Effect of prophylactic plasma transfusion on postoperative bleeding rate in ICU patients after different invasive procedures / 中国输血杂志

【Objective】 To evaluate the association between prophylactic plasma transfusion and postoperative bleeding rate in critically ill patients undergoing different invasive procedures. 【Methods】 The information of ICU patients who received different invasive procedures from January 2019 to December 2019 in 6 tertiary hospitals in China were retrospectively investigated. The inclusion criteria of patients were as follows: age ≥ 18 years; received invasive procedures; INR ≥ 1.5 within 72 hours before surgery. Exclusion criteria were patients with incomplete case records. The patients finally included in the study were divided into prophylactic plasma transfusion group and non-prophylactic plasma transfusion group according to their plasma transfusion status. The outcome variable was the incidence of invasive procedure-related bleeding within 48 hours after different invasive procedures. 【Results】 A total of 407 patients underwent invasive procedures, and 362 patients were finally included in this study after excluding 45 patients with incomplete case records. The proportions of prophylactic plasma transfusion in different types of invasive procedures were central venous catheterization (46/146, 31.5%), thoracentesis (13/37, 35.1%), bronchoscopy (8/31, 25.8%), tracheal intubation (9/38, 23.7%), arterial catheterization (9/50, 18.0%) and others (13/60, 21.7%). The bleeding rates showed that different invasive procedures presented no statistical difference between the groups received plasma transfusion or not. In the prophylactic plasma transfusion group, the bleeding rate of arterial catheterization (4/9, 44.4%) was the highest, but all were potential bleeding, followed by tracheal intubation (4/10, 40.0%) and central venous intubation (16/46, 34.8%), with a higher rate of significant bleeding. 【Conclusion】 Prophylactic infusion of plasma did not reduce the bleeding rate after different invasive procedures, but prospective studies are needed to further confirm the conclusion; this study also provides a certain data basis for later prospective studies.

O Uso do Jogo Digital "Hospital Mirim" como Estratégia de Enfrentamento à Procedimento Invasivo / The Use of the Digital Game "Hospital Mirim" as Coping with the Invasive Procedure / El Uso del Juego Digital "Hospital Mirim" como Estrategia de Enfrentamiento del Procedimiento Invasivo

Os procedimentos invasivos que envolvem agulha são capazes de provocar dor e ansiedade nas crianças, em função de implicarem uma expectativa de sofrimento físico e perda de controle da situação. A utilização de atividades lúdicas visa minimizar os efeitos dos processos dolorosos, se constituindo como estratégias de humanização para o contexto hospitalar. Este trabalho investigou os efeitos do serious game "Hospital Mirim" como estratégia de enfrentamento ao procedimento invasivo de coleta de sangue. Participaram 40 crianças com idade entre seis e 10 anos, sendo 20 do grupo controle e 20 do grupo experimental (intervenção), sorteadas aleatoriamente. Os instrumentos incluíram: (a) Entrevista semiestruturada; (b) Jogo digital Hospital Mirim; (c) Escala de dor; (d) Escala de observação de procedimento invasivo. Os resultados permitiram verificar que: (a) o grupo controle na etapa de pós-procedimento invasivo apresentou maior percepção de nível de dor comparado ao grupo experimental; (b) houve diferença significativa nos grupos entre a percepção da dor e os comportamentos apresentados durante o procedimento; (c) não houve diferença entre os grupos em relação aos comportamentos durante o procedimento invasivo. De modo geral, o jogo foi um instrumento facilitador ao enfrentamento da coleta de sangue pelas crianças, diminuindo a percepção da dor. (AU)

