Aortic valve reconstruction surgery with Ozaki technique: initials results from a single center / Cirugía de reconstrucción de válvula aórtica con técnica de Ozaki: resultados iniciales en un centro de referencia

Abstract Background: Aortic valve (AV) replacement is the gold standard treatment for severe symptomatic AV disease. Recently, AV reconstruction surgery (Ozaki procedure) emerges as a surgical alternative with good results in the medium term. Methods: We retrospectively analyzed 37 patients who underwent AV reconstruction surgery between January 2018 and June 2020 in a national reference center in Lima, Peru. The median age was 62 years, interquartile range (IQR: 42-68). The main indication for surgery was AV stenosis (62.2%), in most cases due to bicuspid valve (19 patients, 51.4%). Twenty-two (59.4%) patients had another pathology with surgical indication associated to AV disease, 8 (21.6%) had dilatation of the ascending aorta with indication for replacement. Results: One in-hospital death occurred (1/38, 2.7%) due to perioperative myocardial infarction. There was a significant reduction in the medians of the peak (70 mmHg, CI 95% = 50.03-79.86 vs. 14 mmHg, CI 95% = 11.93-17.5, p < 0.0001) and mean (45.5 mmHg CI 95% = 30.6-49.68 vs. 7 mmHg, CI 95% = 5.93-9.6, p < 0.0001) AV gradients when we compared baseline characteristics with first 30-days results. In an average of 19 (± 8.9) months of follow-up, survival, reoperation-free survival for valve dysfunction, and survival free of AV insufficiency ≥ II were 97.3%, 100% and 91.9%, respectively. Significant reduction in the medians of the peak and mean AV gradients was maintained. Conclusions: AV reconstruction surgery showed optimal results in term of mortality, reoperation-free survival, and hemodynamic characteristics of the neo-AV.

Resumen Introducción: El reemplazo de la válvula aórtica es el tratamiento de elección para la valvulopatía aórtica severa sintomática. Recientemente, la cirugía de reconstrucción valvular aórtica (procedimiento de Ozaki) emerge como una alternativa quirúrgica con buenos resultados a mediano plazo. Métodos: Analizamos retrospectivamente 37 pacientes intervenidos de reconstrucción de válvula aórtica entre enero de 2018 y junio de 2020 en un centro de referencia nacional en Lima, Perú. La mediana de edad fue de 62 años (rango intercuartílico: 42-68). La estenosis de la válvula fue la principal indicación de cirugía (62.2%), en la mayoría de los casos por válvula bicúspide (19 pacientes, 51.4%). 22 (59.4%) pacientes presentaban otra patología con indicación de cirugía, 8 (21.6%) presentaban dilatación de la aorta ascendente con indicación de reemplazo. Resultados: La mortalidad intrahospitalaria fue de 1/38, 2.7%, por infarto de miocardio perioperatorio. Hubo una reducción significativa en las medianas del gradiente máximo (70 mmHg, IC 95% = 50.03-79.86 vs. 14 mmHg, IC 95% = 11.93-17.5, p < 0.0001) y gradiente medio (45.5 mmHg IC 95% = 30.6-49.68 vs. 7 mmHg, IC 95% = 5.93-9.6, p < 0.0001) de la válvula aórtica cuando comparamos las características basales con los resultados de los primeros 30 días. En una media de 19 (± 8.9) meses de seguimiento la sobrevida fue del 97.3%; la sobrevida libre de reoperación por disfunción valvular, 100% y la sobrevida libre de insuficiencia aórtica ≥ II, 91.9%, respectivamente. Se mantuvo una reducción significativa en las medianas de los gradientes máximo y medio de la válvula aórtica. Conclusiones: La cirugía de reconstrucción de válvula aórtica con pericardio autólogo mostró resultados óptimos en términos de mortalidad, supervivencia libre de reoperación y características hemodinámicas de la neo-válvula.

