The usefulness of abscess tonsillectomy followed by intraoral drainage for parapharyngeal abscess concomitant with peritonsillar abscess in the elderly

Parapharyngeal abscess (PPA) may cause life-threatening complications and peritonsillar abscess (PTA) and tonsillitis frequently precede PPA. The optimal management of PPA caused by PTA has been the subject of debate with respect to the surgical approach. We present three cases of PPA concomitant with PTA in elderly patients. In two cases, the abscesses in parapharyngeal space were drained by abscess tonsillectomy followed by intraoral incision of the tonsillar bed. On the other hand, the third case did not undergo abscess tonsillectomy because of his refusal of surgery and needed extraoral drainage after the aggravation of PPA. Based on the experience of those three cases, it was suggested that abscess tonsillectomy followed by intraoral incision of the tonsillar bed might be a useful surgical approach for the drainage of PPA concomitant with PTA, especially in elderly patients.     

VAC结合游离植皮治疗儿童大面积皮肤缺损疗效观察及对患儿生活质量的影响

目的:探讨负压创面治疗技术(Vacuum assisted closure,VAC)结合游离植皮治疗儿童大面积皮肤缺损疗效及对患儿生活质量的影响。方法:选取2015年2月-2019年2月笔者医院收治的60例大面积皮肤缺损患儿作为研究对象,按照随机数表法分为干预组和对照组,每组30例。对照组采用游离植皮术治疗,干预组在对照组的基础上结合VAC治疗,以皮片成活时间、皮片成活率、换药次数及住院天数评估疗效,以长海痛尺分级法评估患儿疼痛等级,以抑郁自评量表(Self-rating depression scale,SDS)、焦虑自评量表(Self-rating anxiety scale,SAS)评估患儿心理状态,以术后不良反应发生率评估患儿预后情况,以自制生活质量表评估患儿生活质量水平。结果:干预组患儿皮片成活时间、换药次数与住院天数均小于对照组,差异有统计学意义(P<0.05)。干预组患儿皮片成活率为93.33%高于对照组的76.67%,差异有统计学意义(P<0.05)。干预组治疗后疼痛感、SDS与SAS评分低于治疗前,且低于对照组,差异有统计学意义(P<0.05)。干预组患儿术后不良反应发生率为6.67%显著低于对照组23.33%,差异有统计学意义(P<0.05)。两组治疗前活动能力、心理健康及社交能力均低于治疗后,干预组治疗后活动能力、心理健康及社交能力均高于对照组(P<0.05)。结论:VAC结合游离植皮治疗儿童大面积皮肤缺损疗效显著,能有效降低患儿生理疼痛与心理焦虑,减少伤口感染等不良反应的发生,提高患儿生活质量,具有推广价值。     

Cardiac-type total anomalous pulmonary venous return is not benign

ObjectiveThe objective of this study was to investigate the association between morphological variation and postsurgical pulmonary vein (PV) stenosis (PPVS) in patients with cardiac total anomalous pulmonary venous connection (TAPVC).MethodsThis single-center, retrospective study included 168 pediatric patients who underwent surgical repair of cardiac TAPVC from 2013 to 2019 (connection to the coronary sinus [CS], n = 136; connection directly to the right atrium [RA], n = 32). Three-dimensional computed tomography modeling and geometric analysis were performed to investigate the morphological features; their relevance to the PPVS was examined.ResultsThe connection type had no association with PPVS (CS type: 18% vs right atrial type: 19%; P = .89) but there was a higher incidence of PPVS in patients with a single PV orifice than > 1 orifice (P < .001). Confluence-to-total PV area ratio (hazard ratio, 4.78, 95% CI, 1.86-12.32; P = .001) and length of drainage route (hazard ratio, 1.22; 95% CI, 1.14-1.31; P < .001) had a 4- and 1-fold increase in the risk for PPVS in the CS type after adjustment for age and preoperative pulmonary venous obstruction. In the right atrial type, those with anomalous PV return to the RA roof were more likely to develop PPVS than to the posterior wall of the RA (P < .001).ConclusionsThe number of inter-junction PV orifice correlated with PPVS development in cardiac TAPVC. The confluence-to-total PV ratio, length of drainage route, and anomalous PV return to the RA roof are important predictors for PPVS. Morphological subcategorization in this clinical setting can potentially assist in surgical decision-making.     