Invasive procedures involving a needle are capable of causing pain and anxiety in children, as they imply an expectation of physical suffering and loss of control of the situation. The use of playful activities aims to minimize the effects of painful processes, constituting humanization strategies for the hospital context. This paper investigated the effects of the serious game "Hospital Mirim" as a strategy for coping with the invasive blood collection procedure. Forty children aged between six and 10 years participated, being 20 from the control group and 20 from the experimental group (intervention), randomly drawn. The instruments included: (a) Semi-structured interview, (b) "Hospital Mirim" digital game, (c) Pain scale and (d) Invasive procedure observation scale. The results showed that: (a) the control group in the post-invasive procedure stage presented a higher perception of pain level compared to the experimental group; (b) there was a significant difference in the groups between pain perception and behaviors presented during the procedure; (c) there was no difference between groups regarding behaviors during the invasive procedure. In general, the game was a facilitating instrument to cope with the blood collection in children, reducing the perception of pain. (AU)

Los procedimientos invasivos que implican una aguja son capaces de causar dolor y ansiedad en los niños, ya que conllevan una expectativa de sufrimiento físico y pérdida de control de la situación. El uso de actividades lúdicas tiene como objetivo minimizar los efectos de los procesos dolorosos, constituyendo estrategias de humanización para el contexto hospitalario. Este artículo investigó los efectos del juego serio "Hospital Mirim" como una estrategia para hacer frente al procedimiento invasivo de extracción de sangre. Participaron cuarenta niños de entre 6 y 10 años, 20 del grupo control y 20 del grupo experimental (intervención), seleccionados al azar. Los instrumentos incluyeron: (a) Entrevista semiestructurada, (b) Juego digital del Hospital Mirim, (c) Escala de dolor y (d) Escala de observación de procedimientos invasivos. Los resultados mostraron que: (a) el grupo de control en la etapa de procedimiento posinvasivo presentó una mayor percepción del nivel de dolor en comparación con el grupo experimental; (b) hubo una diferencia significativa en los grupos entre la percepción del dolor y los comportamientos presentados durante el procedimiento; (c) no hubo diferencia entre los grupos con respecto a los comportamientos durante el procedimiento invasivo. En general, el juego fue un instrumento facilitador para hacer frente a la extracción de sangre por parte de los niños, reduciendo la percepción del dolor. (AU)

Evaluation of trans thoracic invasive diagnostic procedures in 50 adult patients of mediastinal diseases

Introduction: Mediastinum is a “Pandora’s box” with many neoplastic and nonneoplastic lesions. Clinico-radiological pattern of mediastinal diseases depends on the size, location and etiology. Hence, non-invasive approach to these cases sometimes leads to diagnostic dilemma. Aims: A prospective study was performed over a 1-year period with the objective of evaluation of diagnostic yields and risk of trans thoracic ultra sound (TTUS) and computed tomography (CT) guided fine‑needle aspiration cytology (FNAC) and Tru-cut biopsy along with comparison of cost-effectiveness among mediastinal diseases where clinical and non-invasive imaging could not conclude the diagnosis. Materials and Methods: A prospective study of mediastinal diseases of the adult population without having any diagnosis admitted in a tertiary care hospital in Eastern India was performed after clearance of the ethical committee of the institute. Fifty cases of mediastinal diseases were seen during the study period. One patient sometimes had undergone more than one procedure. The choice of a procedure depended upon the location of the lesion, nature of disease and complication and cost effectiveness ofthe procedures. During the calculation of diagnostic yield of procedure, conclusive results and concordant results to more invasive procedures were considered. Results: Among 50 patients diagnostic yield of TTUS guided FNA and Tru-cut biopsy were 60% and 63.6% respectively. Diagnostic yield of Thoracic CT guided FNA and Tru-cut biopsy were 85% and 92.3% respectively. As a whole TTUS guided invasive procedure and Thoracic CT guided invasive procedure had a diagnostic yield of 61.5% and 87.9% respectively. Complication is less in CT guided invasive procedures (9.1%) compared to Transthoracic USG guided invasive procedures (11.5%) and complication is more common in Tru-Cut biopsy (16.7%) than fine needle aspiration (5.7%). Conclusion: Tru-cut biopsy if applicable is much superior to FNAC for a definite diagnosis of the mediastinal diseases. TTUS guided invasive procedures are very much cost-effective and have added advantage of real time guidance and is comparable with CT guided invasive procedures in respect to risk and diagnostic yields.

