Average Amount Of Bleeding Research Articles

OVERVIEW OF ANEMIA AFTER SCOLIOSIS SURGERY IN THE INTENSIVE CARE UNIT (ICU) SOEHARSO ORTHOPEDIC HOSPITALINDONESIA

Anemia is a condition where the hemoglobin concentration is lower than normal. This condition reflects the lack of the normal number of erythrocytes in the body's circulation and consequently the amount of oxygen delivered to the body's tissues is also reduced. Miller & Thompson (2019) scoliosis comes from the Greek word "scoliosis" which means crooked. Scoliosis is a complex three-dimensional deformity of the spine characterized by a lateral deviation of at least 10 degrees with spinal rotation and is usually associated with a reduction in the normal kyphotic curvature of the spine / hypokyphosis. The cause of bleeding in spinal surgery usually occurs more in cases of rigid scoliosis, pedicle subtraction osteotomy and vertebral column resection often referred to as triple column osteotomy and is considered a procedure with a high risk of complications with massive blood loss, reaching more than 10 liters (Jun. 2019). Based on its classification, this type of research is retrospective descriptive research. studies that discuss one or more variables separately, one-by-one, but do not examine the relationship between these variables, using the observation method with the subject being observed by looking at past conditions (Harlan &Sutjiati, 2022). Using total sampling technique in sampling, the population is the medical records of patients admitted to the ICU, postoperative diagnosis of scoliosis with anemia, the sample size is 58 patient medical records. The variables observed were: indications for ICU admission and postoperative scoliosis, the inclusion criteria were medical record data for postoperative scoliosis patients with anemia admitted to the ICU for the period January 1 - December 31, 2022 and patients with the first scoliosis surgery. Based on this study, the following results were obtained: Most respondents were female (81%), the average age of respondents was 17 years. The most common type of scoliosis is adolescence idiopathic scoliosis (89.7%). The most Lenke classification is Lenke 3 (44.8%), the most types of surgery are stabilization, fusion, discectomy, laminectomy and osteotomy (56.9%). The duration of surgery was mostly 180-240 minutes (46.6%) with an average duration of surgery of 257 minutes, the average amount of bleeding was 884.5 ml, the average preoperative Hb was 13.3g/dL, the average postoperative Hb was 8.8 g/dL. The average postoperative Hemoglobin decrease was 5.3 g/dL, patients who were given blood transfusions (87.9%) with an average of 2.9 bags per patient, the most common type of transfused blood was PRC (90.2%).

Laparoscopic simultaneous anterograde inguinal and pelvic lymphadenectomy for penile cancer: two planses, three holes, and six steps.

To assess the feasibility, safety, and efficiency of simultaneous anterograde video laparoscopic inguinal and pelvic lymphadenectomy for penile cancer. We reviewed retrospectively the records of 22 patients (44 lateral) who underwent inguinal lymph nodes dissection for penile cancer. The procedure was standardized as two planes, three holes, and six steps. Two Separate-planes: superior plane of eternal oblique aponeurosis/ / fascia lata; inferior plane of superficial camper fascia. Three holes: two artificial lateral boundary holes, the internal and external boundary holes, and the hole of oval fossa. Six steps: separate the first separate-plane; separate the second layer; separate two artificial lateral boundary holes; free great saphenous vein; separate the third hole and clean up the deep inguinal lymph nodes; pelvic lymphadenectomy. A total of 22 cases were included and 9 patients underwent simultaneous pelvic lymphadenectomy. The average operation time on both sides was 7.52 ± 3.29 h, which was 0.5-1 h/side after skilled. The average amount of bleeding was 93.18 ± 50.84 ml. A total of 8 patients had postoperative complications, accounting for 36.36%, and no complications great than Clavien-Dindo class III occurred. This study demonstrated that the video laparoscopic simultaneous anterograde inguinal and pelvic lymphadenectomy is a feasible and safe technique. Indocyanine Green was helpful for lymph node identify.

