Progress on study of factors influencing the prognosis and complications of surgery for discoid meniscus injury in children / 中国骨伤

The discoid meniscus is a common congenital meniscal malformation that is prevalent mainly in Asians and often occurs in the lateral discoid meniscus. Patients with asymptomatic discoid meniscus are usually treated by conservative methods such as observation and injury avoidance, while patients with symptoms and tears need to be treated surgically. Arthroscopic saucerization combined with partial meniscectomy and meniscus repair is the most common surgical approach., and early to mid-term reports are good. The prognostic factors are the patient's age at surgery、follow-up time and type of surgery. Some patients experience complications such as prolonged postoperative knee pain, early osteoarthritis, retears and Osteochondritis dissecans. The incidence of prolonged postoperative knee pain was higher and the incidence of Osteochondritis dissecans was the lowest. Retears of the lateral meniscus is the main reason for reoperation.

Efficacy of Neoadjuvant Chemotherapy on Locally Advanced Gastric Adenocarcinoma in Terms of Downstaging and Resectability in a Tertiary Cancer Hospital

Background: Neoadjuvant chemotherapy (NACT) in carcinoma stomach was introduced in an effort to eliminate micro-metastasis and to improve resectablity before surgery which improves R0 resection rates. The aim of the current study was to evaluate the effect of neoadjuvant chemotherapy on downstaging and resectability rate in locally advanced gastric cancer. Material & Methods: This was a single-center quasi-experimental study conducted in the Department of Surgical Oncology in collaboration with the Departments of Medical Oncology, Radiation oncology, and Pathology at the National Institute of Cancer Research and hospital, Dhaka, which is a tertiary care cancer hospital in Bangladesh, between January 2021 and June 2022.Patients with locally advanced adenocarcinoma stomach staged by contrast-enhanced computed tomography (CECT) were randomly included in this study by purposive sampling. Patients in Group I underwent upfront surgery Patients in Group II were started on neoadjuvant chemotherapy, either XELOX or FLOT regimen. Surgery was done following the response assessment CECT. We assessed R0 resection rate, age, sex, comorbidities, tumour size, TNM stage and complications were compared between the two groups. Response to NACT was assessed in Group II. Results: The mean age of patients in groups 1 & 2 was 56 ± 11.06 and 55.70 ± 10.46 years of age respectively (p > 0.05). Majority of the respondents (55/74) were male and 19 patients (26%) were female. Male to female ratio was (24/37 &31/37) in group 1 and (31/37 & 6/37) groups respectively (p > 0.05). Out of 37 patients who received NACT, in 9 patients (24.32%) complete response was noted. Partial response was found in 20 cases (54.05%), p-value (<.0001) while a stable disease was reported in three (8.1%) cases. 5 patients (13.51%) had progressive disease. In the upfront surgery group, R0 resection was feasible in 16 (43.2%) cases, and in the NACT plus surgery group, R0 resection was done in 29 (78.4%) cases. In group 1, R1 resection was done in considerable numbers (19/37) compared to group 2 (5/37), P=0.001. Three patients (8.1%) in group 2 and one (2.7) in group 1 had irresectable lesions. Conclusion: In this study it can be concluded that neoadjuvant chemotherapy could downstage tumour and increase tumor resectability rate in patients with locally-advanced gastric adenocarcinoma. However, further studies are necessary to confirm the effect of this modality on patients’ overall survival. We await survival analysis to further validate the role of NACT.

Analysis of long-term surgical outcome and safety in patients with post-traumatic epilepsy / 中风与神经疾病杂志

@#Objective To investigate the long-term surgical outcome and safety of resective surgical treatment in patients with post-traumatic epilepsy(PTE). Methods Patients with PTE who underwent resective surgery from January 2014 to December 2020 at our center were consecutively included,and their demographic characteristics and clinical data were retrospectively analyzed. Univariate analysis and multifactor Logistic regression analysis were used to identify potential predictors of postoperative outcome,and surgery-related complications were documented and followed-up. Results A total of 104 patients with PTE were included. The postoperative outcomes were graded by Engel class:60.6%(63/104) as Engel class Ⅰ and 39.4%(41/104) as Engel class Ⅱ-Ⅳ with a mean follow-up of(68.7±23.2) months(20-103 months). Univariate analysis showed that age at the time of surgery and surgical side were associated with postoperative outcome,while multivariate analysis showed that only surgical side was an independent predictor of postoperative outcome(OR=2.944,95%CI 1.283-6.753,P=0.011),with 2.9 times the seizure-free(Engel class Ⅰ) rate when the surgical side was right-sided compared with left-sided. 29.8%(31/104) of patients had varying degrees of surgery-related complications,including 20 cases of subcutaneous or subdural effusion;3 cases of cerebral edema;2 cases of cerebral hemorrhage;1 case of hydrocephalus combined with incisional infection;and 5 cases of neurological deficits,4 of which recovered completely during the follow-up period. Conclusion PTE patients treated with resective surgery after comprehensive preoperative evaluation had good long-term surgical outcomes and safety,and good postoperative outcomes were predicted when the surgical side was right-sided.

