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摘要: Background: Transanal endorectal one-stage pull-through (TERPT) procedure in children with Hirschsprung’s disease (HD) is frequently used worldwide. In order to give the families realistic expectations and to plan the medical care for the years after TERPT, the long term outcome is of great importance. Aim: To collect information on the long term outcome reported after one stage TERPT procedure for HD in children 0 - 15 years. Method: A literature review on the outcome of planned TERPT from 2005 through 2012 was carried out. Information was collected on the number of daily stools a few months postoperatively, incontinence and constipation and the measures taken to deal with these. Results: The reports are few and prospective studies were missing. The results show an initial high frequency of daily stools, 12% had later abnormal stool patterns, 21% had fecal incontinence and 10% had problems with constipation. Conclusion: In order to compare the long term outcome, it would be desirable to have uniform regular reports on the daily frequency of passed stools, incontinence and constipation during the first years after TERPT. Such knowledge would be of importance for the information given to the guardians of children with HD preoperatively to TERPT and in the planning of the future care. The findings can, furthermore, provide a benchmark for the outcome from a single centre. ...
摘要:Background: Correction of long face and chin retrusion has a significant effect on facial aesthetic and symmetry. Bimaxillary (Bimax.) Operation has been performed for long face and bimaxillary dentoalveolar protrusion. But bimaxillary surgery cannot address all of complex deformity of mandible. The new technique using horizontal chin bar can treat mandibular dentoalveolar protrusion and chin retrusion in one setting. Objectives: To evaluate the results of mandible segmental osteotomy and jumping genioplasty; To illustrate the versatility and the ease of this procedure and to confirm the good to excellent clinical results obtained with minimal complications. Design: Retrospective study setting, all of the patients of university hospital and private practice who seek medical attention for long face and retruded (and/or deviated) chin were included in the study. Patients and surgeons satisfaction were evaluated. Results: 45 patients, aged 19 - 30 years (mean age, 24 ± 6 years) underwent the creation of a horizontal chin bar (4 - 7 mm wide) as an axis for two opposite bone movement (and a place for fixation) of mandibular dentoalveolar segment and lower chin segment [segmental lower jaw (Kolle’s) operation and genioplasty], and/or with concomitant Bimax. operation. The mean chin advancement was 8 mm (4 - 10 mm). Average setback for mandible was 3 mm (2 - 6 mm). No bone resorption was identified. No permanent nerve paresthesia was noted. There was one case of the bar fracture due to narrowness of the bar. 37 patients were highly satisfied and 8 were satisfied with the results. There was no dissatisfaction in our patients and surgeons. Conclusion: For long face and retruded chin one of the best treatments is horizotal chin bar method with very good long-term results. EBM: Level IV....
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Aim: Many centres have adopted a straight to test approach to deliver a fast-track service for suspected lower GI cancer. We undertook a prospective comparison between patients having a straight to test (STT) flexible sigmoidoscopy and those attending an outpatient appointment (OPA). The study aimed to determine whether STT reduced diagnostic time without additional investigations. Methods: An observational study of 200 consecutive fast-track colorectal referrals was undertaken. Data collected included: patient demographics, whether STT or OPA, investigations undertaken (including dates) and final diagnosis. Outcomes were compared by adjusted linear regression and logistic regression, for numerical and binary outcomes respectively. Potential confounding factors included were: age, gender and whether NICE referral criteria were achieved. Results: 186 out of 200 referrals attended their appointment, 62% (116/186) went STT and 38% (70/186) had an OPA. No significant difference was seen in the number of days to final investigation, adjusted coefficient -3.71, 95% C.I. -8.92 to 1.50. The STT group had 0.4 more tests per patient, adjusted 95% C.I. 0.07 to 0.73, than the OPA group. Significantly more patients in the STT group had a flexible sigmoidoscopy in addition to whole colonic imaging (all modalities), compared to the OPA group, adjusted OR of 93.47 (95% C.I. 29.26 to 298.54). Conclusion: This study highlights the potential disadvantages of STT flexible sigmoidoscopy for patients referred under the two-week-rule with suspected lower GI cancer. Despite the previously published work highlighting the potential cost and time benefits, it may come at the sacrifice of exposing patients to additional investigations.

