Objective To discuss the optimal time for operation in patients with malignant middle cerebral artery (MCA) syndrome. Method The relation between effectiveness and operating time was analyzed in 47 patients to compare the effects of early and delayed operation by SPSS10.0. Results Among 27 patients undergoing early operation, 18 were cured or restored, 4 seriously disabled and 5 died. While among 20 patients undergoing delayed operation, only 9 were cured or restored, 4 seriously disabled and 7 died. The prognosis of delayed operation group was worse than that of early operation group. Conclusions Selecting the optimal time to operate may decrease the mortality and morbidity of MCA syndrome.
ObjectiveTo explore the feasibility of posterior debridement, decompression, bone grafting, and fixation in treatment of thoracic spinal tuberculosis with myelopathy, and investigate the effects of surgical timing on postoperative outcomes.MethodsThe clinical data of 26 patients with thoracic spinal tuberculosis with myelopathy between August 2012 and October 2015 was retrospectively analyzed. All patients underwent posterior unilateral transpedicular debridement, decompression, bone grafting, and fixation and were divided into two groups according to surgical timing. Group A included 11 patients with neurological dysfunction lasting less than 3 months; group B included 15 patients with neurological dysfunction lasting more than 3 months. No significant difference was found between the two groups in gender, age, involved segments, preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle of involved segment, and preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization stay, perioperative complications, and bone fusion time were recorded and compared between the two groups. The change of pre- and post-operative Cobb angle of involved segments was calculated. Neurological function was assessed according to ASIA classification.ResultsAll patients were followed up 25-60 months (mean, 41.6 months). No cerebrospinal fluid leakage occurred intra- and post-operation. The hospitalization stay and perioperative complications in group A were significantly less than those of group B (P<0.05). There was no significant difference in operation time, intraoperative blood loss, and bone fusion time between the two groups (P>0.05). At last follow-up, there was no significant difference in ESR and CRP between groups A and B (P>0.05), but they were all significantly lower than those before operation (P<0.05). In group A, 1 patient with T6, 7 tuberculosis developed sinus that healed after dressing; the implants were removed at 20 months with bony union and no recurrence was found after 36 months of follow-up. One patient with T4, 5 tuberculosis in group B underwent revision because of recurrence and distal junctional kyphosis of the thoracic spine at 26 months after operation. There was no internal fixation-related complications or tuberculosis recurrence occurred in the remaining patients. At last follow-up, the Cobb angles in the two groups significantly improved compared with those before operation (P<0.05), but there was no significant difference in the Cobb angle and correction degree between the two groups (P>0.05). At last follow-up, the ASIA classification of spinal cord function was grade C in 1 case and grade E in 10 cases in group A, and grade D in 2 cases and grade E in 13 cases in group B; the ASIA classification results in the two groups significantly improved compared with preoperative ones (P<0.05), but no significant difference was found between the two groups (Z=–0.234, P=1.000).ConclusionPosterior unilateral transpedicular debridement, decompression, bone grafting, and fixation is effective in treatment of thoracic spinal tuberculosis with myelopathy. Early surgery can reduce the hospitalization stays and incidence of perioperative complications.
Objective To provide references for clinical management of patients with orbital blow-out fractures. Methods Evidence was retrieved from The Cochrane Library online (Issue 1, 2009), ACP online, NGC (1998 to March 2009), PubMed (January 1950 to February 2009), and CBM (1994 to February 2009). The collected evidence was then graded. Results After preliminary research, we identified 12 relevant articles: either retrospective studies or comments from specialists. They studied orbital soft tissue entrapment, diplopia, enophthalmos, or severe oculocardiac reflex in the surgical indications of orbital blow-out fractures. Most of the literature suggested less than five days after the injury incursion for children and less than two weeks for adults was the optimal time to undergo operation. However, advanced surgery was still a good option for the patients that could not undergo early surgery. With regard to the use of poly-pdioxanon- foil and titanium-dynamic mesh, two randomized controlled trials suggested that the former was superior to the latter. Conclusion The application of this surgery should be cautious because of low levels of evidence. Individual therapies should be used after close consideration of clinical characteristics.
Intracranial hemorrhage (ICH) represents a severe complication of infective endocarditis (IE) and stands as a significant contributor to the poor prognosis associated with IE. Current guidelines suggested a delay of 4 weeks for cardiac surgery in patients with ICH, but these recommendations were based on insufficient clinical evidence, and recent studies have yielded different opinions. In this paper, we thoroughly reviewed relevant guidelines and their references in conjunction with 3 typical cases with IE and ICH, discussed the recommendations with controversy, and proposed a process for the management of IE with ICH.
