Surgical management of Boerhaave's syndrome with early and delayed diagnosis in adults: a retrospective study of 88 patients

BACKGROUND: spontaneous esophageal rupture (Boerhaave's syndrome) is a rare and challenging clinical condition. OBJECTIVE: to evaluate the outcome of different surgical treatments for patients with Boerhaave's syndrome with an early diagnosis (< 24 h) and delayed diagnosis (> 24 h), using a retrospective cohort study in a tertiary referral center. PATIENTS AND METHODS: eighty-eight patients with Boerhaave's syndrome who underwent surgical treatment were identified from March 1994 to March 2019 in the First Hospital of Shanxi Medical University. Subsequently, they were retrospectively divided into two groups according to time from symptom onset to diagnosis (group 1, < 24 h, n = 16; group 2, > 24 h, n = 72). Primary suture repair was used in group 1 and reinforcement with a vascular muscle flap was used in group 2, in order to reduce the incidence of fistula. Patients in group 2 were further divided into two subgroups according to reinforcement using diaphragmatic flaps (subgroup 1) or intercostal muscle flaps (subgroup 2). RESULTS: the duration of hospitalization and stay in Intensive Care Unit (ICU) was significantly shorter in group 1 (p = 0.027 and p = 0.001). Group 1 had fewer postoperative esophageal leaks (p = 0.037) compared to group 2. Various aspects were compared in the two subgroups and the differences were not statistically significant (p > 0.05). CONCLUSIONS: it is very important to establish an early diagnosis for patients with Boerhaave's syndrome. Early (< 24 h) and primary suture repair is superior to delayed (> 24 h) primary repair, even for those reinforced with vascular muscle flaps. Furthermore, repair reinforcement with different muscle flaps appears to render similar results for patients with delayed diagnosis

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Surgical management of Boerhaave's syndrome with early and delayed diagnosis in adults: a retrospective study of 88 patients.

BACKGROUND: spontaneous esophageal rupture (Boerhaave's syndrome) is a rare and challenging clinical condition. OBJECTIVE: to evaluate the outcome of different surgical treatments for patients with Boerhaave's syndrome with an early diagnosis (< 24 h) and delayed diagnosis (> 24 h), using a retrospective cohort study in a tertiary referral center. PATIENTS AND METHODS: eighty-eight patients with Boerhaave's syndrome who underwent surgical treatment were identified from March 1994 to March 2019 in the First Hospital of Shanxi Medical University. Subsequently, they were retrospectively divided into two groups according to time from symptom onset to diagnosis (group 1, < 24 h, n = 16; group 2, > 24 h, n = 72). Primary suture repair was used in group 1 and reinforcement with a vascular muscle flap was used in group 2, in order to reduce the incidence of fistula. Patients in group 2 were further divided into two subgroups according to reinforcement using diaphragmatic flaps (subgroup 1) or intercostal muscle flaps (subgroup 2). RESULTS: the duration of hospitalization and stay in Intensive Care Unit (ICU) was significantly shorter in group 1 (p = 0.027 and p = 0.001). Group 1 had fewer postoperative esophageal leaks (p = 0.037) compared to group 2. Various aspects were compared in the two subgroups and the differences were not statistically significant (p > 0.05). CONCLUSIONS: it is very important to establish an early diagnosis for patients with Boerhaave's syndrome. Early (< 24 h) and primary suture repair is superior to delayed (> 24 h) primary repair, even for those reinforced with vascular muscle flaps. Furthermore, repair reinforcement with different muscle flaps appears to render similar results for patients with delayed diagnosis.

Application Analysis of All-blastocyst-culture in Elderly Infertile Patients with Low Ovarian Reserve / 中山大学学报(医学科学版)

[Objective]To determine whether all-blastocyst-culture can benefit elderly infertile patients with low ovarian reserve.[Methods]To retrospectively analyze elderly patients with low ovarian reserve undergoing IVF/ICSI in Reproductive Medicine Re?search Center of the Sixth Affiliated Hospital of Sun Yat-sen University from May 2016 to April 2017.We divide them into group A (All-blastocyst-culture)and group B(None-blastocyst-culture)based on different culture approach of D3 transferrable embryo. To compare the cumulative biochemical pregnancy rate ,cumulative clinical pregnancy rate between them.[Results]A total of 231 eligi?ble patients are included,with130 in group A and 101 in group B. The basic conditions of the two groups show no difference. Cumula?tive biochemical pregnancy rate/clinical pregnancy rate in group A is higher than that of group B ,though the difference is not statisti?cally significant(P>0.05). After removing patients who did not undergo embryo transfer due to failure in blastocyst culture ,the cumu?lative biochemical pregnancy rate/clinical pregnancy rate in group A is significantly higher than group B(P<0.05). Multivariate analy?sis of the patient′s basic condition and the outcome of blastocyst culture showed that the number of D3 transferrable embryo was a risk factor for the failure of blastocyst culture(OR=0.277,95%CI:0.103~0.744,P<0.05).[Conclusion]All-blastocyst-culture will not adversely affect the pregnancy outcome of elderly infertile patients with low ovarian reserve. On the contrary ,once they obtain transfer?rable embryos, pregnancy outcome in All-Blastocyst-Culture group are better than None-Blastocyst-Culture group. A small number of D3 transferrable embryo is a risk factor for failure to culture blastocyst. If the patients were fully informed consent ,we can consider implementing all-blastocyst-culture for elderly infertile patients with low ovarian reserve.

Effects of combination therapy on the movement function of lower extremity after total knee arthroplasty in the elderly / 中国组织工程研究

BACKGROUND: Electromyographic biofeedback therapy has been reported to contribute to the functional recovery of the lower limb after arthroplasty.OBJECTIVE: To compare the effect of different rehabilitation therapies on the movement function of lower limb in elderly patients after total knee replacement.METHODS: Totally 153 patients undergoing total knee replacement were randomly divided into conventional,electromyographic biofeedback and combination groups (n=51 per group), and then subjected to the conventional rehabilitation training, electromyographic biofeedback at the quadriceps femoris, and conventional rehabilitation training,electromyographic biofeedback plus body weight supported treadmill training, respectively. At 8 weeks after treatment,the movement function of lower limbs, activities of daily living and balance abilities, range of flexion-extension of the knee joint, walking ability, Hospital for Special Surgery of the lower limbs, as well as the Lower Extremity Functional Scale scores were evaluated. Besides, the Visual Analogue Scale scores, surface electromyogram of the quadriceps femoris at rest and in activity, co-contraction ratio of antagonistic muscle when ankle dorsiflexion, Fugl-Meyer assessment,modified Barthel index, Berg Balance Scale, and Holden walking function classification were detected.RESULTS AND CONCLUSION: (1) The Visual Analogue Scale scores after treatment in the combination group were significantly lower than those before treatment, in the conventional and electromyographic biofeedback groups (P < 0.01).(2) The Hospital for Special Surgery and Lower Extremity Functional Scale scores in the combination group were significantly higher than those in the conventional and electromyographic biofeedback groups (P < 0.05). (3) The surface electromyogram values, co-contraction ratio of antagonistic muscle, Fugl-Meyer assessment, modified Barthel index,range of flexion-extension of the knee joint, maximum step length and velocity as well as Holden walking function in the combination group were significantly superior to those in the conventional and electromyographic biofeedback groups (P < 0.05). (4) These results indicate that combination therapy is able to significantly improve the movement function and muscle strength of the lower limb, and enhance the postoperative rehabilitation for the elderly after total knee arthroplasty.