,(46.67 ± 9.82) ml,(67.69 ± 7.77) min,(2.64 ±0.58) d in the gallbladder wall thickness of successful LC patients,and (0.52±0.04) cm,(123.53 ±17.30) ml,(134.12±25.51) min,(8.47 ±0.80) d in the laparotomy patients,respectively,showing significant differences in the above indicators between the two groups (P ＜ 0.05).(2) Follow-up situations:56 patients were followed up and without perioperative death.No complications occurred after 3 months of follow-up.Conclusion Elective surgery that is performed in 2-4 months after PTGD for patients with acute pyogenic cholecystitis in the advanced age can reduce the volume of intraoperative blood loss and the rates of converting to laparotomy,shorten the operation duration and the duration of postoperative hospital stay,which is beneficial to the recovery of patients.
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Objective@#To investigate the timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute pyogenic cholecystitis in the advanced age.@*Methods@#The clinical data for 56 advanced age patients with acute pyogenic cholecystitis in the Department of Hepatobiliary Surgery, the 900th Hospital of the Joint Logistics Support Force of People′s Liberation Army from January 2018 to February 2019 were retrospectively analyzed. There were 31 males and 25 females, aged from 70 to 86 years, with average age was (75.52±3.57) years. According to the percutaneous transhepatic gallbladder drainage(PTGD) after laparoscopic cholecystectomy(LC) time interval, all patients were divided into three groups. Patients in the group A(n=12), B(n=21), and C (n=23) performed LC were within 2 months, during 2-4 months, and during 4-6 months, retrospectively. Observation indicators: (1) Surgical situations. The operation and postoperative basic condition of the three groups were compared. (2) Follow-up situations. Patients were followed-up by outpatient examination or telephone interview to detect the postoperative complication in the postoperative three months up to June 2019. Measurement data with normal distribution were represented as (Mean±SD), and comparison multiple groups was done using single factor analysis of variance (AVONA test) , and comparison between groups was done using the t test, and comparison of multiple groups in pairs was done using the SNK-q test, and hierarchical data were analyzed using Kruskal-wallis H test. Count data were analyzed using the chi-square test or Fisher exact probability.@*Results@#(1) Surgical situations: the thickness of gallbladder wall before LC, the rates of converting to laparotomy, the volume of intraoperative blood loss, the operation duration, and the duration of postoperative hospital stay were (0.57±0.04) cm, 50.0%, (95.83±11.45) ml, (107.50±21.90) min, (5.67±3.40) d in the group A, and (0.43±0.03) cm, 9.5%, (69.52±24.59) ml, (71.43±12.16) min, (3.76±2.61) d in the group B, and (0.43±0.05) cm, 39.1%, (68.64±21.89) ml, (77.95±12.88) min, (5.05±2.95) d in the group C, respectively, showing significant differences in the above indicators between the three groups (P<0.05). The thickness of gallbladder wall before LC, the volume of intraoperative blood loss, the operation duration, those in group A were higher than the group B and C (P<0.05), and with no statistically significant different between the group B and C (P>0.05). The rates of converting to laparotomy, the duration of postoperative hospital stay in group B were better than the group A and C (P<0.05), and with no statistically significant different between the group A and C (P>0.05). The thickness of gallbladder wall before LC, the volume of intraoperative blood loss, the operation duration, and the duration of postoperative hospital stay were (0.43±0.03) cm, (46.67±9.82) ml, (67.69±7.77) min, (2.64±0.58) d in the gallbladder wall thickness of successful LC patients, and (0.52±0.04) cm, (123.53±17.30) ml, (134.12±25.51) min, (8.47±0.80) d in the laparotomy patients, respectively, showing significant differences in the above indicators between the two groups (P<0.05). (2) Follow-up situations: 56 patients were followed up and without perioperative death. No complications occurred after 3 months of follow-up.@*Conclusion@#Elective surgery that is performed in 2-4 months after PTGD for patients with acute pyogenic cholecystitis in the advanced age can reduce the volume of intraoperative blood loss and the rates of converting to laparotomy, shorten the operation duration and the duration of postoperative hospital stay, which is beneficial to the recovery of patients.
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Objective To evaluate the effect of transnasal optic nerve decompression for traumatic optic neuropathy in different surgery time. Methods The databases of the Cochrane library, Embase, PubMed, Wanfang Database, China Journal Full-text Database (CNKI), Weipu Database(VIP) were searched for retrospective studies and clinical controlled trials. The search words included traumatic optic neuropathy, TON, eye traumas, transnasal endoscopicoptic decompression, TEOND, decompression of optic canal and endoscopy. According to the inclusion and exclusion criteria, the data were extracted. The RevMan 5.3 was used to analyze the data. Results All of 1 087 studies were detected. Sixteen eligible studies were enrolled, including 803 eyes. Meta analysis showed that the recovery degree of visual acuity, curative effect in operation group within 7 d of trauma was obviously superior to the operation group 7 d after trauma (OR=2.78;95%CI:2.02-3.82;P<0.01). Conclusions Transnasal endoscopic optic nerve decompression in treatment of traumatic optic neuropathy should be operated as soon as possible, and it is better to operate within 7 d.