Plastic and reconstruction surgery for non-healing wound after posterior spinal surgery / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical significance of different plastic surgeries in the treatment of poor healing wound after posterior spinal internal fixation.@*METHODS@#In this study, 16 patients with poor incision healing after posterior spinal internal fixation were retrospectively included, and dif-ferent plastic surgery treatment plans were determined according to the wound characteristics and defect condition. The measures included debridement, vacuum sealing drainage (VSD), and different tissue flaps according to the location and extent of the defect.@*RESULTS@#A total of 16 patients meeting the criteria were included, of whom 3 were treated with debridement combined with VSD and wound suture directly, 6 were treated with debridement combined with Z-flap for wound repair, 1 was treated with bilateral sacrospinous muscle flap for dural defect repair combined with Z-flap for skin wound repair, 1 was treated with lectus dorsi flap for wound repair, 3 were treated with the fourth lumbar artery perforator flap for wound repair. The wound was repaired with local rotating flap in 1 case and gluteus maximus musculocutaneous flap in 1 case. Among the 16 patients, 7 cases were positive for wound culture, including 3 cases of Staphylococcus aureus, 1 case of Pseudomonas aeruginosa, 1 case of Staphylococcus epidermidis, 1 case of Escherichia coli, 1 case of Klebsiella pneumoniae, and the other 9 cases were negative. After surgery, there were 7 patients with different degrees of poor wound healing, including 3 patients undergoing dressing change, 2 patients undergoing secondary debridement and suture, 1 patient undergoing free scalp skin graft, and 1 patient undergoing local effusion suction treatment. All the above 7 patients were discharged from hospital after improvement, and the remaining 9 patients had good first-stage wound hea-ling after surgery. None of the 16 patients underwent internal fixation.@*CONCLUSION@#Multiple factors could lead to poor wound healing after posterior spinal internal fixation. Early intervention, thorough debridement, removal of necrotic/infected tissue, and selection of suitable skin flap for effective wound fil-ling and covering were important means to ensure wound healing after spinal surgery and reduce removal of internal fixation.

Clinical application and effectiveness of patellar tunnel locator in medial patellofemoral ligament reconstruction surgery / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the operability and effectiveness of a self-developed patellar bone canal locator (hereinafter referred to as "locator") in the reconstruction of the medial patellofemoral ligament (MPFL).@*METHODS@#A total of 38 patients with recurrent patellar dislocation who met the selection criteria admitted between January 2022 and December 2022 were randomly divided into study group (the patellar canal was established with a locator during MPFL reconstruction) and control group (no locator was used in MPFL reconstruction), with 19 cases in each group. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, body mass index, disease duration, patella Wiberg classification, constituent ratio of cartilage injury, Caton index, tibia tubercle-trochlear groove, and preoperative Lysholm score, Kujal score, Tegner score, visual analogue scale (VAS) score, and so on. The Lysholm score, Kujal score, Tegner score, and VAS score were used to evaluate knee joint function before operation and at 3 days,1 month, 3 months, and 6 months after operation. The ideal prepatellar cortical thickness and canal length were measured before operation, and the actual prepatellar cortical thickness and canal length after operation were also measured, and D1 (the distance between the ideal entrance and the actual entrance), D2 (the ideal canal length minus the actual canal length), D3 (the ideal prepatellar cortical thickness minus the actual prepatellar cortical thickness) were calculated.@*RESULTS@#Patients in both groups were followed up 6-8 months (mean, 6.7 months). The incision length and intraoperative blood loss in the study group were smaller than those in the control group, but the operation time was longer than that in the control group, the differences were significant ( P<0.05). There was no complication such as incision infection, effusion, and delayed healing in both groups, and no further dislocation occurred during follow-up. One patient in the study group had persistent pain in the anserine area after operation, and the symptoms were relieved after physiotherapy. The VAS score of the two groups increased significantly at 3 days after operation, and gradually decreased with the extension of time; the change trends of Lysholm score, Kujal score, and Tegner score were opposite to VAS score. Except that the Lysholm score and Kujal score of the study group were higher than those of the control group at 3 days after operation, and the VAS score of the study group was lower than that of the control group at 3 days and 1 month after operation, the differences were significant ( P<0.05), there was no significant difference in the scores between the two groups at other time points ( P>0.05). Patellar bone canal evaluation showed that there was no significant difference in preoperative simulated ideal canal length, prepatellar cortical thickness, and postoperative actual canal length between the two groups ( P>0.05). The postoperative actual prepatellar cortical thickness of the study group was significantly smaller than that of the control group ( P<0.05). D1 and D3 in the study group were significantly higher than those in control group ( P<0.05), but there was no significant difference in D2 between the two groups ( P>0.05).@*CONCLUSION@#The locator can improve the accuracy of MPFL reconstruction surgery, reduce the possibility of intraoperative damage to the articular surface of patella and postoperative patellar fractures.