Outcome of superior manual small-incision cataract surgery in pediatric age group - A five year retrospective study at a tertiary eye hospital in Karnataka

Purpose: To analyze intraoperative difficulties and visual and surgical outcomes following pediatric cataract surgery. Methods: This five?year retrospective study (2014�19) included 138 eyes (85 children) with cataract aged between 12 months and 18 years (either sex). All children had undergone best?corrected visual acuity (BCVA), anterior and posterior segment evaluation, intraocular lens (IOL) power calculation, superior manual?small?incision cataract surgery (MSICS) with or without posterior capsulotomy/anterior vitrectomy and IOL implantation under general or local anesthesia, visual rehabilitation, and had been followed up for a minimum period of 12 months. Results: The mean age was 111.27 � 4.84 months. Preoperative BCVA distance: 113 (81.88%)eyes had BCVA < 6/60; near BCVA: 114 (82.6%) eyes had ?N36. At last postoperative follow?up (mean: 20.98 � 13.08 months): distant BCVA? ?6/60 had been recorded in 120 (86.96%) eyes; near BCVA? >N36 in 123 (89.13%) eyes. Improvement in BCVA was statistically significant. Intraoperative scleral tunnel difficulties were seen in three eyes (thin flap in two, and buttonhole in one eye); in the majority of the eyes 113 (81.88%), IOL was placed in the bag. Twenty eyes had early postoperative inflammation. At last follow?up: posterior capsular opacity was recorded in six eyes, IOL decenteration in two eyes, secondary glaucoma in six eyes, and severe amblyopia in 36 (26.09%) eyes. The mean myopic shift was ? 1.11 � 0.89 D and was statistically significant. Conclusion: Superior MSICS as a treatment for pediatric cataract has minimal intraoperative complications and satisfactory visual and surgical outcomes.

Demographic Profile And Surgical Outcome Of Various Types Of Lower Limb Amputations

Background- Amputations is one of the oldest surgery known to mankind.Knowledge on the current trends in amputation is necessary to devise effective preventive measures at community level and to reduce this devastating event. : - 1)To know the incidence of various types of lower-limb amputations in our hospital.2)ToAim And Objectives study the demographic pattern in lower limb amputations in our hospital.3)To know the various risk factors leading to lower limb amputations.4)To know the immediate postoperative complications associated with lower-limb amputations. MATERIALS AND METHODS-This study is a prospective observational study.All patients who have undergone lower limb amputation during 1 year period fulfilling the inclusion criteria were included in the study.Main outcome measures were patient's age, gender, limb affected, indication for amputation, complications, reamputation rate,associated procedure performed, duration of hospital stay and outcome. Of the 96 patients who have underwent lowerResults- limb amputations,the mean age was 57.34 with male: female ratio 3:1.Hospital stay ranged from 3 days to 90days.The presence of comorbidities such as Diabetes Mellitus,Peripheral vascular disease and osteomyelitis were associated with an increased rate of complications postoperatively. The most common complication was stump infection , followed by phantom limb.10 patients died during the hospital stay. Sepsis with MODS was the main cause of death.Reamputation rate in this study was 5%. Diabetic foot and its complications is the leading cause of amputations.ThusConclusion- educating diabetics on proper foot care can prevent diabetic patients from ending up with amputations. Prevention is better than cure

Clasificación American Society of Anesthesiologisth Physical Status: Revisión de ejemplos locales ­ Chile / Local examples of the American Society of anesthesiologists classification

The American Society of Anesthesiologisth Physical Status (ASA PS) scale is one of the most widely used scales in the world, being an integral part of the pre-anesthetic evaluation of each patient. The purpose of the ASA PS scale is to categorize, and subsequently communicate the patient's risk of undergoing any procedure that requires anesthesia. The objective of this article is to review the classification and incorporate examples, associating them with perioperative risk, in order to improve categorization and clinical practice in our setting.