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AIM: To investigate the preoperative binocular visual function of intermittent exotropia and the rebuilding and recovery of the postoperative binocular visual function, and analyze the effect of binocular visual function on orthophoria after surgery. METHODS:From January 2011 to January 2014, 47 basic intermittent exotropia patients caming for treatment were collected in the clinical data. The changes in their near stereopsis, binocular visual function, binocular fusion and distance stereopsis after operations were recorded in the form of data. The preoperative binocular vision and the postoperative rebuilding were analyzed and contrasted with each other. In addition, the effect on the postoperative maintaining of orthophoria due to the existence, recovery and rebuilding of binocular visual function were observed. RESULTS:Intermittent exotropia patients got damage in different levels on their binocular visual functions, especially on distance stereopsis, which was the heaviest and earliest. After the operation, all functions were obviously recovered and reconstructed and the improvements were statistically significant compared against those before the operation (PCONCLUSION: The intermittent exotropia cause damage to the stereopsis which happened the earliest. Obvious recovery and reconstruction of binocular visual function can be observed after the surgery. A relatively good preoperative binocular visual function may lead to the increase in the ratio of orthophoria or cure the intermittent exotropia. Performing an operation when distance stereopsis is damaged can increase the success rate for the surgery and reduce the recurrence rate.
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Bilateral sequential cataract surgery is very common in clinical,but the ophthalmologists often ignore how to choose the timing of operation and whether the first eye can be used to improve the intraocular lens (IOL) power calculation for the second one.Despite the refinements in IOL selection with the use of third-generation IOL formulas,5％ of eyes still result in a postoperative refractive surprise of ± 1.00 D or more.This paper introduced the methods of using refraction error of the first eye to improve the IOL power calculation for the second eye,and the refractive error of the second eye can be improved by modifying the IOL power to correct up to 50％ of the error from the first eye in details.Because of the variation of the postoperative refractive surprise within a month,the interval of three to four weeks between two eyes cataract surgery is highly recommended.These conclusions may provide the advantageous guidance for us in the selection of IOL in bilateral cataract surgery.
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Objective To investigate the management and timing of operation in obstructive acute biliary pancreatifis.Methods A etrospective review was performed of seventy-six consecutive patients who presented to a single tertiary care institution from 2000 to 2010 with obstructive acute biliary pancreatitis.Results Of the seventy-six patients,thirty-six patients underwent operations,with early(after onset within 2 weeks)operations in twenty cases,delayed operationsin sixteen cases and one case dead,no one experienced recurrent pancreatitis during follow-up.Fifteen patients were treated by endoscopy,ERCP/EST in eleven cases,ERCP/ENBD in one case and ERCP only in three case.All patients were cured,only one patient experienced recurrent pancreatitis.Twenty-five patients received conservative treatment,one patient died,six patients experienced recurrent panereatitis.Conclusions Surgery is essential in the management of acute biliary pancreatitis.In cases of obstructive acute biliary pancreatitis,early operation or endoscopic therapy should be performed to remove biliopancreatic obstruction after aggressive conservative treatment.
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PURPOSE: In order to determine the differences in speech outcome based on timing of operation in submucous cleft palate, we have reviewed our experiences in the Furlow palatoplasty over the last 11 years. METHODS: From March 1996 to March 2006, 38 submucous cleft palate patients received Furlow palatoplasty. 10 developmentally delayed patients were excluded and 5 patients were lost to follow up. The rest 23 patients were reviewed. Speech was evaluated preoperatively and postoperatively, and speech therapy was performed accordingly. Perceptual speech assessment included hypernasality, nasal emission and articulation disorder. Cinefluorography was performed to aid perceptual assessment. Based on timing of operation, the patients were divided into 3 groups as following: Group A under 24 months(8 patients), Group B from 25 to 48 months(6 patients), and Group C over 49 months (9 patients). Except 1 patient under speech therapy yet, resultant speech was compared. RESULTS: The rate of abnormal speech was higher in Group C(3/9, 33.3%) than in Group A(0%) or B(0%). All 3 patients who had been discontinued of speech therapy from the parent's judgment had abnormal speech. The reason for the discontinuation was that the regular speech therapy was a burden at school age. Any patients who had continued speech therapy had normal speech. CONCLUSION: The results of our study shows that operative timing is associated with speech development. Maintenance of speech therapy was an important factor for normal speech development. It will be helpful to perform a palatoplasty before 48 months of age to complete speech therapy before the school age.