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摘要:Objective: The purpose of this study was to compare the in vivo corrosion resistance of the implanted titanium, nitinol annular occlusion device to a control device, i.e. an implantable device containing nitinol, approved by the FDA and currently on the market. Methods: The annular occlusion device is a self-closing, implantable clip. Three canines underwent placement of devices on the left and right atrial appendages. Two Vnus U-clips were secured to either atrium. On post-operative day 95, animals underwent en-bloc cardiac resection via the previous left thoracotomy incision. The annular occlusion device and U-clips were dissected free from the atria. The polyester fabric and tissue ingrowth were removed from the devices and were sent for corrosion analysis. Results: Gross examination of resected hearts of two canines revealed no abnormalities. The compressed endocardial surfaces were completely fused and the appendages fully necrosed. All devices were located and harvested. The annular occlusion device clips and Medtronic Vnus U-clips were evaluated using scanning electron microscopy. Both low and high magnification examination of the nitinol springs and the site of insertion of the nitinol springs into the titanium tubes in the annular occlusion device showed no evidence of localized corrosion. In no case was any evidence of general or localized corrosion found in the form of metallic oxidation. Conclusion: The annular occlusion device provides safe and reliable exclusion of the left atrial ap-pendage without evidence of general or localized corrosion over the 95-day exposure period in canines and may therefore provide a reasonable therapeutic option for stroke risk reduction in patients with atrial fibrillation....
摘要:The mechanisms involved in the development of hepatic encephalopathy still remain uncertain. The rodent portacaval shunt is a model that reproduces many of the pathological features observed in humans (1), but is a technically demanding exercise. While the traditional technique involves complete occlusion of the IVC, a c-clamp was fashioned to partially clamp the IVC thereby sustaining venous return and cardiac output. The aim of this study is to determine if the c-clamp technique provides greater hemodynamic stability and enhances the success rate of the portacaval shunt procedure. To answer this question, two experimental groups, c-clamp (N = 7) and cross-clamp (N = 7), and a sham group (N = 3) were included. Intraoperative hemodynamic parameters were recorded at specific times during the procedure. The c-clamp group showed greater hemodynamic stability when compared to the cross-clamp group. It was manifested by 1) significantly higher mean arterial blood pressure [63 (range, 8) vs 47 (range, 10) mmHg, p < 0.05], 2) faster capillary refill [4 (range, 2) vs 6 (range, 2) seconds, p < 0.05], 3) higher urinary output [0.18 (range, 0.02) vs 0.14 (range, 0.02) ml, p < 0.05], and 4) lower bowel wet-to-dry ratio [4.168 (range, 0.258) vs 4.731 (range, 0.271), p<0.05]. We conclude partial IVC clamping improves hemodynamic stability during the construction of the rat portacaval shunt model....
摘要: We report our experience with two cases of anterolateral thigh flaps based on the musculocutaneous perforators arising from a more distal part of the descending branch than in the conventional anterolateral thigh flap. Case 1: A 53-year-old man with a skin ulcer over the anterior surface of the left tibia secondary to plate fixation for an open fracture. The perforator marked with preoperative Doppler was located 8 cm proximal to the superior border of the patella. Without thinning, the flap was 10 × 4 cm in size and 5 mm thick. Case 2: A 46-year-old man with necrosis of the right index finger after replantation. The flap was 5 × 3 cm in size and 3 mm in thickness. This “distal” anterolateral thigh flap can be raised as a quite thin flap with a long pedicle and, therefore, is considered useful in the reconstruction of various soft tissue defects. ...
[期刊论文] Wolfgang A. Pfaeffl
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2013年 03期
摘要: Flaporhexis, a technique to make the femtosecond laser corneal flap was developed primarily to reduce the mechanical trauma associated with separating the corneal tissue by taking advantage of the cornea’s natural anatomy and was first described in a peer reviewed artice in 2008. The anterior part of the cornea tends to be stronger, thereby allowing tearing (Greek “rhexis”) along the preformed cuts of the femtosecond photo disruption. Flaporhexis differs from Binder’s technique of “hinge opening” as published in 2006 by opening the flap from the opposite side. If a femtosecond flap lift is performed correctly, the surgeon will find a virgin, uniform, dry stromal bed, which had not been manipulated by any surgical instrument and is therefore perfect for wavefront guided laser surgery as “Sub-Bowman’s Keratomileusis”. ...