La escala American Society of Anesthesiologisth Physical Status (ASA PS) es una de las escalas más utilizada en el mundo, siendo parte integral de la evaluación preanestésica de cada paciente. El propósito de la escala ASA PS es categorizar, y posteriormente comunicar el riesgo del paciente de someterse a cualquier procedimiento que requiera anestesia. El objetivo de este artículo es revisar la clasificación e incorporar ejemplos, asociándolos con el riesgo perioperatorio, para así mejorar la categorización y la práctica clínica en nuestro medio.

Philippine Surgical Infection Society 2020 Consensus Guidelines on oral hygiene for the improvement of surgical outcomes

@#Nosocomial infections significantly contribute to a patient’s morbidity and mortality, increasing healthcare costs. While previous research has assessed the effect of oral hygiene on the prevention of nosocomial infections and postoperative complications, few guidelines exist that offer evidence-based recommendations on pre- or peri-operative oral hygiene in the surgical setting. The Philippine Surgical Infection Society set out to develop a set of guidelines that provide evidencebased recommendations on oral hygiene for improving surgical outcomes for adoption in the Philippines. Six clinical questions defined the scope of the guidelines. A systematic review was performed to provide the evidence base to develop the recommendations. A consensus meeting participated by 15 representatives from 13 specialty surgical societies and societies concerned with infection control was conducted using the modified Delphi technique to finalize the set of recommendations. A consensus guideline with sixteen recommendations on the use of oral hygiene to improve surgical outcomes is presented for adoption and implementation.

Surgical outcomes of focal cortical dysplasia patients with "difficult to locate" intractable epilepsy and their influencing factors / 中华神经医学杂志

Objective:To explore the surgical outcomes of focal cortical dysplasia (FCD) patients with "difficult to locate" intractable epilepsy and their influencing factors.Methods:Thirty-five FCD patients with "difficult to locate" intractable epilepsy, underwent surgical treatment after intracranial electroencephalogram (iEEG) evaluation in our hospital from January 2011 to December 2018, were chosen in our study. Engel grading was used to evaluate the surgical efficacies of these patients, and they were divided into a satisfied efficacy group (Engel grading I) and an incomplete satisfied efficacy group (Engel grading II-IV). The clinical data of patients from the 2 groups were compared. Multivariate Logistic regression analysis was performed to explore the influencing factors for surgical outcomes of FCD patients with "difficult to locate" intractable epilepsy.Results:Of these 35 patients, 26 patients (74.3%) achieved satisfied efficacy, and 4 had incomplete satisfied efficacy. As compared with those in the satisfied efficacy group, patients in the incomplete satisfied efficacy group had significantly lower total resection rate of epileptogenic foci ( P<0.05). Multivariate Logistic regression analysis showed that incomplete resection of epileptogenic foci was the influencing factor for surgical outcomes of FCD patients with "difficult to locate" intractable epilepsy ( P=0.014, OR=0.050, 95%CI: 0.005-0.547). Conclusion:The FCD patients with "difficult to locate" intractable epilepsy can achieve satisfactory results by surgical resection of epileptogenic zones after iEEG monitoring; these FCD patients with "difficult to locate" intractable epilepsy with incomplete resection of epileptogenic foci often have poor surgical outcomes.

Role of acute physiology and chronic health evaluation II scoring system in risk stratification and management of small bowel perforations

Background: Despite the surgical treatment, sophisticated intensive care units, latest generation antibiotics and a better understanding of pathophysiology, the morbidity and mortality rate of perforation peritonitis are still high. Patients are usually managed by subjective decision of surgeon based on which mortality is very high.Methods: This was a double-blind observational study conducted over a period of 18 months on 50 patients with small bowel perforations. Based on the acute physiology and chronic health evaluation (APACHE) II score at presentation, patients were triaged into 3 groups: group 1 (score ≤10), group 2 (score 11 to 20) and group 3 (score >20). Study population was managed by the subjective decision of the operating surgeon who was blinded off the APACHE II score of patients. Hence removing the possibility of bias and observing a correlation between surgical outcome and APACHE II score of the patient.Results: Patients with higher APACHE II score (>10) were more likely to undergo exteriorization of bowel. Length of hospital stay was also found to be increased with an increase in score. APACHE II score of 10 was found to predict mortality with significant difference between 2 groups. Below this score the mortality was 0% and above this score the mortality rate rose to 31.25%.Conclusions: APACHE II can be used as a reliable and uniform scoring system as its assessment at presentation in patients of small bowel perforations provides an insight to their surgical management as well as predicting overall outcome.