Chronic syndesmosis injury: What can we do? / 国际外科学杂志

Chronic syndesmosis injury is of great difficulty in foot and ankle trauma with a high post-traumtaic arthritis morbidity, deformity and disability rate, which is always caused by a delayed management or improper initial surgical treatment, and need an active intervention. Currently, various of treatment technique for chronic syndesmosis injury has been described, however, the optimal strategy should be determined by patient′s classification, symptoms, activity demands and severity of arthritis to maximally relieve the symptoms, preserve functions and improve the life quality. This article will overview the diagnosis and management of chronic syndesmosis injury in this article.

Clinical value of cephalosporin combined with morinidazole in the prevention of surgical site infection for gastrointestinal fistula / 中华消化外科杂志

Objective:To investigate the clinical value of cephalosporin combined with morinidazole in the prevention of surgical site infection (SSI) for gastrointestinal fistula.Methods:The retrospective cohort study was conducted. The clinicopathological data of 107 patients with gastrointestinal fistula who undergoing selective digestive tract reconstruction surgery in General Hospital of Eastern Theater Command from January to December 2017 were collected. There were 76 males and 31 females, aged from 18 to 79 years, with a median age of 46 years. Of 107 patients, 43 cases receiving cephalosporin for prevention of SSI were allocated into cephalosporin monotherapy group, 64 cases receiving cephalosporin combined with morinidazole were allocated into combination therapy group, respectively. Observation indicators: (1) incidence of SSI; (2) stratification; (3) pathogen culture results of SSI; (4) adverse drug reaction; (5) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect other complications of patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Results:(1) Incidence of SSI: 29 of 107 patients had postoperative SSI, including 15 cases with superficial SSI, 7 cases with deep SSI, and 7 cases with organ/space SSI. There were 18 cases of cephalosporin monotherapy group with SSI, including 7 cases with superficial SSI, 5 cases with deep SSI, and 6 cases with organ/space SSI. The above indicators were 11, 8, 2, 1 of combination therapy group, respectively. There was a significant difference in the overall SSI between the two groups ( χ2=7.925, P<0.05). There was also a significant difference in the organ/space SSI between the two groups ( P<0.05). There was no significant difference in the superficial SSI between the two groups ( χ2=0.305, P>0.05). There was no significant difference in the deep SSI between the two groups ( P>0.05). (2) Stratification: there were 10 cases and 33 cases with type Ⅱ incision and type Ⅲ incision in the 43 cases of cephalosporin monotherapy therapy group, respectively. The above indicators were 11 and 53 in the combination group, respectively. For the type Ⅱ incision, 1 patient of cephalosporin monotherapy group had SSI, and 2 cases of combination therapy group had SSI, showing no significant difference between the two groups ( P>0.05). For the type Ⅲ incision, 17 patient of cephalosporin monotherapy group had SSI, and 9 cases of combina-tion therapy group had SSI, showing a significant difference between the two groups ( χ2=11.499, P<0.05). (3) Pathogen culture results of SSI: of 29 patients with SSI, 21 were positive for bacterial culture, including 12 cases with single bacterial infection, 9 cases with mixed infection of multi-bacteria. A total of 33 strains were cultured. (4) Adverse drug reaction: there was no adverse drug reaction in the 107 patients. (5) Follow-up: 107 patients were followed up for 30 days after surgery. No complication occurred in the 107 patients. Conclusion:Cephalosporin combined with morini-dazole can be used to prevent the SSI for patients with gastrointestinal fistula.

Clinical effect of improved mesh in the treatment of severe pelvic organ prolapse / 中国综合临床