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Humans , Articulation Disorders , Cineradiography , Cleft Palate , Judgment , Lost to Follow-Up , Speech TherapyABSTRACT
BACKGROUND: Though surgery plays an important role in the management of patients with Mycobacterium tuberculosis infection, there is little information regarding the timing of resection. We tried to f ind out the ideal timing of operation. METHOD: A retrospective review was performed in 69 patients underwent pulmonary resection for pulmonary tuberculosis between January 1993 and December 1997. They were categorized into various groups according to the length of preoperative specific drug therapy. The rates of treatment failure, realpse and complication in each group were compared statistically by x2-test. RESULTS: Eighty one point two percent were men and 18.8% women with a median age of 33 years(range, 16 to 63 years). The mean number of resistant drugs was 3.1(range, 0 to 9). Patients were treated properatively with multidrug regimens, which mean number of preoperative specific drugs was 4.6, in an effort to reduce the mycobacterial burden with the mean length of preoperative drug therapy, 5.0 months. Postoperative treatment was conducted for a mean period of 13.0 months with a mean number of postoperative specific drugs, 4.4. Postoperative treatment failures were confirmed in 8 among 69 patients(11.6%). 2 of these 8 patients were showed up in the preoperative 3 to 4 months medication group and each of the rest was occurred in the preoperative 2 to 3, 5 to 6, 6 to 7, 12 to 13, 17 to 18 months, less than one month medication group, respectively. 59 of 69 patients were available for evaluation of the relapse rate with the mean duration of the postoperative follow-up, 19.8 months. In 4 patients bacterial relapse was confirmed(6.8%). Each of these 4 was in the preoperative 1 to 2, 2 to 3, 3 to 4, 5 to 6 months medication group, Categorized into various groups according to the length of preoperative specific therapy, there were no statistical significances of the treatment failure rate, relapse rate and complication rate in the groups. There were seven treatment failures of 28 who were AFB culture positive until the time of operation(25%, p<0.01). Categorized the preoperative AFB culture positive group into various groups according to the length of preoperative drug therapy, there were no statistical significances, either. CONCLUSION: We believe that operation plays an important ancillary role in the treatment of pulmonary tuberculosis. Our results indicate that the timing of resection according to the length of preoperative drug therapy may not cause trouble.
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Female , Humans , Male , Drug Therapy , Follow-Up Studies , Mycobacterium tuberculosis , Recurrence , Retrospective Studies , Treatment Failure , Tuberculosis, PulmonaryABSTRACT
This study is a retrospective clinical analysis of two hundred forty-four consecutive cases of acute subdural hematoma which were confirmed by operation during the last five years at the Department of Neurosurgery of the Dong-guk University Hospital. The authors have attempted, through this analysis to identify the factors affecting the outcome of acute subdural hematoma. A favorable outcome occurred in 40%, and an unfavorable outcome in 21% of patients at the time of discharge while a death ocurred in 39% of the cases. We have concluded that initial GCS, pupillary status, systolic arterial blood pressure, FDP vaules, presence or absence of skull fracture. IICP findings on brain CT, hematoma amount, and associated intracranial lesions are all prognostic factors, although the timing of operation did not reflect a significant difference in the outcome, however the sooner the intracranial hematoma lesion is evacuated, the better the outcome will be.
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Humans , Arterial Pressure , Brain , Hematoma , Hematoma, Subdural, Acute , Neurosurgery , Retrospective Studies , Skull FracturesABSTRACT
A prospective analysis of 80 consecutive operated cases of aneurysm were carried out to know the prognostic factors in intracranial aneurysmal surgery. Analysis of end-results with respect to aneurysmal locations and timing of operation showed that the internal carotid artery aneurysm did not make difference in outcome regardless of the timing of surgical intervention, but anterior cerebral artery, middle cerebral artery, and multiple aneurysm were more poor outcomes in the early surgical group(p<0.05). The more grave initial neurological state showed the worse surgical end-results. The poor results were shown in cases of above 3 mm in thickness of the basal cisternal hemorrhage and/or above 30 ml in volume of the intracerebral hematoma on the brain CT scan. During the operation, no sunkened brain, a spasm of offending artery, premature rupture of aneurysm, and post-operative residual intracerebral hematoma were also adverse effects to the post-operative outcomes.
Subject(s)
Aneurysm , Anterior Cerebral Artery , Arteries , Brain , Carotid Artery, Internal , Hematoma , Hemorrhage , Intracranial Aneurysm , Middle Cerebral Artery , Prospective Studies , Rupture , Spasm , Tomography, X-Ray ComputedABSTRACT
To evaluate the risk of definitive intracranial microsurgical aneurysm obliteration as a function of the timing of the operative intervention, we retrospectively reviewed 167 consecutive patients in the department of Neurosurgery of Busan Paik's Hospital, Inje medical college, from January 1980 to December 1983. The patients who were operated upon within the first 3 days of their most recent subarachnoid hemorrhage formed the early group;the patients operated upon after the 3 days were considered to have undergone the late surgery. On the base of their clinical outcome the patients were allocated to one of five outcome categories(excellent, good, fair, poor, death) both at the time of their hospital discharge and at their most recent clinical revaluation. The 83% favorable outcome estimated from early operation and 72% from late operation. The mortality was estimated 5% from early operation and estimated 11% from late operation. The optimal timing of surgery for ruptured intracranial aneurysms is currently unknown, but early operation is an effective and reliable method to reduce the occurrence of rebleeding, vasospasm, ischemic complication and medical complication etc. Recently, there has been a resurgence of interest in early operation and increasing numbers of surgeons have been adopting this modality, but prompt, accuate diagnosis and early referral to specialized centers is the only way in which significant advances in reducing the overall morbidity and mortality for majority of patients can be achieved.