Visual Prognosis and Satisfaction of Advanced Cataract Patients Unable to be Evaluated by Fundus Imaging

PURPOSE: We evaluated the surgical prognoses of patients with advanced cataract who were unable to be evaluated by fundus imaging and their satisfaction with daily life.METHODS: We retrospectively reviewed 748 eyes of 480 patients who underwent cataract surgery from January 2015 to December 2017. Preoperative factors, surgical technique, degree of cataract, and the best-corrected visual acuity for 1 and 6 months after surgery were analyzed. Among 91 eyes of 78 patients with advanced cataract who were unable to be evaluated by fundus imaging, the degree of discomfort before surgery and postoperative satisfaction were evaluated.RESULTS: Hypertension was positively correlated with visual acuity after cataract surgery (p = 0.004). Low corneal endothelial cell count, primary open-angle glaucoma, a history of trabeculectomy due to glaucoma, corneal dystrophy or corneal opacity, advanced cataract unable to be evaluated by fundus imaging, hypermature cataract, extracapsular cataract extraction, and intracapsular cataract extraction and visual acuity <0.5 after 1 month showed negative correlations with the visual outcomes after 6 months (p = 0.019, p = 0.002, p = 0.037, p = 0.001, p = 0.004, p = 0.012, p = 0.00, and p = 0.00, respectively). The risk of a final visual acuity <0.5 after cataract surgery was 3.18-fold higher in cases of advanced cataract, unable to be evaluated by fundus imaging (p = 0.003). Ten patients with 10 eyes postponed surgery due to poor prognoses, which was expected, and six patients (60%) had a best-corrected visual acuity <0.5 after 6 months. Six patients (60%), expected to have a poor prognosis were satisfied after surgery and the postoperative satisfaction was high when compared with a poor visual outcome.CONCLUSIONS: Poor surgical prognoses were expected in advanced cataract patients unable to be evaluated by fundus imaging. However, advanced cataract patients, who postponed surgery due to an unfavorable visual prognosis, showed a higher subjective satisfaction when compared with the postoperative visual acuity.

Surgical outcomes of microincision vitrectomy surgery in eyes with retinal detachment secondary to retinopathy of prematurity in Indian population

Purpose: To analyze and report outcomes of microincision vitrectomy surgery (MIVS) for Stage 4 and 5 retinopathy of prematurity (ROP). Methods: Medical records of 202 eyes of 129 premature children undergoing MIVS for Stage 4/Stage 5 ROP between January 2012 and April 2015 were evaluated. The primary outcome measure was the proportion of eyes with anatomical success (defined as attached retina at the posterior pole at last follow-up). Complications associated with MIVS were noted and analysis of risk factors associated with poor anatomical outcome was also done using logistic regression. Results: Mean age of presentation of babies with Stage 4 ROP (2.9 ± 1.75 months) was lower than those with stage 5 disease (5.62 ± 2.55 months) (P < 0.005). One hundred seventeen eyes (56% or 58%) had Stage 5, 38 (19%) had Stage 4a, and 47 (23%) Stage 4b. Ninety-four eyes (47%) had received prior treatment (laser and/or anti-vascular endothelial growth factors [VEGF]). Lens-sparing vitrectomy (LSV) was performed in 58 (29%) eyes while lensectomy with vitrectomy (LV) was performed in 144 (71%) eyes. At a mean follow-up of 32.5 weeks, 102 (50.5%) eyes achieved anatomical success, including 74% eyes in Stage 4a and 4b and 33% in Stage 5. Complications included intraoperative break formation (19%), postoperative vitreous hemorrhage (28%), raised intraocular pressure (12.7%), and cataract progression (2.4%). Factors significantly associated with favorable anatomical outcome were Stage 4 disease (vs. Stage 5) (odds ratio [OR] 5.8; confidence interval [CI] =2.6–13.8, P < 0.005), prior treatment (laser ± anti-VEGF) (OR 2.5; CI 1.4–4.7, P < 0.005) surgery with 25G MIVS (vs. 23G) (OR: 1.7; CI = 0.98–3.00, P = 0.05) and LSV (vs. LV) (OR 7; CI = 3.4–14.6, P < 0.005). Retinal break was significantly associated with poor anatomical outcome (OR 0.21; CI = 0.09–0.5, P < 0.005). Conclusion: MIVS along with wide angle viewing systems allow surgeons to effectively manage ROP surgeries while at the same time reducing complication rate in these eyes which have complex pathoanatomy and otherwise grim prognosis.

