Objective To explore the clinical characteristics and management of ovarian tumor complicated by pregnancy and its influence on the pregnancy outcome, so as to provide diagnostic and therapeutic experiences. Methods A total of 248 cases were surgically and pathologically diagnosed as ovarian tumor complicated by pregnancy in The 202 Military Hospital from January, 2003 to December, 2009, and their clinical data were analyzed retrospectively. Results The incidence rate of ovarian tumor complicated by pregnancy was 0.49%. Among total 248 cases, 131 (52.82%) were benign tumors, of which 22.18% were ovarian mature teratomas; 113 (45.57%) were tumourlike lesions, of which most were ovarian chocolatecyst and lutealcyst, and 4 (1.61%) were malignant tumors. There were 212 cases treated by tumorectomy or salpingo-oophorectomy, and 3 of 4 cases with malignant tumors took postoperative chemotherapy. A total of 192 cases were diagnosed by regular antenatal care and ultrasound examination, accounting for 77.42% of the total sample size found during pregnancy. Among 14 cases receiving emergency operations, 9 were complicated by torsion, and the other 5 were by rupture. There were 67 cases receiving operation from the 14th to 18th gestational week, and 57 cases had full-time pregnancy. Conclusion Ultrasonography and pelvioscopy are of principal importance in the diagnosis and detection of ovarian tumor complicated by pregnancy which should be treated by tumorectomy, and suitable surgery intervention during second trimester is safe.
Objective To evaluate the effectiveness and safety of traditional Chinese medicine therapies (TCMT) for prostatitis. Methods We searched Cochrane Controlled Trials Register (CCTR), China EBM/Cochrane center database (CEBM/CCD), PubMed, Chinese Biomedical Literature Database (CBM), Papers on Academic Conference of China (PACC), Chinese Dissertation Database Full-Text (CDDBFT), and Evidence-based Traditional Chinese Medicine Database (EBTCMD). All searches were updated on January 15, 2007. We also performed a manual search of the RCTs of TCMT for prostatitis among periodicals related to TCM, researched the related studies by correlative websites, such as “Baidu” and “Google”, gray literatures, and studies included in the references of eligible studies. At least two reviewers independently screened the studies for eligibility, evaluated the quality, and extracted the data from the eligible literatures, with a cross-check to confirm accuracy. Different views were settled by a third party. We evaluated the quality of eligible studies with the revised Jadad’s scale, and extracted valid data using data tables. Meta-analyses were performed for homogeneous studies using RevMan 4.3 software. If heterogeneity existed among the studies, descriptive analysis was conducted. The potential publication-bias was analyzed by funnel plot analysis. Results A total of 52 randomized clinical trials of TCMT for prostatitis (n=5 209) among 1 282 original studies were identified. The methodological quality ranked high in 9 RCTs (the revised scale were ≥ 4 scores), and 22 RCTS reported the methods of random sequence production. The analysis indicated some TCMT were more effective than the treatments in the controls in relieving the proatatitis patients’ pain or discomfort, paruria, impact of symptoms and NIH-chronic prostatitis symptom index (NIH-CPSI), improving the EPS-WBC and urine flow rate etc. Of the trials, 29 randomized clinical trials of TCMT for prostatitis that studied safety (n=2 502) were identified. The methodological quality ranked high in 8 RCTs (the revised scale were ≥ 4 scores), and 18 RCTs reported the method of random sequence production. Analysis indicated some TCMT may cause lower digestive tract symptoms when compared to the control therapies and some Chinese herbs formulas- may cause sexual disfunction. Conclusion Some TCMT may be more effective than the controls in relieving the patients’ pain or discomfort, paruria, impact of symptoms and NIH-CPSI, improving the prostatic tenderness with DRE, improving the EPS-WBC, lecithin lipophore, and urine flow rate etc. However, some TCMT of the trials included may cause lower digestive tract symptoms when compared to the controls, and some Chinese herbs formulas cause sexual disfunction. Because of the generally low methodological quality and the variations of the herbs used, the overall effects cannot be pooled for analysis. More evidence is needed to support this finding.
