Trans-sternal bilateral thoracotomy for bilateral lung lesions

The trans-sternal bilateral thoracotomy had been used widely in the early days of cardiac surgery, but since the 1960's the median sternotomy has played a great part in open heart surgery. Recently, the simultaneous bilateral thoracotomy has been used for bilateral lung lesions such as bilateral giant bullae, bilateral pneumothoraces and bilateral metastatic lung tumors. Since 1965 we have performed 6 operations using trans-sternal bilateral thoracotomy for several bilateral lung lesions. The diseases which led to the use of the trans-sternal bilateral thoracotomy technique were 2 cases of bilateral simultaneous pneumothoraces and 4 cases of bilateral lung metastatic tumors. The ages of the patients ranged from 17 to 45 years old. The operative blood loss was between 100 and 810 gm. No case showed postoperative respiratory distress or severe thoracic pain. It would like to be pointed out that the trans-sternal bilateral thoracotomy is the most ideal approach for the multiple bilateral lung metastatic lesions which often invade the chest wall or diaphragm.     

Bilateral peroneal nerve injuries in a patient with bilateral femur fractures: a case report

The second reported case in the current literature of peroneal nerve palsy in bilateral femur fractures is described. This is the first case report of bilateral nerve palsies occurring in bilateral femoral fractures and the first report of bilateral peroneal nerve palsy associated with bilateral skeletal traction.     

Synchronous bilateral testicular tumors

Synchronous bilateral testicular tumors are a rare entity. One such case of an elderly male is reported who presented with bilateral painless testicular swellings of 3 months duration. After clinical workup, provisional diagnosis of bilateral testicular tumors was made and bilateral orchidectomy was performed. Histopathology report revealed bilateral seminoma.     

Simultaneous bilateral testicular germ cell tumors with dissimilar histology. Case report and review of the literature

A 32-year-old male presented with simultaneous bilateral germ cell tumors of the testicles. Histological examination revealed dissimilar histology in both testes showing pure seminoma in the left side and mature teratoma with malignant transformation in the right testicle. A survey of the literature revealed a total of 151 previously described cases of synchronous bilateral germ cell tumors, the majority of which presenting as bilateral seminoma. Treatment of synchronous bilateral germ cell tumors with dissimilar histology should consist of bilateral orchiectomy and bilateral retroperitoneal lymph node dissection.     

Bilateral intertrochanteric fractures after surgical treatment of bilateral femoral neck fractures secondary to hypocalcemic convulsions with chronic renal failure: a case report and review of the literature

There have been no reports of bilateral femoral neck fractures followed by bilateral femoral intertrochanteric fractures. A 28-year-old man presenting with bilateral femoral neck fractures due to generalized convulsions was diagnosed with chronic renal failure and treated with percutaneous screw osteosynthesis and hemodialysis. During rehabilitation, the patient again had convulsions resulting in bilateral femoral intertrochanteric fractures 2 months after the operation. He was treated with a compression hip screw on the right side and conservatively on the left side. This is the first well-documented report on bilateral femoral neck fractures followed by bilateral femoral intertrochanteric fractures.     

˫���״�ٰ����ٴ����ص�

目的探讨双侧甲状腺癌的临床新特点。方法回顾性分析比较复旦大学肿瘤医院头颈外科1999年和2009年双侧甲状腺癌的临床资料,以及1999年和2009年初治的同时发生的双侧甲状腺癌的临床病理资料。结果 1999年收治双侧甲状腺癌26例,包括同时发生的双侧甲状腺癌16例,先后发生的甲状腺癌病例10例;2009年收治双侧甲状腺癌130例,包括同时发生的双侧甲状腺癌104例,先后发生的双侧甲状腺癌病例26例。1999年16例同时发生的双侧甲状腺癌病例中,双侧微小癌2例(12.5%),单侧微小癌5例(31.2%);2009年104例同时发生的双侧甲状腺癌病例中,双侧微小癌28例(26.9%),单侧微小癌80例(77%)。2009年104例同时发生的双侧甲状腺癌中,中央区淋巴结转移率达70%,无中央区淋巴结转移病例颈侧区转移率为13.3%,而有中央区转移的病例颈侧区转移率达56%。结论 2009年资料与1999年资料相比,双侧甲状腺癌构成比和微小癌比例差异显著,B超的广泛应用和准确度提高可能是造成这种变化的原因。双侧甲状腺癌应该常规作中央区淋巴结清扫,并且仔细探查有无颈侧区转移。     

