Central retinal artery occlusion following peribulbar anesthesia for pterygium excision

Pterygium is a common ocular surface pathology in tropical environments. In the early stages, it may be managed medically with topical anti-inflammatory agents and ocular lubricants. However as the disease progresses, surgical excision becomes necessary and several anaesthetic methods may be used to assist this. We share our experience of a 30-year old woman who underwent uneventful pterygium excision using peribulbar lignocain injection with adrenaline. She developed sudden blindness due to central retinal artery occlusion with macular infarction. While peribulbar anaesthesia is generally safe, a remote risk of retinal vascular accident exists and its routine use should be done with caution. Where possible topical anaesthesia with or without intra-lesional injection be employed.     

Central retinal artery occlusion associated with migraine.

We report a case of central retinal artery occlusion associated with migraine. Although this association is rare, the importance of early diagnosis, and the long-term management of this form of complicated migraine are briefly discussed.     

Central retinal artery occlusion in a patient with pseudoxanthoma elasticum

We examined a patient with central retinal artery occlusion (CRAO) who was diagnosed as having pseudoxanthoma elasticum and exhibited angioid streaks. Echocardiography revealed stenosis and plaques of the right carotid artery. Magnetic resonance imaging (MRI) showed multiple cerebral infarctions, which were considered to be the result of vascular-endothelial abnormalities associated with pseudoxanthoma elasticum. Systemic examination of any plaque which may cause CRAO is recommended.     

俯卧位脊柱手术的并发症：缺血性眶间隔综合征

目的:报道1例因俯卧位脊柱手术的并发症造成的缺血性眶间隔综合征。设计:干预性病例报道。方法:1例80岁男性患者因椎管狭窄接受了长时间的腰椎椎板减压切除术,俯卧位进行全麻。几个小时后,患者主诉左眼周疼痛,视力降低。检查发现面部明显浮肿,左眼球突出、运动受限、左眼无光感     

脊柱手术致视网膜中央动脉阻塞一例报告

1 临床资料 患者,女性,18岁,因“左眼突然视物不见2d”于2003年7月1日入院。患者曾于2003年6月29日上午因“脊柱侧弯矫形内固定术后”在外院于全麻下行“脊柱侧弯矫形内固定拔除术”,术中采取俯卧位,以手代枕,手术顺利,时间约1h。患者麻醉清醒后发现左眼视物不见,急请眼科会诊,发现患者左眼无光感,瞳孔散大,眼底视网膜水肿,黄斑呈樱桃红。诊断为“左眼视网膜中央动脉阻塞”,立即给予扩     

Branch retinal artery occlusion following embolization of a maxillary sinus tumor

Retinal vascular complications following embolization of carotid artery branches have been occasionally reported. Since the result can be catastrophic and is often irreversible, all efforts to prevent this complication should be considered prior to the intervention. We report the occurrence of a branch retinal artery occlusion following embolization of a maxillary sinus tumor. Cerebral angiography pre- and post-embolization; pathology results from the excised tumor; fundoscopic, visual field, and fluorescein angiographic findings are reported. A combination of risk stratification and preoperative evaluation methods which might help in prevention of this serious complication are discussed.     

俯卧位电视胸腔镜下游离食管治疗食管癌41例临床分析

2006年9月至2010年9月我院行俯卧位胸腔镜下游离食管食管癌切除术共41例,对其临床资料做回顾性分析。患者均为T3N1M0以下分期,手术采用胸腔镜游离胸段食管并清扫纵隔淋巴结,开腹游离胃行食管胃颈部吻合。结果提示,临床分期在T3N1M0以下食管癌患者采取俯卧位时能够更好地显露食管和周围组织,利于食管切除和淋巴结的清扫。     

俯卧位和斜侧卧位术式经皮肾镜取石术患者中效果比较

目的:比较在俯卧位和斜侧卧位术式经皮肾镜取石术患者中的效果。方法:将肾结石、输尿管上段结石患者78例分为俯卧位组和斜侧卧位组。两组患者均实施经皮肾镜碎石取石术。斜侧卧位组患者42例,采取腰硬联合麻醉,斜侧卧位体位取石;俯卧位组患者36例,采取全麻醉,俯卧位体位取石。比较两组患者的手术效果。结果:两组患者的手术时间、术中出血、结石清除率均无差异,住院时间斜侧卧位组患者较俯卧位组短。结论:经皮肾镜取石术在俯卧位和斜侧卧位两种体位取患者结石的效果,除斜侧卧位住院时间较俯卧位短外,其总体效果相同。     

改良俯卧位在侧路椎间孔镜手术的临床应用

目的探讨改良俯卧位在侧路椎间孔镜手术中的效果。方法选取侧路椎间孔镜手术病人130例,随机分为对照组和观察组各65例。对照组采用常规俯卧位的侧路椎间孔镜手术,观察组采用改良俯卧位的侧路椎间孔镜手术。比较2组手术指标、疼痛程度、恢复情况及临床满意度。结果观察组手术时间短于对照组（P＜0.01）,术中C型臂透视次数少于对照组（P＜0.01）,术中出血量与对照组差异无统计学意义（P>0.05）;观察组术后1、2个月视觉模拟评分、Oswestry功能障碍指数与对照组差异均无统计学意义（P>0.05）;观察组临床满意度高于对照组（P＜0.01）。结论改良俯卧位应用于行侧路椎间孔镜手术可有效改善手术指标,提高病人临床满意度。     

