Efficacy Of Different Surgical Methods Research Articles

The effect of the ratio of aneurysm sac diameter to patient age on the long-term efficacy of different surgical methods for infrarenal abdominal aortic aneurysm

Objective: To investigate the effect of the ratio of the maximum diameter of aneurysm sac to age (R) on the long-term efficacy of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in patients with infrarenal abdominal aortic aneurysm (IAAA). Methods: This is a retrospective cohort study.The clinical data of 317 patients with IAAA who underwent surgical repair in the Department of Vascular Surgery,the Third Affiliated Hospital of Sun Yat-Sen University from January 2016 to October 2022 were retrospectively collected.There were 266 males and 51 females,aged (69.7±8.3) years (range:37 to 87 years).The R value of the patient was calculated and the receiver operating characteristic(ROC) curve was used to establish a model to calculate the optimal cut-off value.The propensity score matching method was used to match the baseline data of patients in the EVAR and OSR group by 3∶1 (the caliper value was 0.05),and the patients were stratified according to the cutoff value of R,and the postoperative efficacy and survival of the patients were analyzed.The primary endpoint was the total mortality rate,and the secondary endpoints included the occurrence of postoperative complications and reintervention.Pearson χ2 or Fisher 's exact test was used for categorical variables,and t test was used for continuous variables to compare differences between groups.The survival curves of the two groups were described by Kaplan-Meier method. Results: After propensity score matching,198 cases were in the EVAR group and 66 cases were in the OSR group.The ROC model showed that the best cut-off value of R value was 0.90,and the two groups were divided into two layers:R<0.90 and R≥0.90.Among them,112 patients with R<0.90 (84 cases of EVAR,28 cases of OSR);there were 152 patients with R≥0.90 (114 cases of EVAR and 38 cases of OSR).The follow-up time was (23.6±1.6) months (range:1 to 70 months).In the R≥0.90 stratification,the total mortality (26.3% vs.5.3%,P<0.05),complication rate (44.7% vs.26.3%,P<0.05), and secondary intervention rate (31.6% vs.13.2%,P<0.05) in the EVAR group were higher than those in the OSR group.In the R<0.90 stratification,there was no significant difference in the total mortality rate (13.1% vs.10.7%,P<0.05),complication rate (28.6% vs.35.7%,P>0.05) and secondary intervention rate (14.3% vs.21.4%, P>0.05) between the two groups. Conclusions: When R≥0.90 in IAAA patients,OSR maybe more beneficial to patients in terms of survival rate,postoperative complication rate and secondary intervention rate than EVAR.When R<0.90,there are no significant differences in survival rate,complication rate and secondary intervention rate between the two surgical methods.

Efficacy of various surgical methods in the treatment of allergic rhinitis: A network meta-analysis.

We often use surgery to treat allergic rhinitis (AR) patients who have failed drug treatment, but there is currently no clear gold standard for the treatment of allergic rhinitis. Using network meta-analysis, we evaluated the efficacy of different surgical methods in the treatment of AR. PubMed, Embase, The Cochrane Library, Web of Science, CBM, Wan Fang Data, and CNKI databases were searched to collect clinical randomized controlled trials of AR with different surgical methods that met the inclusion criteria. After two investigators independently screened literature, extracted data, and assessed the risk of bias of included studies, R software was used to evaluate inconsistency using the node splitting method, and Stata15.1 was used to estimate the ranking probability of treatment. A total of 47 randomized control studies involving 17 surgical schemes and 4144 participants were included. The results showed that after excluding surgical methods that did not form a closed loop, in AR patients without chronic rhinosinusitis and nasal polyps, surgical efficiency and symptom score ranked the same, which were posterior nasal neurectomy (PNN), Vidian neurectomy (VN), anterior ethmoid neurectomy (AEN), nasal septal reconstruction (NSR), and bilateral inferior turbinoplasty (BIT). In AR patients with chronic rhinosinusitis with nasal polyps, the effective rate (OR = 5.06; 95% CI = 2.75-9.32) and symptom and sign scores (MD = -3.80; 95% CI = -6.50-1.09) of PNN + FESS (functional endoscopic sinusitis surgery) were higher than FESS, and there was a significant difference. Our findings suggest that PNN is the best single operation for patients with AR and without chronic rhinosinusitis and nasal polyps, and the combination of multiple procedures may be better than a single operation. FESS + PNN is more effectual in AR patients with chronic rhinosinusitis with nasal polyps.