Comparison of Simultaneous Bilateral and Staged Bilateral Total Knee Arthroplasty in Terms of Perioperative Complications

We compared bilateral total knee arthroplasty (TKA) performed at a single session vs those performed at 2 separate sessions with respect to complications, amount of blood loss, and length of hospital stay. Study participants included 119 consecutive patients undergoing simultaneous bilateral TKA and an additional 119 patients undergoing staged bilateral TKA. Systemic complication in the simultaneous bilateral TKA was significantly higher statistically than that in the staged bilateral TKA. Therefore, performing simultaneous bilateral TKA in elderly or high-risk patients results in a significantly higher rate of systemic complications. Simultaneous bilateral TKA is a relatively safe and beneficial procedure with a minimal increase in the risk of systemic complications. However, this procedure should be conducted carefully, particularly in elderly and high-risk patients.     

Staggered bilateral total knee arthroplasty performed four to seven days apart during a single hospitalization

BACKGROUND: The purpose of this study was to evaluate the types and prevalence of complications associated with bilateral total knee replacement performed four to seven days apart during a single hospitalization and to compare them with those associated with bilateral knee replacement performed sequentially under the same anesthetic session or staged unilateral replacements performed during separate hospitalizations. METHODS: Using a computerized database and medical records, we retrospectively evaluated 332 consecutive patients who underwent bilateral total knee replacement performed by two surgeons. A total of 241 patients underwent staggered bilateral knee replacement with the procedures performed four to seven days apart during one hospitalization, twenty-six underwent sequential bilateral total knee replacement, and sixty-five underwent staged bilateral knee replacement performed during two separate hospitalizations. The data on major complications, including death, return to operating room, myocardial infarction, and pulmonary embolism, and on minor complications, including atrial fibrillation, deep-vein thrombosis, and urinary tract infection, were evaluated. RESULTS: Patients undergoing sequential bilateral total knee replacement and staged bilateral knee replacement had an overall rate of complications that was 2.5 times higher than that of the staggered group. Major complications were rare in all groups, but they occurred most often in the staged bilateral replacement group. The overall rate of complications for the patients who had staggered bilateral knee replacement (13%) was significantly less (p = 0.0009) than that for the patients who had sequential bilateral knee replacement (35%) or staged bilateral knee replacement (31%). The length of inpatient stay for those with staggered total knee arthroplasty was four days longer than that for the sequential arthroplasty group (p = 0.0001). CONCLUSIONS: Staggered bilateral total knee replacement, with the procedures performed four to seven days apart in a single hospitalization, is a safe and practical method for performing bilateral total knee replacement.     

Simultaneous bilateral laparoscopic adrenalectomy: a surgical option for multiple endocrine neoplasia (MEN 2) patients with bilateral pheochromocytomas

Multiple endocrine neoplasia (MEN 2) is a rare disorder. Of this group, 42% develop a pheochromocytoma of which 60% will have bilateral involvement. Although the benefits of unilateral laparoscopic adrenalectomy have been well documented, fewer cases of simultaneous bilateral laparoscopic adrenalectomy have been reported. We present the cases of three patients with MEN 2 who underwent successful simultaneous bilateral laparoscopic adrenalectomy after their initial presentation with bilateral pheochromocytoma. Although the management of bilateral pheochromocytomas has traditionally been approached via open laparotomy or bilateral posterior incisions, the bilateral laparoscopic approach should be considered a viable alternative for patients requiring surgical intervention. Clinical outcomes and complications are similar to open laparotomy. Simultaneous bilateral laparoscopic adrenalectomy is a safe and effective procedure that results in a more rapid recovery and a shorter hospital stay for patients with bilateral pheochromocytomas originating from MEN 2.     

Ninety-day mortality after bilateral hip arthroplasty

Despite lack of any studies, to our knowledge, bilateral total hip arthroplasty (THA) is believed to carry higher perioperative mortality. The purpose of this study is to investigate the incidence of mortality within 90 days of bilateral THA in a major urban medical center. The incidence of 90-day mortality after 1-stage bilateral THA performed in 707 patients between 1995 and 2004 was evaluated. A detailed analysis of our database was performed to determine which bilateral THA patients died within 90 days of surgery. Every living patient who had undergone bilateral hip arthroplasty was contacted. One patient (0.14%, 1/707) died within 90 days of 1-stage bilateral THA. The patient developed spontaneous retroperitoneal hematoma requiring massive transfusion. The patient died of multisystem failure 35 days after undergoing bilateral THA. One-stage bilateral uncemented THA performed in a select group of healthy and young patients carries an acceptable risk.     