Outcome Analysis of Distal Tibial Fractures Managed by Open Reduction Internal Fixation using Plate Osteosynthesis

Introduction: Fracture of the distal tibia is one of the common fractures encountered by an orthopedic surgeon. Many studieshave been associated even as little as 1 mm incongruence of articular surface landed with worst outcome. Distal tibial fracturesare complicated by poor bone stock, soft tissue complication, poor vascularity leading to nonunion, gross comminution, andmalalignment.Aim: The aim of the study was to evaluate functional outcome analysis of distal tibial fractures managed by open reductioninternal fixation using plate osteosynthesis.Materials and Methods: This was a prospective study conducted at KAPV Medical College, Tiruchirappalli. A total of 20 patientswere treated with distal tibial plating. Fibular plating was done in eight of these patients. Patients were analyzed using Karlströmand Olerud scoring system, with follow-up of 3–18 months.Results: Ten patients had excellent functional results, six patients had good results, three patients had acceptable results,and 1 patient had a poor result. Quality and vascularity of bone seem to influence the outcome to a large extent.Conclusion: Based on our study, we conclude that distal tibial fractures managed with plate minimally invasive plateosteosynthesis technique allow early mobilization of the patients and provide a good functional outcome.

​Outcome Analysis of Distal Tibial Fractures Managed by Open Reduction Internal Fixation Using Plate Osteosynthesis

Introduction: Fracture of the distal tibia is one of the common fractures encountered by an orthopedic surgeon. Many studieshave been associated even as little as 1 mm incongruence of articular surface landed with worst outcome. Distal tibial fracturesare complicated by poor bone stock, soft tissue complication, and poor vascularity, leading to non-union, gross comminution,and malalignment.Aim: The aim of the study was to evaluate the functional outcome analysis of distal tibial fractures managed by open reductioninternal fixation using plate osteosynthesis.Materials and Methods: This a prospective study conducted at KAPV Medical College, Tiruchirappalli. 20 patients treatedwith distal tibial plating. Fibular plating was done in eight of these patients. Patients were analyzed using Karlström and Olerudscoring system, with follow-up of 3–18 months.Results: Ten patients had excellent functional results, six patients had good results, three patients had acceptable results, andone patient had a poor result. Quality and vascularity of bone seem to influence the outcome to a large extent.Conclusion: Based on our study, we conclude that distal tibial fractures managed with plate minimally invasive percutaneousplate osteosynthesis technique allow early mobilization of the patients and provide a good functional outcome.

Sleeve lobectomy for non-small cell lung cancer / 中国胸心血管外科临床杂志

@#Surgery has remained the cornerstone of lung cancer therapy. Sleeve lobectomy, which is featured by not only the maximal resection of tumors but also the maximal preservation of functional lung parenchyma, has been proved to be a valid therapeutic option for the treatment of some centrally located lung cancer . Evidence points toward equivalent oncologic outcomes with improved survival and quality of life after sleeve resections compared with pneumonectomy. However, the postoperative morbidities and the long-term results after sleeve lobectomy remain controversial, especially in relation to nodal involvement and after induction therapy. With the development of technology, minimally invasive procedures have been performed more and more widely.

Comparison of effectiveness between SuperPATH approach and posterolateral approach in total hip arthroplasty / 中国修复重建外科杂志

Methods: Between January 2016 and December 2016, 84 patients with hip disease were included in the study and randomly divided into 2 groups. Forty patients were treated with THA via SuperPATH approach (SuperPATH group), and 44 patients were treated with THA via posterolateral approach (PSA group). There was no significant difference in gender, age, body mass index, the type of disease, the complicating diseases, and preoperative thrombosis of lower extremity and Harris score between 2 groups ( P>0.05). The operation time, intraoperative blood loss, length of incision, postoperative drainage volume, unloaded activity time, Harris score, and short-form 36 health survey scale (SF-36) score were compared. The postoperative X-ray films were used to observe the position of joint prosthesis.

