Grading static versus dynamic images of contact lens complications

Background: This study was conducted to investigate grading performance when estimating the severity of static versus dynamic images of contact lens‐related ocular pathology. Methods: Thirty‐eight subjects used the Efron Grading Scales for Contact Lens Complications to grade the severity of ocular pathological changes depicted in static and dynamic (movie clip) computer‐displayed images of each of the following contact lens complications: bulbar conjunctival redness, limbal redness, papillary conjunctivitis, corneal staining, corneal infiltrates and meibomian gland dysfunction. The viewing of static and dynamic images was separated by seven weeks. Results: Grades assigned to dynamic images were 0.6 and 0.7 grading scale units higher than those assigned to static images for limbal redness and papillary conjunctivitis, respectively (p < 0.0001 for both). No difference was observed for the other four complications. There was an apparent trend for grading variability to be reduced (that is, observers grading in closer agreement) when grading dynamic versus static images. Conclusions: Absolute grades based on an assessment of signs of pathology represented in static images may, in some instances, underestimate the true severity of the condition.     

Neuroblastoma and anaesthesia

The haemodynamic problems associated with anaesthesia and neuroblastoma were reviewed in 52 children who underwent 138 operations at The Hospital for Sick Children, London, UK. At diagnosis 42 patients (81%) had elevated urinary catecholamine metabolites; nine (17%) were hypertensive, of whom eight were treated with adrenergic blockade. The incidence of intra-operative hypertension due to excess catecholamine release was 9% (13/138), and was confined to the group undergoing tumour excision (29%; 13/45). Hypertension was observed more frequently in patients who had not received chemotherapy. It was effectively controlled by labetalol. Patients symptomatic of catecholamine secretion before surgery should be managed in a similar manner for those with a phaeochromocytoma. Surgical manipulation of the tumour predisposes to paroxysmal hypertension. Careful monitoring is advised.     

Free vascularized jejunum interposition for pharyngoesophageal reconstruction after total laryngopharyngectomy

The records of 28 patients who underwent free jejunal graft reconstruction after resection for cancer involving the pharynx were analysed. Seven patients had a T₃ carcinoma, 15 patients T₄ and six patients recurrence after laryngectomy. Ten patients had received radiotherapy in the past. Post-operatively, 15 patients (54%) had complications and two patients (7%) died. No significant difference was observed in the complication rate between the group that received radiotherapy in the past and those who did not. Nineteen patients received post-operative radiotherapy. Nine patients had no radiotherapy on the basis of complete resection or because of serious complications. For the whole group the 2-year recurrence free period and survival were 42% and 51% respectively. The postoperative radiotherapy group had a significantly better survival (73%) and recurrence free period (63%) than the group without post-operative radiotherapy (0%). Thus, post-operative radiotherapy seems indicated irrespective of resection margins.     

A review of 2975 consecutive operations by one surgeon in an accredited outpatient plastic surgicentre: A Canadian experience

The present paper constitutes a retrospective review of 2975 consecutive operations performed by the author, one of the three owners of the Saskatoon Plastic Surgicentre. The unit opened in 1987; therefore, the study spans 17 years. Patients are not kept overnight, and the Surgicentre is approved and equipped as a level C facility for general anesthesia. Only patients who score 1 or 2 according to the American Association of Anesthesiologists are treated. Only certified anesthesiologists are used. Of the patients with postoperative complications, only two required transfer to a hospital. One developed a pneumothorax, which was treated on arrival at the intensive care unit with no sequelae. The other collapsed following facelift surgery. She was transferred to University of Saskatchewan hospital and died later that evening with a massive pulmonary embolus. In a properly established outpatient centre, a large number of patients can be safely treated with very few complications. However, despite placing patient safety as the first consideration and adhering strictly to the highest standards, death can occur.     

Results of surgical treatment in patients with arachnoid cysts

Summary A retrospective study of 35 patients operated upon for arachnoid cysts during the last 10 years was carried out. In 19 patients treated by craniotomy, membrane resection and drainage into the basal cisterns, clinical improvement could be noted in 13 cases. Correspondingly on the CT-controls the cysts were found to have disappeared in two cases and were reduced in size in seven patients.In 11 patients, however, who were initially treated by a shunting procedure, seven patients became free of symptoms. Postoperative CT-controls showed in three cases a significant reduction of the size of the cyst, which remained unchanged in two other cases.In five patients with the combination of a nonspace-occupying arachnoid cyst and subdural effusions, drainage of the latter only was sufficient to relieve the clinical symptoms.The prominent Endings were the high complication rate of the primary or secondary shunting procedures (48%), as well as the close correlation between the clinical outcome and the postoperative CT-controls.     

