ObjectiveTo analyze the increased risks of nursing due to expansion of ophthalmic day surgery indications, and the countermeasures. MethodsWe collected the information in the last three years from January 2012 to December 2014 in the Department of Ophthalmology, including the number of operations, the proportion of cataract patients, patients aged over 70 and under 12 years old, patients with high-risk fall, the number of general anesthesia operations, adverse events, and the data from the satisfaction survey of the patients. All the data were analyzed by statistical method. ResultsDuring the last three years, the relaxation of ophthalmic day surgery indications led to an increased admission rate of high-risk patients, and caused more nursing risk factors. Through the efforts of prevention and care, during the last three years, there were no adverse events, and patients had a satisfaction rate over 90%. ConclusionAlthough the ophthalmic day surgery indication has been relaxed, through the establishment of nursing risk response system by pre-hospital guidance, admission assessment, peri-operative education and follow-up visit, with the continuous improvement of nursing management system and convenient workflow, we can not only improve the work efficiency, but also ensure nursing safety.
ObjectiveTo review the advances in the diagnosis and treatment of obstetric brachial plexus palsy (OBPP). MethodsThe incidence, risk factors, classification, and imaging tests of OBPP and indication, technique, and results of surgery were reviewed and summarized. ResultsThe incidence of OBPP is not declining in recent years. Birth weight of ≥4 kg, forceps delivery, and prepregnancy body mass index of ≥21 are considered to be major risk factors, and caesarean section delivery seems to be a protective factor. Neurophysiological investigations can be applied to qualitative diagnosis of OBPP, but can not to quantitative one. Sensitivity and specificity of both CT and MRI myelography are about 0.7 and 0.97, respectively. Narakas classification is widely used:C5, 6 injury as type I, C5-7 injury as type Ⅱ, C5-T1 injury as type Ⅲ, C5-T1 injury with Horner's syndrome as type IV. It is generally considered that the brachial plexus exploration should be undertaken for infants without spontaneous recovery of elbow flexion by a maximum of 3 months old; and 10% to 30% of patients may need nerve reconstruction surgery. It is advocated that traumatic neuroma of the upper trunk should be resected with nerve reconstruction. The final evaluation for surgical results should be at minimal 4 years for upper roots and 8 years for total roots. Scales of Mallet, Gilbert, and Raimondi are mostly used for assessing shoulder function, elbow function, and hand function. ConclusionBrachial plexus exploration should be undertaken for infants without flexion of elbow at the age of 3 months. Traumatic neuroma (even neuroma-in-continuity) resection followed by microsurgical reconstruction of the brachial plexus is favored.
Current guidelines recommend follow-up observation for moderate aortic stenosis (MAS), but clinical evidence shows that its prognosis is poor, especially when combined with left ventricular systolic dysfunction, the risk of death and hospitalization for heart failure is significantly increased. With the technical maturity and device development of transcatheter aortic valve replacement (TAVR), its therapeutic potential in MAS has attracted attention. This paper systematically reviewes the risk stratification indicators of MAS and the clinical research results of early TAVR intervention, and analyzes the key clinical issues such as patient selection and operation timing. It points out that early TAVR may improve the prognosis and quality of life of some high-risk MAS patients, but its wide clinical application still needs more evidence-based medical evidence support.
The incidence of rib fracture in patients with chest trauma is about 70%. Simple rib fractures do not need special treatment. Multiple rib fractures and flail chest are critical cases of blunt trauma, which often cause serious clinical consequences and need to be treated cautiously. Nowadays, there is a controversy about the diagnosis and treatment of multiple rib fractures and flail chest. In the past, most of the patients were treated by non-operative treatment, and only less than 1% of the patients with flail chest underwent surgery. In recent years, studies have confirmed that surgical reduction and internal fixation can shorten the hospital stay, and reduce pain and cost for patients with flail chest, but there is still a lack of relevant clinical consensus and guidelines for diagnosis and treatment, which leads to great differences in clinical diagnosis and treatment plans. This article reviewed the treatment, surgical indications and surgical timing of multiple rib fractures and flail chest.
Mitral regurgitation (MR) is the most common type of valvular heart disease. Mitral valve repair/replacement can improve the prognosis of patients with severe MR, but a large proportion of patients cannot tolerate surgical procedures due to comorbidities and surgical risks. Transcatheter mitral valve replacement (TMVR) is a kind of treatment for mitral valve disease in which an artificial valve is delivered to the mitral valve annulus through a catheter and released into place, with the advantages of no thorax opening, less trauma and high safety. Early clinical studies of TMVR have shown good results, but still face many challenges. Strict indications are effective measures to reduce surgical risks and postoperative complications. This article explores the relevant indications of TMVR by analyzing several studies at home and abroad.