A Study on the Perinatal Outcomes of Natural Childbirth Led by Midwives: A Retrospective Study

Purpose: The purpose of this study was to suggest the importance of natural childbirth by investigating the results of midwife-led perinatal periods and whether they were positive experiences for both individual women and their families.Methods: This retrospective study aimed to confirm the perinatal outcomes of midwife-attended vaginal births. Among 1,127 women who gave midwife-led birth in Gyeonggi-do, Seoul between January 1, 2019 and December 31, 2021, data were collected for 829 women. Records were excluded that were missing necessary data. Data on childbirth were analyzed using frequency, percentage, mean, standard deviation, and the chi-square test.Results: Among the mothers who underwent natural childbirth, 549 (66.2%) were multiparous. In addition, all 829 patients (100%) breast-fed their infants. First-degree perineal lacerations occurred in 29.2% of patients, and second-degree lacerations occurred in 48%. Non–high-risk subjects made up 56.0% of the study sample. The average bleeding amount was 281.44±4.50, and the average 1-minute Apgar score for infants was 8.25±0.02.Conclusion: Compared to childbirth in a hospital, natural childbirth was associated with a lower risk of birth canal laceration, postpartum bleeding, and Cesarean section. In addition, the health statuses of the newborns were confirmed to be good . Based on the results of this study, there is a need for a strategy in which midwife-led natural childbirth is integrated into the local medical system, as well as a need to raise women's awareness of natural childbirth and positively influence the experience.

Outcomes of cable fixation after Vancouver type B1 periprosthetic femoral fractures.

In this study, it was aimed to evaluate the patients who underwent cable plate fixation due to a Vancouver-type B1 periprosthetic femur fracture and their clinical results. Vancouver-type B1 patients who were operated on for periprosthetic fractures between 2014 and 2019 were investi-gated. Age, gender, body mass index (BMI), follow-up time, operation time, bleeding amount, non-union fracture, last surgery before fracture, the time between previous surgery and fracture, implant survival, patient survival, and complications were recorded. In addi-tion, the postoperative clinical functions of these patients were compared. 23 patients who met the study criteria (Vancouver type B1 fracture) were identified. The mean age of the patients was 60 (49-76) years, the mean BMI was 26.3 (17.5-40.7), and the postoperative mean follow-up period was 14 (6-36) months. Considering the gender distribution, there were 5 (22%) men and 18 (78%) women. The mean time between the last surgery before the fracture and the fracture was 6 months (0-30). While the mean operation time was 95 min (60-180), the average amount of bleeding was 310 mL (150-600). Functional evaluations of patients: In total, five patients had decreased ambulatory abilities after surgery. Nonunion was observed in 2 patients during the follow-ups, and these patients underwent open surgery for treatment. Cable and locking plate applications are successful in Vancouver type B1 fractures, which are one of the most common forms of periprosthetic fractures. In this technique, the duration of the operation can be shortened under ideal conditions, and the need for blood and blood products is reduced as blood loss is reduced. If there is a complication, you still have the chance to treat it with the option of revision arthroplasty.

Full-Endoscopic Posterior Lumbar Interbody Fusion with Epidural Anesthesia: Technical Note and Initial Clinical Experience with One-Year Follow-Up.

ObjectiveThe purpose of this study was to introduce and evaluate the early clinical outcomes of the full-endoscopic posterior lumbar interbody fusion (Endo-PLIF) technique with epidural anesthesia (EA) for single-segment lumbar degenerative diseases.MethodsIn this retrospective case series study, we explored the feasibility and effectiveness of the Endo-PLIF with EA for single-segment lumbar degenerative diseases. Between March 2018 and January 2019, a series of 24 patients with single-segment lumbar degenerative diseases underwent Endo-PLIF surgery and were followed up for a minimum of 12 months (15.21±2.27 months). Clinical outcomes including visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, and the Short Form-36 health survey questionnaire (SF-36) were evaluated preoperatively, and postoperatively at 3 days and at 3, 6, and 12-months.ResultsAll patients underwent successful single-segment Endo-PLIF surgery. The mean operation time was 209.17±39.49 min, and average amount of bleeding was 43.33±14.87 mL. The VAS for lower extremity pain and back pain significantly improved at 3 days, and at 3, 6, 12 months compared with preoperative, respectively. The ODI scores decreased from 42.04±3.96 to 12.75±2.71 (P<0.001) at preoperative and 12 months postoperatively, respectively. The SF-36 Physical Component Scores (PCS) improved from 34.96±4.63 preoperatively to 52.08±6.05 (P<0.001) at 12 months postoperatively. Additionally, the SF-36 Mental Component Scores (MCS) improved from 39.38±5.70 at preoperative to 53.13±5.97 (P<0.001) at 12 months postoperatively. Two patients experienced dysesthesia, and one patient had a wound infection.ConclusionEndo-PLIF with EA is a feasible and valuable technique for the treatment of single-segment lumbar degenerative diseases in selected patients.