Component alignment in simultaneous bilateral or unilateral total knee arthroplasty

A bilateral total knee prosthesis procedure can be performed simultaneously in patients with bilateral gonarthrosis. The purpose of this study was to evaluate the differences in component alignment between the simultaneous bilateral TKA and unilateral TKA. A total of 20 patients out of 40 underwent simultaneous bilateral TKA, whereas 20 patients had unilateral TKA. The component alignments were compared radiographically. There was no statistically significant difference in the component alignment between the simultaneous bilateral TKA group and the unilateral TKA group. In conclusion, component alignment of the patients with simultaneous bilateral TKA is similar to that of unilateral TKA.     

Lumbar stenosis. An electromyographic evaluation.

Analysis of bilateral EMG and operative findings reveal that there is a definite correlation between bilateral positive EMG in particular and multiradicular EMG's and the findings of stenosis or spondylosis of the lumbar canal. Electromyography is helpful in identifying the atypical patient or the patient with unilateral symptoms who actually has bilateral pathology. The importance of a bilateral electromyographic examination is emphasized and the rarity of bilateral or multiradicular findings in simple herniated nucleus pulposus.     

Bilateral synchronous testicular germ cell tumours in a patient with bilateral cryptorchidism

Bilateral testicular tumours are rare, and 80% of bilateral tumours are metachronous. The incidence of testicular tumours is high in cryptorchidism. Synchronous bilateral testicular tumours are rare, and bilateral synchronous testicular tumours in bilateral cryptorchidism extremely rare, probably not reported previously.     

Bilateral anterior shoulder fracture-dislocation

We report an unusual case of bilateral anterior shoulder dislocation following trauma. Previously reported cases were either of bilateral dislocations or bilateral fracture dislocations. In our case the patient suffered bilateral anterior dislocation with a three part fracture dislocation on the right. A review of the literature is presented.     

Bilateral partial nephrectomy in a case of bilateral synchronous renal cell carcinoma

We report a case of bilateral synchronous renal cell carcinoma in a 66-year-old-man, who underwent bilateral partial nephrectomy. He visited our hospital, complaining of left flank pain. Drip infusion pyelography showed a left ureteral stone and left hydroureteronephrosis. Computerized tomography revealed bilateral renal tumors. These tumors were small (< 2 cm), so bilateral partial nephrectomy and left ureterolithotomy were performed. The pathological examination showed that all tumors were renal cell carcinoma. No recurrence has been seen nine months after the operation. This is the 12th case in the Japanese literature reported as bilateral partial nephrectomy for bilateral synchronous renal cell carcinoma.     

双侧乳房重建118例单中心回顾性研究

目的 探讨双侧乳房重建手术的开展情况和影响因素。方法 对复旦大学附属肿瘤医院2000年1月至2019年12月间接受双侧乳房重建手术的病人资料进行回顾性分析,描述病人人口学、临床病理特征、双侧乳房重建手术规模、手术时机和方式,探讨双侧乳房重建手术方式选择过程中的影响因素。采用t检验、χ2检验以及Fisher检验进行显著性检验;利用单因素及多因素回归分析,对上述影响因素进行统计学检验。结果 2913例病人接受乳腺癌全乳切除术后乳房重建,其中双侧乳房重建病人共118例,占重建总数的4.05%。双侧乳腺癌病人82例,对侧乳房预防性切除的单侧乳腺癌病人31例,15例病人为一侧或双侧延期乳房重建。双侧即刻重建者103例,占87.3%,10例病人行单侧乳房延期重建,5例行双乳延期重建。双侧植入物重建97例（82.2%）,一侧植入物重建另一侧自体重建共9例（7.6%）,其余12例（10.2%）为双侧自体重建。乳房切除动机（治疗性/预防性）、双侧乳房切除时机（同时性/异时性）以及辅助放疗与双侧乳房重建方式选择相关。多因素分析发现,异时性双乳切除病人与术后需要行辅助放疗的病人更倾向于选择一侧或双侧自体重建。同时行双乳切除接受即刻植入物重建时,扩张器-假体两步法占比更高,达76.5%。和单侧乳房重建比较,双侧乳房重建术后非计划再次手术和重建失败的比例差异无统计学意义。结论 当前国内双侧乳房重建的占比虽然较低,但是面临潜在的增长趋势。乳腺癌多学科团队应制订合理的手术适应证,结合病人意愿,选择恰当的手术时机和方式,从而使临床决策更为规范。     