Objective To explore the effect of different pre-labor position for premature rupture of membrane (PROM) after 37 weeks with vertex and engaged presentation on the maternal and neonatal outcomes. Methods A total of 120 women over 37 weeks PROM with single fetus in vertex presentation and engaged head were randomly allocated into two groups. The trial group (60 women) received no limit of movement after hospitalization and before labor while the control group (60 women) adapted lateral and supine position alternatively with hip-up. Labor process and neonatal outcomes were observed and recorded. SPSS 13.0 software was adopted to analyze the data. Results Compared with the control group, the trial group had higher rate of normal birth (70% vs. 46.7%, χ2=6.72, P=0.01), shorter first and second stage of labor (t=2.11, P=0.039; t=2.75, P=0.007), fewer incidence of dysuria during labor (χ2=8.11, P=0.0041), and less amount of amniotic fluid (107±55 mL vs. 248±42 mL, t=4.188, P=0.000 1). Conclusion For PROM over 37 weeks pregnancy with single vertex presentation and engaged head, no limit on the position before labor is safe and feasible, and it can improvie spontaneous delivery rate, shorten labor process, decrease amount of amniotic fluid, and eliminate the incidence of dysuria. It is worth to be popularized in the clinic.
Objective To compare the clinical therapeutic effects of combination therapy of Sanqitongshu capsule and prednisolone with prednisolone alone in the treatment of acute peripheral facial neuritis. Methods A total of 61 patients with facial paralysis were divided into the treatment group and the control group in the outpatient order. The control group used 20 mg oral prednisolone and accepted the non-specific anti-inflammatory treatment every other day. Medication would stop in a week. Oral administration of vitamin B1 and vitamin B12 was also performed for nerve metabolism improvement for 30 days. The therapy of the treatment group was based on the same treatment of the control group with Sanqitongshu capsule for 30 days. Results After 4 weeks, in the treatment group, 20 patients recovered, 5 markedly effective, and 2 effective, and the total effective rate was 90%. In the Control group, 10 patients recovered, 3 markedly effective, and 2 effective, and the total effective rate was 50.0%. There were significant differences between the two groups (Plt;0.05). Conclusion The clinical effectiveness of Sanqitongshu capsule plus prednisolone is better than that of prednisolone alone in the treatment of acute peripheral facial neuritis.
Abstract： Objective To analyze the early outcomes of open heart surgery for congenital heart diseases in sixty low birth weight infants and premature infants. Methods Sixty low birth weight infants （body weight＜2 500 g） and premature infants with congenital heart diseases undergoing surgical repair from May 2003 to October 2011 were studied retrospectively in Guangdong Cardiovascular Institute. There were 43 male patients and 17 female patients with their mean gestational age of 33.5±4.1 weeks （ranging from 26 to 42 weeks） and mean age at operation of 24.9±12.5 d（ranging from 4 to 55 d）. Among them there were 47 premature infants with their mean birth weight of 1 729.3±522.5 g（ranging from 640 to 2 500 g）and mean weight at operation of 1 953.2±463.6 g （ranging from 650 to 2 712 g）. All the patients received preoperative treatment in newborn intensive care unit（NICU） and underwent surgical repair under general anesthesia, including 29 patients without cardiopulmonary bypass （CPB）and 31 patients with CPB . All surviving patients received postoperative monitoring and treatment in NICU, and their postoperative complications and in-hospital death were reported. Results A total of 13 patients died during hospitalization with a total in-hospital mortality of 21.7%（13/60）, including 4 intra-operative deaths, 6 early deaths （within 72 h postoperatively） and 3 patients giving up postoperative treatment. CPB time was 121.0±74.7 min, aortic clamp time was 74.8±44.7 min, and postoperative mechanicalventilation time was （136.9±138.1）h. Thirteen patients underwent delayed sternal closure. Eight patients underwentreexploation for postoperative bleeding. Ten patients had severe pneumonia, 2 patients had pulmonary hypertensive crisis, and 8 patients had low cardiac output syndrome. All the postoperative complications were resolved or improved after proper treatment. Follow-up was complete in 47 patients from 2 to 12 monthes, and all the patients were alive during follow-up. Conclusion Early surgical repair for low birth weight infants and premature infants with congenital heart diseases is safe and effective.
