Objective To evaluate the diagnostic value and safety of surgical lung biopsies ( SLB)in patients with interstitial lung disease ( ILD) . Methods A retrospective analysis was performed on patients undergoing SLB, who were obtained from Chinese literatures through searching PubMed, CBM,Wanfang database, VIP information and CHKD from 2000 to 2010. The data from Affiliated Drum Tower Hospital, Nanjing University Medical College from2000 to 2010 was also reviewed. Results A total of 398cases underwent SLB, including open lung biopsy ( OLB) in 221 cases and video-assisted thoracoscopic lung biopsy ( VATLB) in 177 cases. SLB yielded a specific diagnosis for 386 cases. The total postoperative complication rate was 12. 1% and mortality rate was 2. 0% . The diagnostic yield, post-operative complication rate, and mortality rate between VATLB and OLB had no significant difference. Conclusion SLB is a useful and relatively safe procedure for diagnosis of ILD.
Objective To evaluate the rescue intubation induced by ketamine and midazolam in patients with acute respiratory failure.Methods 81 patients with acute respiratory failure admitted between June 2010 and June 2012 were recruited in the study. They were randomly divided to a MF group to receive 0. 05 mg/kg of midazolam + 1 to 2 μg/kg of fentanyl ( n =41) , and aMK group to received 0. 05 mg/kg of midazolam + 0. 5 to 1 mg/kg of ketamine ( n =40) for rescue intubation. The APACHEⅡ score on initial24 hours after admission in ICU, length of ICU stay, and 28-day mortality were recorded. The differences in arterial blood pressure, heart rate, respiration rate, and blood oxygen saturation before intubation and 10 minutes after intubation were compared. Incidences of hypotension and other adverse events and difficult intubation were also recorded.Results The midazolamdose in the MK group was significantly less than that in the MF group ( P lt; 0. 01) . The blood pressure in both groups decreased. The systolic blood pressure dropped most significantly in the MF group ( P lt;0. 05) . The incidence of hypotension was 41. 5% in the MF group, significantly higher than that in the MK group ( 20. 0% , P lt;0. 05) . The incidence of hypotension had no correlation with midazolamdosage ( P gt;0. 05) . There was no significant difference in adverse events except for the arrhythmia between two groups. The length of ICU stay and 28-day mortality were similar in both groups ( P gt; 0. 05) . The incidence of difficult tracheal intubation was nearly 50% in both groups.Conclusions In patients with respiratory failure, rescue intubation induced by ketamine can reduce the dose of midazolam and reduce the incidence of hypotension without more complications. The optimal dose of ketamine in induced tracheal intubation requires further study.
Objective To evaluate the clinical and histopathological manifestations of sympathetic ophthalmia after pars plana vitrectomy. Methods The clinical data of 8 patients with sympathetic ophthalmia out of 13 000 who underwent pars plana vitrectomy from Jan 1998 to Dec 2004 were retrospectively analyzed. In the 8 patients, 3 evoked eyes underwent ophthalmectomy and were observed histopathologically. Results The incidence of sympathetic ophthalmia was 0.06%. The time from vitrectomy to the occurrence of sympathetic ophthalmia ranged from 7 to 150 days, with a median of (77.8plusmn;50.8) days. All patients had decrease of visual acuity of the sympathetic eye, visual distortion, red eye, and opthalmalgia. The visual acuity was hand moving to 0.5 in the sympathetic eyes, and no light perception to 0.04 in the evoked eyes. Other clinical manifestations included binocular mutton-fat keratic precipitates, anterior chamber flare and cells, vitreous opacity, optic-disc edema and hyperaemia, and retinal edema at the posterior pole; 2 sympathetic eyes had exudative retinal detachment. The visual acuity increased to 0.4-1.2 in sympathetic eyes and light perception -0.25 in evoked eyes in all of the patients after treatment with oral administration of prednisone 1.0-1.5 mg/kg. In the 3 patients who had undergone ophthalmectomy because of total loss of visual acuity, and the pathological examination revealed infiltrated and thickeduvea due to lymphocytes, epithelioid cell nodules, infiltration of lymphocytes to sclerotic passages, and ocular atrophy were observed. Conclusion The incidence of sympathetic ophthalmia is 0.06%, which happened within 3 months after vitrectomy. The clinical manifestations and results of histological examinations accords with the characteristics of sympathetic ophthalmia. (Chin J Ocul Fundus Dis, 2007, 23: 112-114)