Percutaneous golfer's elbow release under local anesthesia: a prospective study / Liberação percutânea do cotovelo de golfista sob anestesia local: um estudo prospectivo

ABSTRACT OBJECTIVES: To evaluate the results of percutaneous golfer's elbow release under local anesthesia. METHODS: From December 2010 to December 2013, 34 elbows in 34 patients (10 males and 24 females) that presented golfer's elbow for over one year were recruited from the outpatient department. All patients were operated under local anesthesia and were followed-up for 12 months. The functional outcome was evaluated through the Mayo Elbow Performance Index (MEPI). RESULTS: Pain relief was achieved on average eight weeks after surgery. The results were excellent in 88.23% (30/34) cases and good in 11.76% (4/34) cases. Neither wound-related complications nor ulnar nerve complications were observed. On subjective evaluations, 88.23% (30/34) patients reported full satisfaction and 11.76% (4/34) patients reported partial satisfaction with the results of treatment. CONCLUSION: Percutaneous golfer's elbow release under local anesthesia is a minimally invasive procedure that can be performed in an outpatient setting. This procedure is easy, quick, and economical, presenting a low complication rate with good results.

RESUMO OBJETIVO: Avaliar os resultados da liberação percutânea do cotovelo de golfista sob anestesia local. MÉTODOS: Entre dezembro de 2010 e dezembro de 2013, 34 cotovelos em 34 pacientes (10 homens e 24 mulheres) que apresentavam cotovelo de golfista havia mais de um ano foram recrutados do ambulatório. Todos os pacientes foram operados sob anestesia local e foram acompanhados por 12 meses. O resultado funcional foi avaliado pelo Mayo Elbow Performance Index (MEPI). RESULTADOS: O alívio da dor foi alcançado em média oito semanas após a cirurgia. Os resultados foram excelentes em 88,23% (30/34) dos casos e bons em 11,76% (4/34) dos casos. Não se observaram complicações relacionadas à ferida nem complicações do nervo ulnar. Em avaliações subjetivas, 88,23% (30/34) dos pacientes relataram satisfação total e 11,76% (4/34) dos pacientes relataram satisfação parcial com os resultados do tratamento. CONCLUSÃO: A liberação percutânea do cotovelo de golfista sob anestesia local é um procedimento minimamente invasivo que pode ser feito em ambulatório. Esse procedimento é fácil, rápido e econômico, apresenta um baixo índice de complicações e bons resultados.

Management of spontaneous large intra cerebral hematoma with minimal invasive procedure (twist drill burr hole) with fibrinolytic therapy

Background: Spontaneous intracerebral haemorrhage (ICH) is associated with the high mortality among cerebrovascular events, and most of the survivors end with significant morbidity. Spontaneous intracerebral haemorrhage (ICH) is the second most common cause of stroke comprising 7.5-30% of all strokes. Surgery mainly helps in decrease in secondary injury and early rehabilitation. Aim: To analyse the outcome and advantages of minimal invasive surgery i.e., burr hole or twist drill craniostomy with intraclot streptokinase injection to dissolve clot and aspiration to reduce mass effect in primary intracerebral hematoma, this help to prevent secondary injury and recovery of salvageable brain. Materials and methods: Prospective study was done over from November 2014 to January 2017 in our department for the patients of spontaneous large intra cerebral hematoma > 80ml who underwent clot evacuation with fibrinolytic therapy with minimally invasive procedure with twist drill burr hole. Total 62 patients were included in the study. All the patients were followed with CT sequential scans to see for the clot size and followed with clinical status. Karla Ravi, Nandigama Pratap Kumar, Ginjupally Dhanunjaya Rao, Savarapu Sai Kalyan, Gollapudi Prakash Rao. Management of spontaneous large intra cerebral hematoma with minimal invasive procedure (twist drill burr hole) with fibrinolytic therapy. IAIM, 2017; 4(11): 229-240. Page 230 Results: Our analysis of 62 patients was consistent with the hypothesis that hematoma evacuation leads to improved neurological outcome, the outcome has been correlated with the rate of clot reduction. Conclusion: Minimally invasive surgery is a safe and effective option in the management of spontaneous ICH especially in the patients whom major surgical procedures pose a significant risk. MIS is associated with lower mortality and better outcomes compared to surgical evacuation or conservative management. Our study have clearly shown an improved outcome after minimally invasive surgery and still there is some emptiness to determine the exact protocol to insist these type of studies to deal with bed occupancy and a burden to the society.