Objective To discuss the clinical effect of improved pelvic floor mesh implantation in the treatment of severe pelvic organ prolapse. Methods From January 2016 to April 2018, eighty-four patients with severe pelvic organ prolapse admitted to Harbin First Hospital were randomly divided into observation group and control group with 42 cases in each group. The control group was treated with traditional pelvic floor reconstruction,which used two meshes to reconstruct front and back of pelvic cavity. 42 cases of the observation group were treated with improved mesh-augmented vaginal reconstructive surgery, which used only one mesh to reconstruct total pelvic reconstruction by changing the location of puncture. The therapeutic effects of the two surgical methods were compared,including general condition of the whole body, perioperative period,operative period and follow-up. Results The amount of blood loss in the observation group were significantly lower than that in the control group((65. 32±20. 39) ml vs. (86. 52±30. 23) ml), and the difference was statistically significant ( t＝ 4. 56, P＜0. 05 ) . The average operation time in the observation group were significantly lower than that in the control group ((40. 35±12. 41) min vs. (57. 83± 17. 54) min),and the difference was statistically significant (t＝6. 56,P＜0. 05). The medical fees in the observation group were significantly lower than that in the control group ((10 600±1 012)yuan vs. (20 200 ±1 123)yuan),and the difference was statistically significant (t＝25. 38,P＜0. 05). After one year follow-up,there were 1 case (2. 4%,1/42) of mesh erosion,2 cases (4. 8%,2/42) of sexual discomfort and 2 cases (4. 8%) of recurrence in the observation group. In the control group,there were 3 cases (7. 1%) of mesh erosion,4 cases (9. 5%) of sexual discomfort and 3 cases ( 7. 1%) of recurrence. The complications caused by mesh in the observation group were significantly lower than those in the control group (2. 4%(1/42) vs.7.1%(3/42),4.8%(2/42) vs.9.5%(4/42)) (χ2 ＝3.98,3.46,P＜0.05).There was no significant difference in the time of catheter placement,the time of exhaust after operation and the recurrence rate between the two groups (t＝0. 08,0. 48,0. 05,P＞0. 05). Conclusion The improved mesh-augmented vaginal reconstructive surgery is an effective minimally invasive surgery,which has small trauma and fewer complications,faster recovery after surgery, can save medical costs, and has broad prospects for clinical application.

Clinical efficacy of pelvic floor reconstruction with autologous tissue in treatment of pelvic organ prolapse / 中华全科医师杂志

One hundred and twenty nine patients with pelvic organ prolapse (stage Ⅲ to Ⅳ according to POP-Q staging) diagnosed in our hospital from January 2010 to December 2016 were enrolled,among whom 66 cases underwent vaginal hysterectomy plus vaginal anterior and posterior wall repair (TO group),63 cases underwent vaginal hysterectomy plus pelvic floor reconstruction with autologous tissue (AT group).Clinical parameters,perioperative and postoperative complications were analyzed.There was no statistically significant difference in intraoperative blood loss,indwelling urethral catheter time,length of hospital stay,and anal exhaust time between group AT and group TO (P＞O.05).The average operation time of group AT was significantly longer than that of group TO (P＜0.05).The postoperative rotation angle of urethra (UR),posterior vesicourethral angle (RVA),and bladder neck descent (BND) of group AT were significantly reduced (P＜0.05).The BND of group AT was significantly smaller than that of group TO 3 months and 12 months after the surgery (P＜0.05).There was no statistically significant difference in UR before and 12 months after surgery in group TO (P＞0.05),while the BND at 12 months after operation in group TO was increased compared to 3 months after operation (P＜0.05).There were significant differences in scores of PFIQ-7 and PISQ-12 before surgery and 12 month after surgery in both groups (P＜0.05).There was no statistically significant difference between the two groups in the incidence of postoperative recurrence and pressure incontinence (P＜0.05).It is suggested that the stability of pelvic floor anatomical structure after pelvic floor reconstruction with autologous tissue is better than that of the traditional surgery,especially for patients with severe pelvic organ prolapse.

Study Of Brachialis Muscle: Additional Slip And Its Clinical Significance

Background: Brachialis is a muscle of anterior compartment of arm. It has two heads. Superficial head insertinginto ulnar tuberosity innervated by musculocutaneous nerve, the deep head inserts into coronoid process ofulna and supplied by radial nerve. Neuromuscular compression due to presence of additional slip of brachialisforms the basis of this study.Materials and methods: Study was done in 60 adult human cadaveric upper limbs of both the sides irrespectiveof sex in the Department of Anatomy, Kempegowda institute of medical sciences (KIMS), Bangalore and othermedical colleges nearby. Presence of additional slips of brachialis with important and interesting relations wasfound which were comparable with previous studies. As qualitative method was done, Descriptive statisticswere utilized.Results: Additional slips were present in 21.6%. It was found mainly in the left upper limbs in 69.2% and rest30.7% are present in right side limbs. Among 13 specimens, additional slips originated mainly from theanteromedial aspect in 84.6% and in 15.3% it originated from the anterolateral aspect of main brachialis.Additional slips were innervated mostly by the musculocutaneous nerve in 69.2%, median nerve in 15.3% andradial nerve in 7.6%. No innervation was observed in one specimen.Conclusion: Knowledge of additional slips and its origin and course is very important for identifying the causefor neurovascular symptoms due to compression of neurovascular structures

