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@#Since the outbreak of COVID-19 pandemic, a large number of elective or limited operations, including tumor treatment, have been postponed. With the deepening of the understanding of the virus and the change of the prevention policy, the impact of the pandemic is gradually shrinking, and a large number of operations delayed by the pandemic will be rescheduled. However, there is no consensus on the best time to perform surgery for patients infected with SARS-CoV-2, and the consensus on thoracic surgery is more limited. This article reviews the research progress in the timing of surgical operations, especially thoracic surgery, after SARS-CoV-2 infection.
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Objective:To explore the changes of sex hormones in children with cryptorchidism of different ages after laparoscopic treatment and the risk factors that affect the timing of surgery, so as to improve the surgical effect of the treatment of children with cryptorchidism.Methods:A total of 80 children with cryptorchidism admitted to our hospital from Jun. 2018 to Aug. 2021 were selected as the study subjects, and all children underwent laparoscopic surgery. Twenty-six children aged 6 to 12 months were included in the younger group, 42 children aged 1 to 2 years were included in the middle age group, and 12 children >2 years old were included in the over-age group. Surgical data of the children were recorded, and the levels of follicle-stimulating hormone (FSH) , Luteinizing hormone (LH) and Testosterone (T) were detected. Logistic analysis was used to analyze the independent risk factors affecting the timing of operation in children with cryptorchidism, and ROC curve analysis was used to analyze the diagnostic value of factors affecting the timing of operation in children with cryptorchidism.Results:The level of T (the younger group (7.36±1.63) vs (7.48±1.67) ng/ml; the middle-age group (7.03±1.26) vs (7.11±1.07) ng/ml; the over-age group (4.81±1.37) vs (4.92±1.63) ng/ml) , occult testicular volume (the younger group (0.30±0.01) vs (0.32±0.03) cm3; the middle-age group (0.45±0.14) vs (0.47±0.11) cm 3; the over-age group (0.45±0.09) vs (0.61±0.08) cm 3) and occult testicular minimum blood flow velocity (the younger group (3.42±0.87) vs (4.26±0.94) cm/s; the middle-age group (3.51±0.26) vs (5.69±0.35) cm/s; the over-age group (8.41±0.34) vs (23.64±0.19) cm/s) increased in all three groups,In terms of intraoperative blood loss, postoperative time to get out of bed, and incision pain time, the over-age group > the middle age group > the younger group; FSH and LH decreased in the young age group and increased in the middle age group and over-age group ( P < 0.05) . Age, family income, primiparas, smoking or passive smoking during pregnancy, gestational diabetes mellitus, and protein supplementation during pregnancy were independent risk factors affecting the timing of surgery in children with untorchidism. The areas under ROC curve were 0.884, 0.704, 0.785, 0.842, 0.904, and 0.845, respectively. The area under ROC curve to evaluate the differentiation was 0.866. Conclusion:The range of sex hormone changes in children with cryptorchidism of different ages after laparoscopic treatment is related to age, family income, primipara, smoking or passive smoking during pregnancy, diabetes mellitus during pregnancy, and no protein supplement during pregnancy are the factors affecting the timing of surgery.
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Objective:To explore the effects of operation timing on postoperative complications and operative duration in children undergoing non-emergency operation for femoral neck fracture.Methods:Fifty-nine children and adolescents with femoral neck fracture were retrospectively analyzed who had been admitted to Department of Pediatric Orthopedics, Zhengzhou Orthopedic Hospital Affiliated to Henan University from February, 2015 to September, 2019. They were 39 boys and 20 girls with a mean age of 11.7 (7.1, 13.7) years. By Delbet fracture classification, 7 cases were type Ⅰ, 27 cases type Ⅱ, 20 cases type Ⅲ, and 5 cases type Ⅳ. The patients were divided into 4 groups by the time from injury to operation (TFITO): 17 cases were assigned into group A with TFITO from 24 to 48 hours, 14 cases into group B with TFITO from 49 to 72 hours, 12 cases into group C with TFITO from 73 to 96 hours, and 16 cases into group D with TFITO>96 hours. The effects of TFITO on postoperative complications and operative duration were analyzed.Results:There were no significant differences between the 4 groups in their preoperative general data, showing they were comparable ( P>0.05). This cohort was followed up for 12 to 62 months (average, 20 months). The operation time was not included for this study in 6 cases whose associated injury had to be treated simultaneously. The median operation time for the other 53 patients was 80 (70, 105) min. The correlation coefficient between TFITO and operation time was 0.098 ( P=0.484). Postoperative complications occurred in 37.3% of the patients (22/59), including 14 cases of avascular necrosis of femoral head. For groups A, B, C and D, the incidences of complications were 47.1% (8/17), 50.0% (7/14), 25.0% (3/12) and 25.0% (4/16) while the incidences of avascular necrosis of femoral head 23.5% (4/17), 31.3% (5/16), 16.7% (2/12) and 18.8% (3/16), showing insignificant differences between the 4 groups in all the comparisons ( P>0.05). Conclusion:The time from injury to operation may not increase operative duration or postoperative complications such as avascular necrosis of femoral head in children undergoing non-emergency operation for femoral neck fracture.
