Deformidad en equino del tobillo en edades pediátricas

La deformidad en equino del tobillo ocurre como consecuencia de múltiples entidades. Aunque la primera línea de tratamiento es la conservadora, las modalidades quirúrgicas son necesarias en la mayoría de los enfermos pediátricos. Estas últimas son las más empleadas por zonas del complejo músculo-tendinoso, en especial los alargamientos fraccionados y en forma de Z-plastia. El objetivo de este trabajo es actualizar y brindar información sobre los distintos procedimientos quirúrgicos en la corrección de la deformidad en equino del tobillo. En la búsqueda y análisis de la información se emplearon las siguientes palabras: equinus deformity, equino varus, equino valgus; drop foot deformity y Achilles tendon Z-lengthening. A partir de la información obtenida, se realizó unala revisión bibliográfica de un total de 187 artículos publicados en las bases de datos PubMed, Hinari, SciELO, EBSCO, Scopus, Medscape y Medline, mediante el gestor de búsqueda y administrador de referencias EndNote. De ellos se utilizaron 30, 28 de los últimos cinco años. Se hace referencia a la anatomía esencial de la zona, al igual que a la prueba de Silfverskiöld. Con relación a la imagenología, se describe la técnica para calcular la distancia del tendón a alargar. Se mencionan las técnicas quirúrgicas de alargamiento fraccionado, por Z-plastia, trasposición anterior del tendón de Aquiles y la hemiepifisiodesis.

Equinus deformity of the ankle occurs as a consequence of multiple entities. Although the first line of treatment is conservative, surgical modalities are necessary in most pediatric patients. The latter are the most used for areas of the muscle-tendinous complex, especially fractional and Z-plasty-shaped lengthening. The aim of this work is to update and provide information on the different surgical procedures in the correction of equinus deformity of the ankle. In the search and analysis of the information, the following words were used: equinus deformity, equinovarus, equinovalgus; drop foot deformity and Achilles tendon Z-lengthening. Based on the information obtained, a bibliographic review of a total of 187 articles published in PubMed, Hinari, SciELO, EBSCO, Scopus, Medscape and Medline databases was carried out using the search manager and reference administrator EndNote. Of these, 30 were used, 28 of the last five years. Reference is made to the essential anatomy of the area, as well as to the Silfverskiöld test. In relation to imaging, the technique to calculate the distance of the tendon to be lengthened is described. Fractional lengthening surgical techniques are mentioned, by Z-plasty, anterior transposition of the Achilles tendon and hemiepiphysiodesis.

Percutaneous vertebral-disc plasty for very severe osteoporotic vertebral compression fractures / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of percutaneous vertebral-disc plasty (PVDP) in the treatment of very severe osteoporotic vertebral compression fractures (vsOVCF).Methods:A total of 26 patients with vsOVCF were treated by PVDP at Department of Spine Surgery, The Second Affiliated Hospital, Nantong University from November 2019 to August 2021. They were 8 males and 18 females with an age of (77.9±5.2) years. Fracture sites: T11 in 9 cases, T12 in 13 cases, L1 in 7 cases, and L2 in 2 cases. The loss of vertebral height exceeded 2/3 of its original height. The curative effects were evaluated by comparing the visual analogue scale (VAS), Oswestry disability index (ODI) and local kyphosis angle (LKA) at preoperation, 1 day postoperation and the last follow-up.Results:This cohort was followed up for 12(10, 15) months. No obvious neurological damage or other serious complications occurred. The VAS scores [(2.9±0.7) and (2.2±0.7) points] and ODIs [28.0%±4.8% and 16.9%±4.0%] at 1 day postoperation and the final follow-up were significantly lower than the preoperative values respectively [(6.7±0.8) points and 66.7%±6.0%], and the values at the last follow-up were significantly lower than those at 1 day postoperation ( P<0.05). The LKAs at 1 day postoperation and the last follow-up (18.1°±4.1° and 19.5°±4.4°) were significantly smaller than that before operation (32.0°±5.2°) ( P<0.05), but there was no significant difference between 1 day postoperation and the last follow-up in LKA ( P>0.05). Conclusion:PVDP is an effective surgical treatment of vsOVCF, because it can relieve pain and improve local kyphosis with satisfactory clinical outcomes.

