Effects of caudal sufentanil supplemented with levobupivacaine on blocking spermatic cord traction response in pediatric orchidopexy

Purposes

Caudal block is one of the most commonly used anesthetic techniques in subumbilical and genitourinary procedures. However, traditional administration of caudal levobupivacaine was inadequate on blocking peritoneal response during spermatic cord traction. The aim of this study was to evaluate whether the addition of caudal sufentanil to levobupivacaine provided better analgesia for children undergoing orchidopexy.

Methods

Sixty-two patients, scheduled for right orchidopexy, received caudal block after induction. Group LS (n = 31) received levobupivacaine 0.25 % 1 ml/kg plus sufentanil 0.5 μg/kg, and group L (n = 31) received levobupivacaine 0.25 % 1 ml/kg only. HR or MAP fluctuation >20 % or entropy increase >15 % during spermatic cord traction was defined as inadequate anesthesia and was treated with increasing sevoflurane concentration. The number of children who needed sevoflurane rescue was counted, and postoperative side effects and quality of sleep were also recorded.

Results

There were no statistically significant differences between the two groups in age, weight, and duration of surgery. Two (6.45 %) children in group LS required inspired sevoflurane rescue to block hemodynamic fluctuation during spermatic cord traction, as compared with 12 (38.71 %) patients in group L (P < 0.001). At the time of exerting spermatic cord traction, the median HR was, respectively, 134 and 145 (P < 0.001); the corresponding response entropy (RE) and state entropy (SE) was 65 and 54, respectively, in group LS versus 76 and 65 in group L (P < 0.001).

Conclusion

In pediatric orchidopexy, the addition of sufentanil to levobupivacaine for caudal blockade offers clinical benefit over levobupivacaine alone in blocking the spermatic cord traction response.     

Does using comprehensive preoperative bowel preparation offer any advantage for urinary diversion using ileum? A meta-analysis

Purpose

The aim of this study was to compare the efficacy of comprehensive bowel preparation to that of limited bowel preparation in prevention of postoperative complications in elective urinary diversion surgery by using ileum.

Methods

Literature search of PubMed, EMBASE and the Cochrane Library was done to identify randomized controlled trials (RCTs) and cohort studies involving comparison of postoperative complications after comprehensive bowel preparation and limited bowel preparation. A meta-analysis was carried out to distinguish overall differences between the two groups.

Results

Our literature search yielded two randomized controlled trials and two cohort studies, involving a total of 346 patients, which met our inclusion criteria. There was no significant difference between the comprehensive bowel preparation and limited bowel preparation in wound infection [relative risk (RR) 95 % confidence interval (CI), 1.05(0.46–2.40); P = 0.86], mortality [RR 95 % CI, 1.06 (0.32–3.55); P = 0.76], ileus [RR 95 % CI, 0.86 (0.37, 2.00); P = 0.40], sepsis [RR 95 % CI, 0.71 (0.20, 2.52); P = 0.78], anastomotic leakage [RR 95 % CI, 0.81 (0.15, 4.21); P = 0.83], wound dehiscence [RR 95 % CI, 0.92 (0.40, 2.13); P = 0.67], peritonitis [RR 95 % CI, 0.64 (0.08, 5.10); P = 0.63] or fistula [RR 95 % CI, 0.71 (0.18,2.75); P = 0.63].

Conclusions

The limited evidence available demonstrated that the use of comprehensive bowel preparation for urinary diversion surgery using ileum does not offer any significant advantage over limited bowel preparation. Future work should target more high-quality RCTs to confirm this.     

Anterior decompression with single segmental spinal interbody fusion for Denis type B thoracolumbar burst fracture: a midterm follow-up study

Purpose

Our goal was to observe the midterm results of a case series of Denis type B thoracolumbar burst fracture treated with anterior decompression with single segmental spinal Interbody fusion.

Methods

Twenty patients with Denis type B thoracolumbar burst fractures underwent anterior decompression with single segmental spinal Interbody fusion. They underwent clinical and radiologic follow-up for at least three years after the surgery.