Bilateral traumatic abducens nerve palsy associated with skull base fracture--case report

A 29-year-old man presented with skull base fractures involving the bilateral petrous bones and clivus to the posterior clinoid process manifesting as bilateral abducens nerves palsy. Conservative treatment resulted in residual bilateral abducens nerves palsy. Posterolateral impact probably resulted in strain-stress in the neighborhood of the foramen lacerum, resulting in a clivus fracture of the posterior clinoid process and bilateral petrous bone fractures. Chalasia of Gruber's ligament then exerted mechanical pressure on the bilateral abducens nerves.     

不同术式的双侧牙槽嵴裂植骨术对唇、颊龈沟深度的影响

目的　研究不同术式的双侧牙槽突裂植骨术对唇、颊龈沟深度的影响。方法　对我科 1992年 4月至 2 0 0 2年 3月间采用 :①提袋手柄式瓣牙槽突裂修复术 ;②双颊瓣牙槽突裂修复术 ;③双颊瓣加鼻中隔犁骨凿断牙槽突裂修复的 4 2例牙槽突裂患者进行分析。结果　将术后唇颊龈沟变浅分为Ⅳ级 ,结果 4 2例中 ,0级 2 0例 ,占 4 7 6 % ;Ⅰ级 10例 ,占 2 3 8% ;Ⅱ级 10例 ,占 2 3 8% ;Ⅲ级2例 ,占 4 7%。采用提袋手柄式瓣和双颊瓣加犁骨凿断牙槽突裂修复术的 6例中 ,唇颊龈沟变浅 2 3者有 4例 ,唇颊龈沟消失者 2例 ,可见这两种术式均可使唇颊龈沟变浅。结论　三种术式均有使唇颊龈沟变浅之可能 ,术中应注意预防之     

Bilateral spermatocele concurrent with bilateral scrotal hydrocele presenting huge scrotal swelling

We report the very rare case of bilateral spermatoceles concurrent with bilateral scrotal hydrocele presenting huge scrotal swelling. A 52-year-old man came to our hospital because of large scrotal swelling. Ultrasonography and magnetic resonance imaging showed bilateral large scrotal hydroceles concurrent with bilateral multicystic spermatoceles above the hydrocele. He had no history of vasectomy or scrotal injury, and the semen examination was normal. The contents of the hydroceles and spermatoceles were first aspirated, but hydrocelectomy and spermatocelectomy were eventually done because after the aspiration the fluid increased more rapidly. Bilateral spermatocele is very rare; moreover, this is the first report of bilateral spermatocele concurrent with bilateral hydrocele.     

Staging of Bilateral Lung Transplantation for High‐Risk Patients With Interstitial Lung Disease: One Lung at a Time

The choice of a single or bilateral lung transplant for interstitial lung disease (ILD) is controversial, as surgical risk, long‐term survival and organ allocation are competing factors. In an effort to balance risk and benefit, our center adopted a staged bilateral lung transplant approach for higher surgical risk ILD patients where the patient has a single lung transplant followed by a second single transplant at a later date. We sought to understand the surgical risk, organ allocation and early outcomes of these staged bilateral recipients as a group and in comparison to matched single and bilateral recipients. Our analysis demonstrates that staged bilateral lung transplant recipients (n = 12) have a higher lung allocation score (LAS), lower pulmonary function tests and a lower glomerular filtration rate prior to the first transplant compared to the second (p < 0.01). There was a shorter length of hospital stay for the second transplant (p = 0.02). The staged bilateral compared to the single and bilateral case‐matched controls had comparable short‐term survival (p = 0.20) and pulmonary function tests at 1 year. There was a higher incidence of renal injury in the conventional bilateral group compared to the single and staged bilateral groups. The staged bilateral procedure is a viable option in select ILD patients.