Application and development of totally thoracoscopic mitral valve plasty / 中国胸心血管外科临床杂志

@#Thoracoscopic minimally invasive technology has been used in mitral valve plasty since 1990s. Totally thoracoscopic mitral valve plasty has the advantages of small trauma, beautiful incision and rapid postoperative recovery. It is favored by more and more patients and cardiac surgeons. However, according to the reports, the proportion of totally thoracoscopic mitral valve surgery in China is still low. Mitral valve plasty via the totally thoracoscopic approach is still controversial in terms of population adaptation, perioperative complications and long-term prognosis. In addition, the technical difficulty and the long training cycle of surgeons also limit the popularization of this technology. By summarizing the existing literature, this paper analyzes the application and development of totally thoracoscopic approach in comparison with the traditional median thoracotomy mitral valve plasty.

Strategy of laparoscopic treatment of right posterior bile duct hepatolithiasis / 中华消化外科杂志

Hepatolithiasis is a common biliary disease in China. Surgical treatment principles of hepatolithiasis include "removing lesions, cleaning stones, correcting strictures, recovering the drainage and preventing the recurrence". Laparoscopic techniques have been increasingly applied in surgical treatment of hepatolithiasis recently. Right posterior bile duct is a predilection site of hepatolithiasis. Due to its unique anatomy, right posterior lobectomy, right posterior bile duct lithotomy and plasty remain challenging under laparoscopy. Based on relevant literatures and clinical experiences, the authors explore the strategy of laparoscopic treatment right posterior bile duct hepatolithiasis, aiming to provide reference for surgical colleagues.

Treatment of neovascular glaucoma by anti-vascular endothelial growth factor combined with ultrasonic ciliary plasty / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical efficacy and safety of ultrasonic ciliary plasty(UCP)combined with injection of anti-vascular endothelial growth factor(VEGF)in the treatment of neovascular glaucoma(NVG).METHODS: A total of 30 NVG patients(30 eyes)admitted to the First Affiliated Hospital of Bengbu Medical College from September 2020 to September 2021 were selected. After admission, all the eyes of the patients were injected with anti-VEGF drug(ranibizumab). After surgery, 15 patients were randomly selected for UCP treatment(UCP group), and the other 15 patients received trabeculectomy(trabeculectomy group). During the 10mo postoperative follow-up, the decrease of intraocular pressure was compared between the two groups and the changes of the degree of ocular pain and the occurrence of related complications were evaluated at each follow-up visit.RESULTS: The intraocular pressure and pain degree of the UCP and trabeculectomy groups were significantly lower than those before operation, and the complication probability of the UCP group was less than that of the trabeculectomy group.CONCLUSION: With fewer complications and high safety, UCP combined with anti-VEGF injection can effectively control intraocular pressure and pain in NVG patients.

Cierre de fístula traqueocutánea recidivante / Closure of Recurrent Tracheocutaneous Fistula

Introducción: La fístula traqueocutánea es la complicación más frecuente de la traqueostomía, que lleva a la necesidad de usar diferentes tipos de plastias para lograr un cierre definitivo. Objetivo: Mostrar una opción de tratamiento quirúrgico para garantizar un cierre definitivo de la fístula traqueocutánea recidivante. Caso clínico: Se presenta paciente masculino de 45 años con antecedentes de traqueostomía sin cierre espontáneo; quien desarrolló fístula traqueocutánea tratada con doble plastia de deslizamiento frontal tipo Szymanowski, con posterior recidiva, motivo por el que acude a consulta. Se realizó cierre directo de mucosa traqueal con plicatura de músculo platisma y avance de colgajos de piel rectangulares para reforzar cobertura de la pared anterior de la tráquea. Se logró corregir la fístula mediante un procedimiento simple, rápido y efectivo. Conclusiones: Este método evita las dificultades encontradas en otros procedimientos y garantiza la corrección funcional y estética con el empleo de una técnica simple con baja morbilidad(AU)

Introduction: Tracheocutaneous fistula is the most frequent complication of tracheostomy, leading to the need to use different types of plasties to achieve a definitive closure. Objective: To show a surgical treatment option for guaranteeing a definitive closure of recurrent tracheocutaneous fistula. Clinical case: We present the case of a 45-year-old male patient with a history of tracheostomy without spontaneous closure, who developed tracheocutaneous fistula managed through double plasty of anterior sliding of Szymanowski type, followed by recurrence. Direct closure of the tracheal mucosa was performed with platysma muscle plication and advancement of rectangular skin flaps for reinforcing coverage of the anterior wall of the trachea. Correction of the fistula was achieved by a simple, fast and effective procedure. Conclusions: This method avoids the difficulties found in other procedures, and guarantees functional and aesthetic correction with the use of a simple technique with low morbidity(AU)

Effects of double eyelid plasty with incision in eyelids margin position and internal fixation / 中华医学美学美容杂志