Objective To analyze the prognosis and indications of transjugular intrahepatic portosystemic shunt (TIPS) in patients with Budd-Chiari syndrome (BCS). MethodsPatients with primary BCS who received TIPS in the Department of Gastroenterology, West China Hospital of Sichuan University between February 2009 and February 2020 were retrospectively reviewed. The medical history, preoperative imaging, surgical records, and postoperative outpatient follow-up medical records were recorded. The laboratory indexes before and after operation were compared, and the cumulative free from hepatic encephalopathy rate, stent patency rate, and cumulative survive rate were calculated. Cox proportional hazards model was used to analyze the independent risk factors of hepatic encephalopathy, shunt dysfunction and death. Results A total of 48 patients were included. The main indications for TIPS included variceal bleeding (16 cases), refractory ascites (24 cases), and diffuse obstruction of hepatic vein with acute liver function impairment (8 cases). The cumulative 1 year, 2 years and 3 years of free from hepatic encephalopathy rates were 92.3%, 89.2% and 85.3%, respectively. The stent patency rates were 89.7%, 72.2% and 54.8% at postoperative 1 year, 3 years and 5 years, respectively. The cumulative survival rates were 86.0%, 79.5% and 71.4% at postoperative 1 year, 3 years and 5 years, respectively. Conclusion TIPS can achieve good efficacy in patients with BCS, and most patients receive TIPS for portal hypertension complications rather than acute liver function impairment.
This paper describes the advantages and disadvantages of radiofrequency ablation from the current situation of hepatocellular carcinoma treatment, radiofrequency ablation treatment, the efficacy of radiofrequency ablation in hepatocellular carcinoma, the shortcomings of radiofrequency ablation treatment, and the experience of the author’s treatment team. For the treatment of liver cancer, we should not blindly pursue minimally invasive and ignore the principle of radical resection, nor blindly pursue radical resection and ignore the risk of surgery. We should choose reasonable treatment methods, let the patient get the best treatment.
ObjectiveTo analyze the short- and long-term therapeutic effects of heart transplantation in children. MethodsA retrospective study was conducted on recipients and donors who underwent heart transplantation at the 7th People’s Hospital of Zhengzhou from May 2018 to August 2023, analyzing their clinical characteristics, surgical data, postoperative complications, and survival rates. ResultsA total of 22 children underwent heart transplantation, including 14 males and 8 females, with a median age of 13.5 (10.0, 15.0) years and a median weight of 41.9 (30.5, 55.4) kg. The primary diseases included: dilated cardiomyopathy in 16 patients, hypertrophic cardiomyopathy in 1 patient, myocardial dysplasia in 3 patients, right ventricular dysplasia in 1 patient, and congenital heart disease with abnormal coronary artery origin in 1 patient. The median age of the donors was 21.0 (13.0, 29.0) years, and the median weight was 50.5 (47.3, 75.0) kg. The blood types of the donors and recipients were the same, with type A in 10 patients, type B in 5 patients, type O in 5 patients, and type AB in 2 patients. Before transplantation, all children had a New York Heart Association cardiac function grade Ⅳ, with 1 patient assisted by intra-aortic balloon pump (IABP), 3 patients assisted by extracorporeal membrane oxygenation (ECMO), 2 patients assisted by continuous renal replacement therapy (CRRT), and 2 patients on mechanical ventilation. Nine patients met the criteria for emergency child status allocation, and the panel reactive antibody level in the patients was<10%. The median cold ischemic time of the donor heart was 355.0 (262.0, 395.5) min, the median aortic cross-clamping time was 45.0 (38.3, 51.3) min, the median mechanical ventilation time was 22.5 (16.8, 52.5) h, the median postoperative hospital stay was 29.5 (20.0, 43.0) d, and the median intensive care unit stay was 6.0 (5.0, 8.3) d. After surgery, 4 patients were assisted by ECMO, 2 patients by CRRT, and 7 patients developed complications, including lung fungal infection in 6 patients, liver and kidney dysfunction in 1 patient, local wound non-union and mediastinal infection in 1 patient, and multiple organ failure in 1 patient. Kaplan-Meier curve analysis showed that the survival rates of children after surgery were 91.3% at 1 year and 3 years; the survival rates of adult heart transplant recipients at our center were 86.7% and 73.8% at 1 year and 3 years, respectively, indicating that the survival rate of children with heart transplantation was higher than that of adult patients. ConclusionHeart transplantation is an effective treatment for end-stage heart failure in children, and the short- and long-term survival rates of children with heart transplantation are superior to those of adults. There are still many difficulties to be solved in pediatric heart transplantation, requiring joint efforts from society and the medical community.