Transfusion of Blood Products in the Postoperative of Cardiac Surgery

Background: The indiscriminate use of blood transfusion in surgery has been associated with increased risk of infection and increased length of hospital stay. Objective: To identify the average amount of bleeding and rates of transfusion of blood products in the postoperative period of patients undergoing cardiac surgery in a cardiology center. Methods: Medical records of patients who underwent myocardial revascularization surgery and/or heart valve replacement with use of cardiopulmonary bypass (CPB) were analyzed. Perioperative data such as CPB time, [...]

Curative effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury

To explore the effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury. From January 2016 to June 2018, 16 patients with severe thoracolumbar burst fractures (more than 50% of ratio of spinal canal encroachment, reverse fragment at the posterior edge of the vertebral body) with spinal cord injury were retrospectively analyzed, including 10 males and 6 females, ranging in age from 19 to 57 years old. Causes of injury:8 cases of fall injury, 6 cases of traffic accident injury and 2 cases of other injuries. Fracture site:T11 in 4 cases, T12 in 5 cases, L1 in 5 cases, L2 in 2 cases. All the patients underwent anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach. The curative imaging effects were evaluated by measuring the loss height of the anterior edge of the injured vertebra, Cobb angle of the adjacent segment of the injured vertebra, and ratio of spinal canal encroachment. The clinical effects were evaluated by Frankel spinal cord injury rating and visual analogue scale (VAS). All 16 patients were followed up, and the average follow up time was (15.9±5.4) months. The average operation time was (234±41) minutes and the average amount of bleeding was (431±93) ml. The loss of anterior height of injured vertebrae was (52.25±10.10)% before operation, (8.93± 3.61)% at 3 days after operation, and (9.25±2.88)% at the latest follow up. The results of 3 days after operation and the latest follow up were better than that before operation, and there was no significant differencesbetween results at the latest follow up and 3 days after operation (P<0.01). Cobb angle of adjacent segment of injured vertebrae was (28.19±10.89)°before operation, (5.31±5.14)° 3 days after operation, and (6.81±4.59)°at the latest follow-up. The ratio of spinal canal encroachment was (67.68±12.45)% before operation, (7.69±4.46)% at 3 days after operation, and (4.75±1.63)% at the latest follow-up. At 3 days and the latest follow-up, the rate recovered to a certain extent (P<0.05). At the latest follow up, spinal nerve function was improved in 12 patients, no improvement in 4 patients and no deterioration in nerve function. VSA score was improved from preoperative 7.8±0.9 to final follow-up 1.8±0.7. For severe thoracolumbar burst fracture and spinal cord injury, with more than 50% of ratio of spinal canal encroachment and reverse fragment at the posterior edge of the vertebral body, the anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach has the characteristics of accurate reduction, complete decompression and firm fixation, and the clinical effect is satisfactory.

Clinical effect of using MultiLoc® nails to treat four-part proximal humeral fractures.

ObjectiveThis study was performed to evaluate the clinical effect of MultiLoc® nails (DePuy Synthes, Raynham, MA, USA) on the treatment of four-part proximal humeral fractures (PHFs).MethodsFrom January 2014 to January 2018, 32 patients with four-part PHFs were treated with intramedullary MultiLoc® nails in our hospital. The operation time, bleeding volume, postoperative X-ray findings, and fracture healing status were recorded and analyzed. At the end of follow-up, the clinical outcome was evaluated based on the visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) shoulder score, Constant–Murley score (CMS), and occurrence of any complications.ResultsAmong all patients, the average operation time was 124.5 minutes (range, 91–152 minutes), the average amount of bleeding was 90 mL (range, 55–150 mL), and the fracture healing rate was 100%. At the end of follow-up, the mean VAS score was 1.6 ± 0.4, mean ASES score was 84.4 ± 6.3, and mean CMS was 70.3 ± 6.1; no serious complications had occurred; and the patients exhibited good recovery of shoulder function.ConclusionsMultiLoc nails® can be applied to the treatment of four-part PHFs. This surgical fixation method has no obvious complications and helps to restore shoulder function.