Objective:To explore the clinical efficacy of the double eyelid plasty with incision in eyelids margin position and internal fixation.Methods:A retrospective analysis was carried out in 47 patients who underwent double eyelid surgery in the outpatient department of our hospital from September 2015 to June 2017. There were 5 males and 42 females, aged from 17 to 32 (25±4) years. The skin was incised above the eyelid margin of 1-2 mm after anesthesia, orbicularis oculi muscle under the eyelid line, loose organization, and orbital septum fat were stripped and removed. The dermis and the tarsus were sutured under the double eyelid line, and the skin was sutured without any tension.Results:After collecting and analyzing 47 cases from September 2015 to June 2017 in our hospital with this method, we found that all 47 patients achievedⅠincision healing, which showed slight swell, natural and smooth radian of double eyelid, and without complications such as infection, hematoma and ptosis. And this method showed no obvious scar hyperplasia around incision line and thus possessed high patient satisfaction.Conclusions:With the advantage of less trauma, quick recovery, unobvious scar, natural and beartiful double eyelids, this method can be used as a supplementary method for the reconstruction of the blepharoplasty, which is worth promoting.

" Watching without dealing" aortic root repair in the treatment of acute Stanford type A aortic dissection: a prospective observational study / 中华胸心血管外科杂志

Objective:To evaluate the clinical effects of " watching without dealing" aortic root repair technique in acute Stanford type A aortic dissection(ATAAD).Methods:From October 2017 to October 2018, " watching without dealing" technique was performed in ATAAD patients with mild aortic root involvement. The proximal aortic anastomosis was at the level of the sinotubular junction, without " pursuing" complete excision of the intra-sinus dissections. The perioperative clinical data and follow-up imaging results of the patients were collected and analyzed to evaluate early and mid-term efficacy of the technique.Results:A total of 20 patients received " watching without dealing" technique in our hospital, including 15 males and 5 females with a mean age of(48.0±12.1) years old(34-73 years old). The preoperative aortic sinus diameter was(41.3±3.6)mm and the aortic sinotubular junction diameter was(43.9±6.6) mm. All patients underwent ascending aortic replacement and total arch replacement plus frozen elephant trunk surgery. The cardiopulmonary bypass time was(179.5±41.5)min(132~255 min), the cross-clamp time was(120.3±23.7) min(95~180 min), and the circulatory arrest time was(8.8±7.6) min(2~22 min). During perioperative period, no adverse events such as death, secondary opening, renal failure, cerebral infarction, and paraplegia occurred. The CTA examination of the aorta before the patients were discharged showed that all residual false lumen in the sinus disappeared, the diameter of the aortic sinus was(30.8±2.6) mm, and the diameter of the aortic sinotubular junction was(27.2±2.5) mm. The patients were followed up for mean(28.5±7.8) months(3~35 months). No surgical re-intervention of the aortic root occurred. The aortic CTA during follow-up period showed no residual or new dissection in the aortic sinus, the diameters of the aortic sinus and aortic sinotubular junction were(30.9±2.4) mm and(27.5±2.7) mm respectively; the ultrasonic cardiogram showed normal aortic valve structure and function. No statistically significant differences were found when comparing the aortic sinus diameter and aortic sinotubular junction diameter between two time points of at discharge and follow-up.Conclusion:The " watching without dealing" aortic root repair technique for ATAAD is relatively simple to learn and safe in the perioperative period. Early and mid-term follow-up imaging showed normalization of the aortic sinus structure. Further follow-up and observation were necessary to figure out the long-term clinical outcome of this modified aortic root repair.

3D printing-assisted percutaneous balloon dilatation plasty for treatment of osteoporotic calcaneal fractures of Sanders type Ⅱ or Ⅲ in the elderly patients / 中华创伤骨科杂志