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Acute-on-chronic liver failure (ACLF) is a syndrome of acute liver failure complicated by other organ failure on the basis of chronic liver disease. Liver transplantation is the only effective treatment for ACLF. There is still discussion space on the optimal operation timing of ACLF, how to reduce postoperative infection rate, improvement of nutrition and body function. Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association and Enhanced Recovery of Liver Transplantation Group of Enhanced Recovery after Surgery Committee of Chinese Research Hospital Society organized relevant experts to discuss the perioperative management of ACLF liver transplantation from the operation timing, organ protection, nutritional support, infection prevention and control, rehabilitation exercise and regulation of the internal environment, etc. And the expert consensus was developed for the reference of clinicians.
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Objective To explore the effects of operative time on the prognosis in patients with complicated ocular trauma undergoing vitrectomy.Methods Clinical data of 120 patients (128 eyes) with complicated ocular trauma from May 2012 to May 2017 in our hospital were retrospectively analyzed.Then all the subjects were divided into five groups according to the different operative time of vitrectomy,and the functioncure rate was compared in the 5 groups.Results There were 6 patients (6 eyes) receiving operation on day 0 to 5 after the injury,and the functional cure rate was 66.67％,48 patient (50 eyes) receiving operation on day 6 to 10 after the injury,followed by 32 patients (34 eyes) being functional cured with the curative rate of 68.00％,30 patient (34 eyes) receiving operation on day 11 to 15 after the injury,followed by 24patients (26 eyes) being functionally cured with the curative rate of 76.47％,18 patient (20 eyes) receiving operation on day 16 to 20 after the injury,followed by 8 patients (8eyes) being functionally cured with the curative rate of 40.00％,10 patient (10 eyes)receiving operation on day 21 to 25 after the injury,followed by 2 patients (2 eyes) being functionally cured with the curative rate of 20.00％,8 patient (8 eyes) receiving operationover 25 days after the injury,followed by 2 patients (2 eyes) being functional cured with the curative rate of 25.00％,which suggested that patients suffered the injury with 11 days to 15 days had the highest function-cure rate (all P ＜0.05).Conclusion The operative time does matter,which can affect the cure rate of patients with complicated ocular trauma undergoing vitrectomy,and the most suitable time of ocular trauma surgery is 11-15 days after the injury.
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Acute severe ulcerative colitis (ASUC) is a potentially life-threatening condition.Inappropriate salvage therapy might delay the surgery and increase the mortality and postoperative complications in ulcerative colitis (UC).Timely surgical intervention for UC is the key to reduce the rate of mortality and postoperative complications via evaluating the effect of therapy combining with characters of patients' history,clinical symptoms,biochemical markers,radiological and endoscopic criteria.
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Surgical treatment of ulcerative colitis (UC) has received increasing attention.Total proctocolectomy with ileal pouch anal anastomosis (IPAA) has become a standard procedure.Acute severe UC (ASUC) is a difficult point of treatment.The commonly used strategy is to determine whether conversion therapy is performed after the observation of hormone therapy.Critical UC (CUC) is more urgent and complex due to the critical condition of the disease,which is often combined with uncontrollable massive hemorrhage,toxic megacolon or colonic perforation.Therefore,higher requirements for surgical and perioperative management are necessary.At present,when surgeons face CUC patients,what surgical strategy should be adopted is still lack of unified standard.The authors intended to sort out the timing,operation procedure and postoperative management of CUC so as to give full play to the value of surgical treatment and to improve the prognosis of CUC patients.