摘要:Velopharyngeal closure function following modified unified velopharyngeal plasty performed by a single surgeon was evaluated pre- and postoperatively in 14 children with cleft palate after cleft palate closure and no improvement by speech training. Subjects were evaluated for velopharyngeal closure function before and after surgery at 1 (short-term evaluation) and 3 (mid-term evaluation) years. Degree of hypernasality and degree of air leakage through the nose in the soft blowing test were each classified into three grades and each grade was given scores. Velopharyngeal closure function was classified according to the total score into four grades: “good”, "fair”, "slightly poor” and “poor”. At the short-term evaluation, 11 patients (78.6%) achieved an improvement to “good” or “fair” on the overall evaluation. More satisfactory results were obtained at the mid-term evaluation, with 14 patients (100%) graded as “good” or “fair”. Our results indicate that this modified unified velopharyngeal plasty effectively improves velopharyngeal insufficiency when performed as a secondary surgery for cleft palate in children....
摘要:The objectives were to determine the frequency of hepatic abscess, and to describe the clinical and para-clinical aspects and the therapeutic modalities. Method and material: This is a prospective study covering 24 months (January 2016-December 2017). Results: This was a prospective study of 30 cases of liver abscess, ranging from January 2016 to December 2017, a period of 12 months. Inclusion criteria: What were included in this study were all patients hospitalized and treated for liver abscess. Criteria for non-inclusion: Abscess cases have not been treated in the service. The sex ratio was 2.3 and the average age was 35 years old. The main clinical signs were: fever (56.7%), hepatitis (73.3%) and hepatomegaly (26.7%). Hepatic collections objected to abdominal ultrasonography were localized in the right lobe in 70%. Surgical treatment was performed in 10% of cases. Medical treatment alone was performed in the majority of cases (56.7%); eclocated puncture was required in 10 cases (33.3%). The follow-up was simple in all our patients and we did not register deaths; the average duration of treatment was 5 days. Conclusion: Topical pathology in surgical practice in our country, liver abscess is common in our department; medical treatment is curative in the absence of complications....
摘要:We present the case of a 4 year old girl whose adenoidectomy had to be performed via an endoscopictrans oral approach due to the unexpected inability to fully open the mouth during the procedure. The patient had previously been taking Risperidone for behavioral symptoms associated with her autism. The jaw tone returned to normal following the procedure and there were no complications. An interaction between the Risperidone and the anesthetics were the likely cause of the trismus....
摘要:Triple arthrodesis is an invasive procedure that involves denuding and fusion of three foot joints; Talocalcaneal (T-C), Talonavicular (T-N) and Calcaneocuboid (C-C). Traditionally, with external fixation triple arthrodesis has been per-formed without corresponding internal fixation. The purpose of this study is to take a scientific look at the compressive forces acting on the joint surfaces using the arch wire technique without the use of rigid internal fixation. Five fresh cadaveric lower-limb specimens were prepared for the triple arthodesis by anatomic dissection. External fixators were applied to the limbs and pressure sensors from the Tekscan 6900C were placed in the three foot joints where tension was applied. After several trials with different variables it was seen that the arched wire technique on the footplate alone does not allow constant compression at the three joints. However weightbearing increased compression across all three joints regardless of the arch wire compression. This study proves that weightbearing alone provides more compression at all 3 joints in a triple arthrodesis....
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The After cancer resection including bone, recently, bone resected with cancer has been considered to be reusable. We newly examined superheated steam treatment for bone reuse and compared it to existing treatments. Forty male C3H/HeN mice were used to establish a model of mandible invasion by oral squamous cell carcinoma (OSCC). The mice were sacrificed to harvest the tumor invading mandible bone. The resected tumor with mandible bone was treated by one of four kinds of treatment, no treatment for the control, the Pasteur method, liquid nitrogen treatment, micro-wave treatment and superheated steam treatment. After each treatment, the resected bone was transplanted into a syn-geneic mouse back. Eight weeks after transplantation, the mice were sacrificed and evaluated pathologically. Grafted tumors showed recurrence: 7/7 in the control, 6/8 in the liquid nitrogen treatment, 1/8 the microwave treatment and 2/8 the superheated steam treatment groups. No recurrence, on the other hand, was observed in the Pasteur method (0/8). The Pasteur method is a good treatment to remove malignant cells.