Intravenous Administration of Carbetocin Versus Oxytocin for Preventing Postpartum Hemorrhage After Vaginal Delivery in High Risk Women: A Double-blind, Randomized Controlled Trial

Abstract Objective: To compare the effects between carbetocin and oxytocin on reducing postpartum hemorrhage (PPH) after vaginal delivery in high risk pregnant women. Methods: A prospective double-blinded randomized study was conducted in the Nanjing Drum Tower Hospital from March to May 2018. Women at or beyond 28 gestational weeks, cephalic presentation, 18–45 years old, and with at least one risk factor for PPH, were enrolled. Using a computer-generated randomization sequence, women were randomized to carbetocin group or oxytocin group which receive 100 μg intravenous infusion carbetocin or 10 IU intravenous infusion of oxytocin after anterior shoulder and before placental delivery. The primary outcome was the incidence of blood loss ≥500 mL within 24 hours postpartum. The secondary outcomes were amount of total blood loss, blood loss within 2 hours after delivery, the rate of blood loss ≥ 1 000 mL postpartum, need for a second-line uterotonics and interventions, blood transfusion, difference between hemoglobin before and 48 hours after delivery, adverse maternal events attributed to the trial medication. Hemodynamic status (blood pressure and pulse) was measured at 0 minutes, 30 minutes, 60 minutes, and 120 minutes after delivery. Results: A total of 314 and 310 participants constituted the carbetocin and oxytocin groups, respectively. The baseline characteristics were comparable between the groups. The carbetocin group had similar rates of PPH (blood loss ≥500 mL) and rates of ≥1 000 mL PPH, (29.6% vs. 26.8%, P = 0.48) and (3.2% vs. 3.5%, P = 0.83), to the oxytocin group. The average amount of bleeding was (422.9 ± 241.4) mL in carbetocin group and (406.0 ± 257.5) mL in oxytocin group, which was no statistically significant difference (P = 0.40). Either the amount of blood loss within 2 hours ((55.5 ± 33.9) mL vs. (59.9 ± 48.7) mL) was no statistically significant difference (P = 0.19). The need for therapeutic uterotonics was 23.9% in carbetocin group and 23.5% in oxytocin group, which was also no statistically difference (P = 0.93). The rate of blood transfusion (P = 0.62) and hemoglobin change (P = 0.07) were not differ between the carbetocin and oxytocin groups. However, the rate of manually removing placenta was significantly different between two groups regarding the need for manually remove of placenta because of uterine bleeding in the third stage of labor (4 cases in carbetocin group vs. 13 cases in oxygen group), especially in those after oxytocin-induced or augmented labor (relative risk:3.39, 95% confidence interval: 1.09–10.52). After delivery, the blood pressure in the carbetocin group tend to be lower than that in the oxytocin group (P &gt; 0.05), especially at 30 minutes postpartum (P &lt; 0.05), while pulse tend to be simultaneously higher (P &gt; 0.05). Conclusion: Among women with high risk of PPH, intravenous carbetocin infusion did not better than oxytocin in the prevention of blood loss ≥500 mL after vaginal delivery.

Surgery for retrosternal goiter: cervical approach.