Comparative efficacy of eight therapeutic methods in the treatment of left main coronary artery disease: a Bayesian network meta-analysis protocol

IntroductionAs for coronary artery bypass grafting, although there are many direct comparative studies on different minimally invasive methods and traditional thoracotomy (off-pump/on-pump), there is still a lack of further ranking...

Comparative Analysis of the Comprehensive Efficacy of Different Surgical Methods in the Treatment of Senile Cataract

Comparative Analysis of the Comprehensive Efficacy of Different Surgical Methods in the Treatment of Senile Cataract

Follow-up outcomes of different bypass surgical modalities for adults with ischaemic-type moyamoya disease

Purpose The preferred surgical method for treating adults with moyamoya disease (MMD) remains controversial. The purpose of this study was to compare the efficacy of different surgical methods in the treatment of adults with ischaemic-type MMD. Methods We retrospectively analyzed the data of patients with ischaemic-type MMD who underwent indirect bypass (IB), direct bypass (DB), or combined bypass (CB) at the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2019. Postoperative complications, improvements in neurological function, haemodynamics, recurrent stroke and neovascularization were compared. Results A total of 310 adults (371 hemispheres) with ischaemic-type MMD were included in our study. Ninety, 127, and 154 hemispheres underwent IB, DB and CB, respectively. A total of 24 (6.5%) ischaemic events and 8 (2.8%) symptomatic hyperperfusion events occurred after the operations. There was no significant difference in postoperative complications among the three types of surgery (p = 0.300). During the follow-up period, there were 21 cases (5.7%) of recurrent ischaemia and 12 cases (3.2%) of recurrent haemorrhage. Kaplan-Meier survival analysis showed that the ischaemia-free survival of the CB group was significantly longer than that of the IB group (p = 0.047), but there was no significant difference in haemorrhage-free survival among the three groups (p = 0.660). Six months after the operation, DB and CB were superior to IB in improving cerebral blood flow and neovascularization (p = 0.002), but there was no significant difference in the improvement of neurological function among the three groups at the last follow-up (p = 0.784). Conclusion The three surgical methods achieved satisfactory results in the treatment of ischaemic-type MMD. DB and CB can significantly improve haemodynamics and reduce recurrent stroke. In terms of improving neurological function, the curative effect of the three surgical methods remains to be further explored.

Feasibility analysis of different surgical methods for uterine cesarean section scar diverticulum.

This study analyses the effects of surgical indicators and clinical efficacy of different surgical methods for uterine cesarean section scar diverticulum. This retrospective cohort study included 65 patients who underwent surgery and postoperative follow-up at Gansu Provincial Maternity and Child-care Hospital from 1 January 2013 to 31 February 2019. All participants were treated surgically. Among them, patients in Group A underwent combined laparoscopic and hysteroscopic surgery (n = 45), Group B underwent transvaginal surgery (n = 11), Group C underwent laparotomy (n = 9). The primary outcomes were surgical indicators. The secondary outcomes were clinical efficacy. Bleeding, operation time and hospitalization expenses were significantly different among the three groups (P < 0.05). There was no difference in the hospital stay among the three groups P = 0.22). The menstrual period before and after surgery was significantly different among the groups (P < 0.05). The recurrence outcome was no significantly different (P = 0.16), but the pregnancy outcome was not (P = 0.78). The three surgical methods are effective for treating cesarean section scar diverticulum with favorable effects. Laparoscopic combined with hysteroscopic surgery is minimally invasive with less bleeding compared with the other two techniques and it is easier for patients to accept. It is the most widely used surgical method.