Laparoscopic right hemihepatectomy following a standardized technique / 中华肝胆外科杂志

Objective To determine the clinical value of laparoscopic right hepatectomy (LRH) carried out following a standardized technique.Methods The medical records of 15 patients who underwent LRH at the First Affiliated Hospital of Soochow University were retrospectively reviewed.The perioperative indicators which included the operation duration,blood loss,tumor diameter,hospitalization duration and postoperative complications were analyzed.Results There was no conversion to open surgery.The operation duration was (251.1 ± 73.3) min.The resected tumor diameter was (8.5 ± 4.2) cm,the blood loss was (550.8 ± 343.6) ml,and the hospitalization duration was (10.2 ± 3.7) days.There was one patient who developed postoperative bile leakage.There was no other complication and there was no perioperative death.Conclusions The standardized technique of LRH was easy and effective.This technique shortened the operation duration and improved patient safety.

Nucleoplasty: Percutaneous Plasma Disc Decompression for the Treatment of Lumbar Disc Herniation

STUDY DESIGN: A review of the literature regarding nucleoplasty. OBJECTIVES: This aim of this article is to provide current information on nucleoplasty as a therapeutic intervention for herniated disc or discogenic back pain in degenerative disc disease. SUMMARY OF LITERATURE REVIEW: Nucleoplasty as a therapeutic intervention for discogenic pain is performed with increasing frequency, and has been reported to involve few complications and to have satisfactory clinical results. MATERIALS AND METHODS: Review of the literature. RESULTS: In nucleoplasty, the intervertebral disc is approached percutaneously. In this paradigm, a bipolar high frequency device in combination with ablation and coagulation is used to create a channel in the intervertebral disc in order to reduce intervertebral disc volume and to decrease intervertebral pressure and inflammatory markers. Standard indications for nucleoplasty have not been established, but it has been reported that the procedure had excellent outcomes regardless of the presence of radiculopathy or the results of discography. Many studies have reported their outcomes using various categories, because the procedure is comparatively new. Concomitantly, long-term follow-up studies remain to be performed, and each study reported a different follow-up period. CONCLUSIONS: Nucleoplasty has been found to show an excellent prognosis for discogenic back pain and a low incidence of complications. Moreover, since it is a minimally invasive procedure, it offers improved possibilities for return to daily life and work. If degenerative changes have not progressed to a great extent or the intervertebral level remains intact, nucleoplasty may be considered prior to surgery. Due to the lack of reports on the subject, prospective analyses in the future are required.

Rhytidectomy by multi-method joint application of W incisions in temporal hair line / 中华医学美学美容杂志

Objective To introduce an operative method of rhytidectomy with W-incision and fewer complications for facial rejuvenation.Methods A total of 84 patients were treated with rhytidectomy by multi-methods and followed up from January 2007 to December 2012.The rhytidectomy was done along the temporal hairline edge through the combined procedures,including sharp and blunt separation,liposuction and filling with autologous fat,tighting and fixing the fascial flap of superficial musculoaponeurotic system,as well as the suspension of the zygomatic cheek fiber fat pad.Results Follow-up for 3 moths to 2 years after surgery in 84 patients showed that the wound was healing with good concealment and without complications such as facial nerve injury or local uneven.All the cases achieved good results in facelift with high satisfaction rate after the combined operations.Conclusions This combined rhytidectomy is safe,effective,simple and easy.And it is a good and ideal approach of facial rejuvenation worthy of clinical application.