Retrosternal goiter refers to when the thyroid gland extends from the neck to the substernal portion, descending below the thoracic inlet into the mediastinum. It is typically accompanied by compressive symptoms, and most patients need to undergo surgery. This retrospective study set out to analyze the surgical approach to retrosternal goiter and to evaluate perioperative complications, with the aim of recommending best surgical technique. We carried out retrospective analysis of 115 patients with retrosternal goiter treated at our center between May 4, 2011 and March 19, 2019. We analyzed patient characteristics, surgical methods, and perioperative complications using SPSS. Of the 115 patients in our study, 112 underwent thyroidectomy by cervical approach, with only 3 requiring an extracervical approach. The median age of the patients was 52.3 years, and the majority were female (81.74%). Most of the patients (73.91%) experienced no symptoms but were diagnosed with tracheal compression during surgery or preoperative imaging examination. Ninety-eight (85.22%) of our patients underwent preoperative evaluation of their condition by CT imaging. No obvious surgical contraindications were found before thyroid function tests. The mean operation time was 115.11 min, and the average amount of bleeding during surgery was 54.43 mL. The mean postoperative hospital stay was 5.38 days. In 109 cases (94.78%), the goiter was found to be benign, and malignancy was diagnosed in 6 patients (5.22%). Of the 112 patients who were treated with the cervical approach, 7 (6.25%) experienced recurrent laryngeal nerve palsy; 6 of these cases were transitory and 1 was permanent. The number of patients treated by cervical and extracervical approach who experienced transient hypocalcaemia was 23 (20.54%) and 2, respectively. Transient hypoparathyroidism affected 16 patients (14.29%) treated by cervical approach. Two patients had tracheomalacia phenomenon and one patient had pleural effusion after surgery. No cases experienced permanent hypocalcemia, permanent hypoparathyroidism, postoperative hematoma, tracheostomy, or death. Retrosternal goiter surgery is challenging for surgeons. The best surgical approach for the patient should be based on CT scan evaluation. In our study, based on preoperative CT imaging and in-operation evaluation, 50% of the tumor volume was located below the thoracic inlet and 50% of the tumor volume was located above the thoracic inlet in almost all of the patients. Both sections could be successfully removed via a cervical incision, and no obvious complications were observed during the perioperative period. With careful planning and execution before surgery and meticulous operation during surgery, most retrosternal goiters can be safely treated by cervical approach.

Real impact of surgical robotic system for precision surgery of parotidectomy: retroauricular parotidectomy using da Vinci surgical system.

We performed robotic parotidectomy with or without robotic neck dissection via a retroauricular approach in patients with parotid benign and malignant tumors and analyzed treatment outcomes of the patients to evaluate the safety and feasibility of robotic parotidectomy. Between January 2017 and July 2018, 53 patients received robotic parotidectomy with/without robotic neck dissection through a remote access retroauricular incision without a preauricular incision. All operations were successfully performed in all patients without significant perioperative complications or tumor spillage. Tumors were located in the superficial lobe of the parotid gland in 40 patients, and the remaining 13 tumors were located in the deep lobe of the parotid gland. Postoperative pathologic examination revealed benign tumor in 32 patients and malignant tumors in 18 patients. The mean operation time was 226 minutes in patients who underwent only parotidectomy and 375 minutes in patients who underwent parotidectomy with robotic neck dissection. The average amount of bleeding was 23 mL, and the amount of drainage after operation averaged 171 mL. The average length of hospital stay was 6 days. Postoperative complications were limited to transient facial paralysis in three patients, all of which resolved within 1 month. All patients were satisfied with their cosmetic results at 6 months after operation. Robotic parotidectomy with/without robotic neck dissection through a retroauricular approach was a feasible and safe technique in patients with parotid benign and malignant tumor. Specifically, we found it to be helpful in young patients with malignant parotid tumors who should receive cervical lymphadenectomy and parotidectomy, because it does not leave a visible scar on the face or neck. In the future, long-term follow-up will be necessary to validate its oncologic safety and functional outcomes.

Do Chamomile effect on duration, amount of bleeding, and interval of menstrual cycles?

ObjectivesHeavy menstrual bleeding has a significant effect on women’s daily life and health consequences for theirs. Attention to women’s and girls’ menstrual health is critical for their health. This study presents the results of a novel research on the effect of chamomile capsule on the amount of bleeding, and the duration and interval of menstrual cycles.MethodsThe current study was a randomized, double-blind, clinical trial, which was carried out on 118 female students living in dorms of Guilan University of Medical Sciences. The participants were divided into two groups of 59, each receiving either chamomile capsule 250 mg or placebo three times a day, for an interval beginning from 7 days before the starting menstruation till the next onset. Higham chart is the pictorial blood loss assessment to determine the amount and duration of menstrual bleeding. Data were analyzed using SPSS version 20. Alpha was set at 0.05 for all analyses.ResultsThe average amount of bleeding in the chamomile group decreased after taking the capsule (p = 0.001). However, statistical tests did not show any significant difference in terms of duration and interval between two bleeding in both the experimental and control groups (p > 0.05).ConclusionThe present study showed that the chamomile capsule decreases the amount of menstrual bleeding and can be used as a therapeutic method.