Qualitative research on the sex and emotional experience of breast reconstruction after breast surgery / 中国实用护理杂志

Objective To describe the relationship status of breast reconstruction after mammary gland surgery, and to explore the changes of sexual and emotional experience in breast reconstruction. Methods A semi-structured in-depth interview was conducted in 19 patients admitted to Hunan Cancer Hospital from October 2015 to December 2017 for reexamination in the hospital from 2 to 26 months after breast reconstruction. The Giorigi method was used to analyze data in the phenomenological analysis of qualitative research. Data collection, transfer and analysis are conducted simultaneously, and the method and content of the next interview were constantly adjusted with the existing data analysis results. Results The sex and emotional experience of breast reconstruction after breast surgery could be summarized into 5 subjects. The first was cognition of sexual life . The second was sexual psychological change.The third was physiological changes. The forth was the desire for sexual information. The fifth was breast reconstruction surgery brings the emotional fluctuation of both husband and wife. Conclusions Understanding of breast cancer postoperative breast reformer sexual and emotional experience can help medical personnel through effective communication and evaluation, provide targeted health education and consultation, improve recovery quality of life of patients.

The effect of education on the family function of breast reconstruction after breast cancer / 中国实用护理杂志

Objective To evaluate the effect of education on the family function of breast reconstruction after breast cancer. Methods Totally 130 cases of breast reconstruction after breast cancer were selected from January 2015 to August 2017, and 65 cases were divided into observation group and control group by random number table method. The control group received routine education; The observation group and the spouse received synchronous education. In the preoperative and postoperative 3 months, 6 months after the Female Sexual Function Index (FSFI) to assess patients sexual function, the Family Intimacy and Adaptability Scale to assess the patient's family intimacy and adaptability, comparing the indicators of two groups of patients. Results After 6 months of operation, the two groups were compared, and the intervention group was (24.82 ± 3.75) points, and the control group was (22.32±4.75), with statistically significant difference(t=- 3.35, P < 0.05). Comparison of familial closeness and adaptability score of the two groups, the intervention group was (76.80 ± 8.14) points, (59.98 ± 3.56) points; The control group was (68.48 ± 11.46) points, (52.27 ± 9.49) points,with statistically significant difference(t=-4.81,-6.18, P<0.05). Conclusion The simultaneous education can improve the sexual function and familial intimacy and adaptability of breast reconstruction after breast cancer.

A new method for asses sing symmetry of breast / 中华内分泌外科杂志

Objective To compare a novel mirror-overlap method with the traditional manual measurement and the subjective assessment in assessing breast symmetry after oncoplastic surgery.Methods 59 patients with breast cancer who underwent conservation/reconstruction surgery were recruited.The post-operative assessment for breast symmetry was conducted using manual measurement,subjective assessment by the patient,their family member and a nurse,and the mirror-overlap method respectively.The latter method involved using the Photoshop to assess the area differences in breast outlines and shadows created by a flashlight when bilateral images were overlapped in the axis of midline.Results The distance differences between bilateral breasts measured using manual method were negatively correlated with symmetric coefficients in the mirror-overlap method (P＜0.05).There was a positive correlation between the average scores in the subjective assessment and symmetric coefficients of mirror-overlap method (P＜0.05).Conclusion The mirror-overlap method is an easy,feasible and cheap method which collects 3D breast information and provides an effective approach to assess breast symmetry after oncoplastic surgery.