Effects of preoperative percutaneous transhepatic biliary drainage on surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma / 中华外科杂志

Objective@#To investigate the effects of preoperative percutaneous transhepatic biliary drainage on surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma.@*Methods@#Clinical data of 72 patients with hilar cholangiocarcinoma of the Bismuth-Corlette type Ⅲ and Ⅳ treated at Department of General Surgery,First Affiliated Hospital of Bengbu Medical College from January 2010 to December 2017 were analyzed retrospectively.Patients were divided into two groups based on whether PTBD was performed:a drained group and an undrained group.In the drained group,there were 31 patients,20 males and 11 females,aged (59.9±9.7)years (range: 39-73 years).Among them,14 patients underwent hepatectomy with half or more than half of the liver removed (extended hepatectomy)and 17 patients underwent non-anatomical hepatectomy in the hilar region (limited hepatectomy).In the undrained group,there were 41 patients, 26 males and 15 females, aged (60.8±7.8)years(range: 45-75 years).Among them, 17 patients underwent hepatectomy with half or more than half of the liver removed (extended hepatectomy)and 24 patients underwent non-anatomical hepatectomy in the hilar region (limited hepatectomy).Percutaneous transhepatic biliary drainage(PTBD)was used in the drained group.Under the guidance of ultrasound,one or more hepatobiliary ducts could be sufficiently drained,which had good effect and was not restricted by the obstruction location of hilar cholangiocarcinoma.The analysis of the measurement data was performed using t test,and the analysis of the count data was performed using χ2 test,and the survival curve was plotted using Kaplan-meier method.@*Results@#In total, 72 jaundiced patients with hilar cholangiocarcinoma underwent surgical treatment: 31 had PTBD prior to operation while 41 did not had PTBD.There were significant differences in ALT((93.2±21.4)U/L vs.(207.4±65.1)U/L),AST((87.6±18.1)U/L vs.(188.9±56.6)U/L)and total bilirubin((68.8±12.6)μmol/L vs.(227.5±87.7)μmol/L)between the patients after treatment and those before treatment(t=10.958, P=0.000; t=10.845, P=0.000; t=10.386, P=0.000).Compared with those in the undrained group, the operation time was shorter, the amount of intraoperative bleeding and the incidence of complications were lower in the drained group(t=-2.840, P=0.006; t=-3.698, P=0.000; χ2=4.108, P=0.043).There were no perioperative death cases in drained group and 2 perioperative death cases in undrained group.There was no significant difference in R0 resection rate between the two groups(χ2=0.778,P=0.378).The 1-,3-,5-year survival rate of patients in the drained group and the undrained group was 72.7%,34.2%, 13.7% and 72.8%, 31.5%, 11.8%, respectively.The difference was not statistically significant(all P>0.05).@*Conclusions@#The preoperative percutaneous transhepatic biliary drainage in patients with hilar cholangiocarcinoma of Bismuth-Corlette type Ⅲ and Ⅳ could effectively shorten operative time, reduce amount of intraoperative bleeding and incidence of postoperative complications,but have no significant effect on the R0 resection rate and survival rate.

Surgical outcome evaluation and prediction analysis of laparoscopic left sided hepatectomy for hepatolithiasis / 中华外科杂志

