Objective To summarize the visual outcome of patients with severe ocular trauma treated with vitreous surgery. Methods Clinical data of 188(191 eyes) with severe ocular trauma treated with vitreous surgery in a period from November 1996 to April 1998 were analysed retrospectively. Results The study included penetrating injury in 56 eyes, foreign bodies in the posterior segment in 70 eyes, blunt injury in 41 eyes , and globe rupture in 24 eyes. Main complications included endophthalmitis in 35 eyes, choroidal bleeding in 20 eyes, retinal detachment in 60 eyes, and vitreous hemorrhage in 97 eyes. Post-opera-tively, out of 188 eyes, except for 3 of patients too young to examine, visual acuity improved in 133(70.7%), including 85(45.2%) with visal acuity 0.02-1.0, 46(24.5%) remained unchanged; and 9(4.8%) had worse vision. Among 34 with no-light-perception, 12 had light-perception or over. Conclusion A majority of severe trauma eyes can be salvaged with considerable visual recovery after adequate and timely vitreous surgery. (Chin J Ocul Fundus Dis,1999,15:4-6)
Objective To Investigate the indications, surgical technique and perioperative management of orthotopic liver transplantation.Methods Orthotopic liver transplantation was successfully performed on a unresectable liver cancer on caudate lobe, 2 cases with Caroli’s disease and 7 cases with advanced liver cirrohosis. A 11 year’s old girl with Caroli’s disease was performed on one reduced size liver transplantation (RSLT). Results The recovery of liver graft function was good after the operation in those patients without perioperative death. The case of liver cancer died of recurrent cancer on the 139th postoperative day, 1 case died of severe fungus infection and one died of gastric stress ulcer perforation, other 7 cases recovered well without complications. Conclusion The results suggest that unresectable central liver cancer, terminal liver cirrohosis or benign liver diseases combined with severe liver disfunction are good indications for liver transplantation. Good surgical technique and perioperative management are key points to succucess of the liver transplantation.
ObjectiveTo investigate the role of amygdala volume index(AVI) in surgcial evaluation in patients with mesial temporal lobe epilepsy (mTLE), including clinical features, etiologies and surgical outcome. MethodsThirty six patients were diagnosed as mTLE after surgical evaluation including clinical manifestations, video-electroencephalogram (VEEG) and magnetic resonance imaging (MRI) at the Second Affiliated Hospital of Zhejiang University between March 2013 and March 2016. Bilateral amygdala AVI was then calculated from amygdala volumes on MRI, which were measured with region of interest (ROI) analysis. All patients were treated surgically. Etiologies of mTLE were further confirmed by the histopathology of the resected tissue. ResultsAmong the 35 patients, there is a strong correlation between AVI on the lesion side and age of onset (R =-0.389, P = 0.019) as well as age of surgery (R =-0.357, P = 0.032). No obvious relation can be seen between AVI and gender, history of febrile convulsion, duration of epilepsy, secondary generalized seizure, side of lesion, presurgical seizure frequency and electrode implantation. There is no significant difference in AVI among the five etiologies. At follow-up, thirty patients (80.5%) reached seizure-free, AVI on the lesion side is nota predictor of surgical failure (P > 0.05). ConclusionAVI plays a role in etiology evaluation in patients with mesial temporal lobe epilepsy. Moreover, a larger AVI on the lesion side is correlated with an earlier age of onset. There is limited value of amygdala volume insurgical outcome prediction of patients with mTLE.