Relationship of endplate changes and low back pain after discectomy

ObjectivesDiscectomy is a conventional surgery for lumbar disc herniation. However, recurrence and residual back pain are the main postoperative complications. The contribution of endplate changes to the occurrence of these complications remains controversial. This study aimed to investigate the effect of endplate changes after discectomy. Patients and MethodsWe conducted a retrospective evaluation of 128 patients who had endplate changes after undergoing discectomy in our hospital. The patients were divided into three groups according to severity of abnormality according the Weishaupt classification (mild, moderate, and severe). The Oswestry Disability Index (ODI) and visual analog scale (VAS) were used to evaluate the efficacy of different surgical methods. ResultsSeventeen patients dropped out of the follow-up study. Satisfactory efficacy was observed in most patients, but 16 patients underwent reoperation. Significant differences were observed among the three groups in terms of low back pain severity and ODI (p < 0.05), but not radicular leg pain severity. The severe group had a higher recurrence rate of disc herniation (23.5%) than the mild and moderate groups (10.3% and 10.4%, respectively). ConclusionDiscectomy had a noticeable efficacy. However, severe endplate changes, which indicated fissures on the endplate, damaged the lumbar stability and resulted in a higher recurrence rate and residual back pain. For such cases, internal fixation surgery should be considered.

Clinical efficacy of different surgical methods in the treatment of cholecystolithiasis combined with choledocholithiasis and its effect on immune function

Objective To compare the clinical efficacy of different surgical methods in the treatment of cholecystolithiasis combined with choledocholithiasis, and its effect on immune function. Methods From December 2009 to February 2017, 93 patients with cholecystolithiasis combined with choledocholithiasis in Rongjun Hospital and the First Hospital of Jiaxing, were divided into the observation group and the control group according to random number table method.The observation group(47 cases) was given laparoscope combined surgery, and the control group(46 cases) was given conventional laparotomy surgery.The immune function, pain condition, complete stone clearance rate and analgesics use rate of the two groups were compared. Results After treatment, the CD4+ /CD8+ , CD4+ , CD8+ , CD3+ in the observation group were (1.39±0.36), (40.12±8.70)%, (22.62±2.22)%, (56.77±3.47)%, respectively, which were significantly lower than those in the control group[(1.70±0.40), (46.00±9.00)%, (25.00±2.11)%, (60.00±4.40)%], and the differences were statistically significant (t=3.93, 3.20, 5.30, 3.93, all P<0.05). The use rate of analgesics in the observation group (4.26%) was significantly lower than that in the control group (21.74%) (χ2=6.32, P<0.05). The complete stone clearance rate of the observation group(95.74%) was significantly higher than that of the control group (80.43%)(χ2=5.22, P<0.05). After treatment for 3d, 7d, 14d, the VAS scores of the observation group were (3.60±1.20)points, (2.57±1.60)points, (0.60±0.06)points, respectively, which were significantly lower than those of the control group[(5.20±2.22)points, (4.12±2.30)points, (2.77±1.30)points], and the differences were statistically significant (t=4.31, 3.77, 11.31, all P<0.05). Conclusion For the patients with cholecystolithiasis combined with choledocholithiasis, laparoscope combined surgery has better clinical efficacy, it can significantly improve the patients’ immune function and reduce pain. Key words: Cholecystolithiasis; Choledocholithiasis; Cholecystectomy, laparoscopic; Cholecystectomy; T-lymphocyte subsets

Clinical efficacy of different surgical methods for treatment of displaced femoral neck fracture in elderly patients

Objective To investigate the clinical effect of internal fixation(IF) and total hip replacement (HA) for treatment of displaced femoral neck fracture in elderly patients. Methods Sixty-three cases with femoral neck fracture hospitalized in Chaoyang Central Hospital from January 2010 to January 2015 were selected as research subjects and were divided into IF group (33 cases) and HA group (30 cases) according to the different treatment methods.The patients in IF group were treated with internal fixation and the patients in HA group were treated with hip replacement.The duration of operation, intraoperative blood loss, length of hospital stay, incidence of postoperative complication and reoperation rate in both groups were recorded.The hip function was evaluated by Harris score, and the hip function of the two groups was compared in 1 year, 2 years after operation. Results Compared with HA group, the patients in IF group had shorter operation time, less intraoperative blood loss and shorter hospitalization time ((0.8±0.3) h vs.(1.7±0.2) h; (110.9±9.9) ml vs.(587.2±35.7) ml; (16.4±2.0) d vs.(24.8±3.7)d), the differences among the two groups were statistically significant (P=0.041, 0.000, 0.038). Th incidence of long term postoperative complication was 27.3% (9/33) in IF group and was 10.0% (3/30) in HA group.The reoperation rate was 24.2% (8/33) in IF group and was 6.7%(2/30) in HA group.The differences between the two groups were statistically significant (P=0.045, 0.039). The excellent and good rates of hip joint function in HA group after 1 and 2 years after operation were 83.3% and 80.0%, and 63.6% and 57.6% in IF group in 1 and 2 years after operation respectively.The differences between the two groups were statistically significant (P=0.043, 0.042). Conclusion Internal fixation and hip replacement in the treatment of displaced femoral neck fractures in the elderly effect have their own advantages and disadvantages.Internal fixation has the advantages of less trauma, less blood loss and rapid recovery, but the long-term complications and reoperation rates are higher than those in HA.The long-term clinical effect of HA for the treatment of femoral neck fracture in elderly patients is better than that of internal fixation and it is worthy of clinical promotion. Key words: Femoral Neck Fracture; Elderly Patients; Hip Replacement; Internal Fixation; Complication; Hip Joint Function