Gastrostomías mínimamente invasivas.experiencia en el instituto nacional del cáncer Prof. Dr. Manuel Riveros / Minimal invasives gastrostomies. the experience at the national institute of cancer Prof. Dr. Manuel Riveros

OBJETIVO: Analizar las indicaciones y ventajas de las Gastrostomías mínimamente invasivas. MATERIAL Y MÉTODOS: Estudio Prospectivo, Longitudinal, analítico de intervención cuasiexperimental no aleatorio en pacientes oncológicos e indicación de gastrostomías que fueron intervenidos con anestesia local por acceso mínimo en El Instituto Nacional del Cáncer Dr. Prof. Manuel Riveros en el periodo de meses desde Mayo 2013 hasta Setiembre 2014. RESULTADOS: 32 pacientes con diagnóstico oncológico fueron sometidos a Gastrostomías de Mínimo Acceso con anestesia local en el 100% de los procedimientos, no se han registrado complicaciones intraoperatorias; a mediano plazo se registro 5 complicaciones menores, 4 con eritema por perdida perisonda del contenido gástrico por mal manejo de la sonda al alta y 1 Absceso de pared a nivel del punto de fijación. El tiempo medio operatorio fue de 30 minutos y el inicio de la introducción de alimentación por gastroclisis fue inmediato con buena tolerancia y un promedio de 3,2 días de internación. CONCLUSIÓN: La casuística inicial sugiere que el abordaje mínimo para la realización de las gastrostomías debido a la baja cantidad de complicaciones, son efectivas y proporcionan un acceso único, temporal, rápido y seguro para un manejo nutricional adecuado en los pacientes oncológicos con pronta recuperación.

OBJECTIVE: To analyze the indications, advantages and surgical approaches to minimally invasive Gastrostomy. MATERIALS AND METHODS: Prospective, Longitudinal, Analytical study of non-randomized quasi-experimental intervention in oncological patients and indication that underwent surgery under local anesthesia in minimally access in the National Cancer Institute Prof. Dr. Manuel Riveros in the period from May 2013 to September 2014. RESULTS: 25 patients diagnosed with cancer were successfully submitted to the sf Minimum Access gastrostomy under local anesthesia in 100% of the procedures in which there have been no intraoperative complications although in the medium term five minor complications, 4 consisted of erythema perisonda loss of gastric contents for mishandling the gastrostomy tube and discharge one wall abscess in a male patient at the point of attachment was recorded. The average operative time was 20 minutes and the beginning of the introduction of gavage feeding of 5% dextrose solution was immediate with good tolerance and an average of 3.2 days in hospital. CONCLUSION: The results of this initial case series suggests that the minimum approach to the realization of the gastrostomy due to the low number of complications, are effective and provide a unique, fast and secure access to adequate nutritional management in cancer patients with quick recovery.

Stenotrophomonas maltophilia pseudo-outbreak at a University Hospital Bronchoscopy unit in Turkey / Pseudo-brote de Stenotrophomonas maltophilia en una unidad de Broncoscopia del Hospital Universitario en Turquía

OBJECTIVE: Stenotrophomonas maltophilia is an opportunistic pathogen found predominantly in the enviroment and hospital setting. Invasive procedures and treatment methods, instruments used for diagnosis and irrational antibiotic use play major roles in the spread of this pathogen. The study aimed to evaluate consecutive S maltophilia isolation from bronchoalveolar lavage samples during bronchoscopy procedure during a week. METHODS: Four patients consecutively had S maltophilia isolated during bronchoscopy between September 8 and 15, 2012. The identification of the isolates and their antibiotic susceptibility were studied by automated Vitek version 2.0 (Biomerieux, France) system. The clonal relationship between the isolates was studied by enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR). RESULTS: Four consecutive S maltophilia isolates had identical band patterns and showed clonal relatedness. CONCLUSION: Bronchoscopy is a common invasive procedure that is utilized in chest diseases departments and intensive care units (ICUs). Contamination may take place due to inappropiate use and cause spread of infectious pathogens. In the current study, we detected consecutive S maltophilia strains with identical band patterns isolated within a week. After appropiate disinfection and cleaning procedures, no further isolation was detected.