Preventive Effect of Immediate-effect Moxibustion on Joint Stiffness in Patients After Knee Ligament Reconstruction Surgery / 广州中医药大学学报

Objective To observe the clinical efficacy and safety of immediate-effect moxibustion combined with massage for the treatment of knee stiffness after knee ligament reconstruction surgery.Methods A total of 138 patients after knee ligament reconstruction surgery were randomly divided into control group and observation group,69 cases in each group.The control group received joint rehabilitation therapy,which included TDP light radiation,joint exercise by continuous passive motion apparatus,contraction and relaxation of quadriceps femoris muscle and ankle pump.The treatment group was given immediate-effect moxibustion combined with massage based on the treatment for the control group.The treatment lasted from postoperative day 3 to 14.Before and after treatment,Lysholm knee joint scores,joint activity scores and activities of daily living(ADL) scores of the two groups were observed.Results After treatment,the Lysholm knee joint scores,joint activity scores and ADL scores of the two group were obviously increased (P ＜ 0.05 or P ＜ 0.01 compared with those before treatment),and the increase in the observation groups was superior to that in the control group,the differences of the alove indexes except for joint activity scores being statistically significant between the two groups (P ＜ 0.05 or P ＜ 0.01).Conclusion Immediate-effect moxibustion combined with massage is effective on preventing knee from postoperative ankylosis after knee ligament reconstruction surgery.

Surgery Effects in a Cohort of 42 Patients Received Facial SchwannomaResection and Facial Nerve Reconstruction Simultaneously / 听力学及言语疾病杂志

Objective To evaluate the effects of facial nerve reconstruction surgery by reviewing the clinical information and follow-up results of 42 cases.Methods The clinical data of 42 patients who were diagnosed as facial schwannoma and received tumor resection and facial nerve reconstruction simultaneously from January 2004 to December 2015 in our department were studied.The surgeries included anastomosis between the two faical nerves(3 cases), facial nerve transplantation(4 cases), Hypoglossal/masseteric-facial nerve anastomosis(27 cases) and cross-facial nerve graft(8 cases).We evaluated the facial nerve function using H-B grade and Fisch score post-operation (1 week, 3 months,6 months and 1 year after surgery).Results The Fisch scores were significantly different between 1 week and 3 months, 3 months and 6 months post-operation for patients received cross-facial nerve graft.The facial nerve function became better as time went by.While there were no difference between 6 months and 1 year post-operation.On the other hand, the scores were significantly different between 6 months and 1 year post-operation for patients received hypoglossal/masseteric facial nerve anastomosis.Conclusion Most patients received tumor section and facial nerve reconstruction simultaneously could gain good results, it took a long time for the facial nerve function to return to a stable state and some of them were still in recovering 1 year after surgery.

Application of epidural anesthesia combined with propofol sedation performed by targeted concentration infusion in patients undergoing total pelvic floor reconstruction surgery / 重庆医学

Objective To evaluate the feasibility of combining the sedation performed by propofol targeted concentration in-fusion with epidural anesthesia in patients undergoing total pelvic floor reconstruction.Methods A total of 80 eligible patients were recruited and were assigned randomly into the study group(n=40)and the control group(n=40).All patients in both groups were administered epidural anesthesia with the puncture and catheter placing in the space between the 2nd-3rd lumbar vertebras.After the epidural anesthesia,patients in the study group were administered propofol by targeted concentration infusion (TCI)system. The plasma concentration of propofol was modulated to obtain the BIS maintaining between 65-80,and the OAA/S maintaining at 3 scores.The propofol was continuously infused until closing the incision.Values of HR,MAP at different time points in the opera-tion were recorded,and the plasma concentrations of propofol,the incidences of adverse events were recorded.Results The HR and MAP of patients in the study group decreased at T1 (given the anesthetic),T2 (the beginning of the operation),T3 (the beginning of the operation),compared with those at T0 (before the anesthetic)and T4 (30 min after the operation)(P 0.05).BIS of study group was (73.3 ±4.8)-(76.1 ±3.4),and the plasma concentrations of propofol was(1.32 ± 0.29 )μg/mL - (1.52 ± 0.26 )μg/mL.Conclusion The combination of propofol sedation performed by TCI and epidural anesthesia could be safely and effectively used in patients undergoing total pelvic floor reconstruc-tion.