ObjectiveTo evaluate nutritional risk of patients with esophagus cancer before operation using nutritional risk screening 2002 (NRS2002), and explore the relationship between nutritional risk score and postoperative results. MethodsWe prospectively evaluated the nutritional risk of 225 patients with esophagus carcinoma patients who were admitted in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between March 2012 and March 2013 using NRS2002, in accordance with disease severity score, nutritional status score and age score(age≥70 years old score was 1 point, < 70 years old for 0 point). There were 136 males and 89 females with age of 64.0±8.2 years (ranged from 41 to 85 years). Postoperative results include postoperative complications, mortality, and length of hospital stay. ResultsThe number of patients with preoperative score≥3 points was 75 (33.3%), < 3 points was 150 (66.7%). The incidence rate of postoperative complications was 26.7% in the patients with NRS2002 score≥3 points, and was 12.0% in those with NRS2002 score < 3 points(P < 0.05). And the total hospital stay time was longer in the patients with NRS2002 score≥3 points than that with NRS2002 score < 3 points(29.80±7.94 d vs. 15.30±2.05 d, P < 0.05). Logistic regression analysis showed that the preoperative NRS2002, the underlying diseases, and surgical method were risk factors for postoperative complications. ConclusionsPreoperative NRS2002 score≥3 points can predict more postoperative complications and longer hospital stay time in patients with esophagus carcinoma. It indicates that scientific nutrition support is necessary for esophagus carcinoma patients with NRS2002 score≥3 points. NRS2002 can be used as a predictive index of nutritional risk after operation of esophagus carcinoma.
ObjectiveTo evaluate the clinical value of multi-slice CT in the diagnosis of complications due to breast augmentation. MethodsWe collected the imaging data of 32 female patients who accepted multi-slice CT examination in the second People's Hospital of Chengdu after breast augmentation between February 2010 and February 2015. The position, shape, edge, internal density, leakage, rupture and hard nodules of the prosthesis were observed and analyzed carefully. ResultsIn the 32 patients with breast augmentation, 12 were normal with bilateral symmetry and without abnormal shape or density. Among the other 20 patients, 11 had capsular contracture, 5 had prosthesis leakage, rupture and hard nodules, 4 had breast infection, 1 had fibroadenoma, 1 had cystoma, and 5 had little calcified nodules in the breast tissue. ConclusionThe multi-slice CT scan can clearly and accurately show the position, shape and size of the breast prosthesis as well as the existence of leakage, rupture and hard nodules in the prosthesis. It plays a very important role in the diagnosis of the complications due to breast augmentation and can be effective guidance for clinical operation.
Objective To investigate the clinical value and complication factors of percutaneous transthoracic needle biopsy (PTNB) guided by multislice computed tomography (MSCT). Methods From January 2013 to December 2016, 179 patients treated with MSCT-guided lung biopsy in the Affiliated Hospital of North Sichuan Medical College and Dianjiang People’s Hospital were reviewed. Occurrence rate and the influencing factors of complications were analyzed. Meanwhile, biopsy findings and diagnostic accuracy rate were summarized. Results A total of 129 cases of lung cancer were detected under MSCT-guided percutaneous biopsy in 179 patients with a diagnostic accuracy of 93.30%. The correct rate of malignant tumor diagnosis was 92.14%. The main complications were pneumothorax, pulmonary hemorrhage, dyspnea and hemoptysis. Major risk factors of MSCT-guided PTNB complications included lesion size ≤ 2 cm, the shortest distance to the diaphragm ≤ 5 cm, puncture depth > 5 cm, pleural puncture angle > 50°, the puncture times ≥ 2, puncture time ≥ 20 minutes, age of patients > 60 years, and existence of pulmonary disease (P<0.05). Conclusions The clinical application value of MSCT-guided PTNB is high. Skilled puncture technique and appropriate puncture procedure are helpful to reduce complications.