Lingual lymph nodes: Anatomy,clinical considerations,and oncological significance

Lingual lymph nodes are an inconstant group of in-transit nodes, which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II. There is growing academic data on the metastatic spread of oral cancer, particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes. These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer. Combined information on surgical anatomy, clinical observations, means of detection, and prognostic value is presented. Anatomically obtained incidence of lingual nodes ranges from 8.6% to 30.2%. Incidence of lingual lymph node metastasis ranges from 1.3% to 17.1%. It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control. Extended resection volume, which is required for the surgical treatment of lingual node metastasis, cannot be implied to every tongue cancer patient. As these lesions significantly influence prognosis, special efforts of their detection must be made. Reasonably, every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis. Lymphographic tracing methods, which are currently implied for sentinel lymph node biopsies, may improve the detection of lingual lymph nodes.     

敷料更换的不同次数对穿刺引流术后穿刺口感染的影响

目的 研究敷料更换的不同次数对穿刺引流术后穿刺口感染的影响.方法 随机将该院2013年6月—2014年7月收治的100位进行穿刺引流术的患者分为两组,50例为A组,50例为B组. 为A组患者1周更换1次敷料,B组患者1周更换2次敷料. 对两组患者穿刺口感染的情况进行分析比较. 结果 A组患者穿刺口感染的几率显著低于B组(P<0.05),A组患者的病原菌定植率显著低于B组(P<0.05),两组患者导管相关性血流感染率差异无统计学意义(P>0.05). 结论 穿刺引流术后的患者1周更换1次敷料比较合理,既能降低患者术后穿刺口感染的几率,又能降低医护人员的工作量,但要注意在敷料发生松动或者潮湿时也要及时进行更换.     

ENDOSCOPIC NASOBILIARY DRAINAGE: CURRENT INDICATIONS AND EVALUATION OF THE PRODUCTS

Endoscopic nasobiliary drainage (ENBD) is a well established mode of biliary decompression. Although ENBD is certainly an uncomfortable procedure with the potential risk of spontaneous dislocation or removal of the drainage catheter by disoriented patients, it has several advantages over endoscopic biliary drainage (EBD) using an indwelling stent. The current indications for ENBD are: (i) temporary drainage to treat obstructive jaundice and cholangitis caused by malignant or benign biliary stricture; (ii) urgent drainage to treat suppurative cholangitis primarily caused by common bile duct stones; (iii) temporary drainage after stone removal in patients with suspected incomplete clearance and/or with cholangitis; and (iv) biliary leaks that occur primarily after surgery, as well as other indications. Different types of nasobiliary catheters are currently available that have been designed with various diameters, shapes, and materials. However, the current catheters are not considered by most endoscopists to be sufficient. Further improvements are needed to achieve better drainage and better maneuverability.     

Percutaneous management of lymphatic fluid collections

Eight lymphatic fluid collections were drained percutaneously. There were no immediate or late complications. Seven patients had follow-up; 1 required surgical drainage of a residual or recurrent lymphocele, and another had reaccumulated fluid in a lymphocele which was detected on autopsy. The remaining lymphatic collections responded to percutaneous drainage. Percutaneous drainage is safe and can be an effective tool in the management of lymphatic collections.     

Clinical background of cases showing a positive culture of pleural effusion at Shin-Kokura Hospital over a period of 5 years

We investigated the clinical background of patients at Shin-Kokura Hospital who showed a positive culture of pleural effusion during the period from January 1998 through December 2002. Microorganism cultures of the pleural effusions of 127 patients were performed in this 5-year period. Seventeen patients showed a positive microorganism culture from a pleural effusion, and 12 of these patients (70.6%) were 60 years old or more. Ten patients were diagnosed with thoracic empyema. Thirteen patients had an underlying disease such as malignancy (5 cases), diabetes mellitus (4 cases), etc. A purulent effusion and a high concentration of lactic dehydrogenase (LDH) in the pleural fluid were more frequently recognized in the positive-culture group. A total of 21 strains of microorganism were isolated from the 17 patients, including 10 strains of Gram-positive cocci, 6 strains of Gram-negative bacilli, 3 strains of anaerobes, 1 strain of mycobacterium (Mycobacterium tuberculosis), and 1 strain of fungus. Susceptibility to antimicrobial agents was generally good for most of the microorganisms isolated. Of the 17 patients, chest-tube drainage was performed in 13, and 6 needed a surgical operation. Twelve patients improved, but 5 died. In this study, thoracic empyema accounted for 58.8% of the 17 cases with a positive culture of pleural effusion. Of the 10 thoracic empyema patients, 5 patients needed surgical treatment in spite of adequate antimicrobial treatment and chest-tube drainage. Our data indicate that thoracic empyema is still difficult to treat, and thus adequate and rapid treatment is needed for any pleural infection.