Evolution and focus of parastomal hernia repair / 中华消化外科杂志

Due to the high incidence and postoperative high recurrence rate, parastomal hernia is one of the most difficult ventral hernias for clinical treatment. Currently, there are numerous of surgical options for the treatment of parastomal hernia, including suture repair, stoma relocation, onlay mesh repair through hernia ring, stoma relocation combined with sublay mesh prophylactic and repairing, Sugarbaker technique repair and its modified operation, Keyhole technique repair and its modified operation, Sandwich technique repair and hybrid surgery. However, none of them could achieve a satisfactory efficacy of low recurrence rate and few complications. With the increasing application of enhanced view-totally extraperitoneal technique in ventral hernia, laparoscopic extraperitoneal parastomal hernia repair has been applied and explored in clinical practice. There are contrary results in clinical studies on whether the prophylatic mesh placement can reduce the incidence of parastomal hernia. Hence, the treatment and prevention of parastomal hernia is still a long-term and arduous task in the field of abdominal wall defect repair, which needs to be further explored and verified by more high-quality and meaningful clinical studies.

Surgical treatment of chronic prolonged mandibular dislocation: case report and literature review / 口腔疾病防治

Objective@#To investigate the treatment methods of chronic prolonged mandibular dislocation.@*Methods@#Surgical reduction was performed in a case of temporomandibular joint dislocation over 6 months after manual reduction failure. The flap was removed under general anesthesia, and the bone of the condyle were removed. The articular disc was aligned and incision was sutured, and the procedure was combined with intermaxillary fixation for a correct occlusion and traction. After the operation, the surgical efficacy was observed, and the related literature was reviewed. @*Results@#The patient recovered well after the operation; the mouth opening was 3 cm, and the occlusion was normal. No recurrence was observed after 10 months of follow-up. The literature shows that surgery is a common treatment for temporomandibular joint dislocation after the failure of manual reduction, and postoperative patient education can reduce recurrence and complications. @*Conclusion @#Surgery combined with intermaxillary traction can effectively treat chronic prolonged mandibular dislocation.

Comparison of efficacy and safety of laparoscopic surgery for gallstones and common bile duct stones / 中国基层医药

Objective@#To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones.@*Methods@#Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group(38 cases) underwent laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE), and B group(49 cases) underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). The curative effect of the two groups was observed.The operation time, the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery, and the complications of the two groups were recorded.@*Results@#In A group, the average diameter of common bile duct stones was (1.02±0.25)cm, the average diameter of common bile duct diameter was (1.15±0.25)cm.In B group, the mean diameter of common bile duct stones was (0.99±0.26)cm, and the average diameter of common bile duct was (1.13±0.26) cm.The differences between the two groups were not statistically significant (t=0.513, 0.437, 0.367, P=2.083, 1.533, 1.095). The successful operation rate of A group was 92.11%(35/38), which in B group was 91.84%(45/49), the difference was not statistically significant between the two groups(χ2=0.006, P=0.974). The incidence rate of complications in B group was 20.41%, which was significantly higher than that in A group, the difference was statistically significant(χ2=3.654, P=0.019). The hospitalization time, hospitalization expenses in A group were (10.6±2.6)d, (26 649.8±3 478.6)CNY, respectively, which were significantly better than those in B group (t=21.971, 17.168, all P<0.05).@*Conclusion@#The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery, and the safety of the former is higher than the latter.

Comparison of efficacy and safety of laparoscopic surgery for gallstones and common bile duct stones / 中国基层医药

Objective To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones.Methods Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group (38 cases) underwent laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE),and B group (49 cases) underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC).The curative effect of the two groups was observed.The operation time,the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery,and the complications of the two groups were recorded.Results In A group,the average diameter of common bile duct stones was (1.02 ± 0.25) cm,the average diameter of common bile duct diameter was (1.15 ± 0.25) cm.In B group,the mean diameter of common bile duct stones was (0.99 ± 0.26) cm,and the average diameter of common bile duct was (1.13 ± 0.26) cm.The differences between the two groups were not statistically significant (t =0.513,0.437,0.367,P =2.083,1.533,1.095).The successful operation rate of A group was 92.11％ (35/38),which in B group was 91.84％ (45/49),the difference was not statistically significant between the two groups (x2 =0.006,P =0.974).The incidence rate of complications in B group was 20.41％,which was significantly higher than that in A group,the difference was statistically significant(x2 =3.654,P =0.019).The hospitalization time,hospitalization expenses in A group were (10.6 ± 2.6) d,(26 649.8 ± 3 478.6) CNY,respectively,which were significantly better than those in B group (t =21.971,17.168,all P ＜ 0.05).Conclusion The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery,and the safety of the former is higher than the latter.