Objective:To compare the clinical efficacy between 3D printing-assisted percutaneous balloon dilatation calcaneal plasty (3D-PCP) and conventional open reduction and internal fixation (ORIF) via the extended lateral L-shaped approach in the treatment of osteoporotic calcaneal fractures of Sanders type Ⅱ or Ⅲ in the elderly patients.Methods:Retrospectively analyzed were the data of 36 elderly patients with osteoporotic calcaneal fracture of Sanders type Ⅱ or Ⅲ who had been surgically treated at Department of Orthopaedics, Yixing People's Hospital from June 2012 to June 2018. According to their treatment methods, the patients were divided into a 3D-PCP group [16 cases, 9 males and 7 females with an age of (73.0 ± 3.4) years] and an ORIF group [20 cases, 8 females and 12 females with an age of (71.4 ± 2.6) years]. The 2 groups were compared in terms of hospital stay, operation time, intraoperative fluoroscopy frequency, suture removal time, weight bearing time, fracture healing time, visual analogue scale (VAS) for the surgical site 2 days and one year after surgery, American Foot and Ankle Surgery Association (AOFAS) ankle-hindfoot score, calcaneal imaging parameters (B?hler angle, Gissane angle, and length, width and height of the calcaneus axis) at 2 days and one year after surgery, and postoperative complications.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P > 0.05). All patients were followed up for 14 to 18 months (mean, 15.6 months). Compared with the ORIF group, the 3D-PCP group had significantly shorter hospital stay, significantly shorter operation time, significantly earlier suture removal, significantly earlier weight-bearing, significantly lower VAS scores at 2 days after surgery, significantly higher AOFAS ankle-hindfoot scores at one month after surgery, but significantly more times of intraoperative fluoroscopy (all P < 0.05). In all patients, the VAS scores at 2 days after surgery were significantly lower than those before surgery, and those at one year after surgery significantly lower than those at 2 days after surgery ( P < 0.05). In all patients, the AOFAS ankle-hindfoot scores at one month after surgery were significantly higher than those before surgery ( P < 0.001). In the ORIF group, the AOFAS ankle-hindfoot scores at one year after surgery were significantly higher than those at one month after surgery ( P < 0.05), but in the 3D-PCP group there was no such a significant difference between one year and one month after surgery ( P > 0.05). There was no significant difference in VAS score, AOFAS score, fracture healing time or postoperative imaging parameters between the 2 groups at one year after surgery ( P > 0.05). There was no significant difference either in the incidence of complications between the 2 groups ( P > 0.05). Conclusion:In the treatment of osteoporotic calcaneal fractures of Sanders type Ⅱ or Ⅲ in the elderly patients, compared with conventional ORIF, 3D-PCP shows advantages of shorter operation time, minimal invasion, quicker incision healing, shorter hospital stay, earlier weight-bearing exercise, and better functional recovery but a disadvantage of increased times of intraoperative fluoroscopy.

Herida facial por mordedura canina en un anciano / Facial wound due to canine bite in an old man

Se presenta el caso clínico de un anciano de 73 años de edad, que fue asistido en el Cuerpo de Guardia del Hospital General Docente Enrique Cabrera Cossío de La Habana por haber sido mordido en el rostro, en la región supraciliar derecha, por un perro, que le causó una herida avulsiva, con pérdida considerable de tejidos blandos, abundante sangrado y dolor. Luego de efectuar antisepsia del área y profilaxis con antibióticos, se practicó rápidamente el procedimiento quirúrgico, que consistió en desbridamiento de la herida y reconstrucción del defecto a través de plastia primaria con técnica de colgajos locales de avance y rotación, lo que permitió una evolución favorable, tanto estética como funcional, en el paciente.

The case report of a 73 years old man is presented. He was assisted in the Emergency Service of Enrique Cabrera Cossío Teaching General Hospital in Havana city, due to a dog bite in his face, in the right supraciliary region, that caused him a lacerated wound, with considerable loss of soft tissues, abundant bleeding and pain. After making antisepsis of the area and prevention with antibiotics, the surgical procedure was quickly practiced that consisted on debridement of the wound and reconstruction of the defect through primary plasty with technique of advance and rotation local flaps, that allowed a favorable clinical course in the patient, both cosmetic and functional.

Profundaplastia femoral como un proceder inusual en la "era endovascular" / Femoral deep plasty as an unfrequent procedure in the "endovascular era"

Introducción: La arteria femoral común y sus ramas suministran la mayor parte del flujo sanguíneo al muslo, así como a la totalidad de la pierna y el pie, lo que da lugar a la mayor rama del triángulo femoral: la arteria femoral profunda. Objetivo: Exponer la efectividad de la profundaplastia femoral en la "era endovascular". Reporte del caso: Se presenta un caso de enfermedad arterial periférica de múltiples sectores, sin criterio de cirugía revascularizadora (derivación protésica aorto bifemoral). El paciente manifestaba claudicación intermitente a menos de 30 metros, localizada en pantorrilla derecha. En el estudio hemodinámico se apreciaron los índices de presiones tobillo/brazo disminuidos en arteria tibial posterior (0,46) y pedia derecha (0,33). La ecografía doppler del sector femoral derecho evidenció una estenosis de la arteria femoral profunda en su origen, que producía aumento de las velocidades picos sistólicos (479 cm/s), con flujo desorganizado, dilatación posestenótica y oclusión de la arteria femoral superficial en su origen. Se realizó endarterectomía femoral común y profunda con colocación de parche de politetrafloroetileno. El paciente evolucionó sin complicaciones posoperatorias. En el seguimiento se observó mejoría clínica en relación con la distancia de claudicación y un aumento de los índices de presiones tobillo/brazo en arteria tibial posterior y pedia derecha (0,50), respectivamente. Conclusiones: La profundaplastia femoral, aún en la "era endovascular", permanece como un proceder eficaz que resulta alternativa de tratamiento revascularizador en la enfermedad arterial periférica de localización infrainguinal(AU)