Correction of Caudal Septal Dislocation or Subluxation with Excision and Suturing the Cartilage to the Premaxilla Bone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is difficult to correct anterior nasal septal dislocation and subluxation. This study reviewed our surgical technique for correcting septal dislocation and subluxation. SUBJECTS AND METHOD: This retrospective study reviewed the medical records of 20 patients who underwent septal reconstructive suturing of the cartilage to the premaxilla. Acoustic rhinometry, endoscopic pictures, visual analogue scale (VAS) scores, and patient satisfaction were evaluated. RESULTS: The results of acoustic rhinometry showed that there was significant (p<0.05) improvement in the minimum cross-sectional area on both sides of the nasal cavity. The nasal cavity volume was also increased bilaterally, although not significantly on the convex side (convex side, p=0.108; concave side, p=0.007). Thirteen patients had complete correction of the septal deformity on the endoscopic pictures and seven had incomplete correction. The VAS score for nasal obstruction was decreased significantly (p<0.05). Most patients (85%) felt satisfied with the surgery. Only one patient complained about a mild deformity of the external nose. No other major complications were encountered. CONCLUSION: The correction of caudal septal dislocation or subluxation with the excision of excessive septal cartilage and suturing the cartilage to the premaxilla are both successful methods for treating septal deformities.

Endoscopic intranasal structure reconstruction surgery in treating rhinogenic headache / 局解手术学杂志

Objective To investigate the efficacy of endoscopic intranasal structure reconstruction surgery for rhinogenous headache. Methods 82 cases of rhinogenous headache were given endoscopic intranasal structure reconstruction. Compared VAS scores before and 6 months after treatment, counted the effective rate. Results Among the 82 patients, 69 patients(84. 1%) were cured, 8 cases (9. 8%) were of obvious effect, 5 cases (6. 1%) were invalid, and the total efficiency was 93. 9%. VAS scores of the mucosal contact headache group before treatment were greater than that of the sinus headache group (P0. 05). Conclusion Endoscopic surgical operation can remove the extrusion of the nasal cavity and paranasal sinuses and factors of nasal congestion, and then reconstruct normal anatomical structure of nasal cavity, thus restoring normal function of paranasal sinuses. It has good therapeutic effect on rhinogenic headache.

Clinical analysis on pelvic organ prolapse treated by pelvic floor reconstruction surgery with Prolift system and routine transvaginal surgery / 重庆医学

Objective To investigate the clinical effectiveness of pelvic floor reconstruction surgery with Prolift system and rou‐tine transvaginal surgery in treating pelvic organ prolapse (POP) .Methods We analyzed an retrospective study of 64 patients with POP patients from June 2009 to March 2011 .All patients were divided into two groups ,32 cases of the reconstruction group were treated with pelvic floor reconstruction surgery with Prolift system ,as reconstruction group ,the other 32 cases in routine treatment group with routine transvaginal surgery ,which inclouded transvaginal hysterectomy ,repair of anterior and posterior vaginal wall ,as routine treatment group ,the pre operative ,peri operative data and follow up results were compared between the two groups and to evaluate the outcomes of the two groups after surgery .Results The age ,body mass index ,menopause age ,pregnant times and the degree of uterus prolapse were no significant difference between the two groups (P>0 .05) .The operation of all the patients were successful .No patient were infected after surgery ,no vascular injury ,or urinary system injury ,or rectal injury occurred .Reconstruc‐tion group showed more significant in the amounts of blood loss ,average operation time ,anal exsufflation time ,mean of highest postoperative body temperature ,the urinary canal indwelling time and the postoperative hospitalization time compared with routine treatment group(P0 .05) ,but the objective cure rate at 12 months after operation was significantly different between the two groups (P<0 .05) .The objective curative rate in reconstruction group was significantly higher than that in routine treatment group .Conclusion Pelvic floor reconstruction surgery with Prolift system is a safe and effective methods of minimally invasive surgery ,patients had better regain integrity of anatomical structure and functions of pelvic floor in short term for POP when compared with routine transvaginal sur‐gery ,but its long term study is still needed .

Integração do tendão do músculo semitendíneo na reconstrução do ligamento cruzado anterior: estudo biomecânico, histológico e ressonância magnética em coelhos / The incorporation of the semitendinous tendon autograft at the femoral femoral bone tunnel after anterior cruciate ligament reconstrcuction in rabbits: biomechanical histology and magnetic resonance image analysis