New concept of surgical treatment for biliary dilatation / 中华消化外科杂志

At present,it is not uncommon for patients with biliary dilatation who have failed to undergo multiple operations in clinic.Dong's classification has a definite guiding significance for choosing appropriate surgical methods.Active hepatectomy with "tailor-made" treatment can cure refractory biliary dilatation involving intrahepatic bile ducts.At present,there are still some controversies about the range of hepatectomy and the management of type D lesions in children.At the same time,we should pay close attention to the long-term complications after dilated bile duct resection.

Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic review with meta-analysis

SUMMARY OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of the harmonic scalpel compared to the conventional technique in patients submitted to total thyroidectomy. METHOD: This is a systematic review with inclusion of randomized controlled trials (RCTs) that compared both techniques. An electronic search was carried out in the Medline and Lilacs databases until June 2017. The outcomes analysed were operation time, intraoperative bleeding, surgical morbidity, and costs. RESULTS: Data from 31 primary studies were included. The use of the harmonic scalpel correlates to a shorter operation time (p <0.001) and a lower volume of intraoperative bleeding (p <0.001). There were no differences in the risk of transient (p = 0.53) and permanent (p = 0.70) hypocalcaemia, transient (p = 0.61) and permanent (p = 0.50) dysfunctions of the inferior laryngeal nerve and hematoma (p = 0.14). CONCLUSION: Total thyroidectomy using a harmonic scalpel is effective and safe compared to the conventional technique.

Técnica endonasal para cirurgia de descompressão orbitária em paciente com exoftalmopatia de Graves / Endonasal technique for orbital decompression surgery in a patient with Graves' exophthalmopathy

Resumo Paciente do sexo feminino, 29 anos, ex-tabagista, diagnosticada em setembro de 2012 com doença de Graves e apresentação rápida de exoftalmia bilateral. Na avaliação oftalmológica, apresentava motilidade preservada, proptose e bolsa de gordura superior em AO com retração de PPSS e PPII e exoftalmetria em OD de 26 mm,e em OE de 24 mm. Em maio de 2014,fez o mapeamento da retina que evidenciou cicatrizes de coriorretinite em ambos os olhos e campimetria computadorizada, apresentando degrau nasal em OD, contração superior, depressão centro-inferior. Em junho de 2016, realizou cirurgia de descompressão orbitária de paredes medial e inferior bilateral por via endoscópica com uso de endoscópio nasal Karl Storz, em 30 graus de óptica. A abordagem cirúrgica da oftalmopatia de Graves deve ser empregada na fase cicatricial exceto nos casos com risco de perda da visão. Antes realizada por acesso externo, atualmente a descompressão orbitária pode ser realizada via endoscópica, com mínima invasividade e permite a remoção da parede inferior e medial sem necessidade de incisões externas. É um procedimento seguro para o tratamento da orbitopatia distireoidiana associada a menor morbidade, no qual se evita lesões ao ducto nasolacrimal, nasofrontal ou ao infraorbital e se possibilita redução da proptose entre 3 a 4 mm. Os benefícios da descompressão estão relacionados com a melhora da acuidade visual, além do resultado estético. A continuidade do tratamento cirúrgico será realizada por meio de correção de retração palpebral seguida de blefaroplastia.

Abstract Female, 29, former smoker, diagnosed in September 2012 with Graves' disease and rapid presentation of bilateral exophthalmos. In the ophthalmologic evaluation, it presented preserved motility, proptosis and upper fat sac in OA with retraction of PPSS and PPII and exophthalmetry in OD of 26 mm, and in OE of 24 mm. In May 2014, he performed the mapping of the retina that showed scars of chorioretinitis in both eyes and computerized campimetry, presenting a nasal step in OD, superior contraction, central-inferior depression. In June 2016, he underwent orbital decompression surgery of the medial and inferior bilateral walls by endoscopic approach using the Karl Storz nasal endoscope at 30 degrees of optics. The surgical approach of Graves' ophthalmopathy should be used in the cicatricial phase except in cases with risk of loss of vision. Before performed by external access, orbital decompression can now be performed endoscopically, with minimal invasiveness and allows the removal of the inferior wall and Without external incisions. It is a safe procedure for the treatment of dysthyroidal orbitopathy, associated with lower morbidity, in which lesions are avoided in the nasolacrimal, nasofrontal, or infraorbital ducts and it is possible to reduce proptosis between 3 and 4 mm. The benefits of decompression are related to Improvement of visual acuity, besides the aesthetic result. The continuation of the surgical treatment will be performed by correction of palpebral retraction followed by blepharoplasty.

