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 explore the influence of cirrhotic portal hypertension and its complications on liver transplantation. Methods The literatures of the recent years on influence of hepatic cirrhotic portal hypertension on liver transplantation were reviewed. Results Splenomegaly, hypersplenism, portal vein thrombosis, portosystemic shunt and collateral flow in cirrhotic patients will increase the difficulty of liver transplantation and lead to more postoperative complications. Appropriate handling of these conditions can achieve a higher success rate of liver transplantation. Conclusion Correct management of end-stage cirrhotic portal hypertension and its complications can expand the indications of liver transplantation and improve long-term survival rates.
ObjectiveTo study the clinical characteristics of elderly hemodialysis (HD) patients and discuss how to control their complications, in order to improve their quality of life and lower their mortality rate. MethodContrastive study and analysis were performed on the clinical data of 98 maintenance HD patients (between elderly and young HD patients) between January 2013 and January 2014. Complications, rate of hospitalization and mortality were analyzed during the follow-up of one year. ResultsThe ratio of hypertensive kidney disease and diabetic nephropathy, as primary disease of the elderly HD patients, gradually increased. More people chose to use semi-permanent jugular vein catheter for elderly HD patients. Compared with young HD patients, the levels of hemoglobin, albumin, serum creatinine, KT/v were lower in the elderly patients, and C-reactive protein was much higher (P<0.05). There was no significant difference in cholesterol, triglyceride, calcium, phosphorus, parathormone between the two groups (P>0.05). Dialysis-related hypotension and blocking of vascular access occurred more frequently in elderly HD patients. Hospitalization rate and mortality rate were higher in elderly HD patients (P<0.05). ConclusionsImproving nutritional status, keeping vascular access unobstructed for a long time and decreasing complications related to hemodialysis are helpful for elderly HD patients to enhance their quality of life and reduce the mortality rate.
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.
Conduit failure and conduit airway fistula are rare complications after esophagectomy, however they can be catastrophic resulting in high mortality. Survivors can expect a prolonged hospital course with multiple interventions and an extended period of time prior to being able to resume oral nutrition. High index of suspicion can aid in early diagnosis. Conduit failure usually requires a period of proximal esophageal diversion and staged reconstruction. Conduit airway fistulas may be amenable to endoscopic repair but this has a high failure rate and many patients will require surgical repair with closure of the fistula and interposition of vascularized tissue to minimize recurrence.
Objective To summarize the advantages and complications of implantation of venous access port via axillary vein in the operation of breast cancer, and to explore the countermeasures against the complications. Methods A total of 40 female patients with breast cancer were enrolled in this observational study between January 2011 and September 2014. They were aged from 32 to 62 years with a mean of 49.3 years. The time for implantation, catheter life, reasons for port removal and complications were evaluated. Results The average time for implantation was 23.3 minutes. The catheter life ranged from 142 to 917 days with a mean of 395 days. Four patients (10%) had port-related complications including 2 cases of pocket infection and 2 of catheter dysfunction. Thirty-one ports were removed for termination of chemotherapy, and four were removed for complications. Conclusions It is simple and time-saving to implant venous access port via axillary vein in the operation of breast cancer. The incidence of pocket infection is high, and is expected to be reduced by choosing appropriate cases and taking strict aseptic norms.