Introduction: The normal femoral artery and its branches supply most of the blood flow to the thigh, as well as to the whole leg and foot, which forms the largest branch of the femoral triangle: the deep femoral artery. Objective: Show the effectiveness of femoral deep plasty in the "endovascular era". Case report: It is presented a case of peripheral artery disease in multiple sectors, without surgical criteria of revascularization (derivación protésica aortobifemoral). The patient presented intermittent claudication in less than 30 meters, and it was located in the right calf. In the hemodynamic study, the ankle-arm pressure indexes were dicreased in the posterior tibial artery (0,46) and right dorsalis pedis artery (0,33). The doppler echocardiography of the right femoral sector confirmed a stenosis in the deep femoral artery in its origin, which produced an increase in the peak systolic velocity (479 cm/s), unorganized flows, poststenotic dilatation and occlusion of the superficial femoral artery in its origin. It was performed a common and deep femoral endarterectomy with colocation of polytetrafluoroethylene patch. The patient evolved without post-surgical complications. In the follow-up, it was observed a clinical improvement in relation with the claudication distance and the increase of the ankle-arm pressure indexes in the posterior tibial artery and right dorsalis pedis artery (0,50), respectively. Conclusions: The femoral deep plasty, still in the ´´endovascular era´´, is an efficient procedure that is an alternative to the revascularization treatment in the peripheral artery disease with infrainguinal location(AU)

Application of double V-Y advancement of mucosal flap procedure for lower-lip paramedian tubercles plasty / 中华医学美学美容杂志

Objective:To prove the effect of double V-Y procedure for paramedian tubercles plasty in patients with thin lower lips and dissatisfied appearance of lower lips.Methods:From 2013 to 2019, 127 Chinese cases of thin and dissatisfied appearance of lower lips were included. A double V-Y procedure for paramedian tubercles plasty was performed. Objective data of lip morphology before and after operation were measured, and subjective satisfaction survey and long-term follow-up were conducted.Results:The midline lower red lip height, the height of paramedian tubercles of lower-lip and the protrusion of lower-lip were significantly higher than that before the operation. The time of apocatastasis, scar softening of incision, natural expression recovery and local numbness relief were evaluated by following up at 7 d, and 3-24 months after operation, and it showed 73.2% of subjective satisfaction. The time of detumescence was 6-32 (15.2±3.5) days; the time of incision scar softening was 2-10 (5.1±2.3) months; the time of expression recovery was 1-7 (3.1±0.9) months; the time of numbness disappearance was 5 d-2 years (158.2±82.6) days.Conclusions:The double V-Y advancement of vermilion mucosa flap procedure for paramedian tubercles plasty displays a significant effect in improving volume and shape of lower lips. It is recommended for further clinical application.

Effect of allogeneic sclera transplantation combined with arbitrary flap plasty in the treatment of moderate and severe deep and full-thickness eyelid defect / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the application and therapeutic effect of allogeneic sclera transplantation combined with arbitrary flap plasty in the treatment of moderate and severe deep and full-thickness eyelid defect.<p>METHODS: Medical records of 103 patients(103 eyes)who underwent allogeneic scleral transplantation combined with random flap plasty in the treatment of moderate and severe deep and full-thickness eyelid defect from June 2017 to June 2020 were retrospectively reviewed. All patients were followed up for 1-6mo after operation was performed to evaluate the postoperative effects of the resorption and compatibility of allogeneic sclera, the survival situation of skin flaps, eyelid appearance, eyelid closure, eyelid scar.<p>RESULTS: Follow up observation from 1-6mo after operation, the allogeneic sclera was gradually replaced by the receptor tissue, allogeneic sclera in the inner layer of the eyelid was covered with conjunctival cells, allogeneic sclera and skin join closely together in the outer layer of the eyelid. There was no rejection in allogeneic sclera. All patients had survived skin flaps, good eyelid shape, natural eyelid closure, and no scars.<p>CONCLUSION: The allogeneic sclera transplantation combined with random flap plasty has curative effect in the repair of moderate and severe deep and full-thickness eyelid defect. It has both function and aesthetics result, and it is suitable for clinical promotion.