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摘要:Background: The question of a selective approach to sending all gallbladders for histology following cholecystectomy has been postulated in many journals but as yet no guidelines have been published in light of such concern. This project will attempt to analyse and address the controversy surrounding sending all gallbladders for histology following cholecystectomy. Objective: To ascertain whether there is a feasible and safe alternative to sending all gallbladders to histology following cholecystectomy and to challenge such a hypothesis. Design: Retrospective study. Methods: Analysis of gallbladder pathology reports, patient medical records and computerised test results from cholecystectomies done in the last 5 years within the Lancashire Teaching Hospital Trust. Results: The alternative selective method based on pre-operative investigations and intra-operative macroscopic detail is shown to be significant (P < 0.05). Conclusion: The results from this study show that there is safe and efficient way of selecting which gallbladders are sent for histology based on age, pre-surgical suspicion and intra-operative macroscopic abnormalities....
摘要:Introduction: Hemorrhoids are a frequent and familiar concern of patients in the general practice and surgery settings. Colonoscopy is both diagnostic and therapeutic. In Qatar, There are little data available about coincidental pathology in elderly patients with hemorrhoids. Objective: To assess the outcome of colonoscopy in management patients with hemorrhoidal disease and average-risk for colorectal cancer and its clinical significance. Method: A retrospective study of 200 patients with hemorrhoids with average risk colorectal cancer (anal bleeding and anal symptoms) and subjected to colonoscopic examination at Al Khor hospital’s endoscopy unit during the period from May 2005 till August 2012. Patients below 50 years and high risk patients for colorectal cancer; with the following alarm signs: Positive personal history of colorectal neoplasms or Inflammatory Bowel Disease (IBD), positive first degree family history of colorectal neoplasms, history of altered bowel habits, recent significant weight loss, presence of iron deficiency anemia, and history of previous colonoscopy were excluded. All significant endoscopic co-findings (diverticuli, polyps, cancer, angiodysplasia and varices, or colitis) were recorded. Results: There were 200 patients; 134 male, 66 female; Mean patient age was 56.3 years (range, 50 to 82 years), who met the eligibility criteria. 200 colonoscopies were performed. Evaluation of these patients revealed Polyps in 16 patients (13 benign and 3 malignant), seven malignant lesions(one annular lesion and 6 fungating masses), Ulcerative colitis in 5 patients, no crohn’s disease, diverticular disease in 4 patients, no Vascular malformations, bleeding piles in 3 patients controlled by injection, and 65.5% of patients were free from any additional pathology. Colonoscopy changed the treatment plan in 58 patients (29%). No complications were encountered. Conclusion: Coincidental abnormalities in colon and rectum in elderly patients with hemorrhoids are common. Benign polyps, followed by diverticular diseases, anal fissures then colorectal cancer were the commonest findings. Endoscopic evaluation of elderly patients with hemorrhoids and average risk for colorectal cancer is advocated. Omitting endoscopy in these patients can lead to major doctors’ delay....
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Introduction: Laparoscopic assisted colonoscopic polypectomies have been well described in the literature and are well established in surgical practice, for removal of large, inaccessible, or flat based polyps. Laparoscope allows the endoscopist a serosal viewpoint and thus clear indication of perforation, in addition to enhancing endoscopic positioning through colonic mobilisation, facilitating polypectomy. We describe a previously rarely published technique, in which the colonoscope directs the surgeon to polyps and laparoscopy enables wedge resection of benign polyps using Endo GIA staplers. Using this method, the colonoscope provides an intra-luminal view ensuring adequate excision with margins whilst the laparoscope provides intra-peritoneal access for the wedge resection. Methods: This is a case series of 12 patients with large tubulovillous adenomas, found and biopsied at colonoscopy. Under a general anaesthetic, an on table colonoscopy was performed to identify and reassess the polyp, whilst a laparoscopy was performed to excise the polyp via wedge resection, using the endoscopic view as guidance. Results: The polyp was identified and completely resected in our 12 patients. All patients were discharged on the first post-operative day. Of the polyps excised, a focus of adenocarcinoma was detected in one and an adjacent endocrine tumour was found in another patient in histology along with tubulovillous adenoma. Rest were all tubulovillous adenomas only. Conclusion: We propose that this technique should be regarded as an alternative to Right hemicolectomies and difficult endoscopic mucosal resections for large adenomas, and be regarded as a definitive and safe procedure in its own right.