ObjectiveTo summarize the progress of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and evolution of surgical procedure improvement, so as to summarize experience in selecting appropriate surgical method for patients. MethodThe domestic and foreign literature on the evolution of ALPPS surgical procedure improvement in recent years was reviewed. ResultsIn the decade since the emergence of ALPPS, the ALPPS had been rapidly developed in the hepatobiliary surgery. The ALPPS promoted a rapid increase in future liver remnant during a relatively shorter period to contribute to resectability of liver tumors and reduce the rate of postoperative liver failure, the patients with intermediate to advanced and huge liver cancer could obtain the surgical radical resection. In recent years, the domestic and foreign experts had refined the ALPPS procedure, which mainly focused on the operation of hepatic section separation and hepatic artery flow restriction in stage Ⅰ surgery, including partial ALPPS, radiofrequency ablation ALPPS, tourniquet ALPPS, transcatheter arterial embolization ALPPS, hepatic artery ringed and operation ALPPS, as well as laparoscopic ALPPS and robotic ALPPS with minimally invasive approach. ConclusionsDespite the ongoing controversy over ALPPS, with the continuous progress and innovation of improved procedures and the utilization of laparoscope and robot in surgery, the trauma of ALPPS surgery has a further reduction, and the morbidity and mortality have gradually been decreased. It is believed that with the continuous advancement and improvement of ALPPS surgery technology, the indications and safety of ALPPS will be further enhanced, bringing hope to more patients with intermediate to advanced liver cancer with huge tumors.
Objective To investigate the effects of adenosine 2A receptor (A2AR) activation on oxidative stress in small-forsize liver transplantation. Methods A rat orthotopic liver transplantation model was performed using 40% graft, 18 recipients were given intravenously saline (control group), CGS21680 (A2AR agonist, CGS21680 group) or ZM241385 (A2AR antagonist, CGS21680+ZM241385 group) randomly. Aspartate aminotransferase (AST), enzymatic antioxidants 〔superoxide dismutase (SOD); catalase (CAT); glutathione peroxidase (GSH-Px)〕, non-enzymatic antioxidants 〔ascorbic acid (AA); glutathione (GSH); α-tocopherol (TOC)〕 and lipid oxidant metabolites malondialdehyde (MDA) were measured and analyzed at 6 h after reperfusion. Results Compared with the control group and CGS21680+ZM241385 group, A2AR activation increased the activities of SOD and GSHPx (Plt;0.05), reduced the productions of AST and MDA (Plt;0.05), increased the levels of AA, GSH and TOC (Plt;0.05) in CGS21680 group. But there was no significant change in CAT activity (Pgt;0.05) among 3 groups. Conclusions A2AR activation improves the antioxidant enzyme activities, promotes the production of antioxidants, and slowes down the increase in MDA level, depresses of the increase in AST activity. A2AR activation suppresses oxidative damage and increases the antioxidant capacity which in turn minimizes their harmful effects of ischemia-reperfusion in small-for-size liver transplantation.
Objective To investigate the impact of injection of acetic acid hypertonic saline solution (AHS) in dog liver during radiofrequency ablation (RFA) on its destructive zone. Methods RFAs were performed in dog livers by using LDRF-120S mutiple probe ablation system combining 50% acetic acid 5% hypertonic saline solution injection. Thirty healthy adult hybrid dogs were randomly divided into 5 groups (n=6). Group A: RFA was performed immediately after injection of 2 ml AHS; Group B: RFA was performed 5 min after injection of 2 ml AHS; Group C: RFA was performed immediately after injection of 4 ml AHS; Group D: RFA was performed 5 min after injection of 4 ml AHS; Group E: RFA was performed immediately after injection of 6 ml AHS. Results There were no significant differences in the mean initial impedance within 5 groups. The mean ablation times were different significantly among 5 groups (F=83.831, P＜0.001). The mean ablation time was different significantly between any two groups by LSD-t analysis (P＜0.001). The mean coagulation diameters were different significantly among 5 groups （F=53.488, P＜0.001）. The mean coagulation diameter of group E was the largest among 5 groups. Besides mean coagulation diameter was no significant difference between group D and E (Pgt;0.05), the mean coagulation diameter was different significantly between any two groups by LSD-t analysis (P＜0.001). Obviously thrombus were shown in coagulation necrosis zone and nearly normal tissue with gordon amp; sweet. AHS spillage from the injection site occurred in group E. Four dogs died in group E within 14 d but no dog died in the other groups. Conclusion RFA is performed 5 min after injection of 4 ml AHS in dog liver produces the ideal ablation destructive zone.