Advantages of using the midline incision right retroperitoneal approach for abdominal aortic aneurysm repair

This study was conducted to compare the midline incision right retroperitoneal approach for repairing abdominal aortic aneurysms (AAA) with the transperitoneal approach. The intra- and postoperative course of 15 patients who underwent AAA repair using the transperitoneal approach between 1987 and 1991 and another 15 patients who underwent AAA repair using the retroperitoneal approach between 1991 and 1994 were evaluated. The incidence of postoperative wound complications was also assessed. There was no operative or hospital death in either group. Although a significantly longer interval was required from the incision to the aortic clamp using the extraperitoneal method, there were no statistical differences in the aortic clamping time, total operation time, or blood loss between the two groups. On the other hand, there was a statistically significant improvement in bowel function and a significant reduction in the length of postoperative hospitalization following the extraperitoneal procedure. Furthermore, no wound complications such as those associated with the left flank incision developed after the extraperitoneal procedure. Thus, we recommend the midline incision right retroperitoneal approach for AAA as it does not involve muscle division and is associated with fewer complications.     

腹部器官移植术后并发症的磁共振检查

目的探讨磁共振在腹部器官移植并发症中的诊断价值。方法对4例肝移植、5例胰肾联合移植及2例肾移植患者进行磁共振检查，检查时间在术后28d至2年，采用GE1．5TMR机型，成像技术包括常规平扫及增强扫描。结果4例肝移植，1例发生肝动脉狭窄伴肝坏死，1例发生下腔静脉血栓形成，1例为肝静脉与下腔静脉吻合口明显狭窄，1例为左右肝管明显狭窄；5例胰、肾联合移植中，1例并发急性排斥反应，1例为移植胰慢性排斥反应伴纤维化，1例为迟发性胰腺炎，移植肾4例正常，1例并发急性排斥反应伴肾梗死；2例单纯肾移植者，1例为肾动脉局限性中度狭窄，1例为肾动脉与髂内动脉吻合口处动脉瘤形成。上述病理改变均经组织病理检查和数字减影血管造影证实。结论磁共振可作为腹部器官移植并发症的一种无损伤检查手段，对于血管并发症，有其独有的优势。     

Avoiding complications in arthroscopic subacromial space and instability surgery

Arthroscopic shoulder surgery has become a safe tool for evaluation and treatment of a wide range of shoulder problems with few complications. With ever-improving technology (and commitment to motor skill development among arthroscopists), we can expect to maintain this low rate despite increasing procedure complexity. Avoiding complications in arthroscopic shoulder surgery requires careful preoperative planning, judicious patient selection, a thorough understanding of arthroscopic anatomy, and facility with arthroscopic techniques.     

妊娠黄体瘤1例报告并文献复习

目的：探讨妊娠黄体瘤（LP）的误诊原因。方法：对1例典型LP病例进行全面病理学检查和组化及免疫组化染色，与正常卵巢黄体进行对比分析，并复习文献。结果：LP均发生于妊娠后期，临床无明显自觉症状，其病理形态学、组织学、免疫组化反应与正常卵巢黄体相似。多在剖腹产时偶然发现而误为卵巢肿瘤。结论；LP为妊娠后期卵巢黄素化细胞的结节状增生，并非真性肿瘤。妊娠期出现卵巢明显增大，应首先考虑到本病的可能性。必要时术中可作活检，以避免误切卵巢。     

肝移植患者术后早期精神症状的观察

目的探讨肝脏移植术后早期精神系统并发症发生的原因和防治经验。方法回顾性分析 12 5例原位肝脏移植患者的临床资料 ,以术后 2周作为观察时点 ,分析肝脏移植术后早期精神系统并发症发生的原因 ,总结防治经验。结果有症状组和无症状组在性别、年龄、肝功能以及血环孢素A浓度方面无明显差异 ;但有症状组的无肝期时间 (93 74± 2 8 98)min和手术时间 (4 14 6 5±6 1 92 )min却长于无症状组 (P <0 0 5 ) ;另外 ,术前有无肝性脑病、术后感染以及静脉使用免疫抑制剂和术后精神症状的发生明显相关。结论肝脏移植术后早期精神系统并发症发生的原因是多方面的 ,通过积极的对症支持治疗 ,预后良好。