Objective To summarize the visual outcome of patients with severe ocular trauma treated with vitreous surgery. Methods Clinical data of 188(191 eyes) with severe ocular trauma treated with vitreous surgery in a period from November 1996 to April 1998 were analysed retrospectively. Results The study included penetrating injury in 56 eyes, foreign bodies in the posterior segment in 70 eyes, blunt injury in 41 eyes , and globe rupture in 24 eyes. Main complications included endophthalmitis in 35 eyes, choroidal bleeding in 20 eyes, retinal detachment in 60 eyes, and vitreous hemorrhage in 97 eyes. Post-opera-tively, out of 188 eyes, except for 3 of patients too young to examine, visual acuity improved in 133(70.7%), including 85(45.2%) with visal acuity 0.02-1.0, 46(24.5%) remained unchanged; and 9(4.8%) had worse vision. Among 34 with no-light-perception, 12 had light-perception or over. Conclusion A majority of severe trauma eyes can be salvaged with considerable visual recovery after adequate and timely vitreous surgery. (Chin J Ocul Fundus Dis,1999,15:4-6)
Objective To summarize the experience of open heart operation on neonates with critical and complex congenital heart diseases and evaluate the methods of perioperative management. Methods From May 2001 to January 2003, 12 patients of neonates with congenital heart diseases underwent emergency operation. Their operating ages ranged from 6 to 30 days, the body weights were 2.8 to 4.5 kg. Their diagnoses included D-transposition of the great arteries in 4 cases, ventricular septal defect with atrial septal defect in 5 cases, complete atrioventricular septal defect, obstructed supracardiac total anomalous pulmonary venous drainage and cardiac rhabdomyomas in 1 case respectively. 12 cases were operated under moderate or deep hypothermic cardiopulmonary bypass. Results All cases were observed in ICU for 2-11 days and discharged 7-19 days after operation. The postoperative complications included low cardiac output, mediastinal infection, respiratory distress syndrome, systemic capillary leak syndrome and acute renal failure. All cases were cured and the follow-up (from 6 months to 2 years) showed satisfactory outcome. Conclusion A particular cardiopulmonary bypass and proper perioperative management is very important to ensure the successful outcome. Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in neonates.
ObjectiveTo summarize experience of surgical treatment of ascending aortic aneurysm and analyse related problems.MethodsOne hundred and fourteen (containing 62 cases had aortic dissection) consecutive cases underwent replacement of diseased ascending aorta alone (9 cases) or Bentall operation.ResultsThere were seven operative death (6.14%). The cardiac function, in six of them, was in class Ⅳ(NYHA) preoperatively. Follow up was completed in 107 patients, with a duration of 40±30 months. Eight patients succumbed due to intracranial hemorrhage (3 cases), rupture of abdominal aortic lesion (3 cases), cardiac failure after coronary artery bypass grafting (1 case), and sudden death of unknown cause (1 case),respectively. All 99 long term survivors (86.8%) were in NYHA class Ⅰor Ⅱ.ConclusionThe results indicate that Bentall operation for treating ascending aortic aneurysms and aortic insufficiency, or aortic replacement alone for treating ascending aortic aneurysm gives good functional recovery and an active life for the vast majority of survivors.
Objective To introduce the application of the pedicled anterolateral thigh flap transferring for coverage of the oversized skin defect of the hand. Methods The pedicled anterolateral thigh flap was transferred to cover the large skin defects of the hands or the skin defects of theabdomen after the abdominal flap transferred to the hand in 5 male patients aged 16-44 years from April 2002 to August 2005. The injured sites were as follows:4 right hands and 1 left hand, including 2 hands injured by a machine and 3 hands injured by burning.The mechanically injured patients underwent an operation within 6 hours after the injury. The burned patients were reconstructed by the flap transferring 4-7 days after the burn when the decayed tissues could be clearly indentified.The areas of the hand defects were 12.19 cm×18.22 cm.The areas of the pedicled anterolateral thigh flaps were 7.12 cm×16.24 cm. The areas of the abdominal flaps were 13.20 cm×19.23 cm.The pedicles were separated 3 weeks after the repairing operation. Results All the flaps survived well and there was no vascular crisis, with the wound healing of the first intention. The skin defects of the hand were covered completely. Five patients were followed up for 6-12 months. The texture of the flaps was soft and the flaps had a good blood circulation. Of the patients, 3 underwent the finger exclusion and degreasing operation 47 months after operation. All the flaps of the hands had protective sensation, which could meet the requirement of the daily life. Conclusion The pedicled anterolateral thigh flap can provide the large coverage for the skin defects of the hands. The risk of the operation can be greatly decreased by obviation of the vessel anastomosis. It can be an optimal choice for themanagement of the oversized skin defects of the hands.