硅胶啫喱垫在俯卧位手术中的应用

目的:观察硅胶啫喱垫在俯卧位手术中的应用效果。方法:通过使用传统弓形脊柱手术托架摆放俯卧位与使用啫喱垫摆放俯卧位的比较,总结两种摆放手术体位的临床效果。结果:采用硅胶啫喱体位垫可有效缩短患者摆放体位时间,减少因手术体位引发的并发症。结论:采用硅胶啫喱垫摆放俯卧位不但操作简便,而且可以达到保护患者安全的目的,值得临床推广应用。     

光化学法诱导家兔视网膜中央动脉阻塞

目的 建立家兔视网膜中央动脉（ＣＲＡ）主干阻塞的动物模型。方法 手术暴露出０视网膜中央动脉后,采用光化学法造模,随后对模型进行荧光眼底照相及电镜检查。结果 视网膜中央动脉内血栓形成,阻塞血管腔。视网膜的节细胞层及神经纤维层在缺血６ｈ后均出现变性、坏死的改变。结论 采用光化学方法,可以成功复制出视网膜中央动脉主干阻塞模型,且缺血达６ｈ后视网膜节细胞层及神经纤维层可发生不可逆性损伤。     

Routine intubation in the prone position

Abstract

Background. Tracheal intubation in the prone position has previously been reported only as a necessity in a very few emergency situations. It emerged at our clinic as a routine after invention of a test aimed at pinpointing a painful motion segment in patients with chronic low back pain who were candidates for lumbar fusion operation.

Material and methods. During a 6-year period 247 consecutive patients were treated at our clinic, 91 men and 156 women, mean age 42.8 years, range 25.3–62.8. Classification of the pharyngeal structures according to Mallampati et al. was done the day before surgery, and grading of visualization of the glottis as described by Cormack and Lehane was done during intubation, with the aim of revealing factors of importance for the possibility of performing tracheal intubation in the prone position.

Results. The large majority of patients classified preoperatively as Mallampati class 1 had Cormack and Lehane grade 1 at laryngoscopy, although some patients had grades 2, 3, and 4. Most problems with intubation in the prone position were anticipated among those classified preoperatively as Mallampati class 3, but tracheal intubation in the prone position was still possible in 21 of the 23 patients in this group. In all, tracheal intubation in the prone position was successful in 244 of the 247 patients (98.8%).

Conclusion. Routine tracheal intubation in the prone position can be performed effectively by experienced anaesthesiologists, but this requires continuous training and good support from the anaesthesiology staff.     

Routine intubation in the prone position

Background.

Tracheal intubation in the prone position has previously been reported only as a necessity in a very few emergency situations. It emerged at our clinic as a routine after invention of a test aimed at pinpointing a painful motion segment in patients with chronic low back pain who were candidates for lumbar fusion operation.

Material and methods.

During a 6-year period 247 consecutive patients were treated at our clinic, 91 men and 156 women, mean age 42.8 years, range 25.3–62.8. Classification of the pharyngeal structures according to Mallampati et al. was done the day before surgery, and grading of visualization of the glottis as described by Cormack and Lehane was done during intubation, with the aim of revealing factors of importance for the possibility of performing tracheal intubation in the prone position.

Results.

The large majority of patients classified preoperatively as Mallampati class 1 had Cormack and Lehane grade 1 at laryngoscopy, although some patients had grades 2, 3, and 4. Most problems with intubation in the prone position were anticipated among those classified preoperatively as Mallampati class 3, but tracheal intubation in the prone position was still possible in 21 of the 23 patients in this group. In all, tracheal intubation in the prone position was successful in 244 of the 247 patients (98.8%).

Conclusion.

Routine tracheal intubation in the prone position can be performed effectively by experienced anaesthesiologists, but this requires continuous training and good support from the anaesthesiology staff.     

玻璃体视网膜联合术治疗急性视网膜坏死性视网膜脱离

目的 :研究治疗急性视网膜坏死性视网膜脱离的玻璃体视网膜联合手术效果。方法 :急性视网膜坏死性视网膜脱离 4例患者 ,1例行超声乳化白内障吸出加玻璃体切除加眼内光凝加硅油填充加巩膜环扎术 ;2例行玻璃体切除加眼内光凝加C3F8填充术 ;1例行玻璃体切除加眼内光凝加硅油填充术。结果 :4例患者的炎症均控制良好 ,视网膜均成功复位。随访 9个月～ 3年 ,4例视力分别为 0 0 1(矫正视力 0 12 ) ,0 15,0 1,0 3。结论 :视网膜脱离是急性视网膜坏死的严重并发症 ,通过玻璃体视网膜联合手术 ,可有效地提高视网膜脱离的复位率 ,挽救患者的视功能。