Objective@#To explore the risk factors of long-term treatment outcomes and establish predicting model for laparoscopic left hepatectomy in hepatolithiasis.@*Methods@#Clinical data of 108 patients with hepatolithiasis who underwent laparoscopic left sided hepatectomy and with complete follow-up data were retrospectively collected from June 2011 to June 2016 at the Second Affiliated Hospital of Nanchang University. Twenty-six males and 82 females were enrolled. The age was (52.4±11.7) years (range:20-80 years) , and the median follow-up time was 36 months (range: 24-83 months) . Patients were randomly divided into training group (79 cases) and validation group (29 cases) with a ratio of about 3∶1. Twenty-five preoperative and intraoperative clinical factors were selected for potential factors that might affect long-term outcomes, and quality of life was used as an surrogate evaluation index. Univariate analysis and multivariate logistic regression analysis were used to investigate the potential risk factors, and to construct and validate the predictive nomogram for surgical outcomes.@*Results@#Among 108 patients, 10 patients (9.3%) had residual stones, 8 patients (7.4%) had recurrent stones, 12 patients (11.1%) had recurrent cholangitis and 3 patients (2.8%) died. Univariate analysis showed that history of hepatobiliary surgery, gender, activation of partial thromboplastin time, alkaline phosphatase, use of choledochoscopy, postoperative stone residual, serum creatinine, postoperative biliary drainage and operation time were risk factors that may affect long-term outcomes (all P<0.15) . Multivariate analysis showed that the history of previous hepatobiliary surgery (OR=2.305, 95% CI: 0.383-4.227, P=0.019) , postoperative biliary drainage (OR=2.043, 95% CI: 0.182-4.209, P=0.048) , operation time ≥262.5 minutes (OR=1.971, 95% CI: 0.154-4.023, P=0.045) were independent risk factor affecting long-term outcomes. Based on the above factors, the predictive nomogram model was constructed. Internal and external validations showed good discrimination (area under the curve of receiver operating curve>0.7) and calibration (Hosmer-Lemeshow test: P>0.05) performance, which indicated that the prediction effect was favorable.@*Conclusions@#History of previous hepatobiliary surgery, postoperative biliary drainage and operation time ≥262.5 minutes are independent risk factors for long-term outcome. The predictive nomogram model based on risk factors relates to surgical outcomes presented good clinical predictive effects, which might contribute to the prediction of the long-term outcomes of laparoscopic left sided hepatectomy for hepatolithiasis.

Comparison of Delorme-Thiersch Operation Outcomes in Men and Women With Rectal Prolapse

PURPOSE: The laparoscopic rectopexy has become increasingly popular with verified stability, surgical route selection should be tailored to individual patient characteristics rather than operative risk. The perineal approach is useful in young male patients who need to preserve fertility. This study aimed to compare the characteristics of men and women who underwent Delorme-Thiersch procedures and analyze the postoperative outcomes of the perineal approach by sex. METHODS: We retrospectively reviewed the medical records of 293 patients who underwent Delorme-Thiersch operations in Seoul Song Do Colorectal Hospital between January 2011 and September 2017. Patient clinical characteristics and postoperative complications were analyzed by sex. We analyzed surgical outcomes with preoperative and 3-month postoperative incontinence questionnaires, constipation levels, and anal manometry. RESULTS: In this study, men with rectal prolapse were younger than women with the same condition. American Society of Anesthesiologists physical status classifications were higher in women and women had more L-spine X-ray and pudendal nerve terminal motor latency test abnormalities. Anorectal manometry pressures were higher in men. Men also had longer operation times and hospital stays and more postoperative complications (8 T ring infections, 6 patients with bleeding, 3 with strictures, 2 with severe pain, and 2 with rectal perforations). The recurrence rate was higher among women. CONCLUSION: Men with rectal prolapse were younger, healthier, and had relatively better anorectal function than women. The Delorme-Thiersch operation in men promoted lower recurrence rates and was advantageous in preserving the fertility of young patients, but the incidence of complications was also higher in men. Adequate counseling and preparation for the possibility of complications are needed.

Recent Trends in Demographics, Surgery, and Prognosis of Patients with Surgically Resected Lung Cancer in a Single Institution from Korea

BACKGROUND: Over the past few decades, demographics information has changed significantly in patients with surgically resected lung cancer. Herein, we evaluated the recent trends in demographics, surgery, and prognosis of lung cancer surgery in Korea. METHODS: Patients with surgically resected primary lung cancer from 2002 to 2016 were retrospectively analyzed. Multivariable Cox regression analysis was conducted to identify prognostic factors for overall survival. The annual percent change (APC) and statistical significance were calculated using the Joinpoint software. RESULTS: A total of 7,495 patients were enrolled. Over the study period, the number of lung cancer surgeries continued to increase (P < 0.05). The proportion of women to total subjects has also increased (P < 0.05). The proportion of elderly patients (≥ 70 years) as well as those with tumors measuring 1–2 cm and 2–3 cm significantly increased in both genders (all P < 0.05). The proportion of patients with adenocarcinoma, video-assisted thoracic surgery, sublobar resection, and pathological stage I significantly increased (P < 0.05). The 5-year overall survival rate of lung cancer surgery increased from 61.1% in 2002–2006 to 72.1% in 2012–2016 (P < 0.001). The operative period was a significant prognostic factor in multivariable Cox analysis (P < 0.001). CONCLUSION: The mean age of patients with lung cancer surgery increased gradually, whereas tumor size reduced. Prognosis of lung cancer surgery improved with recent increases in the frequency of adenocarcinoma, video-assisted thoracic surgery, sublobar resection, and pathological stage I. The operation period itself was also an independent prognostic factor for overall survival.

