Bezoar-induced ulceration and perforation of the upper gastrointestinal tract in mentally retarded patients

Symptoms of bezoars are often nonspecific and may mimic those of other gastrointestinal diseases. Therefore, this diagnosis should be kept in mind to avoid severe complications such as bleeding, perforation, or obstruction, especially when treating mentally retarded or psychiatric patients. We describe two young, mentally handicapped patients with perforation of the gut due to bezoars. The pathophysiology of this complication is discussed and the literature reviewed.     

CT在胃肠道穿孔定位诊断中的价值

目的探讨CT在胃肠道穿孔定位诊断中的价值。方法对16例成人胃肠道穿孔患者进行回顾性分析。结果16例患者中,胃、十二指肠球部穿孔9例,十二指肠腹膜后段穿孔1例,空回肠穿孔4例,阑尾炎穿孔1例,结肠癌伴穿孔1例。CT表现为：气腹、腹膜腔及腹膜后间隙积液、穿孔部位局限性肠壁增厚和周围脂肪间隙模糊。结论CT不仅能确定有无胃肠道穿孔,而且能初步判断其穿孔部位。其中局限性肠壁增厚及周围脂肪间隙密度增高、邻近腹腔、腹膜后间隙积液为诊断穿孔部位较为特异性的征象。     

Plug it,fill it and forget it!

Background:Management of posterior scleral perforation is commonly done with cryotherapy/laser or scleral patch graft depending on the size of perforation. However, for large perforations, the availability of donor sclera is always an issue. To overcome this problem, we tried using absorbable gelatin sponge to plug the perforation as an alternative.Purpose:To evaluate the efficacy of gelatin foam as an alternative to scleral patch graft in cases with perforation of posterior sclera.Synopsis:Here we report the case of a 27-year-old male, who sustained penetrating injury to right eye with two metallic intraocular foreign bodies with visual acuity of hand movement close to face. Primary wound repair was done, followed by retrieval of the first piece of metallic foreign body that measured 11X3mm in size. The second foreign body visualized at posterior pole adjascent to the disc was removed using Machemar forceps and it measured 10X3 mmin size. Leakage of PFCL at the site confirmed a posterior scleral perforation. Cryotherapy was avoided due to its proximity to optic nerve head, and donor sclera was not readily available at that moment. We managed the case by plugging the defect with absorbable gelatin foam, followed by silicone oil injection into the vitreous cavity. Post operative outcome was good with restoration of anatomical integrity of the globe along with improvement in visual acuity upto 6/18.Highlights:Gelatin foam being absorbable and inciting less reaction aids in sealing the perforation and maintenance of globe contour with the advantage being readily available, cost-effective and it can be left in situ without the need for additional surgery for its removal. This would be of use in situations where the donor sclera is not readily available, and thus can be a potential alternative. However, further studies with larger sample size need to be done to evaluate and compare its effectiveness over donor scleral grafts.Online Video Link: https://youtu.be/fkardnkMQQo     

板层角膜移植联合自体角膜瓣填垫治疗边缘性角膜穿孔

目的:探讨用自体角膜瓣封闭角膜穿孔,联合板层角膜移植治疗边缘性角膜溃疡穿孔的临床疗效。方法:对17例(17眼)不同病因引起的边缘性角膜溃疡穿孔患者行自体角膜瓣填垫及板层角膜移植,术后对植片愈合、虹膜前粘连、继发青光眼、视力、免疫排斥反应进行观察。结果:随访3～12(平均6)mo,所有患者植片透明,未见排斥反应,层间积液2例至术后1mo吸收,前房轴深正常,虹膜粘连于角膜穿孔处3例,无继发青光眼。随访>3mo,视力较术前提高12眼,无进步5眼。结论:板层角膜移植联合自体角膜瓣填垫是治疗边缘性角膜穿孔的有效方法。     

Acute Mediastinitis – Outcomes and Prognostic Factors of Surgical Therapy (A Single-Center Experience)

Purpose: The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors’ worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy.Methods: During the period 2006–2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment.Results: The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times.Conclusion: Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.     

儿童胆道穿孔的超声诊断分析

目的 探讨超声检查在儿童胆道穿孔诊断中的价值及诊断要点.方法 回顾性分析重庆医科大学附属儿童医院1996年9月至2019年6月经手术确诊为胆道穿孔的41例患儿临床资料和超声声像图表现.采用四格表分析超声检查提示胆道扩张和胆囊壁增厚对胆道穿孔的诊断效果.结果 胆道穿孔患儿主要临床表现:呕吐31例、腹痛23例、腹胀21例、...     

经鼻填充鼻中隔软骨修复眶内侧壁骨折

目的：探讨应用鼻内镜填充鼻中隔软骨,修复眶内侧壁骨折,经鼻做眼部手术的可能性。方法：选取眶内侧壁骨折患者11例（11眼）,术前检查均有不同程度的眼球内陷、复视、视力减退症状,行眼眶CT诊有眶内容物疝入筛窦并伴积液,其中6例内直肌肿胀。手术开始在内镜直视指引下,经鼻腔开放筛窦,摘除筛房,暴露骨折的纸板,将疝入物回纳眶内,鼻中隔软骨覆盖骨折区。结果：患者手术后全部治愈。双眼突出度相差≤1mm,平均0.11mm。视力较术前不改变或者略有改善。鼻内镜检查见筛窦术腔上皮化,填充的鼻中隔软骨无移动,无感染及排斥现象。结论：经鼻填充鼻中隔软骨修复眶内侧壁骨折方法简便,成功率高。自体鼻中隔软骨无排斥反应。     

自体鼻中隔软骨联合耳廓软骨的鼻中隔延伸物移植术在鼻尖整形中的应用

目的:探讨运用鼻中隔软骨联合耳廓软骨构建鼻中隔延伸物复合体重置鼻尖位置和重塑鼻尖形态的可行性。方法:2018年9月至2019年10月,以中国医学科学院整形外科医院17例低鼻患者为研究对象,17例患者中男2例,女15例;年龄19~39岁,平均27岁。17例患者均为初次鼻整形病例。术中在全身麻醉下行鼻整形术。切取鼻中隔软骨...     

针刺配合复方三白散治疗胃十二指肠溃疡穿孔59例

目的 探讨中西医结合治疗胃十二指肠溃疡穿孔的有效治疗方法.方法 将117例患者随机分为两组,治疗组采用自拟复方三白散、针刺治疗,对照组仅用西医常规治疗.结果 经统计学处理,两组痊愈率、总有效率、平均住院时间及3年总复发率比较均有显著性差异(P均＜0.01).结论 中西医结合治疗胃十二指肠溃疡穿孔,可缩短住院时间,减轻痛苦,提高非手术治愈率.     

鼻中隔偏曲矫正术后预防并发鼻中隔穿孔的研究

目的探讨鼻中隔偏曲矫正术后并发鼻中隔穿孔的预防措施。方法采用回顾性研究,总结分析20年来我科经治的243例鼻中隔偏曲患者术后疗效及穿孔的发生情况。结果鼻中隔粘膜下矫正术组185例,其中发生黏膜破损41例（22．16％）,术后并发鼻中隔穿孔1例（0．54％）,与鼻中隔黏膜下切除术组比较,差异有统计学意义,P〈0．05。疗效评定：鼻中隔黏膜下矫正术组,治愈31例（74．59％）,好转47例（25．41％）,与黏膜下切除术组疗效比较,差异有统计学意义,P〈0．005。结论无论从预防鼻中隔穿孔的角度,还是手术的疗效角度,鼻中隔偏曲黏膜下矫正术都是比鼻中隔黏膜下切除术更理想的术式。