Objective To analyse the factors of complications aftertreatment of intertrochanteric fractures with Gamma nail. Methods From January 1998 to May 2004, 50 patients were treated with Gamma nail, including 18 males and 32 females and ageing from 47 to 82 years. The locations were the left side in 16 cases andthe right in 34 cases. According to Evans classification, there were 4 cases oftype Ⅰ, 2 cases of type Ⅱ, 23 cases of type Ⅲ, 10 cases of type Ⅳ and 11 cases of type Ⅴ. Results Fifty patients were followed up 429 months. Accordingto the Harris criterion for evaluation, the results were excellent and good in 35 cases, showing sthenic weight loading walking and normal range of motion of the hip joint. The postoperative complications appeared in 15 cases: 5 cases of coxa vara or coxa valga, 3 cases of rotation deformity of lower limb, 2 cases oftension screwprotrusions and lower shorten, 1 case of failure of internal fixation, 1 case of femoral fracture, 2 cases of coxalgia and 1 case of pain in knee joint and stiff knee joint. Conclusion The reason of complications was various, mainly lies in insufficient comprehension and analysis of the types of fractures, unfamiliarity with the characteristics and usage of the instruments and neglected rehabi litation instruction, inappropriate functional training and too early weight loading after operation.
Objective To compare the mean operative time and complications between the LigaSure device and Harmonic Scalpel during video-assisted endoscopic approaches thyroidectomy. Methods The clinical data of 684 cases performed Miccoli thyroidectomy by the same operation team from January 2007 to December 2011 in the department of general surgery，Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University were analyzed. Three hundred and forty-nine patients were used Harmonic Scalpel，335 patients were used LigaSure device. The mean operative time and complications （such as hematoma，transient hoarseness，permanent recurrent laryngeal nerve injury，and hypocalcemia） were compared between two groups. Results A total of 684 patients were included in the study，of whom 263 underwent total thyroidectomy and 421 underwent lobectomy. There were not significant differences of the operative time and the complications in both thyroidectomy and lobectomy between the LigaSure device and Harmonic Scalpel（P＞0.05）. Conclusions The uses of the LigaSure device and Harmonic Scalpel in thyroid surgery are safe and reliable，surgeons may choose surgical instruments by habits and medical equipments.
【Abstract】Objective To study the clinical application of laparoscopic operation. Methods The clinical findings from 13 840 cases of laparoscopic surgery in this hospital from 1992 to 2005 were reviewed retrospectively.Results Laparoscopic operation were performed successfully in 13 653（98.6%）,187 cases were transferred to open operation. Complications were occurred in 115 cases, including common bile duct injury in 3 cases. Combined treatment with laparoscope and endoscope were performed in 162 cases. Eleven thousand three hundred and fiftytwo patients had been succeeded in followup survey. Over 90.0 percent of patients recovered smoothly. Conclusion Laparoscopic operation may be applied in a more extensive scope. The major complications can be reduced by strict procedures of laparoscopic operation. The combined treatment of laparoscope and endoscope should be further studied and widely used.
Objective To compare the advantages and disadvantages of the PercuTwist technique．Methods Clinical data of patients undergoing PercuTwist and traditional tracheostomy during Jan 2007 to Feb 2008 in the department of pulmonary disease of Changhai Hospital were collected and analyzed．Results Of 16 patients with PercuTwist，12 were males and 4 were females．The minimum platelet before operation was 15 X 109／L The mean operating time f from local anesthesia to connecting ventilator)was(4.3±1.0)min，and complications occurred in 2 cases with 2 incidences．Of the 12 patients with traditional tracheostomy，8 were males and 4 were females．The minimum platelet before operation was 85 X 109／L．The mean operating time was(33.3±8.6)min，and complications occurred in 8 cases with11 incidences．There were significant differences in complications and operating time between the patients with PercuTwist and the patients with traditional tracheostomy(P lt;0.001 or 0.01)．Conclusions Compared with the traditional surgical tracheostomy，the PercuTwist technique takes less operating time and causes fewer complications．