Results

The mean follow-up period lasted 57 months. To the last follow-up, there were no cases of internal fixation loosening, failure and other complications. Titanium mesh or interbody bone grafts were in good position. Spinal kyphosis was not observed. Interbody fusion was achieved for all cases. The average fusion time was 4.5 months. Based on visual analogue scale (VAS) pain scores, percentage of vertebral body height loss and Cobb angle, the difference was statistically significant between the preoperative period and postoperative one year or final follow-up (P < 0.05). Results at postoperative one year and final follow-up were better than the preoperative period. However, the difference was not significant between postoperative one year and final follow-up (P > 0.05).

Conclusions

Good midterm results on clinical and radiologic evaluation of anterior decompression with single segmental spinal Interbody fusion for suitable patients with Denis type B thoracolumbar burst fracture can be achieved. The incident rate of relative complications is low.     

Nodal Skip Metastasis is not a Predictor of Survival in Thoracic Esophageal Squamous Cell Carcinoma

Background

The presence of nodal skip metastasis (NSM) has been found to be of clinical importance in non-small cell lung cancer, but the study of this phenomenon in esophageal carcinoma is relatively rare. The purpose of this study was to identify risk factors influencing NSM and to assess its prognostic value in thoracic esophageal squamous cell carcinoma (ESCC).

Methods

A total of 207 patients with thoracic ESCC who underwent three-field lymphadenectomy and who had lymph node metastasis were reviewed. Associations of NSM occurrence with the clinicopathological characteristics of patients and primary tumors were evaluated using logistic regression analysis. The influence of NSM on the overall survival (OS) was assessed by log-rank tests and Cox regression analysis.

Results

NSM were present in 58 (26 %) patients. No factor was significantly associated with the incidence of NSM except for the location of primary tumor. There were no NSMs in the 29 patients from our study with upper thoracic ESCC, and the rates of tumors occurrence in the middle and lower third of the esophagus were 38.9 and 14.9 %, respectively. The median OS was 30 months, and no significant difference in OS was found between the patients with or without NSM (p = 0.767). Only N status was found to be the independent risk factor for OS by Cox multivariate analysis.

Conclusions

NSM is common in thoracic ESCC, especially in patients with tumors located in the middle and lower third of the esophagus. However, the presence of NSM did not predict prognosis.     

Predictive Factors of Lymph Node Status in Small Peripheral Non-small Cell Lung Cancers: Tumor Histology is More Reliable

Background

During the past two decades, many studies have sought to find reliable predictors of N0 status in small-sized lung cancers. However, the way of tumor size measurement was usually not clearly stated, and controversy remains as to whether systematic lymph node dissection should be performed in patients with subcentimeter tumors.

Methods

We reviewed correlations between lymph node involvement and clinicopathological variables in 243 small peripheral non-small cell lung cancers with their size measured in fresh specimens before formalin fixation. Histologic subtypes of adenocarcinomas were classified in line with the new International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) lung adenocarcinoma classification.

Results

Incidence of N1 and N2 nodal involvement was 5.3 and 6.6 %, respectively. N2 disease was present in a proportion of subcentimeter tumors (2/53, 3.8 %). No lymph node metastasis was revealed in squamous cell carcinomas, adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic predominant adenocarcinoma, or invasive mucinous adenocarcinoma. Collectively, the five cell types accounted for 34.6 % of all the small peripheral cases.

Conclusions

Precise measurement of tumor size in fresh tissues revealed that tumor size was not a reliable predictor of N0 status. However, through histologic classification, systematic lymph node dissection might be avoided in more than one third of small peripheral NSCLC.     