Clinical features of secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To investigate the clinical characteristics of secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation, and to analyze the influence of operation on visual acuity and intraocular pressure (IOP). ·METHODS:Totally 38 cases (38 eyes) of the secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation in ophthalmology department of our hospital from December 2014 to December 2016 were enrolled and their medical records were analyzed retrospectively to observe the clinical characteristics of glaucoma. Preoperative mydriasis was carried out and surgical methods were chosen according to the lenses location and extent of suspensory ligament. Preoperative and postoperative anterior chamber depth, corneal endothelial cell density, IOP, visual field, visual acuity and complications were analyzed. ·RESULTS:The average intraocular pressure was 18.17± 1.43mmHg at postoperatively 10d,which was significantly lower than 38. 77 ± 2. 45mmHg before operation, the difference had statistical significance (P<0.05). The IOP of 25 eyes returned to normal (≤21mmHg) at 3d after surgery. The IOP of 34 eyes with the usage of IOP lowering medication returned to normal at postoperative 10d. The IOP of 4 eyes came to normal after undergoing glaucoma drainage valve implantation again. There were 5 eyes with visual acuity ranged 0.1 to <0.2,17 eyes 0.2 to <0.5,16 eyes≥0.5 preoperatively,and 2 eyes,17 eyes and 19 eyes postoperatively, the difference was not significant (P>0.05). The postoperative anterior chamber depth was 2.45 ± 0.44mm, which was significantly higher than 1.23 ± 0.35mm before operation, the difference had statistical significance (P < 0. 05). The postoperative corneal endothelial cell density was 878.34 ± 322.12/mm2 and decreased significantly, compared with 1735.32 ± 340. 32/mm2before operation, the difference had statistical significance (P<0.05). There were 8 eyes with corneal edema,4 eyes with iris adhesion or varying degrees of atrophy,3 eyes with anterior chamber hemorrhage,and 2 eyes with pupil exudate at 3d after surgery. · CONCLUSION: Clinical symptoms and signs of secondary glaucoma in patients with lens suspensory ligament laxity or occult subluxation are more complex, which needs to be distinguished with other types of glaucoma in clinical treatment, and its surgical methods shall be chosen according to different suspensory ligament site and lens subluxation scope.

Recent advances in the effects of various surgical methods on tear film after pterygium surgery / 国际眼科杂志(Guoji Yanke Zazhi)

Pterygium is a common ocular disorder with a high prevalence.Surgical resection is the main method of treating pterygium.Recurrence rate of traditional surgical methods such as simple excision of pterygium is high.In recent years,amniotic membrane transplantation,autologous limbal stem cell transplantation,application of mitomycin (MMC) and some other methods become commonly used.Autologous limbal stem cell transplantation is being most widely used.Pterygium has a close relationship with dry eye,and dry eye is one of the important reasons for its recurrence.Different surgical methods have different effects on postoperative tear film.This review will summarize the recent points as below.

Historical Clarification and Review of Usage of Surgical Instruments in Mongolian Medicine from XVII to the XIX Century / Монголын Анагаах Ухаан

@#History of surgical services in Mongolian medicine began at least from New Stone Ages (Neolithic Era). However, we decided to study usage of surgical instruments in Mongolian medicine from 1578 to the XIX century. Because, the third transmission of Buddhism into Mongolia occurred during the time of the Altan Khan of the Southern branch of Central Mongols, a descendent of Kublai Khan, tried to revive Mongol strength and unification. After that Undur Gegeen Zanabazar was also holding a religious service around his residence. Furthermore, in 1651 he established 7 parts of the Monastery including Financial, Lamasery, Food service, and Personal physician’s divisions based on his attendants, people, and lamas. The Personal physician’s division was one of the basis for the sect of “Four Medical Tantras”. Since that time the sect of “Four Medical Tantras,” had been spread effectively and many medical schools were established near the Buddhist temples in Mongolia. They respected “Four Medical Tantras,” and “Shun,” as the main scripts and focused to base it on their theory and practice. </br> During the research we identified that from the XVII century, Mongolian doctors and scientists wrote many commentary books on “Four Medical Tantras” and renewed some of the content of “Four Medical Tantras.” Especially, Agvanluvsandanbijaltsan and Jambaldorj wrote a medical and medicinal books including surgical instruments. Also Ishbaljir wrote practical book about internal medicine, surgical methods, and services. </br> The major conclusion to this study was that Mongolian nation established their own medical art, comprehensive knowledge, and surgical methods as well as updated surgical instruments during the XVII and XIX Century. Particularly, they could renewed surgical methods and surgical instruments, which came from Indian Ayurveda and Tibetan medicine.

