Delayed Post-operative Spinal Epidural Haematoma after Posterior Spinal Surgery: Report of Two Cases

@#Delayed post-operative spinal epidural haematoma (DPSEH) is diagnosed when the onset of symptoms is more than three days from the index surgery. DPSEH is a rare but serious complication of spinal surgery. Missed diagnosis will result in irreversible neurological deficit which may lead to permanent disabilities. We report two cases of DPSEH who presented with worsening neurological deficit four days after the index surgery. Magnetic resonance imaging (MRI) showed the presence of an epidural haematoma compressing the spinal cord. Surgical evacuation of haematoma were performed for both patients. Both patients experienced neurological improvement. Surgeons should have high index of suspicion to identify delayed onset of spinal epidural haematoma (SEH) and timely intervention should be taken to avoid irreversible neurological damage.

The predictive value of cleveland clinical score for acute renal injury after cardiac valve surgery in Chinese adult patients / 中华胸心血管外科杂志

Objective To validate the value of Cleveland Clinical Score in predicting acute renal injury requiring renal replacement therapy(RRT-AKI) after cardiac valve surgery in Chinese adult patients.Methods An analysis was conducted for all the adult patients who underwent cardiac valve surgery from January 2010 to December 2014 in Changhai Hospital,Shanghai.A total of 3 230 adult patients were included.Based on Cleveland Clinical Score,the patients were divided into 3 risk stages:0 to 2 point,3 to 5 point,and 6 to 8 point.The incidence of RRT-AKI were compared between different stages.And the predictive value of the Cleveland Clinical Score model was assessed by area under the receiver operating characteristic curve(AUC-ROC) and the model calibration was assessed using the Hosmer-Lemeshow test.The patients were also divided into two groups:Non-RRT group and RRT-AKI group.The mortality were compared between these two groups.Results The incidence of RRT-AKI was 1.67％ vs the predicted ratio of RRT-AKI 1.70％ (x2 =0.018,P =0.892).Among the stage 1,2,and 3,the actual incidence of RRT-AKI,was 1.23％,2.66％,and 16.7％ vs the predicted incidence 0.40％,1.80％,and 9.50％,respectively.The AUC-ROC for Cleveland Clinical Score predicting RRT-AKI was 0.64 [95 ％ CI(0.57,0.71),P ＜0.01].Compared with Non-RRT group,the RRT-AKI group got a higher mortality(87.00％ vs 1.50％,x2 =1 330,P ＜0.01).Conclusion The Cleveland Clinical score had no real predictive value for RRT-AKI in Chinese adult patients after cardiac valve surgery.The incidence of RRT-AKI of the whole population and the stage 3 patients could be predicted by the model.And the patients with a high Cleveland score got a higher mortality than that of patients with a low Cleveland score.

Bilateral extraluminal ectopic ureters in a Maine Coon cat / Ureter ectópico extraluminal bilateral em um felino da raça Maine Coon

Ectopic ureters are rarely observed in cats. Therefore, for a better chance of success in the corrective surgical procedure and survival of the patient, diagnosis should be confirmed early. This report illustrates the occurrence of bilateral ectopic ureters in a seven month old Maine Coon cat and describes the medical and surgical management adopted for correction of the abnormality.

A ectopia dos ureteres é raramente observada em gatos. Assim, para aumentar as chances de sucesso do procedimento cirúrgico corretivo e promover a sobrevivência, o diagnóstico deve ser firmado precocemente. O relato em tela ilustra a ocorrência de ureter ectópico bilateral em uma gata Maine Coon, de sete meses, e descrevem-se as manobras médico-cirúrgicas adotadas na correção dessa anormalidade.

Avaliação de eventos adversos cirúrgicos em hospitais do Rio de Janeiro / Evaluation of surgical adverse events in hospitals of Rio de Janeiro

