Femoral pseudo-hernias

Before surgical intervention in the femoral area, doctors should be mindful of two situations in which surgery is not indicated and, in fact, may cause harm. Electronic Publication     

Cosmetic benefits of lower midline skin incision for pediatric open heart operation

OBJECTIVE: Since we developed the procedure in 1996, we have now performed 100 pediatric open heart operations using a lower midline skin incision and a minimal sternotomy approach. METHODS AND RESULTS: To elucidate the benefits of this approach, we analyzed these 100 cases retrospectively. There was no death, and no major complication, caused by this approach, and the resulting scarring in each patient is difficult to be seen under a common undershirt. CONCLUSION: This review shows that the technique of a lower midline skin incision and minimal sternotomy approach is a safe reliable and cosmetically advantageous method for a pediatric cardiac operation.     

Arthroscopic rotator cuff repair:Indications and technique

Arthroscopic repair of rotator cuff tears is now possible. By using the biomechanical principles of margin convergenceand the balance of force couples, even large cuff defects can be repaired. Suture anchors are particularly suitable for arthroscopic repairs, and a corkscrew anchor design lends itself to a trans-tendon approach     

Gastro-oesophageal reflux disease: Medical or surgical treatment? Report of an interactive workshop

Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract. With the introduction of proton pump inhibitors medical treatment of GERD has been significantly improved. However, the development of laparoscopic antireflux surgery resulted in an increasing interest of surgeons in this disease. An interactive meeting was organized in order to develop an agreement between gastoenterologists and surgeons regarding therapeutic decisions and this is the main topic of this paper.     

微创手术治疗高血压脑出血

目的 探讨微创手术治疗高血压脑出血的临床疗效。方法 132例高血压脑出血分成微创手术组(68例)和传统开颅手术组(64例)，分析两组手术的特点和手术时机，比较两组手术治疗的疗效。结果 微创组术后GOS良好23例、中残24例、重残9例、植物生存3例、死亡9例；传统组术GOS良好16例、中残15例、重残12例、植物生存6例、死亡15例。两组超早期或早期手术均有良好的预后，而微创组效果更佳。结论 微创手术治疗高血压脑出血能明显提高临床疗效，降低病死率。     

Office-based anaesthesia for vitreoretinal surgery

The objectives of this study were to consider the effectiveness of local anaesthesia (LA) for office-based vitreoretinal (VR) surgery, the requirement to supplement the anaesthetic blockade, the demographic pattern of the sample and the acceptance of LA by patients. This prospective observational audit involved 111 patients that had undergone 128 VR procedures. Assessment data included: patient’s information, details of type of anaesthetic, and pain during surgery. A clinical audit was also carried out with telephone survey to establish the postoperative use of analgesics, the frequency of nausea, emesis, and insomnia. Results suggest that VR surgery can be carried out effectively and safely with LA, in an office-based surgery, provided that experienced surgeons exist. We noted a high degree of patient acceptance, a reasonable level of postoperative pain and a low frequency of nausea and vomits.     

不经胸食管钝性剥离拔脱术的临床应用

应用不经胸食管钝性剥离拔脱术治疗26例咽下癌与高位食管癌,效果良好,术后5例发生开发症,其中颈部吻合口痿3例,暂时性咳呛1例,腹部切口局限裂开1例。手术死亡率7.6%(2/26)。介绍了手术方法,对不经胸施术、胃体缝缩、颈部食管胃Gambee氏吻合法应用进行了讨论。     

Impact of Dialysis and Older Age on Survival after Liver Transplantation

Because creatinine is heavily weighed in the MELD (model for end-stage liver disease) score, we sought to determine the impact of MELD-based organ allocation on outcomes after transplantation in the pre- and post-MELD eras, focusing on recipients over age 65 on dialysis prior to transplant. A total of 20 196 patients from the UNOS database were analyzed. Comparing the pre-MELD to MELD era, there was a 41% increase in patients on dialysis (p<0.0001), and a 117% increase in combined liver/kidney transplants (p<0.0001). In the pre-MELD era, 1-year patient survival in recipients greater and less than age 65 on dialysis who received liver transplant alone was 56.8% and 76.4%, respectively (p=0.13). In the MELD era these rates were 50.7% and 77.8% (p=0.04). In the pre-MELD era, 1-year patient survival in recipients greater and less than age 65 on dialysis who underwent combined liver/kidney transplantation was 25.0% and 83.2%, respectively (p=0.0002). In the MELD era, these rates were 67.0% and 82.5% (p=0.18). In conclusion, a greater proportion of patients in the MELD era are on dialysis prior to transplant, and more receive combined liver/kidney transplants compared with the pre-MELD era. Candidates over age 65 who are on dialysis at the time of transplant have decreased survival after isolated liver transplantation.     

完全胸腔镜下心内直视手术的实验研究

目的　探索完全胸腔镜下心内直视手术可行性手术过程中的可能风险。方法　选取 6 0支杂种成年狗 ,雌雄不拘 ,按手术前后顺序分为A、B、C三组 ,每组 2 0例 ,行完全胸腔镜下心内直视手术。记录每例手术时间、术中出现的意外损伤 ,对各组结果进行比较。结果　手术平均时间分别为 :A组 (5 6± 1 2 )h ,B组 (3 4± 0 8)h ,C组 (2 1± 0 3)h ;手术失败三组分别为 3、0、0例 ;三组实验动物意外损伤发生率 ,A组明显高于B、C组 (P <0 0 5和 0 0 1) ,分别为 2 4、8、1处。结论　经过一定时间技能训练 ,行完全胸腔镜下心内直视手术是可行的     

Effects of Dopexamine on Lipid Peroxidation During Aortic Surgery in Pigs: Comparison with Dopamine

OBJECTIVE: We investigated the dose-related effect of dopexamine and dopamine on free radical production and lipid peroxidation estimated by MDA measurements in an ischaemia-reperfusion model of supraceliac aortic repair. DESIGN: Prospective, randomized, blinded experimental study. MATERIALS: Twenty-five healthy pigs. METHODS: All experiments were performed under general endotracheal anaesthesia. Supraceliac aortic cross clamping was performed in all pigs. The pigs were randomly assigned into five groups (n=5 in each group) and received a continuous intravenous infusion of normal saline (CTL), dopamine 2 microg kg(-1)min(-1) (dopa 2), dopamine 8 microg kg(-1)min(-1) (dopa 8), dopexamine 2 microg kg(-1)min(-1) (dopex 2), dopexamine 8 microg kg(-1)min(-1) (dopex 8). Cardiac output, mean arterial pressure, arterial blood gas analysis and blood sampling for plasma MDA measurements (to reveal lipid peroxidation) were recorded after induction of anaesthesia (baseline), 60 and 120 min after cross-clamping of aorta (ischaemia phase), and 60 and 120 min after restoration of flow (reperfusion phase). RESULTS: Dopexamine and dopamine at 8 microgkg(-1)min(-1) reduced MDA at 60 and 120 min after reperfusion. CONCLUSION: Dopexamine seems superior to dopamine in reducing oxygen free radicals and subsequent lipid peroxidation during reperfusion after supraceliac aortic cross clamping in pigs.