Surgical way of pregnancy termination for patients with placenta previa during midtrimester / 局解手术学杂志

Objective To investigate the effect of rivanol induction on pregnancy termination for patients with placenta previa during midtrimester.Methods From January 2010 to December 2015,16 patients of placenta previa underwent pregnancy termination induced by rivanol during midtrimester were regarded as the observation group, and 22 patients with normal placental position were regarded as the control group.The delivery time,amount of postpartum hemorrhage within 24 hours,one-time success rate of induced abortion,caesarean due to massive haemorrhage and postoperative infection of the two groups were recorded to analyze the clinical effect of rivanol.Results There was no statistically significant differences in the success rate,delivery time and caesarean due to massive haemorrhage between the two groups(P>0.05).The amount of intrapartum and postpartum hemorrhage in the observation group was more than that of the control group,with a statistically significant difference(P<0.05),but it was less than 500 mL,which did not significantly increase the related risk for patients.Conclusion Induced abortion by rivanol is a simple,safe and effective method for patients with placenta previa during midtrimester with fewer side effects and less trauma,which is the preferred method for such patients.

Cost effectiveness evaluation of four kinds of surgical methods for hepatic echinococcosis / 中国人兽共患病学报

We analyzed the cost effectiveness of four different surgical methods (A,B,C and D) in treatment of hepatic echinococcosis.Totally 757 cases of hepatic echinococcosis surgery clinical data and cost information of hospitalized cases were collected from nine hospitals in Xinjiang during 2005-2013.The clinical effects,cost effectiveness ratio and incremental costeffectiveness ratio were analyzed and compared.The total complication rates were 15.8％,9.2％,0％ and 2.9％;the recurrence rates were 7.3％,6.2％,0％ and 0％;the cure rates were 77.8％,84.6％,100.0％ and 97.1％;the cost (RMB) were 11 947.3,18 543.6,25 510.7 and 18 877.4,cost-effectiveness ratio were 153.6,219.1,255.1 and 194.3,incremental cost-effectiveness ratio /C//E were 964.4,610.4 and 358.0 respectively for group A,B,C and D.The results after adjusting of price factor were consistent with original cost effectiveness analysis.The complete resection of inner and outer capsule (D) is the most effective and economical way of clinical operation and may worthy be promoted in treatment of hepatic echinococcosis.

ANATOMIC STUDY OF THE NERVOUS COMMUNICATION BETWEEN THE MEDIAN AND MUSCULOUCUTANEOUS NERVE

ABSTRACT Objective: The aim of this study was to analyze the incidence of nerve communication between the musculocutaneous and median nerve . Methods: Anatomical dissection of 40 limbs from 20 fetal cadavers was performed at the Laboratory of Anatomy, Faculdade de Ciências Médicas e da Saúde da Pontifícia Universidade Católica de São Paulo . Results: A communicating branch was found in 10 upper limbs. In nine limbs there was a musculocutaneous-median anastomosis (type I); and in one limb there was a median-musculocutaneous anastomosis (type II) . Conclusion: It is very important to know these anatomical variations, especially when considering clinical examination, diagnostic, prognostic and surgical treatment. Level of Evidence IV, Case Series.

Different surgicaI methods on the tear fiIm stabiIity in treating pterygium patients / 国际眼科杂志(Guoji Yanke Zazhi)

· AlM:To compare the therapeutic effects of different surgical methods in treating pterygium patients and to observe tear film stability. · METHODS: A total of 120 pterygium patients ( 120 eyes) were divided into three groups, each 40 cases (40 eyes).Data including SchirmerⅠtest (SⅠt), tear break-up time ( BUT) , corneal fluorescein staining ( CFS) were recorded preoperatively and postoperatively to evaluate the clinical efficacy of surgery and the effects of tear function changes. ·RESULTS:There were no significant differences in BUT in group A before the operation and one month after operation.Groups B and C showed significant difference before and after operation, but differences were not statistically significant ( all P compared it between groups B and C, there showed no significant difference; Group A showed no significant difference in SⅠt compared with preoperative, SⅠt of groups B and C were significant differences compared with preoperative (P ·CONCLUSlON: Pterygium excision combined with self-corneal limbal stem cell transplantation and Tenon capsule closed is an ideal surgical to reduce the recurrence and improve tear film function to some extent.