Objective To evaluate clinical outcomes of complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with peripheral lung cancer.?Methods?We retrospectively analyzed clinical data of 90 consecutive patients with peripheral lung cancer who underwent complete VATS lobectomy from July 2009 to December 2011 in Provincial Hospital Affiliated to Anhui Medical University. There were 55 male patients and 35 female patients with their age of 33-79 （62.5 ±11.5） years. Lymph node dissection group and number, operation time, intraoperative blood loss, length of postoperative chest drainage, length of postoperative hospitalization, postoperative morbidity and pain score were analyzed.?Results?There was no hospital death in this group. Operation time was 135.0±32.5 min, intraoperative blood loss was 230.0±80.4 ml, length of postoperative chest drainage was 4.8±2.1 days, and pain score on the third postoperative day was 5.3±1.2. A total of 520 groups and 1 568 lymph nodes were dissected during the operation, with 5.8 groups and 17.4 lymph nodes dissected in each patient. There were 71 groups with lymph node metastasis, a positive rate of 13.7% （71/520）. Postoperatively, 2 patients had hoarseness and 3 patients had chylothorax, who were all cured after proper treatment. Ninety patients were followed up for 1-24 months. During follow-up, 4 patients died of tumor metastasis, and other patients were all alive with good quality of life.?Conclusion?Complete VATS lobectomy is a minimally invasive technique for patients with peripheral lung cancer with better postoperative recovery and reduced pain level. The safety and degree of radical resection of complete VATS lobectomy is similar to those of routine thoracotomy lobectomy. Complete VATS lobectomy can be recommended as a surgical treatment for patients with peripheral lung cancer.
Abstract: Objective To evaluate the longterm results of surgical treatment of tetralogy of Fallot (TOF) in adults and discuss the perioperative treatment skills. Methods From January 2000 to March 2008, 149 patients older than 14 years with tetralogy of Fallot received surgical treatment in Changhai Hospital. Among the patients, there were 78 males and 71 females with ages ranged from 14 years to 53 years and the average age was 26.3 years. Twenty patients had previous pulmonary arterial shunts before radical treatment. A total of 129 patients underwent primary radical treatment. Thirtyeight patients received a right ventricular outflow tract patch, 107 patients had transannular patch, and 4 patients had homograft aorta with valves. Results Hospital mortality was 4.0%(6/149). Four patients died of low cardiac output syndrome (LCOS), and multiple organ failure, and 2 patients died of acute renal failure. The postoperative complications included pleural effusion in 11 patients, pulmonary edema in 10 patients, severe LCOS in 9 patients, severe cardiac arrhythmia in 7 patients, reoperation for excessive bleeding in 7 patients, reintubation in 6 patients, and residual ventricular septal defect (VSD) in 5 patients (two of them had reoperation for residual VSD repair and 2 received transcatheter closure of VSD). One hundred and thirtyfour patients were followed up for 3 to 102 months (47.2±28.6 months) with a followup rate of 93.7%(134/143). Late death occurred in 2 patients, one of whom died of secondary infective endocarditis and the other had a sudden death 29 months after operation. During the followup, one patient had residual VSD (2 mm), but had a normal life. The peak systolic right ventricletopulmonary artery pressure gradient exceeded 40 mmHg in 4 patients. Two patients had severe pulmonary regurgitation. A total of 132 patients survived and had an improved life. One hundred and twentyone patients had class Ⅰ heart function (NYHA), and 11 patients in class Ⅱ. Conclusion The pathophysiologic conditions of the patients with tetralogy of Fallot in adults are very complicated due to longterm right ventricle outlet stricture and chronic hypoxia. Preoperative evaluations and postoperative treatment of complications are necessary. The systemicpulmonary arterial shunts should be performed when hypotrophy of the pulmonary arteries or left ventricles exists. Repair of tetralogy of Fallot in adults has acceptable morbidity and mortality rates with goodlongterm outcomes.