OBJETIVO: Stenotrophomonas maltophilia es un patógeno oportunista que se encuentra predominantemente en el medio ambiente y entorno de los hospitales. Los procedimientos invasivos y los métodos de tratamiento, los instrumentos utilizados para el diagnóstico y tratamiento, así como el uso irracional de antibióticos, desempeñan un importante papel en la propagación de este patógeno. Este estudio persigue evaluar el aislamiento consecutivo de S maltophilia de las muestras de lavado broncoalveolar durante el procedimiento broncoscópico en el período de una semana. MÉTODOS: A cuatro pacientes se les aisló S maltophilia consecutivamente en broncoscopias realizadas entre el 8 y el 15 de septiembre de 2012. La identificación de los aislamientos y su sensibilidad a los antibióticos fueron estudiados por el sistema automatizado Vitek 2 (Biomerieux, Francia). La relación clonal entre los aislamientos fue estudiada mediante consenso intergénico repetitivo enterobacteriano (ERIC) en conjunción con la reacción en cadena de la polimerasa (PCR). RESULTADOS: Cuatro aislados consecutivos de S maltophilia tenían patrones de banda idénticos y exhibían conexidad clonal. CONCLUSIÓN: La broncoscopia es un procedimiento invasivo común que se aplica en los departamentos de enfermedades torácicas, y las unidades de cuidados intensivos (UCI). La contaminación puede ocurrir debido a usos inapropiados y a la propagación de agentes patógenos infecciosos. En el presente estudio, hemos detectado cepas de S maltophilia consecutivas con idénticos patrones de banda aislados en una semana. Después de los procedimientos de limpieza y desinfección adecuada, no se detectó ningún otro aislamiento.

A Minimally Invasive Rabbit Model of Progressive and Reproducible Disc Degeneration Confirmed by Radiology, Gene Expression, and Histology

OBJECTIVE: To develop a simple, reproducible model of disc degeneration in rabbits through percutaneous annular puncture and to confirm the degree of degeneration over time. METHODS: Fifteen New Zealand white rabbits (4 to 5 months old and weighing approximately 3 to 3.5 kg each) underwent annular puncture of the L2-L3, L3-L4, and L4-L5 discs. Rabbits were sacrificed at 4, 8, or 20 weeks after puncture. For a longitudinal study to assess changes in disc height over time, serial X-rays were performed at 0, 2, 4, 8, and 20 weeks for rabbits in the 20-week group. Upon sacrifice, the whole spinal column and discs were extracted and analyzed with magnetic resonance imaging (MRI), real time reverse transcriptase-polymerase chain reaction, and histological staining. RESULTS: The X-rays showed a slow, progressive decrease in disc height over time. Significant disc space narrowing compared to preoperative disc height was observed during the time period (p<0.001). The MRI grade, aggrecan, and matrix metalloprotease-13 mRNA expression and hematoxylin and eosin/safranin O/anti-collagen II staining were consistently indicative of degeneration, supporting the results of the X-ray data. CONCLUSION: Percutaneous annular puncture resulted in slow, reproducible disc degeneration that was confirmed by radiology, biochemistry, and histology. This in vivo model can be used to study and evaluate the safety and efficacy of biologic treatments for degenerative disc disease.