Translational Research: Palatal-derived Ecto-mesenchymal Stem Cells from Human Palate: A New Hope for Alveolar Bone and Cranio-Facial Bone Reconstruction

The management of facial defects has rapidly changed in the last decade. Functional and esthetic requirements have steadily increased along with the refinements of surgery. In the case of advanced atrophy or jaw defects, extensive horizontal and vertical bone augmentation is often unavoidable to enable patients to be fitted with implants. Loss of vertical alveolar bone height is the most common cause for a non primary stability of dental implants in adults. At present, there is no ideal therapeutic approach to cure loss of vertical alveolar bone height and achieve optimal pre-implantological bone regeneration before dental implant placement. Recently, it has been found that specific populations of stem cells and/or progenitor cells could be isolated from different dental resources, namely the dental follicle, the dental pulp and the periodontal ligament. Our research group has cultured palatal-derived stem cells (paldSCs) as dentospheres and further differentiated into various cells of the neuronal and osteogenic lineage, thereby demonstrating their stem cell state. In this publication will be shown whether paldSCs could be differentiated into the osteogenic lineage and, if so, whether these cells are able to regenerate alveolar bone tissue in vivo in an athymic rat model. Furthermore, using these data we have started a proof of principle clinical- and histological controlled study using stem cell-rich palatal tissues for improving the vertical alveolar bone augmentation in critical size defects. The initial results of the study demonstrate the feasibility of using stem cell-mediated tissue engineering to treat alveolar bone defects in humans.

The comparative study of Duply combined with Duckett and Koyanagi surgery for severe hypospadias / 中国医师进修杂志

Objective To compare the treatment effect between Duply combined with Duckett and Koyanagi surgical methods in severe hypospadias.Methods Forty-two cases of severe hypospadias were divided into two groups according to the surgical method,23 cases was enrolled in Duply combined with Duckett group while 19 cases in Koyanagi group.The operation time,the incidence rate of urinary fistula,urethral stricture,urethral diverticulum and penis torsion were compared.Results The operation time between two groups had no significant difference (P ＞ 0.05).The incidence rate of urinary fistula,urethral stricture,urethral diverticulum and penis torsion between two groups had no significant difference (x2 =0.04,0.31,0.03,1.16,P ＞ 0.05).The total incidence rate of complications between Duply combined with Duckett group and Koyanagi group had significant difference [69.6％ (16/23) vs.6/19] (x2 =4.59,P ＜ 0.05).Conclusion Each of the two methods can be a choice in treatment of severe hypospadias.

Breast reconstruction after mastectomy: a preoperative evaluation system / 中华医学美学美容杂志

Objective To establish a preoperative evaluation system for breast reconstruction,and to simplify the selection of surgical methods for breast reconstruction in a standard way.Methods We investigated respectively 192 successful cases that underwent breast reconstruction from July 2003 to July 2009.The factors influencing selection of methods for breast reconstruction were studied.The results presented in more than 50 ％ were collected.Results A special table of the preoperative evaluation system for breast reconstruction was established by analyzing statistical results. Conclusions The selection of methods for breast reconstruction is simplified according to this preoperative evaluation system.

The prevalence of endometriosis in cases of total hysterectomy / 대한산부인과학회지

OBJECTIVE: We investigated whether surgical methods, age, parity and obesity were correlated to endometriosis in patients who had hysterectomy. METHODS: This research was surveyed and reviewed of patients who underwent total abdominal hysterectomy, laparoscopic hysterectomy and vaginal hysterectomy in Kyungpook National University Hospital from 1999 to 2006, based on clinical recordings and pathologic reports. Based on these data, we investigated whether age, parity, obesity and pathologic diagnosis were correlated to prevalence rate of endometriosis. Also we investigated the correlations with anatomic lesion of endometriosis and surgical methods. SPSS version 12.0 chi- square test was conducted as the statistical data. RESULTS: The total 4,830 cases of hysterectomy were undergone. Out of these, endometriosis was found at 125 cases (2.5%). Among them, 76 cases of endometriosis were found at 2,260 cases of abdominal hysterectomy (3.3%). 31 cases of endometriosis were found at 1,589 cases of vaginal hysterectomy (1.95%), and 18 cases of endometriosis were found at 981 cases of laparoscopic hysterectomy (1.83%). The correlation with laparoscopic hysterectomy and endometriosis had the statistically significant high rate (P0.05). CONCLUSION: Even the prevalence of endometriosis was low (2.5%) in total cases of hysterectomy, laparoscopic hysterectomy had more prevalence rate of endometriosis than other types of hysterectomy. because suspicious lesions were inspected carefully, Magnified laparoscopic view make us to identify suspicious endometriotic lesion more clearly than other type of hysterectomy.