Abstract： Surgical repair of functional tricuspid regurgitation (FTR) is often carried out concomitantly with other leftsided heart valve procedures. Though diseases of both left heart valve and tricuspid were treated during the surgery, postoperative residual or recurrent tricuspid regurgitation has been clearly associated with progressive heart failure and worsened longterm survival. To date, surgical interventions mainly address FTR at three anatomic levels: commissure, annulus and leaflets. However, a certain mid and longterm failure rate after operation still exists. High surgical mortality rates have been reported in patients with recurrent tricuspid regurgitation requiring complex reoperations. With a better understanding of tricuspid anatomical complex and valvuloplasty, significant improvements have been made in FTR surgical indications and techniques. This review article will focus on the development of surgical indications in tricuspid valve repair, while the repair techniques and their impact on longterm clinical outcome will also be compared.
Objective To evaluate the risk factors affecting the prognosis in patients with myasthenia gravis after thymeetomy. Methods Therapeutic effects were evaluated with Relative Counting Method in 136 cases with myasthenia gravis who receivingthymectomy. Six clinical factors including sex, age, preoperative course, et al. were converted into quantitative parameters and used for analysis. Cumulative logit model for ordinal response was employed to investigate the therapeutic effects of various factors. Results Sex, age and preoperative course exerted significant effects on postoperative prognosis in patients with myasthenia gravis, while clinical subtype, pathological changes and preoperative administration of cholinesterase inhibitors had no significant impact on therapeutic effects. Conclusion Some factors may lead to the remission and improvement in postoperative patients with myasthenia gravis, therefore, they should be included for the evaluation of prognosis. Early diagnosis and early thymeetomy may improve the therapeutic effects and shorten the duration of amelioration.
Objective To explore the surgical method and cl inical short-term outcomes of internal fixation combined closed reduction with arthroscope aid in treating patellar fracture. Methods From June 2004 to July 2008, 42 patients with fresh simple patellar fracture underwent internal fixation combined closed reduction with arthroscope aid, included28 males and 14 females, aged 16-59 years (35 years on average). The locations were 19 left knees and 23 right knees. Injury was by traffic accident in 21 cases, by fall ing in 11 cases, by sports in 7 cases and by crush in 3 cases. All the patients had fresh closed fracture, including 38 cases of transverse fracture and 4 cases of stellate fracture. The Lysholm score was 68.60 ± 15.20; the proprioceptive function of the knee joints was (3.72 ± 0.12)°. The time from injury to operation was 3-42 hours (12 hours on average). After the treatment of affil iated injury under the arthroscope, patellar fracture was reduced with manipulation method, fracture was fixed with tensile force screw or modified tension band. Results All incisions obtained heal ing by first intention after operation, 42 patients were followed up for 12-39 months (16 months on average). The X-ray films showed callus at the fracture and the smooth cartilage surface 6-9 weeks (7 weeks on average) after operation. The flexed motion range of knee joint at last follow-up was at normal range in 38 cases, was l imited in 4 cases. Circumference of suffered l imbs 15 cm above the patella was the same as normal ones in 23 cases, atrophied 0.7 cm in 19 cases. There were no breakage of internal fixation and shift of fracture and patellofemoral arthritis at last follow-up. The proprioceptive function of the knee joints was (2.06 ± 0.11)° and the Lysholm score was 95.10 ± 3.92; all showing statistically significant differences when compared with preoperation (P lt; 0.05). Conclusion This treatment method has advantages as follows: mini-wound, early exercises and few compl ications, which can rinse articular cavity and repair the affil iated injury at the same time.