Navigation-guided K eyhole Approach for Unruptured Intracranial Aneurysms / 대한뇌혈관외과학회지

OBJECTIVES: In vascular neurosurgery, the pterional approach has primarily been used in the treatment of a wide variety of diseases. However, there has been an increasing interest in minimally invasive procedures or keyhole approaches for treating cerebral aneurysms. We report our experience with a neuronavigation-guided keyhole approach in the treatments of various intracranial aneurysms. METHODS: Between December 2008 and December 2010, 32 patients with unruptured intracranial aneurysms were treated by direct surgical neck clipping through the neuronavigation-guided keyhole approach. A 4 to 5 cm-sized skin incision and a small 2.5 x 4 cm craniotomy was performed around the sylvian fissure. The remainder of the aneurysm surgery was performed using conventional microsurgical techniques. RESULTS: The enrolled patients comprised 15 men and 17 women, with a mean age of 63.06 years (range, 47 to 79 years). Of these, 21 aneurysms were in the middle cerebral artery (MCA) bifurcation; 3, in the M1; 5, in the posterior communicating artery segment; 2, in the anterior communicating artery; and 1, in the anterior choroidal artery segment. The size of the aneurysms ranged from 3.5 to 4.8 mm. Mean operation time was 2.19 hours (range, 100 to 150 minutes). All patients were clipped successfully. There were no procedure related complications. CONCLUSION: We suggest that the navigation-guided keyhole approach is useful for the treatment of anterior circulation aneurysms in selected cases. It has the advantages of less operative time, fewer days of hospitalization, and cosmetic results.

Navigation-guided K eyhole Approach for Unruptured Intracranial Aneurysms / 대한뇌혈관외과학회지

OBJECTIVES: In vascular neurosurgery, the pterional approach has primarily been used in the treatment of a wide variety of diseases. However, there has been an increasing interest in minimally invasive procedures or keyhole approaches for treating cerebral aneurysms. We report our experience with a neuronavigation-guided keyhole approach in the treatments of various intracranial aneurysms. METHODS: Between December 2008 and December 2010, 32 patients with unruptured intracranial aneurysms were treated by direct surgical neck clipping through the neuronavigation-guided keyhole approach. A 4 to 5 cm-sized skin incision and a small 2.5 x 4 cm craniotomy was performed around the sylvian fissure. The remainder of the aneurysm surgery was performed using conventional microsurgical techniques. RESULTS: The enrolled patients comprised 15 men and 17 women, with a mean age of 63.06 years (range, 47 to 79 years). Of these, 21 aneurysms were in the middle cerebral artery (MCA) bifurcation; 3, in the M1; 5, in the posterior communicating artery segment; 2, in the anterior communicating artery; and 1, in the anterior choroidal artery segment. The size of the aneurysms ranged from 3.5 to 4.8 mm. Mean operation time was 2.19 hours (range, 100 to 150 minutes). All patients were clipped successfully. There were no procedure related complications. CONCLUSION: We suggest that the navigation-guided keyhole approach is useful for the treatment of anterior circulation aneurysms in selected cases. It has the advantages of less operative time, fewer days of hospitalization, and cosmetic results.

CT guided percutaneous radiofrequency ablation in treatment of patients with inoperable lung cancer / 肿瘤研究与临床

Surgical resection remains the cornerstone of therapy for early stage lung cancer. Five-year survival rates are reported as high as 92% for stage Ⅰ non-small cell lung cancer (NSCLC). However, many patients presenting with resectable early stage disease are unable to tolerate pulmonary resection, even sublobular resection, because of compromised cardiopulmonary functions or other comorbidities. Traditionally,patients deemed medically inoperable have been treated by external-beam radiation. But the results were poor with a mean survival of 20 months and a 5-years survival rate of 12%. In this scenario, we need to develop other non-surgical local therapies. One of these was image-guided percutaneous radiofrequency ablation(RFA).Many clinical trials show that RFA for lung tumors is a minimally invasive, feasible and safe technique with minor mortality and morbidity. Moreover, its efficacy seems to be promising, even in the long-term follow-up.Further experiences and comparison with other emerging minimally invasive local treatments are required to determine its rote in the treatment of medically inoperable early stage NSCLC.