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摘要:Recurrent thrombotic occlusions are one major problem in patients with thrombosis of the inferior vena cava. Due to this, we report a new surgical strategy for the construction of aorto-caval (mesenteric-caval) fistula in a patient with homozygous Antithrombin III (ATIII)-Deficiency. The patient survived postoperatively and only surgical complications grade I and II (Clavien-Dindo classification) were reported after short-term and one year follow-up. After one year, the CT-angiography did not show any caval thrombosis or stenosis and no restriction or occlusion of the fistula. Thus, the mesenteric-caval fistula could be safely performed and resulted in a satisfactory patency....
摘要:Purpura fulminans is a hemorrhagic condition associated predominantly with meningococcal and other gram negative septicemias. It occurs mainly in infants and younger children. Features include tissue necrosis, small vessel thrombosis, disseminated intravascular coagulation, multi-organ failure and death. Other causes include clotting factor deficiencies and idiopathic varieties. The condition is uncommon due to gram positive bacterial sepsis. We report one such case with gram positive bacterial infection....
摘要:Necrotizing fasciitis (NF) is still remained a dreaded disease with high morbidity and mortality due to rapidly progressive necrotizing infection. Objective: Review recent available literature on necrotizing fasciitis (NF) and compare it with our publications. Data and Source: Local and international published literature on NF from early nineties to 2012; Midline and pub Med literature search using the term “necrotizing fasciitis”. Data Synthesis: NF is more common in male patient, it is frequently polymicrobial. Common site of NF is the extremities. NF is classified according to the microbes. Common co-morbid condition associated with NF is diabetes mellitus. Minor trauma and surgery are the major etiological risk factors for NF. There seems to be significant correlation between the use of non steroidal anti-inflammatory medication (NSAID) and NF. Severe pain disproportionate to injury is the presenting symptom. Laboratory risk indicators for necrotizing fasciitis (LRINEC) score will diagnose NF early in emergency clinics. Tissue biopsy is the gold standard for the diagnosis of NF. Pathophysiology of NF is rapid horizontal spread of infection with fascial necrosis and secondary vertical involvement of skin. More than 90% of NF patients need intensive care therapy. Early and bold debridement in combination with brave organ supportive intensive care will have better outcome of NF patients. Conclusion: High index of suspicion and knowledge is essential for early diagnosis of NF. Finger test and LRINEC score may help in early diagnosis. Early debridement, proper antibiotics and organ supportive intensive care will improve morbidity and mortality of NF patients....
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2011年 06期
摘要:Purpose: 1) To compare the survival of patients with colorectal liver metastases who underwent resection as the primary treatment against patients who had chemotherapy as the primary treatment. 2) To compare the survival in patients with recurrent inoperable liver metastases (after resection) treated with Oxaliplatin or Irinotecan against those patients with inoperable recurrence who were treated with 5-FU. Patients and Methods: 538 patients with colorectal liver metastases were referred to our unit between November 1997 and May 2005; 247 underwent liver resection and 291 had palliative chemotherapy. Results: Only 7.8% of non-operated patients survived for 5 years compared to 31.5% of the liver resection group. After surgery, 191 patients developed inoperable recurrent disease. These patients were treated with chemotherapy; Ox/Ir patients had a 3 year survival of 55% compared to 32% of those who received 5-FU. Our data shows that in patients who relapse after liver surgery, chemotherapy with Oxaliplatin or Irinotecan confers a significant survival benefit....
摘要:Objectives: To evaluate the quality of the information provided to patients for their consent to be operated laparoscopically in the “A” surgery service of Point “G” University Hospital in Bamako (Mali). Methodology: The study was transversal, descriptive and prospective from November 1, 2016 to December 31, 2017 (14 months). It was performed at the general and laparoscopic surgery department of the Point “G” University Hospital in Bamako. Laparoscopically operated patients in scheduled or emergency programm whom consented the study and answered the questions before and after the surgical procedure were included. Results: One hundred patients were retained. The sex ratio was 4.2 for women. The surgery was scheduled in 93% (programmed surgery) of cases versus 7% (urgent surgery). Gynecological and obstetric surgery was performed in 54%, digestive surgery in 43% and laparoscopic exploration in 3%. The information was provided by surgeons, anesthetists, fellowship and students in respec-tively 63%, 6%, 11% and 9%. The reflection period before consenting to the act was greater or equal to 3 days in 90%. The media used were found to be suitable in 62%. The information was considered satisfactory preoperatively in 54% and postoperatively in 88%. Patients wanted additional information on post-surgery outcomes in 21%. Conclusion: The establishment of an information system and a free and informed consent form is a prerequisite for the quality of care in laparoscopic surgery....
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