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Objective To investigate the influence of different timing of surgery on patients with poor-grade intracranial aneurysm. Methods The clinical data of 86 patients with aneurysmal subarachnoid hemorrhage (Hunt-Hess gradeⅣ toⅤ)were analyzed retrospectively. The patients were divided into an ultra-early treatment group (the operative time within 24 h after onset;n=40),an early treatment group, (24 to 72 h after onset;n=27),and middle and late treatment group (>72 h after onset;n=19)according to the different timing of surgery. The prognosis of patients at 6 months after procedure was evaluated with the modified Rankin Scale (mRS)scores. The differences of the rate of good prognosis (mRS 0 to 2)and mortality in patients of the 3 groups were compared. Results (1 )The ratios of good prognosis in the ultra-early treatment group,early treatment group,and middle and late treatment group were 55. 0%(n=22),33. 3%(n=9),and 21. 1%(n=4),respectively. There were significant differences (P0. 05). The mortality ratios in patients of the 3 groups were 2/18,4/11,and 6/11,respectively. There were significant differences (P<0. 05). Conclusion Ultra-early operation may benefit part of the patients with poor-grade aneurysm,particularly in patients with gradeⅣ. As for the patients with grade Ⅴ, ultra-early operation may help to reduce short-term mortality rate,however,the rate of vegetative state is high.
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Objective To approach the surgical timing for the conjoined twins, location of the separation line for the joined liver, and the separation method.Methods The common bile ducts of the conjoined twins were considered as two vertical lines, and a vertical line running parallel to the two lines was set as the separation line for the joined liver.Local blood flow blocking method was then used to separate the joined liver.Results Among all the three cases of the conjoined twins, one case was with sternoxiphopagus and the other two with thoracoabdominalpagus.All the three cases of con-joined twins shared the common livers, but each case had respectively separated gallbladders and bile ducts.They underwent the surgical separation at the age of 28 d and 96 d and 89 d successfully.Their liver sections bled rarely by blocking the local blood flow.The liver function recovered successfully af-ter the operation.All the 6 sick children recovered and were discharged from our hospital.Conclusion Porvided the conjoined twins shared the joined liver with respectively separated common bile ducts, in most cases, the injuries of the important liver vascular as well as bile ducts could be avoided when the separation line for the joined liver was selected with the common bile ducts of the conjoined twins as the longitudinal coordinate.The local blood flow blocking method only blocked the local blood flow, in-terfering to the liver blood flow in the non-operating areas rarely, which was instrumental in the recovery of the liver function and increase of the survival rate of the conjoined twins after the operation.
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An electrical burn used to result in the damage of the skin and underlying deep soft tissue injury. Thus, in order to preserve devitalizing tissues and promote the structural survival free flaps with ample blood supply are frequently employed. However, early unpredictable vascular injury and progressive tissue necrosis may cause the free flaps full of hazards. We applied 50 free flaps upon 41 acute electrical burn cases between 1998 and 2004. Injured areas, timing of operation and causes of flap loss were studied. The victim's ages ranged from 13 to 60 years. (an average 37.8 years) Thirteen out of 50 free flaps were lost totally: three cases were due to arterial insufficiency and ten venous congestion. Total loss of flaps were observed in 5 of 12 cases in the postoperative 3 weeks, 6 of 20 cases between 3 and 6 weeks and 2 of 18 cases after 6 weeks. In three of 12 cases the free flap was lost partially in the postoperative 3 weeks, 4 of 20 cases between 3 and 6 weeks and 1 of 18 cases after 6 weeks. The result was statistically significant by a T-test (p<0.05). This study showed that timing of the operation is accountable for the loss of free flap. It is most important to conduct the free flap procedure on an electrical injury at the time when the recipient vessel is definitely discernible and intact so as to minimize the loss of flap and spare the structures.
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Burns , Free Tissue Flaps , Hyperemia , Necrosis , Skin , Soft Tissue Injuries , Vascular System InjuriesABSTRACT
ObjectiveTo study the age factor in cryp to rchidism in children,the optimal timing of cryptorchidopexy and short-term effe ct following the operation.MethodsThe levels of serum epidermal growth factor(EGF),testosterone(T),5?-dihydrotestosterone (5?-DHT) ,estradiol(E 2),luteinizing hormone(LH),follicle-stimulating hormone(FSH) and prolactin(PRL) were measured with radioimmunoassay (RIA) in 88 children with cry ptorchidism before and after operation,and the expression of EGF receptor(EGF-R ) and androgen receptor(AR) was determined using immunohistochemical technique. ResultsAmong the 88 children with cryptorchidism,the i mpalpable testes were more common in 2-to 4-year group (9/24,37.5%),whereas th e extracanalicular testes were more common in 10-to 14-year group (20/24, 81. 8 %).The difference was significant ( P