Eventos adversos (EAs) cirúrgicos contribuem significativamente para amorbidade pós-operatória, são desfavoráveis, indesejáveis e prejudiciais, têm impacto sobre o paciente e estão associados a um processo da assistência à saúde, mais do que a um processo natural de doenças. Estudos sobre eventos adversos têm demonstrado a complexidade de sua análise devido à variabilidade dos sistemas de registro e a extensa gama de definições na literatura científica para complicações pós-operatórias. O estudo dos EAs cirúrgicos tem especial relevância por sua frequência, porque em parte são atribuíveis a deficiências na atenção à saúde, pelo impacto considerável sobre a saúde dos pacientes, pela repercussão econômica no gasto social e sanitário e por constituir um instrumento de avaliação da qualidade da assistência. O objetivo deste estudo é avaliar a incidência de eventos adversos cirúrgicos e os fatores contributivos em hospitais do Rio de Janeiro. Esta pesquisa é um estudo de coorte retrospectivo que buscou realizar análise descritiva de dados secundários do banco de dados gerado pelo Programa Computacional Eventos Adversos, que foi desenvolvido para a coleta de dados da pesquisa de avaliação da ocorrência de eventos adversos em três hospitais de ensino localizados no Estado do Rio de Janeiro. A incidência de pacientes hospitalizados com EAs cirúrgicos foicalculada em 3,5 por cento (38 de 1.103 pacientes) (IC 95 por cento 2,4 - 4,4) e a proporção de pacientes submetidos à cirurgia entre os com EAs cirúrgicos 5,9 por cento (38 em 643) (IC 95 por cento 4,1 – 7,6). A proporção de pacientes com EAs cirúrgicos evitáveis foi 65,8 por cento (25 de 38 pacientes) (IC 95 por cento 50,0 por cento a 81,6 por cento) e cerca de 1 em 5 resultaram em incapacidade permanente ou óbito. Mais de 60 por cento dos casos foram classificados como pouco ou nada complexo e de baixo risco de ocorrer um EA relacionado ao cuidado.

Surgical adverse events (AEs) are unfavorable, undesired, and damaging, that impact the patient and contribute significantly to the postoperative morbidity. They are associated toa health care process, rather than a natural disease process. AEs studies have shown the complexity of its analysis, due to the variability of the registrations systems, as well asthe large range of definitions for postoperative complications present in the scientific literature. The study of surgical AEs have special relevance for their attendance, in part because they are attributable to deficiencies in health care, the impact on the patient health, the economic repercussions on social spending and health and as an instrument of quality assessment assistance. The aim of this study is evaluate the incidence of surgicaladverse events and its contributive factors in hospitals of Rio de Janeiro. This research is a cohort retrospective study that aimed to develop a descriptive analysis of secondarydata provided from the Adverse Events software’s database. This program was developed for the data gathering concerning the research of evaluation of the occurrence of adverse events in three teaching hospitals in Rio de Janeiro. The incidence of hospitalized patients with surgical AEs was 3,5% (38 of 1.103 patients) (CI 95% 2,4 - 4,4) and the proportion of patients who underwent an operation with surgical AEs was 5,9% (38 of 643) (CI 95%4,1 - 7,6). The proportion of preventable surgical AEs was 65,8% (25 of 38 patients) (CI 95% 50,0% - 81,6%). Over 60% cases were categorized as of low complexity or notcomplex and of low risk of occurring an AE related to care.

Effect of filtering surgery on glaucoma / 中国康复理论与实践

@#ObjectiveTo investigate the effect of filtering surgery on glaucoma.Methods50 glaucoma cases (60 eyes) were underwent trabeculectomy, including paracentesis in advance, suturing of sclera flap and conjunctiva flap, using mitomycin (MMC) and forming anterior chamber as soon as finished operation. All cases were followed up 1 year.ResultsPostoperative IOP was lower than 21 mmHg in 54 eyes, 6 eyes were <30 mmHg when treated with drugs. After operation, there were only 2 eyes had lower vision, the others had higher vision. Two eyes had conjunctiva filtering, two eyes had choroidal separation, but they recovered after non surgical therapy.ConclusionFiltering surgery can decrease common complications, increase vision of early stage, and make IOP recovered to normal.

A Case of Spontaneous Intracerebral Hemorrhage during Ear Surgery under General Anesthesia

There are many complications after the ear surgery to correct chronic otitis media(COM). They include facial nerve paralysis, perichondritis, injury of the dura or the sigmoid sinus, chocolate cyst or mucocele in the healed mastoid cavity, recurrence of cholesteatoma, granulation tissue and otorrhea. However, there has been no report of spontaneous intracerebral hemorrhage during ear surgery to correct COM under general anesthesia. We had encountered one case of spontaneous intracerebral hemorrhage after COM ear surgery under general anesthesia. There was no problem during the operation. We suspected that certain cerebral vascular anomaly triggered the intracerebral hemorrhage while under the general aesthsia. However, the speculation remains verified.