ObjectiveTo review the current status and progress of surgical methods for inducing hepatic volume hyperplasia. MethodThe procedures inducing liver volume regeneration in clinical practice, including portal vein embolization, liver venous deprivation, Yttrium-90 selective internal radiation therapy, and associating liver partition and portal vein ligation for staged hepatectomy were reviewed and summarized. ResultsAll kinds of surgical methods to induce liver volume hyperplasia could effectively stimulate the increase in liver volume, which could provide more surgical opportunities for patients with too small future liver remnant, but there were differences in the degree of trauma, proliferation efficiency and popularization and acceptance. ConclusionsAll kinds of operations provide new hope for patients with too little residual liver volume after operation, and have good application scenarios. However, at present, there is no unified opinion on the comparison between the advantages and disadvantages of each operation and the best indication, which needs further study.
ObjectiveTo investigate the risk factors of cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). MethodsBetween March 2011 and March 2012, 98 patients with single level OVCF were treated by PVP, and the cl inical data were analyzed retrospectively. There were 13 males and 85 females, with a mean age of 77.2 years (range, 54-95 years). The mean disease duration was 43 days (range, 15-120 days), and the mean T score of bone mineral density (BMD) was-3.8 (range, -6.7--2.5). Bilateral transpedicular approach was used in all the patients. The patients were divided into cement leakage group and no cement leakage group by occurrence of cement leakage based on postoperative CT. Single factor analysis was used to analyze the difference between 2 groups in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, preoperative vertebral body wall incompetence, cement volume, and volume ratio of intravertebral bone cement to vertebral body. All relevant factors were introduced to logistic regression analysis to analyze the risk factors of cement leakage. ResultsAll procedures were performed successfully. The mean operation time was 40 minutes (range, 30-50 minutes), and the mean volume ratio of intravertebral bone cement to vertebral body was 24.88% (range, 7.84%-38.99%). Back pain was alleviated significantly in all the patients postoperatively. All patients were followed up with a mean time of 8 months (range, 6-12 months). Cement leakage occurred in 49 patients. Single factor analysis showed that there were significant differences in the volume ratio of intravertebral bone cement to vertebral body and preoperative vertebral body wall incompetence between 2 groups (P < 0.05), while no significant difference in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, and cement volume (P > 0.05). The logistic regression analysis showed that the volume ratio of intravertebral bone cement to vertebral body (P < 0.05) and vertebral body wall incompetence (P < 0.05) were the risk factors for occurrence of cement leakage. ConclusionThe volume ratio of intravertebral bone cement to vertebral body and vertebral body wall incompetence are risk factors of cement leakage in PVP for OVCF. Cement leakage is easy to occur in operative level with vertebral body wall incompetence and high volume ratio of intravertebral bone cement to vertebral body.
In different stages of schizophrenia (SZ), alterations in gray matter volume (GMV) of patients are normally regulated by various pathological mechanisms. Instead of analyzing stage‐specific changes, this study employed a multivariate structural covariance model and sliding‐window approach to investigate the illness duration‐related developmental trajectory of GMV in SZ. The trajectory is defined as a sequence of brain regions activated by illness duration, represented as a sparsely directed matrix. By applying this approach to structural magnetic resonance imaging data from 145 patients with SZ, we observed a continuous developmental trajectory of GMV from cortical to subcortical regions, with an average change occurring every 0.208 years, covering a time window of 20.176 years. The starting points were widely distributed across all networks, except for the ventral attention network. These findings provide insights into the neuropathological mechanism of SZ with a neuroprogressive model and facilitate the development of process for aided diagnosis and intervention with the starting points.