Spontaneous cerebellar hemorrhage with severe brainstem dysfunction through minimally invasive puncture treatment by locating the simple bedside

This study aims to evaluate the feasibility and effectiveness of minimally invasive puncture treatment by positioning the simple bedside for spontaneous cerebellar hemorrhage.From January 2017 to March 2018, the investigators applied simple bedside positioning to perform the intracranial hematoma minimally invasive surgery for 21 patients with cerebellar hemorrhage.For these 21 patients, the bleeding amount and Glasgow Coma Scale (GCS) score before the operation were 18.5 ± 5.0 cc and 9.5 ± 3.3, respectively; 24 hours after the operation, the GCS score was 11.0 ± 4.6. Five patients died within 7 days of the operation and the head computed tomography (CT) was re-examined. It was found that the average bleeding amount was 3.4 ± 0.9 cc, the operation success rate was 76.2%, and the accurate puncture rate was 100%. Six months later, the Modified Rankin Scale (MRS) score was 2.5 ± 2.0. The postoperative recovery was good. The situation shows that patients with favorable outcomes (MRS score 0–2) accounted for 38.1% (8/21), and the fatality rate was 33.3% (7/21).The efficacy of the intracranial hematoma minimally invasive surgery by positioning the simple bedside for spontaneous cerebellar hemorrhage with severe brainstem dysfunction is good.

Minimally invasive treatment of double forearm fractures in children with elastic intramedullary nails

Objective To investigate the clinical efficacy and surgical techniques of elastic intramedullary nail in the treatment of double forearm fractures in children. Methods From March 2014 to July 2017, 12 children with double forearm fractures were treated with titanium elastic intramedullary nails. The elastic intramedullary nails were inserted from the distal radius and proximal ulna, and the affected limb was fixed with plaster over elbow and wrist for 4 to 6 weeks. When X-ray showed that the callus was well formed, the plaster was removed for functional exercise. The elastic intramedullary nails were removed after fracture healing. Results The closed reduction of radius and ulnar was performed in 7 and 8 cases respectively. The open reduction of radius and ulnar was performed in 5 and 4 cases respectively. The average length of incision at nail entry point was (1.17±0.17) cm. The average length of incision for open reduction was (1.54±0.29) cm. The operation time was (1.71±0.63) hours. The average amount of bleeding during operation was (12.92±7.53) ml. The postoperative follow-up period was 8 to 48 months, with an average of (23.58±11.42) months. The duration of bone healing was 3 to 8 weeks with an average of (4.92±1.38) weeks. The pronation angle of forearm was (83.75±6.44)°, and the supination angle was (85.83±5.15)°. The flexion and extension activities of elbow and wrist joints were similar to those of the healthy side. No complications such as nonunion, malunion, epiphyseal injury and needle tail irritation symptoms occurred in all the cases. Conclusion The application of titanium intramedullary nail is effective and minimally invasive in the treatment of double forearm fractures in children. Key words: Child; Forearm; Fractures,bone; Intramedullary nails

Clinical analysis of transumbilical single-incision laparoscopic cholecystectomy with totally free umbilical ring by conventional instruments

Objective: To summarize the clinical experience of transumbilical single-port laparoscopic cholecystectomy, and evaluate its clinical utility and the feasibility of widely usage. Methods: Between April 2012 and June 2017, 500 cases who underwent transumbilical single-port laparoscopic cholecystectomy with totally free umbilical ring by conventional instruments were enrolled. The clinical data were retrospectively analyzed. Results: A total of 487 patients were successfully completed the operation. In addition, 3 cases were converted to open cholecystectomy, 10 cases were converted to multi-port laparoscopy and drainage tubes were placed in 5 cases. The mean operating time of transumbilical single-port laparoscopic cholecystectomy(from the Trocars being put to the gallbladders being removed)shortened from 72.3 min to 13.2 min. The average bleeding amount was less than 10 ml. After the operation, 3 cases had delayed bile leakage and 3 cases had transient up-regulation of bilirubin at the beginning of the technique. No patients had hemorrhage and Trocar hernia. The average hospital stay of patients was 2.1 days. The cosmetic effect was remarkable during follow-up. Conclusion: The transumbilical single-port laparoscopic cholecystectomy with totally free umbilical ring by conventional instruments should be widely carried out in hospitals at all levels because of its minimal postoperative pain, rapid recovery, hidden incision, low costs and low incidence of port-site hernia.