Bupivacaine-induced myotoxicity during a continuous perineural femoral block: case report / Miotoxicidad inducida por bupivacaína durante un bloqueo continuo del nervio femoral: reporte de caso

Abstract Introduction: Regional anesthesia is widely used for postopera tive analgesia in total knee arthroplasty (TKA). Although it is a safe and effective procedure, serious complications may still develop. In the event of an unusual or torpid evolution, the possibility of local anesthetic-induced myotoxicity should be suspected. Case presentation: A 54-year old patient, American Society of Anesthesiologists (ASA) II, underwent TKA due to primary gonarthrosis.. The analgesic technique used was a femoral nerve block associated with continuous perineural infusion. 24 hours later, the patient's medical condition deteriorated presenting pain, edema, and functional limitation of the thigh of the operated extremity. The symptoms were suggestive of myotoxicity, confirmed with diagnostic images leading to the removal of the catheter. The patient experienced then a significant improvement and was discharged 5 days after surgery. Conclusion: The diagnosis of myotoxicity from local anes thetics is rare, since its manifestations may be masked by the usual symptoms of the postoperative period. Early identification of the condition is fundamental to reduce its negative impact on the patient's recovery and satisfaction. Since the scope of the damage depends particularly on the concentration and duration of the exposure to the local anesthetic agent, there is a need to implement protocols that enable an effective block with the lowest concentration and volume of the medication.

Resumen Introducción: La anestesia regional es ampliamente usada para la analgesia posoperatoria en la Artroplastia de Reemplazo de Rodilla (ARR). Aunque son procedimientos seguros y efectivos, la posibilidad de complicaciones graves existe. Ante una evolución inusual o tórpida se debe sospechar la posibilidad de miotoxicidad inducida por anestésicos locales. Presentación del caso: En un paciente de 54 años, American Society of Anesthesiologists (ASA) II, se llevó a cabo ARR por gonartrosis primaria. Como técnica analgésica se usó el bloqueo de nervio femoral asociado a infusión continua perineural. 24 horas después el paciente presenta deterioro clínico dado por dolor, edema y limitación funcional en muslo de extremidad operada. Ante síntomas sugestivos de miotoxicidad confirmada por imágenes diagnósticas, el catéter fue retirado. Posteriormente, presentó una mejoría significa tiva y egresó del hospital al quinto día posoperatorio. Conclusiones: El diagnóstico de miotoxicidad por anestésicos locales es poco frecuente debido a que sus manifestaciones pueden estar enmascaradas por los síntomas habituales durante el periodo posoperatorio. Su identificación temprana es funda mental para disminuir el efecto negativo sobre la recuperación y la satisfacción del paciente. Dado que la magnitud del daño depende especialmente de la concentración y la duración de la exposición al anestésico local, es necesario implementar proto colos que permitan lograr un bloqueo efectivo con la menor concentración y volumen posible del medicamento.

Fifteen years of experience with frontalis suspension using polytetrafluoroethylene (Gore-Tex®) suture in blepharoptosis repair / 15 anos de experiência em suspensão frontal com fio de politetrafluoretileno (Gore-Tex®) na correção de ptose palpebral

ABSTRACT Purpose: To review the outcomes of frontalis suspension surgeries with the use of polytetrafluoroethylene in patients with blepharoptosis. Methods: A retrospective observational study analyzed the outcomes of frontalis suspension surgeries performed in a single institution from 2003 to 2018. All procedures were performed with closed incision and single pentagon techniques. Outcomes were classified as satisfactory or unsatisfactory, with satisfactory defined as a margin reflex distance of >3 mm and <1 mm between eyelids and unsatisfactory as hypocorrection, surgical complications, and asymmetry. Results: We included a total of 76 eyelids from 52 patients in our study. Within a mean postoperative follow-up of 16.8 ± 18.5 months (range, 3-95), 59 (77.6%) eyelids had a satisfactory outcome, and 17 (22.4%) were unsatisfactory (8 cases of asymmetry, 3 granulomas, 3 suture extrusions, 2 abscesses, and 1 case of cellulitis). Nine eyelids from the unsatisfactory group required reoperation. Among the patients with a follow-up of ³12 months (38 surgeries), lasting results were observed in most eyelids, except for 2 late-onset suture extrusions. Conclusion: The use of polytetrafluoroethylene in frontalis suspension surgery was shown to be predictable, safe, and lasting. Our findings support previous studies that have shown adequate functional results and low complication rates.