ObjectiveTo summarize the procedures of the shoulder arthroplasty and the evolution of the shoulder prosthesis, and to discuss the indications and contraindications of the several common shoulder arthroplastis. MethodsThe related literature on shoulder arthroplasty was extensively reviewed, summarized, and analyzed. ResultsAt present, shoulder arthroplasties can be classified into shoulder hemiarthroplasty, total shoulder arthroplasty, resurfacing shoulder arthroplasty, stemless shoulder arthroplasty, and reserve shoulder arthroplasty, etc. Each type of the prosthesis has several special indications and contraindications. Mostly, the shoulder arthroplasties achieved the satisfied results, such as pain-relief and restoration of the elevation and adduction of shoulder. The survival rate of the most shoulder prostheses may reach 10 years or more. ConclusionMost shoulder arthroplasties are effective and satisfied to treat the shoulder traumas and diseases in pain-free and functional restoration of shoulders.
ObjectiveTo explore the vascular conditions and the necessity of vascular reconstruction in the treatment of chronic ischemic diseases of lower extremities with tibial transverse transport (TTT) from the perspective of vascular surgery.MethodsA clinical data of 59 patients with chronic ischemic disease of lower extremities treated by TTT between February 2014 and July 2019 were analyzed retrospectively. Among them, there were 41 patients with diabetic foot (DF), including Wagner grade 3-4, Texas grade 2-3, and stage B-D lesions; the disease duration ranged from 0.7 to 2.4 years, with an average of 1.5 years, and 5 cases complicated with arteriosclerosis obliteran (ASO). There were 14 patients with ASO (Fontaine stage Ⅳ and Rutherford stage Ⅲ-Ⅳ) with an average disease duration of 10.8 months (range, 1.5-23.4 months). There were 4 patients with thromboangiitis obliteran (TAO) with an average disease duration of 12.3 months (range, 2.1-18.2 months), and the clinical stages were all in the third stage. In 18 patients that ankle brachial index (ABI) of anterior or posterior tibial artery was less than 0.6 before operation, or the blood flow of the three branches of inferior anterior tibial artery did not reach the ankle by imaging examination, vascular reconstruction was performed before TTT (5 cases of DF combined with ASO, 12 of ASO, 1 of TAO). After operation, the effectiveness was evaluated by ulcer wound healing, skin temperature, pain visual analogue scale (VAS) score, ABI, and CT angiography (CTA) examination.ResultsThe patients with DF were followed up 8-16 months (mean, 12.2 months); the ulcer wounds healed with a healing time of 5.1-9.2 weeks (mean, 6.8 weeks); CTA examination showed that the branches of inferior anterior tibial artery were opened in 5 patients after revascularization; and the tibial osteotomy healed for 5-14 weeks (mean, 8.3 weeks). The patients with ASO were followed up 13-25 months (mean, 16.8 months); the ulcer wounds healed with a healing time of 6.2-9.7 weeks (mean, 7.4 weeks). CTA examination showed that the branches of inferior anterior tibial artery were opened in 12 patients after revascularization; all tibial osteotomy healed, and the healing time was 4.5-14.4 weeks (mean, 10.2 weeks). The patients with TAO were followed up 12-23 months with an average of 12.3 months, and toe/limb amputation was performed after ineffective treatment. The patients were divided into two groups according to whether they were combined with revascularization or not. The ABI, VAS score, and skin temperature in the combined revascularization group significantly improved at 6 months after operation (P<0.05); while there was no significant difference in ABI at 6 months after operation in the TTT group (P>0.05), but the skin temperature and VAS scores significantly improved when compared with those before operation (P<0.05).ConclusionThe ABI of anterior or posterior tibial artery is more than 0.6, radiological examination shows that at least one of the three branches of inferior anterior tibial artery leads to ankle artery, which is a prerequisite for successful TTT in the treatment of chronic ischemic disease of lower extremities. DF is the indication of TTT. ASO can choose TTT, and TAO should use this technique cautiously.