Risk factors of perioperative complications for posterior spinal fusion in degenerative scoliosis patients: a retrospective study

BackgroundsRare study has been conducted to detect risk factors of perioperative complications, which are closely related to preoperative status of the patients and surgical stress. The aim of this study is to detect these relationships in degenerative scoliosis (DS) patients.MethodsPerioperative complications of 226 cases with DS (56 males and 170 females; 65.5 ± 8.1 years old), who accepted posterior fusion in our hospital from January, 2013 to July, 2017, were retrospectively reviewed. Potential risk factors were first compared between patients with or without perioperative complications using student t test or Chi-squared test. Then, the unevenly distributed variables between the two groups were analyzed with binary logistic regression model.ResultsAll patients separately underwent decompression with short limited instrumentation (116, 51.3%) or with long instrumentation for correction (110, 48.7%). The mean operation duration (OD) was 216.9 ± 64.2 min and the average amount of bleeding was 587.4 ± 357.2 ml. 44 cases (19.5%)suffered from the complications during the perioperative phase, including incision complications (5.3%), urinary infection (3.5%), dura tears/cerebrospinal fluid (CSF) leakages (3.5%) and new neurological deficits (2.7%). Hospital stay was significantly extended for the complications (p < 0.001). Univariate analysis showed that OD (p < 0.001), bleeding (p = 0.014), American Standards Association (ASA) grade > 2 (p = 0.011) and RBC transfusion≥4 U(p = 0.028) were associated with these complications. Multivariate logistic regressions revealed that only ASA grade > 2(p = 0.011, Odds Ratio[OR] = 4.104, 95% Confidence Interval[CI] = 1.413~ 11.917) and OD (p = 0.013, OR = 2.697, 95% CI = 1.233~ 5.899) were the independent risk factors.ConclusionsThe high morbidity of perioperative complications for posterior spinal fusion would significantly extend hospital stay of DS patients. It was independently related to higher ASA grade and longer OD.

Clinical application of iFlow and perfusion blood volume imaging in preoperative embolization of hypervascular meningiomas

Objective To investigate the role of iFlow and PBV (perfusion blood volume) imaging in preoperative embolization of hypervascular meningiomas. Methods A total of 21 cases of hypervascular meningiomas were admitted to Department of Neurosurgery, Nanjing General Hospital of PLA from June 2015 to June 2017 and were retrospectively reviewed. All patients underwent digital subtraction angiography (DSA). The iFlow and PBV softwares were used for imaging post-processing to evaluate the blood supply of tumors. Among them the cases, classified as Manelfe type Ⅰ or type Ⅱ, underwent embolization, while the remaining cases, classified as Manelfe type Ⅲ did not undergo embolization. The tumor resection was performed 1-3 days post interventional therapy. Results The iFlow and PBV imaging in 21 patients showed that the blood supply was extremely rich in the tumors. Among them, 17 cases had no obvious arterial blood supply or staining within the tumor after selective vascular embolization, while the other 4 patients did not undergo embolization. The average amount of bleeding was 544±276 ml in the patients with embolization and 975±171 ml in those without embolization. The difference was statistically significant (P=0.008). Multiple linear regression analysis revealed that preoperative embolization was an independent factor in intraoperative blood loss (F=8.774, R2=0.316, P=0.008). All 21 cases achieved total excision (Simpson grade Ⅰ). None of the patients had serious complications associated with embolization or tumor resection. Conclusion The application of iFlow and PBV imaging helps to clearly show the blood supply of hypervascular meningiomas which could facilitate the decision making of preoperative embolization, improve the rate of total resection and reduce the incidence of complications. Key words: Meningioma; Embolization, therapeutic; Neurosurgical procedures; Blood flow images of color full cycle; Perfusion blood volume

What is the fracture displacement influence to fracture non-union in intramedullary nail treatment in subtrochanteric fracture?