RESUMO Objetivo: Revisar os resultados de cirurgias de sus pensão ao músculo frontal com o uso de fio de politetrafluoretileno em pacientes com blefaroptose. Métodos: Em um estudo observacional retrospectivo, foram analisados os resultados das cirurgias de músculo frontal de uma instituição, realizadas entre 2003 e 2018. Todos os procedimentos foram realizados com incisão fechada e técnica de pentágono. Os desfechos foram classificados como satisfatórios ou insatisfatórios com definição satisfatória definida como distância margem-reflexo >3mm e <1mm entre as pálpebras e insatisfatória como hipocorreção, complicações cirúrgicas e assimetria. Resultados: Incluímos um total de 76 pálpebras de 52 pacientes em nosso estudo. Com um tempo médio de seguimento pós-operatório de 16,8 ± 18,5 meses (intervalo 3-95), 59 (77,6%) pálpebras apresentaram desfecho satisfatório e 17 (22,4%) insatisfatórios (8 casos de assimetria, 3 granulomas, 3 extrusões de sutura, 2 abscessos e 1 caso de celulite). Nove pálpebras do grupo insatisfatório necessitaram de reoperação. Entre os pacientes com seguimento ³12 meses (38 cirurgias), resultados duradouros foram observados na maioria dos casos, exceto por 2 extrusões de sutura de surgimento tardio. Conclusão: O uso de politetrafluoretileno na cirurgia de músculo frontal mostrou ser previsível, seguro e duradouro, Nossos achados corroboram com estudos prévios que mostraram resultados funcionais adequados e baixos índices de complicação.

Surgical treatment of deep sternotomy infection caused by residual pacing lead: 78 cases analysis / 中华胸心血管外科杂志

Objective@#To analysis and summarize the experience of surgical treatment of deep sternal infection caused by residual epicardial pacing.@*Methods@#Retrospective analysis of 78 patients with deep incision infection due to residual epicardial pacing lead after heart disease were selected from the Seventh Medical Center of PLA General Hospital from May 2014 to December 2018. Including 47 males and 31 females, aged 3-72 years old. 38 patients with heart valve surgery(including 18 cases with aortic valvuloplasty, 9 cases with aortic valve replacement, 11 cases with double valve replacement), 14 cases with coronary artery bypass grafting, 26 cases with congenital heart disease surgery(10 cases with atrial septal defect repairment, 11 cases with ventricular septal defect repairment, 5 cases with complex malformation surgery). All patients were infected with sternal incision due to incomplete extraction of the cardiac pacing lead, and treated with the muscle flap turnover operation. The treatment time was 1-5 years after the cardiac surgery in 32 cases, and 46 cases in 1 year.@*Results@#There was no death in the study. 70 cases were cured in stageⅠ, 5 cases in stageⅡ, and 3 cases were cured after re-operation. 71 cases were followed up for 1 year, there was no recurrence of wound infection.@*Conclusion@#The operation of pectoralis major muscle flap turnover has opened up a new approach for the treatment of thoracic incision infection caused by residual epicardial pacing lead after cardiac surgery, and it is worth popularizing in clinical practice.

Deficiencia femoral congénita tipo IIIb. Presentación de un caso / Type IIIb congenital femoral deficiency. Case report

Se trata de un paciente de sexo masculino de 12 años de edad, quien presenta una Hipoplasia Postaxial, con una Deficiencia Femoral Congénita tipo IIIb (Paley), caracterizada por una ausencia de la articulación de la cadera por agenesia del tercio proximal del fémur también denominada Deficiencia Femoral Focal Proximal y la presencia del tercio distal del fémur con rodilla displásica y movilidad limitada. Antecedente de cirugía previa en pie y tobillo en la infancia con anquilosis de tobillo como secuela. Se le realizó plastia de rotación con técnica de Brown modificada por Paley, rodilla pro-cadera mediante fusión iliofemoral acompañada de una amputación distal tipo Syme. El objetivo fue brindarle al paciente una extremidad funcional mediante la confección de una neo-cadera y un muñón que con una adecuada adaptación protésica logrará conseguir un adecuado patrón de marcha, coherente con una amputación supracondílea de fémur o una desarticulación de rodilla.

We present the case of a 12-year-old male patient who presents a Postaxial Hypoplasia with a Congenital Femoral Deficiency type IIIb (Paley), characterized by absence of the proximal third of the femur also called Proximal Focal Femoral Deficiency and the presence of the distal third of the femur with a dysplastic knee with limited movement. Previous surgery in foot and ankle during early childhood with ankle ankylosis as a sequel. We performed a rotationoplasty with the Brown technique modified by Paley, knee pro-hip by iliofemoral fusion accompanied by a Syme distal amputation. The aim of this procedure was to achieve a functional limb by performing a neo-hip and a stump, that with an adequate prosthetic adaptation could achieve a gait pattern, similar to a supracondylar amputation or a disarticulation of the knee.