Unilateral cleft lip: evaluation and comparison of treatment outcome with two surgical techniques based on qualitative (subject/guardian and professional) assessment

OBJECTIVES: The outcomes of the treatment of unilateral cleft lip can vary considerably due to variations in repair techniques. The aim of this study was to evaluate and compare treatment outcomes of surgical repair of unilateral cleft lip using either the Tennison–Randall or Millard technique based on (qualitative) parent/subject and professional assessments. MATERIALS AND METHODS: This was a prospective, randomized, controlled study conducted at Lagos University Teaching Hospital between January 2013 and July 2014. A total of 56 subjects with unilateral cleft lip presenting for primary surgery who satisfied the inclusion criteria were recruited for the study. Subjects were randomly allocated to surgical groups A or B through balloting. Group A underwent cleft repair with the Tennison–Randall technique, while group B underwent cleft repair with the Millard rotation advancement technique. Surgical outcome was assessed using qualitative evaluation by the guardian/subject and independent assessors based on a modified form of the criteria described by Christofides and colleagues. RESULTS: Of the 56 subjects enrolled in this study, 32 were male, with a male to female ratio of 1.3:1. Fifteen of the guardians/subjects in the Tennison–Randall group were most bothered about the lower part of the residual lip scar, while 12 guardians/subjects in the in the Millard group were most bothered about the upper part of the scar. More noses were judged to be flattened in the Millard group than in the Tennison–Randall group. Assessors observed a striking disparity in scar transgression of the philtral ridges between the two groups. CONCLUSION: Essentially, there were no major difference in the overall results between Millard rotation-advancement and Tennison–Randall repairs. Both Millard and Tennison–Randall's techniques require significant improvements to improve the appearance of the scar on the upper part and lower part of the lip, respectively.

Precision pulse capsulotomy in phacoemulsification: Clinical experience in Indian eyes

Purpose: To evaluate the surgical outcome of precision pulse capsulotomy (PPC) in phacoemulsification surgery. Methods: One hundred twenty-three eyes of 99 consecutive patients who underwent phacoemulsification with PPC through a 2.8 mm clear corneal incision were prospectively studied at a tertiary care centre. The size, shape of capsulotomy and intraoperative capsulotomy, and surgery-related complications were noted. Visual outcome, IOL stability, and signs of capsular opacification/contraction were evaluated at 3 and 6 months. Results: The mean age of patients was 49.5 ± 7.77 years. Complete, circular capsulotomy averaging 5.5 mm diameter was achieved in 117 of 123 eyes. In seven eyes, we experienced complications like capsulorhexis tear (n = 6) and inadvertent iris capture (n = 1). Probe malfunction occurred in six cases. Stable intracapsular intraocular lens (IOLs) fixation and centration was achieved in all eyes. None of the eyes had any significant posterior capsular opacification or capsular contraction at 3 and 6 months. In one eye anterior capsular opacification at the capsulotomy edge was noted at 6 months. Conclusion: PPC is a useful device for achieving a perfectly round capsulorrhexis. However, it has a learning curve and chances of skip areas in capsulorhexis, capsular tag, and its extension should be kept in mind. Special care should be taken in initial cases and while operating on eyes with poorly dilating pupil and mature cataracts.

A Retrospective Analysis of Clinical Profile and Surgical Outcome in Patients with Spinal Dysraphism at Tertiary Care Center