IntroductionThe fracture displacement in intramedullary nail in femoral subtrochanteric fracture may cause fracture non-union. We retrospectively analysed our recent experience to clear the influence about fracture displacement in intramedullary nail in femoral subtrochanteric fracture. Materials and methodsThis study includes 36 patients in the intramedullary nail group followed up for more than 12 months; these patients suffered from femoral subtrochanteric fracture from 2009.1–2014.12 in our hospital. The operation time, amount of bleeding, length of hospital stay, fracture healing time, Harris function score of hip joint, fracture displacement, TAD and postoperative complications were summarized. ResultsThe average follow up time was 20.2 months, average operation time was 126 min, average amount of bleeding was 258 ml, average hospitalization was 13.1 days, average fracture healing time was 6.8 months, average fracture displacement was 1.23 cm, average TAD was 19.7 mm and average hip Harris function score was 82.5 points. Five cases suffered non-union. Only the fracture displacement degree made significant correlation with fracture non-union. All union patients had a fracture displacement less than 2.2 cm and all non-union patients had a fracture displacement more than 2.5 cm. ConclusionIntramedullary nail treatment must focus on fracture reduction and recovery of femoral medial support with assisted incision technique or closed cerclage wire technique when necessary. In our opinions, only the fracture displacement degree made significant correlation with bone non-union and all cases achieved bone union when it less than 2.2 cm according to our statistics. But it still need further research to find out the displacement of fracture fragments could be tolerant.

Using laparoscopic double hemicircumferential running single-layer suture in hepaticojejunostomy for choledochal cysts in children

BackgroundTo evaluate the feasibility and effectiveness of implementing a double-hemicircumferential running suture in laparoscopic hepaticojejunostomy for choledochal cysts (CDC) in children. MethodsFrom October 2001 to October 2009, we performed Roux-en-Y hepaticojejunostomy for 218 patients with congenital choledochal cyst. The choledochal cysts were excised laparoscopically. The jejunal Roux loop was fashioned extracorporeally by using hand-suturing technique. Laparoscopic “double-hemicircumferential” end to side anastomosis between the common hepatic duct stump and Roux loop was carried out. Early postoperative and follow-up results were analysed. ResultsDouble-hemicircumferential running suture was conducted for hepaticojejunostomy on 218 patients with choledochal cyst. The mean anastomosis time was 13.5±2.5min, and average bleeding amount was 9.1±6.1ml. The average postoperative hospital stay time was 7.4±2.4days. The median follow-up period was 122months. Morbidities associated with anastomosis, such as anastomotic stenosis, cholangitis, and stone formations do not occurred during follow-up period. ConclusionsThe double-hemicircumferential running suture technique has the advantages of easy to operate in laparoscopy, saving time and less complications, thus it is an effective improvement of hepaticojejunostomy for choledochal cyst.

Comparison of effects of nasal endoscopic adenoid body excision and conventional adenoid body shaving in the treatment of adenoid hypertrophy

Objective To compare the effect of adenoidectomy with adenoidectomy under nasal endoscope in the treatment of adenoid hypertrophy. Methods 120 cases with adenoid hypertrophy were selected as the research subjects.The patients were randomly divided into two groups by random number table, and the control group(n=60) was treated with routine adenoidectomy.The surgical treatment of the observation group(n=60) was performed under nasal endoscope.Surgical treatment, surgery related indicators(operative time, the average amount of bleeding, hospitalization time and the incidence of postoperative complications) were compared between the two groups.Before and after operation, acoustic rhinometry examination of nasopharynx was used to detect the smallest cross-sectional area and compared. Results In the observation group, the operation time, the average amount of bleeding, hospitalization time and incidence rate of postoperative complication were (5.32±2.05)min, (51.05±8.26)mL, (8.50±2.50)d, 15.00%, respectively, which in the control group were (8.56±2.68)min, (78.45±10.15)mL, (12.00±3.50)d, 36.67%, respectively, there were significant differences between the two groups(t=7.44, 15.98, 6.30, χ2=7.35, all P<0.05).12 months after surgery, the nasal minimal cross-sectional area of nasal pharynx in the observation group was (1.99±0.51)cm2, which of the control group was (1.81±0.48)cm2, there was significant difference between the two groups(t=3.99, P<0.05). Conclusion Compared with conventional adenoidectomy, endoscopic adenoidectomy in the treatment of adenoid hypertrophy has good clinical curative effect, less bleeding, shorter operative time and less postoperative complications and other advantages, it is worthy of promotion. Key words: Adenoidal hypertrophy; Adenoidectomy; Endoscopy; Child