To compare the effectiveness of the operations in treatment of thoracolumber spine fracture and dislocation with spinal cord injury in different periods. Methods Between June 2003 and June 2008, 80 cases of thoracolumber spine fracture and dislocation with spinal cord injury were treated. There were 52 males and 28 females with an average age of 37.6 years (range, 28-49 years). According to different operative time, they were divided into 2 groups by randomized controlled study: group A (n=39, operation was performed within 24 hours) and group B (n=41, operation was performed at 3-7 days). In group A, there were 23 cases of degree I-II (group A1), 16 cases of degree III-V (group A2) according to Meyerding standard, including 17 cases of grade A, 7 cases of grade B, 9 cases of grade C, and 6 cases of grade D according to Frankel scoring system. In group B, there were 21 cases of degree I-II (group B1) and 20 cases of degree III-V (group B2), including 20 cases of grade A, 7 cases of grade B, 11 cases of grade C, and 3 cases of grade D. All cases were treated with posterior spinal cord decompression and reduction, with internal fixation by pedicle screw-rod system and transforamen lumbar interbody fusion. Results The blood loss was (407.4 ± 24.3) mL in group A1 and (397.4 ± 8.2) mL in group B1, showing no significant difference (t=1.804, P=0.078); the blood loss was (1 046.9 ± 128.6) mL in group A2 and (494.4 ± 97.7) mL in group B2, showing significant difference (t=14.660, P=0.000). All 80 patients were followed up 2 years to 2 years and 6 months (mean, 2 years and 3 months) with satisfactory results in spinal cord decompression and reduction, and bony fusion was achieved at 12 months. There was no significant difference in the vertebral canal volume, vertebral height, and Cobb angle at both pre- and postoperation between 2 groups (P gt; 0.05). No loosening or breakage of screws and rods occurred. At 12 months after operation, the cure rates were 47.83% (11/23) in group A1 and 19.05% (4/21) in group B1, showing significant difference (χ2=4.046, P=0.044); the cure rates were 12.50% (2/16) in group A2 and 10.00% (2/20) in group B2, showing no significant difference (χ2=0.056, P=0.813). There was no significant difference (χ2=0.024, P=0.878) in the cure rates in the patients at grades A and B before operation between group A (12.50%, 3/24) and group B (11.11%, 3/27); but there was significant difference (χ2=5.992, P=0.014) in the cure rates in the patients at grades C and D before operation between group A (66.67%, 10/15) and group B (21.43%, 3/14). Conclusion Emergency operation of posterior pedicle screw-rod system for treatment of thoracolumber spine fracture and dislocation with spinal cord injury can provide good reduction, rigid fixation, and high fusion rate, so it is asafe and effective treatment method.
Objective To explore the timing and safety of limited-period lung cancer surgery in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Clinical data of of patients infected with COVID-19 undergoing lung cancer surgery (an observation group) in the Department of Thoracic Surgery of Guangdong Provincial People's Hospital, the Department of Thoracic Surgery of General Hospital of Southern Theater Command of PLA, and the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Guangdong Pharmaceutical University from December 2022 to January 2023 were retrospectively analyzed and compared with patients who underwent surgery during the same period but were not infected with COVID-19 (a control group), to explore the impact of COVID-19 infection on lung cancer surgery. Results We finally included 110 patients with 73 patients in the observation group (28 males and 45 females at age of 52.62±12.80 years) and 37 patients in the control group (22 males and 15 females at age of 56.84±11.14 years). The average operation time of the observation group was longer than that of the control group, and the incidence of anhelation was higher than that of the control group (P<0.05). There were no statistcal differences in blood loss, length of hospital stay, moderate or above fever rate, degree of cough and chest pain, or blood routine between the two groups. ConclusionIt is safe and feasible to perform lung cancer surgery early after recovery for COVID-19 patients with lung cancer.
Since the outbreak of COVID-19 pandemic, a large number of elective or limited operations, including tumor treatment, have been postponed. With the deepening of the understanding of the virus and the change of the prevention policy, the impact of the pandemic is gradually shrinking, and a large number of operations delayed by the pandemic will be rescheduled. However, there is no consensus on the best time to perform surgery for patients infected with SARS-CoV-2, and the consensus on thoracic surgery is more limited. This article reviews the research progress in the timing of surgical operations, especially thoracic surgery, after SARS-CoV-2 infection.
Objective To investigate the effectiveness of Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy in treating Tönnis type Ⅲ and Ⅳ developmental dysplasia of the hip (DDH) in children and explore the urgical timing. Methods A retrospective collection was performed for 74 children with Tönnis type Ⅲ and Ⅳ DDH who were admitted between January 2018 and January 2020 and met the selection criteria, all of whom were treated with Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy. Among them, there were 38 cases in the toddler group (age, 18-36 months) and 36 cases in the preschool group (age, 36-72 months). There was a significant difference in age between the two groups (P<0.05), and there was no significant difference in gender, side, Tönnis typing, and preoperative acetabular index (AI) (P>0.05). During follow-up, hip function was assessed according to the Mckay grade criteria; X-ray films were taken to observe the healing of osteotomy, measure the AI, evaluate the hip imaging morphology according to Severin classification, and assess the occurrence of osteonecrosis of the femoral head (ONFH) according to Kalamchi-MacEwen (K&M) classification criteria. Results All operations of both groups were successfully completed, and the incisions healed by first intention. All children were followed up 14-53 months, with an average of 27.9 months. There was no significant difference in the follow-up time between the two groups (P>0.05). At last follow-up, the excellent and good rates according to the Mckay grading were 94.73% (36/38) in the toddler group and 83.33% (30/36) in the preschool group, and the difference between the two groups was significant (P<0.05). The imaging reexamination showed that all osteotomies healed with no significant difference in the healing time between the two groups (P>0.05). There was no significant difference in AI between the two groups at each time point after operation (P>0.05), and the AI in the two groups showed a significant decreasing trend with time extension (P<0.05). The result of Severin classification in the toddler group was better than that in the preschool group at last follow-up (P<0.05). There was no significant difference in the incidence of ONFH between the two groups (P>0.05). In the toddler group, 2 cases were K&M type Ⅰ; in the preschool group, 3 were type Ⅰ, and 1 type Ⅱ. There was no dislocation after operation.ConclusionSalter osteotomy combined with subtrochanteric shortening and derotational osteotomy is an effective way to treat Tönnis type Ⅲ and Ⅳ DDH in children, and surgical interventions for children aged 18-36 months can achieve better results.