The Role of Tissue Resection Length in the Determination of Post-Operative Eyelid Position for Muller’s Muscle-Conjunctival Resection Surgery

Purpose: To investigate the relationships between pre-operative marginal reflex distance (MRD), tissue resection length, phenylephrine response, and change in MRD with surgery for a cohort of individuals undergoing Muller’s muscle conjunctival resection (MMCR) surgery.

Methods: All cases of MMCR surgery performed over a 13-year period at a single institution were screened for entry. Individuals with adequate photographic documentation and follow up were included. Patients with previous or concurrent upper eyelid, orbital or eyebrow disease of surgery were excluded. Marginal reflex distance (MRD) was calculated based on photographs utilizing public domain software. Data was plotted for inspection and appropriate statistical tests were performed.

Results: During the study period 198 eyes fit criteria for analysis. A loose association between tissue resection length and change in MRD with surgery was found (r?=?0.176, p?p?=?0.367). There was a strong association between MRD change with surgery and pre-operative MRD (r?=?0.498, p?r?=??0.441, p?2?mm and pre-operative MRD as variables revealed a model with pre-operative MRD as the only significant predictor (p?Conclusion: Tissue resection length and phenylephrine response play small roles relative to pre-operative MRD in the determination of change in MRD with MMCR surgery.     

Anastomotic leakage in rectal cancer surgery: The role of blood perfusion

Anastomotic leakage after anterior resection for rectal cancer remains a common and often devastating complication. Preoperative risk factors for anastomotic leakage have been studied extensively and are used for patient selection, especially whether to perform a diverting stoma or not. From the current literature,data suggest that perfusion in the rectal stump rather than in the colonic limb may be more important for the integrity of the colorectal anastomosis. Moreover, available research suggests that the mid and upper rectum is considerably more vascularized than the lower part, in which the posterior compartment seems most vulnerable. These data fit neatly with the observation that anastomotic leaks are far more frequent in patients undergoing total compared to partial mesorectal excision, and also that most leaks occur dorsally. Clinical judgment has been shown to ineffectively assess anastomotic viability, while promising methods to measure blood perfusion are evolving. Much interest has recently been turned to near-infrared light technology, enhanced with fluorescent agents, which enables intraoperative perfusion assessment. Preliminary data are promising, but large-scale controlled trials are lacking. With maturation of such technology, perfusion measurements may in the future inform the surgeon whether anastomoses are at risk. In high colorectal anastomoses, anastomotic revision might be feasible, while a diverting stoma could be fashioned selectively instead of routinely for low anastomoses.     

The gap balanced total knee arthroplasty

The goals of knee arthroplasty (TKA) are to restore a neutral mechanical axis to the leg, and to create symmetric collateral ligament tension throughout the arc of knee motion. What technique best achieves this remains controversial. The two most commonly used techniques for performing TKA are measured resection and gap balancing. Measured resection relies on identification of bony landmarks to set the rotation of the femoral component. The gap balancing technique sets the rotation of the femoral component parallel to the cut tibial surface with symmetric tension on the collateral ligaments.     

影响LEEP治疗宫颈上皮内瘤变预后的因素分析

目的:探讨影响宫颈环状电切术(loop electrosurgical excision procedure,LEEP)治疗宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的预后因素。方法:2011年8月至2013年12月选择在我院进行诊治的宫颈上皮内瘤变患者170例,都给予LEEP治疗,观察术后疗效及其不良反应发生情况。结果:所有患者都完成LEEP术,有效率为94.7%;发生不良反应14例,发生率为8.2%,都经过对症处理后好转。Logistic回归模型进行分析结果显示年龄、CIN分级、宫颈糜烂状况是影响宫颈上皮内瘤变预后的主要独立危险因素(P<0.05)。结论:LEEP治疗宫颈上皮内瘤变具有很好的预后疗效,不良反应较少,影响其预后的因素主要为年龄、疾病分级与宫颈糜烂状况。     

Parathyroid carcinoma: Diagnostic criteria,classification, evaluation

Parathyroid carcinoma is a little-known cancer, difficult to diagnose. We focus this short review on the current diagnostic criteria, the classification and the evaluation tools for this cancer based on latest publications.     

Clinical impact of left atrial appendage resection versus preservation during surgical ablation of atrial fibrillation

IntroductionResection of left atrial appendage (LAA) during surgical ablation of atrial fibrillation may decrease the incidence of postoperative cerebrovascular events and increase the induction and maintenance of sinus rhythm (SR). This study evaluates the effect of LAA resection after the surgical ablation of atrial fibrillation.Materials and methodsA retrospective analysis was made of 599 patients who underwent surgical myocardial revascularization and/or valve surgery with concomitant surgical ablation of atrial fibrillation. The LAA was resected in 140 patients and preserved in 459 patients. Postoperative, 1-month and 1-year results were compared between the groups in terms of TIA/CVA, maintenance of sinus rhythm, pacemaker dependence and mortality.ResultsThe patients who underwent LAA resection were older, had more frequent persistent AF and underwent more frequently biatrial ablation set. In this group, longer times of extracorporeal circulation and longer cross-clamp times were observed. During the follow-up period, the resection group has shown lower incidence of TIA/CVA and the overall mortality was also lower in this group of patients.ConclusionThe resection group in our study has shown the trend toward lower incidence of TIA/CVA and statistically significant decrease of overall mortality. This finding can support routine LAA resection during surgical ablation of atrial fibrillation.     

Circumferential Resection Margin as a Hospital Quality Assessment Tool for Rectal Cancer Surgery

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Comparison of Gap Balancing vs Measured Resection Technique in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee

BackgroundTotal knee arthroplasty requires careful surgical technique to attain the goal of a well-aligned and symmetrically balanced knee. Soft tissue balance and correct femoral component rotation are paramount in achieving these goals. The two competing techniques to select femoral component rotation and soft tissue balance are the gap balance technique and the measured resection technique.MethodsWe performed a randomized, prospective study to compare the two techniques in patients undergoing simultaneous bilateral total knee arthroplasty, whereby one technique was performed in each knee. Fifty (50) subjects were enrolled into the study. The inclusion criteria were osteoarthritic varus knee deformities with similar deformities in both knees. Subjects were followed up for a minimum of two years.ResultsThe knees balanced via the gap balance technique had significantly more posterior medial bone removed from the femur than those knees balanced via the measured resection technique (P < .001). Knees in the gap balance group tended to require more medial knee releases in extension and tended to have smaller sized femoral components as a result of cutting more bone from the femur in flexion. The modular tibial polyethylene bearing tended to be thicker in the gap balance group. Despite these differences, average knee flexion and functional revised Oxford Knee Scores at 2-year follow-up were not statistically different.ConclusionAt 2-year follow-up, there were no differences between the function and scores using the two techniques. Long-term follow-up will be necessary to evaluate any differences in long-term durability.