Abstract The narrow pedicled intercostal cutaneous perforater (np-ICP) thin flaps were successfully used for reconstruction of hand deformity from scar contraction. This flap was designed with a narrow pedicle (3～5cm in width) which included ICPs of 4th～9th intercostal spaces, and with awide distal part (the maximum is 15cm×15cm) which covered the lower chest and upper abdomen. The thickness of flap was cut until the subdermal vascular networkwas observed. The pedicle was divided between the 7th～14th days after operation. Sixteen flaps in 15 cases were transferred for covering of the skin defects at the dorsum of the hand. The perforators which were included in the narrow pediclewere mostly from the 7th intercostal spaces in 9 flaps. Fifteen of the 16 flapswere survived almost completely, except in one case there was necrosis of the distal portion of the flap. It seemed that this flap was more useful than the conventional methods, not only functionally but also aesthetically. Moreover, the operative techinque was more simple and safer than the island or free intercostalflap due to without the necessity to dissect the main trunk of the intercostalneurovascular bundle. Gentle pressure on the thinning portion of the flap for a short time after operation was important.
Objective To investigate the changes of renal medulla aquaporin 2 expression and morphological changes of epithelia of collecting tube after bile duct recanalizaiton operation. Methods Thirty rats were divided into two groups randomly. Common bile duct ligation was performed on 20 experimental rats with silicon tubes 2 mm in extre-diameter, and sham operation on the other 10 rats. Seven days later, bile duct recanalizaiton was performed on obstructive jaundice group and sham operation on contrast group. Experimental rats were divided into two subgroups randomly. Half of them were killed immediately and the others would be killed 24 hours later. Serum of each rat was collected to detect hepatic function and renal function. Renal medulla was fixed for microscopic examination and was kept in the -80 ℃ refrigerator for aquaporin 2 expression measurement by Western blot technique. Results All of the animals accomplished the experiment smoothly. Golden ascites were found in the rats of obstructive jaundice group. Twenty-four hours after recanalization, serum bilirubin levels decreased 〔(45.95±8.39) μmol/L〕, P＜0.01, and there was no significant change in blood urine and creatine level. Compared with sham operation group (21 966.20±1 544.70), expression of aquaporin 2 decreased significantly after common bile duct ligation in obstructive jaundice group (15 665.30±1 181.85), P＜0.01. After recanalizaion, the expression of aquaporin 2 in obstructive jaundice group increased (19 490.80±4 239.32), P＜0.01. Conclusion Common bile duct obstruction would lead to epithelium injury of renal collecting tube, and down regulate the aquaporin 2 expression.
Objective To explore the clinical significance on protection of parathyroid and recurrent laryngeal nerve （RLN） by meticulous capsular dissection and exposure of RLN in thyroid lobectomy. Methods Clinical data of 452 patients who underwent thyroid lobectomy by meticulous capsular dissection and exposure of RLN in our hospital from Jan. 2010 to Dec. 2012 were retrospectively analyzed. Results All of the 452 cases underwent thyroid lebectomy successfully without death， and the operative time was 45-110min （average 60 min）， the blood loss was 5-100mL （average 20mL）. The pathological results showed that there were thyroid adenoma in 193 cases， nodular goiter in 175 cases， Hashimoto thyroiditis in 38 cases， thyroid cancer in 46 cases. After operation， 4 cases suffered RLN injury， 1 of the 4 cases recovered after removal of drainage tube， and other 3 cases recovered during 0.5 to 3.0 months. In addition， 2 cases suffered laryngeal nerve injury whose symptoms disappearred within 1 week， 5 cases suffered parathyroid founctional damage without permanent hypocalcemia whose symptom had kept 1-5 days after treatment. Three cases were reoperated because of bleeding， including branch of anterior venous bleeding in 1 case， thyroid side arterial tube bleeding in 1 case， and thyroid stump bleeding in 1 case. Twenty one cases suffered hypothyroidism in 1 month after operation， and no recurrence happened during the followed up period. Conclusions Meticulous capsular dissection can effectively protect function of parathyroid and reduce the injury probability of RLN. Exposure of RLN is safe and feasible， which plays an important role in avoiding serious RLN injury.