单侧微小型唇裂的微小皮肤切口修复术

目的 探讨尽可能减少白唇部皮肤切口瘢痕的单侧微小型唇裂(单侧Ⅰ度唇裂)的修复方法.方法 遵循微创技术操作原则,采用鼻堤Z成形术切口,行白唇区、鼻基底区口轮匝肌浅面皮下剥离,部分离断降鼻肌并松解患侧鼻翼基部在上颌骨的粘连,切取患侧口轮匝肌瓣向内向上推进与健侧口轮匝肌重叠缝合,固定于鼻小柱基部患侧皮下深层,结合唇系带松解、去表皮唇黏膜下组织瓣填充于红唇凹陷部位以修复红唇唇裂.结果 7例先天性单侧微小型唇裂修复后均甲级愈合.后随访6～18个月,唇裂鼻堤、红唇凹陷修复效果明显,且患侧鼻孔宽大及唇高短缩畸形亦有改善.结论 鼻堤切口结合去表皮唇黏膜下组织瓣修复单侧唇裂,可在尽可能避免白唇切口瘢痕的前提下,明显改善单侧微小型唇裂存在的鼻堤、红唇凹陷、鼻孔宽大畸形,并延长了患侧唇高,可达到满意的手术效果,并符合微创技术原则.     

复方玄驹胶囊联合十一酸睾酮治疗特发性少弱精症疗效观察(附96例)

目的 探讨复方玄驹胶囊联合十一酸睾酮治疗特发性少弱精症的临床效果.方法 96例少、弱精子症患者分为轻、中、重度三组,各组均给予复方玄驹胶囊、十一酸睾酮口服治疗,连续治疗3个月后评价临床疗效.结果 96例中,11例用药期间女方妊娠,各组治疗前后的精子密度、A级精子、(A+B)级精子、重度组的(B+c)级精子,均有显著改善,差异具有统计学意义(P＜0.01).结论 复方玄驹胶囊联合十一酸睾酮,是治疗特发性少弱精症的有效方法.     

半肩假体置换治疗肱骨近端复杂性骨折的应用研究

目的探讨半肩假体置换治疗肱骨近端NeerⅢ和NeerⅣ骨折的临床疗效及手术要点。方法从2005年9月～2010年10月,本组收治了33例肱骨近端复杂骨折的患者,男14例,女19例;年龄62～80岁,平均73.7岁;左侧11例,右侧22例,NeerⅢ13例,NeerⅣ20例,行LINK半肩假体置换治疗。术后应用改良的半肩关节置换评分系统（scoring system-modification for hemiarthroplasty,SSMH）评分和美国肩肘医师评分（American Shoulder and Elbow Surgeon Score,ASES）评价治疗效果。结果 33例患者中均得到随访,随访时间6～55个月,平均28个月。SSMH评分术后1周平均评分14.5分,末次随访（所有患者随访时间均〉6个月）平均评分25.6分,ASES评分术后1周平均评分45分,末次随访平均为84分。结论半肩关节置换是一种治疗肱骨近端复杂性骨折的有效方法,肩袖重建方式、假体与关节盂吻合度、术后功能锻炼是影响疗效的主要因素。     

基于增材制造和凝胶注模成型技术的多孔生物陶瓷支架制备与表征

目的探讨基于增材制造和凝胶注模成型技术的多孔β-磷酸三钙（TCP）生物陶瓷支架的制备方法及其表征。方法利用计算机辅助设计（CAD）软件设计支架内部孔隙结构,通过光固化快速成型技术制造相应的树脂模具,在模具中填充生物材料,待其固化后通过热分解去除树脂模具,然后对所形成的多孔β-TCP支架的微观孔隙结构特征、力学性能以及体外细胞相容性进行检测。结果多孔β-TCP支架孔隙结构与设计结构一致,孔隙率为45.1%±1.2%,孔的尺寸为300～500μm;力学性能测试表明,支架的平均抗压强度为5.3±0.8 MPa;成骨细胞能够在支架上黏附生长,支架具有良好的生物相容性。结论基于增材制造技术和凝胶注模成型工艺的多孔生物陶瓷支架制备方法,可实现支架复杂外形与内部微结构的精确控制和一体化制造。