O estudo analisa experimentalmente a integração tendinosa no túnel ósseo femoral na reconstrução do ligamento cruzado anterior do joelho esquerdo com o tendão do músculo semitendíneo autólogo, utilizando imagens de ressonância magnética, teste biomecânico e análise histológica em 15 coelhos da raça Nova Zelândia. Após os períodos de quatro, oito e doze semanas do procedimento cirúrgico, os animais foram submetidos ao exame de ressonância magnética para avaliar o túnel femoral dos joelhos. A seguir os animais foram eutanasiados e os joelhos foram submetidos a testes de tração em uma máquina de ensaios mecânicos Kratos para verificar a integração do enxerto nos túneis e a exame histológico do túnel femoral. A análise dos resultados demonstrou integração mecânica do tendão no túnel femoral a partir da 4ª semana em todos os animais estudados e observou-se na histologia e nas imagens da ressonância magnética alterações do enxerto e da área ao redor de forma heterogênea, sugerindo um processo de cicatrização do tendão-osso, porém não se pode afirmar que ocorria a integração até a 12 semanas.

The purpose was to verify the incorporation (healing) of the graft of the semitendinous tendon into the femoral bone tunnel after an anterior cruciate ligament reconstruction, and verify the post operative evolution of the biomechanical histology and magnetic resonance image analysis of the graft into the femoral bone tunnel. Fifteen New Zealand white rabbits were submitted to an intra-articular anterior cruciate ligament reconstruction in the left knee, using semitendinous tendon autograft. The rabbits were submitted to an magnetic resonance image at 4, 8 and 12 weeks after surgery, after which they were euthanized. The left knee of each rabbit was disarticulated and the anterior cruciate ligament reconstruction was tested for the biomechanical properties and histological analysis of the femoral tunnel. Every rabbit knee showed incorporation of the tendon at the femoral tunnel as of the fourth week in all of the knees studied. After the fourth week signs of integration occurred in the histological analysis and heterogeneous alterations in the magnetic resonance image of the graft and the surrounding areas, which suggests a healing process. Despite the biomechanical incorporation of the graft in the femoral bone tunnel after the fourth week it was not possible to affirm that there occurred incorporation of the graft until the completion of 12 weeks in histological and magnetic resonance image analysis.

Secondary Reconstruction of Mandibular Depression Deformity with Pedicled Latissimus Dorsi Myocutaneous Flap / Oral Science International

When secondary reconstruction is required in the head and neck region where a primary operation was performed before, it is important to select a flap which is not only suitable for the purpose, but also can be transferred more safely. In the present case, a female patient, 33 years old, complained of depression deformity around the left mandibular region. She had undergone segmental mandibulectomy coupled with radical neck dissection because of adenoid cystic carcinoma of the left submandibular gland 12 years ago. The deformity was thought to be mainly due to the deficiency of subdermal soft tissue. The insertion of a denuded and folded pedicled latissimus dorsi myocutaneous flap into the submandibular space satisfactorily restored the depressed mandibular contour. The pedicled latissimus dorsi myocutaneous flap can acquire a bulkiness by being folded, whose atrophy is tolerable for a long period, and is safe for secondary reconstruction.

A Study of Surgical Treatment of Cutaneous Malignant Tumors / 대한피부과학회지

BACKGROUND: The incidence of cutaneous malignant tumors and surgical approaches to treat them by dermatologists have been increasing recently. OBJECTIVE: The purpose of this study was to analyze our experience of removal and reconstruction surgery to treat malignant skin tumors. METHOD: We clinically analyzed 177 cases of cutaneous malignant tumors which had been operated at the department of dermatology, Chonnam University Hospital in Gwangju during the last 5 years between July 1998 and June 2003. RESULTS: 1. The most common cutaneous malignant tumors was basal cell carcinoma (BCC) (62.7%), followed by squamous cell carcinoma (SCC) (15.3%), malignant melanoma (11.9%), Bowen's disease (5.6%), and extramammary Paget's disease (2.8%), respectively. 2. The most common site of all cutaneous malignant tumors was the face (69.2%), followed by lower extremities (10.4%), upper extremities (6.6%), trunk (6.6%), and scalp (4.9%). In each tumor, the face was the most common site for BCC and SCC, lower extremities for malignant melanoma, trunk and lower extremities for Bowen's disease, respectively. 3. The local flap was the most common method to repair surgical defects (51.1%), followed by primary closure (29.1%), and skin graft (19.8%) in general. In terms of tumor types, the most commonly used method was local flap for BCC and SCC, primary closure for Bowen's disease, and skin graft for malignant melanoma, respectively. In terms of location, the most commonly used method was local flap for the face, primary closure for the scalp and trunk, and skin graft for the upper and lower extremities, respectively.