Efficacy of punctoplasty combined with lacrimal ductule blocking core implantation in the treatment of puncta stenosis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the feasibility and efficacy of punctoplasty combined with lacrimal ductule blocking core implantation in the treatment of puncta stenosis.<p>METHODS: Fifty-six patients(88 eyes)who had epiphora due to puncta stenosis or atresia from March 2018 to July 2019 were enrolled in Jinan mingshui eye hospital. All patients underwent punctoplasty by using trabeculectomy punch combined with a lacrimal ductule blocking core. The core was removed at 2wk after operation. A follow-up of 3mo was taken for final analysis. The epiphora scores, the gradation of punctal morphology and fluorescein staining disappearance test were analyzed pre- and postoperatively.<p>RESULTS: The epiphora scores 3mo after surgery was decreased compared with the preoperative ones. Both the punctal morphology and the fluorescein staining disappearance test were significantly improved 3mo after surgery. One patient had second puncta atresia due to scar hyperplasia after removing the core. The total effectiveness was 98%, of which 81 eyes(92%)were cured compeletely and 5 eyes(6%)were improved significantly. Only 2 eyes(2%)had no effect. No intraoperative complications were observed and minor complications rate was 7%.<p>CONCLUSION: Punctoplasty combined with lacrimal ductule blocking core implantation is a safe and effective new method for the puncta stenosis, which is easy to perform and improve the effect of punctoplasty.

A Study of 25 Diagnosed Cases of Abdominal Tuberculosis – A Review Article

Background: The objective of this study is to evaluate diagnosed cases of abdominal tuberculosis (TB) in terms of incidence,manifestation in different age groups, clinical presentations, treatment received (conservative or surgical), lesions foundintraoperatively, and its outcome on follow-ups.Methods: It is a retrospective study with 25 cases of abdominal TB treated at Guru Gobind Singh Hospital, Jamnagar, duringthe period of 2005–2007. Detailed history, physical examination, necessary investigations such as complete blood counts, ESR,urine examination, sputum examination, and radiological investigations were prescribed in all cases. Barium study, Mantouxtest, ascitic fluid examination, and computed tomography scan abdomen were carried out when indicated. Tissue or biopsymaterials were histologically examined. Results were analyzed with patient’s health status.Results: In 25 case series of abdominal TB, the average age of presentation was between 10 and 40 years with definitemale predominance (male:female = 3:2). Most of the patients belonged to low socioeconomic class which, in turn, reflectsovercrowding, undernourishment, bad sanitation, and poor hygiene in living conditions. In our study, ESR was raised in morethan 90% of patients. Abdominal pain was the most common presenting symptom followed by anorexia, fever, and vomiting.About 25% of patients were having TB foci in lung either active or healed lesion. Uncorrected anemia, malnutrition, andpulmonary TB were all contributory to poor prognosis and prolonged morbidity. Anti-TB drugs gave most satisfactory resultsin our patients.Conclusions: Koch’s abdomen is a clinical entity with varied clinical presentation. It is very common in tropics and maypresent with complications. Most of the patients are cured with conservative treatment and anti-TB drugs. Surgery is requiredin case of complications only. No drug-resistant cases have been found in this study. Investigations have played major role inconfirmation of disease.

Left ventricular aneurysm repair: off-pump linear plication versus on-pump patch plasty

Abstract Objective: The study aimed to compare the clinical outcomes of simplified linear plication and classic patch plasty in patients with left ventricular aneurysm (LVA). Methods: We retrospectively reviewed 282 patients undergoing LVA repair between 2006 and 2016. After propensity score matching, 45 pairs of patients receiving LVA surgery were divided into either a patch group (on-pump endoventricular patch plasty) or a plication group (off-pump linear plication). Then, their early surgical outcomes and long-term survival were compared in two matched groups. Results: The heart function improvement at discharge was similar in the two matched groups, while patients in the patch group more commonly suffered from low cardiac output syndrome (P=0.042) with higher proportion of intra-aortic balloon pumping assistance (P=0.034) than patients in the plication group. Compared with patients in the patch group, the patients in the plication group had shorter recovery times, regarding to mechanical ventilation, intensive care unit stay, and hospital stay (P<0.001, P<0.001, and P=0.001, respectively). No significant difference was found in the long-term survival (P=0.62). Conclusions: Off-pump linear plication presented acceptable results in terms of early outcomes and long-term survival. For high-risk patients, the simplified LVA repair technique may be an option.