Background: Spinal dysraphism refers to a spectrum of congenital anomalies of the spine resulting in a defective neural arch through which meninges and / or neural elements herniated leading to a variety of clinical manifestations. Aim: This study aimed to evaluate the incidence, clinical presentations, and surgical outcome in spinal dysraphism patients. Materials and methods: This study was a retrospective study which consisted of 32 patients conducted in Academy of Medical Sciences, Pariyaram over a period of March 2015 to March 2017. All the patients were admitted in Department of Gynecology and Pediatrics. Results: The incidence was high in females 54.29% than males 45.71%. Spina bifida aperta (open type) was present in 44 patients (62.86%) and more common than Spina bifida occulta (closed) which was present in only in 26 patients which constituted 37.14%. The commonest site of occurrence of spinal dysraphism was the lumbo sacral region in 32 patients which constituted to 45.7%. Most common finding was myelomeningocele in 41 (58.6%) cases; myelocele was seen in 6 cases (8.6%). Lipomyelomeningocele was seen in 8 cases which was most common finding in closed type. The most common associated anomaly was hydrocephalus in 25 patients and next common was Arnold Chairi malformation type 11 in 20 cases. Motor weakness in the form of paraparesis or paraplegia present in25 patients preoperatively, out of which only 14 improved. Major cases of sensory deficits did not improved and remained static. In the majority of cases of 11 sphincter function, 6 cases remained status quo same as in the preoperative period. Conclusion: The most common congenital cause of disability in children is spinal dysraphism encountered by paediatric neurosurgeon. Open type spina bifida is more common than closed one .At Premlal KV. A Retrospective Analysis of Clinical Profile and Surgical Outcome in Patients with Spinal Dysraphism at Tertiary Care Center. IAIM, 2018; 5(5): 63-68. Page 64 peripheral centres, inadequatetreatmentshouldbeavoided.Spinaldysraphismpatientsshould be referred to higher tertiary centre where all the facilities are provided to the patients.

Clinical Characteristics, Imaging Findings and Surgical Outcomes of Chiari Malformation Type Ⅰ in Pediatric and Adult Patients / 华中科技大学学报（医学）（英德文版）

A growing number of children and adolescents are being diagnosed as Chiari malformation type Ⅰ (CM-Ⅰ) for behavioral disorders,developmental delay,seizures,or abnormal orpharyngeal function.The aim of this study was to compare the clinical characteristics,imaging findings and surgical outcomes of CM-Ⅰ in pediatric and adult patients.Between January 2014 and June 2017,84 patients with CM-Ⅰ underwent surgical treatment in our department.We divided the patients into two groups:pediatric group (n=1 1,age ＜18 years)and adult group (n=73,age ≥18 years).Data on clinical characteristics,imaging findings,surgical outcomes,and prognosis were retrospectively reviewed and compared between these two groups.For clinical presentation,scoliosis (36.4％) and developmental delay (36.4％) were more common in pediatric patients,whereas,sensory disturbance (58.9％) and motor weakness (41.1％) were more common in adult patients.Imaging findings showed that the incidence of hydrocephalus and craniovertebral junctional abnormalities was significantly higher in pediatric group than in adult group (P＜0.05).Compared to adult group,pediatric group showed a better improvement or resolution of syrinx and tonsillar herniation after surgical treatments (P＜0.05).The total Chicago Chiari Outcome Scale (CCOS) score in pediatric patients at the last follow-up was significantly higher than that in adult patients (P=0.002).In conclusion,the clinical characteristics and imaging findings appeared to be different in pediatric and adult patients with CM-Ⅰ.The surgical outcomes of pediatric patients were shown to be significantly better than those of adult patients.

Clinical Characteristics, Imaging Findings and Surgical Outcomes of Chiari Malformation Type Ⅰ in Pediatric and Adult Patients / 华中科技大学学报（医学）（英德文版）

A growing number of children and adolescents are being diagnosed as Chiari malformation type Ⅰ (CM-Ⅰ) for behavioral disorders,developmental delay,seizures,or abnormal orpharyngeal function.The aim of this study was to compare the clinical characteristics,imaging findings and surgical outcomes of CM-Ⅰ in pediatric and adult patients.Between January 2014 and June 2017,84 patients with CM-Ⅰ underwent surgical treatment in our department.We divided the patients into two groups:pediatric group (n=1 1,age ＜18 years)and adult group (n=73,age ≥18 years).Data on clinical characteristics,imaging findings,surgical outcomes,and prognosis were retrospectively reviewed and compared between these two groups.For clinical presentation,scoliosis (36.4％) and developmental delay (36.4％) were more common in pediatric patients,whereas,sensory disturbance (58.9％) and motor weakness (41.1％) were more common in adult patients.Imaging findings showed that the incidence of hydrocephalus and craniovertebral junctional abnormalities was significantly higher in pediatric group than in adult group (P＜0.05).Compared to adult group,pediatric group showed a better improvement or resolution of syrinx and tonsillar herniation after surgical treatments (P＜0.05).The total Chicago Chiari Outcome Scale (CCOS) score in pediatric patients at the last follow-up was significantly higher than that in adult patients (P=0.002).In conclusion,the clinical characteristics and imaging findings appeared to be different in pediatric and adult patients with CM-Ⅰ.The surgical outcomes of pediatric patients were shown to be significantly better than those of adult patients.