Surgical Experiences for Intracranial Aneurysms(3,000 Cases)

OBJECTIVE: The present study evaluated overall surgical results for 3,000 patients with intracranial aneurysms, operated on in Busan Paik Hospital institution. METHODS: Three thousand aneurysm cases, operated on in Busan Paik Hospital between January 1980 to June, 15th, 2005, were evaluated based on the following criteria;aneurysm form, aneurysm location, surgical results, postoperative complications, and seasonsonality of occuence. 957 cases were anterior communicating artery aneurysms, 776 were internal carotid artery(ICA) aneurysms, 755 were middle cerebral artery(MCA) aneurysms, 96 were anterior cerebral artery(ACA) aneurysms, 128 were vertebro-basilar artery(VBA) aneurysms and 288 were multiple aneurysms. The male to female ratio was 0.7 to 1. Surgical methods included 2,738 clippings, 219 coating and wrappings, 23 aneurysmoraphies, 20 proximal ligations. RESULTS: Rebleeding occured in 5.1% of the early operation group and 16% of the late operation group respectively. Incidence of clinical vasospasm was 16.6% and angiographic vasospasm was 24.1%. The percentage of the multiple aneurysms was 9.5%, the percentage of the dissecting aneurysm was 6 cases (0.2%), 6 of the total (0.2%);De Novo" aneurysm, the percentage of lobectomies with clipping cases was 9 cases (0.3%), the percentage were incidental aneurysms;164 (5.5%). 88.1% had overall favorable surgical results with a 5.5 % mortality rate. Calcium-channel blocker and "Triple H" therapy did not improve mortality but did significantly improve morbidity. In the old age group, early operation reduced vasospasm, rebleeding and medical complications. The early surgery group exhibited a 86.2% favorable outcome with a 8.1% mortality rate. Intraoperative angiography reduced residual or remained aneurysms in large, giant aneurysm, especially in A.com artery aneurysm. CONCLUSION: The surgical results for the early surgery group according to surgical timming was better, but there were not statistically significant. ntraoperative angiography was especially useful on large aneurysms of the anterior communicating artery.

Clinical Aspects and Surgical Methods in Perianal Hidradenitis Suppurativa

PURPOSE: Hidradenitis suppurativa is a chronic suppurative and cicatricial inflammatory disease involving apocrine gland- bearing areas including the axilla, groin, and anogenital regions. Recurrence after surgery is not rare, and there is much debate about operative methods. This study analyzed the clinical characteristics and the relationship between different surgical methods and recurrences of perianal hidradenitis suppurativa. METHODS: A retrospective study of 20 patients with perianal hidradenitis suppurativa was done. The clinical characteristics were examined. The patients were divided into several groups (acute, chronic regional, chronic extensive) according to lesion status; then, different operative methods and recurrence rates were compared. RESULTS: All of the patients were male smokers. The mean age of onset was 28.4 years. The mean duration of disease was 10 years. The total number of operations, including incision and drainage, was 29 cases. Only 4 patients were overweight or obese. The most common symptom was pus discharge (52%). The recurrence rate after final surgery was 30.0%. After incision and drainage in the acute group, 7 of 8 cases (87.5%) recurred. In the chronic regional group, 5 of 9 cases (55.6%) experienced recurrence after excision and primary repair. After excision and healing by secondary intention, 1 of 7 cases (14.3%) had recurrence. In the case of one unroofing and marsupialization, there was no recurrence. In the chronic extensive group, 1 recurrence was noted in 4 unroofings and marsupializations. CONCLUSIONS: In the case of abscess, proper incision and drainage is needed, but further definitive surgery must be done. In the case of chronic disease, if the lesions are regional, excision and healing by secondary intention is more ideal for decreasing the recurrence rate. If the lesions are extensive, unroofing and marsupialization is recom-mended.