Research on the trend of the decrease of human chorionic gonadotropin in the treatment of cesarean scar pregnancy by different surgical treatments

To explore the clinical effect of different surgical methods in the treatment of cesarean scar pregnancy, the decline trend of human chorionic gonadotropin (hCG) and the indications of different treatment methods. This study was a prospective cohort study. The clinical data of 120 patients with cesarean scar pregnancy who were treated with four different surgical methods in the Beijing Obstetrics and Gynecology Hospital from June 2013 to December 2014 were collected. Seven cases ultrasonic curettage, 63 cases uterine arterial embolization (UAE) with hysteroscopic pregnancy embryo removal surgery, 41 cases UAE + B-ultrasound or laparoscopic monitoring hysteroscopic pregnancy embryo clearance surgery and 9 cases UAE + hysteroscopic and laparoscopic removal of pregnancy scar and uterine repair. The clinical efficacy of different surgical methods and the decrease trend of serum HCG in postoperative period were analyzed. (1)The levels of serum beta hCG in patients with cesarean scar pregnancy after different surgical treatments decreased (84.5±9.7)%, (97.7±3.2)% and (99.6±1.2)% after the 2 days, 7 days and 14 days respectively. The average time of blood beta hCG level dropped to normal was (22.4±6.7) d. (2)There was a significant difference in the amount of bleeding and the time of hospitalization among the patients treated with different surgical methods. (3)There was a significant difference in the analysis of the decline percentage rate of serum beta hCG under the interactive effect between different surgical methods and postoperative recovery time (P<0.01). The level of serum beta hCG in patients with cesarean scar pregnancy were reduced to normal range after 3 weeks of operation. The choice of surgical approach should be based on the degree of implantation of embryo sac scar, the thinnest muscle thickness, local blood flow, serum beta hCG levels, gestational sac size, process to the bladder and fertility desire to determine.

Surgical treatment of popliteal cyst: a systematic review and meta-analysis.

BackgroundThis systematic review and meta-analysis of the clinical efficacy of different surgical methods in the therapy of popliteal cysts may provide evidence about effective surgical treatments.MethodsPubMed, EMBASE, and OVID were searched with the following terms: (popliteal cyst* OR baker’s cyst*) AND (arthroscopic OR excision OR operative OR treat* OR surgery). Inclusion criteria included the following: studies reported the efficacy of different surgical methods in popliteal cyst patients; patients were ≥16 years; and studies must have involved a minimum of 10 patients. Studies were grouped according to the surgical methods, and a meta-analysis was employed to identify the success rate based on the pooled data.ResultsA total of 11 studies were included: The communication between the cyst and the articular cavity was enlarged in 7 studies; this communication was closed in 3 studies; and only intra-articular lesions were managed in 1 study. After the data were pooled, the success rates were 96.7 and 84.6 % in the communication-enlargement group and communication-closure group, respectively. Studies with communication enlargement were subgrouped into the cyst wall resection group and the non-cyst wall resection group, for which the success rates were 98.2 and 94.7 %, respectively.ConclusionsBased on the current available evidence, at present, any how arthroscopic excision of the cyst wall, arthroscopic management of intra-articular lesions, and enlarging the communication between the cyst and the articular cavity is an ideal strategy for the popliteal cyst. The current literature on the treatment of popliteal cysts is limited to retrospective case series. Future prospective studies with high-quality methodology and uniform scoring system are required to directly compare communication-enlargement surgery and communication-closure surgery and determine the optimal treatment of popliteal cysts. Cyst wall resection may improve the therapeutic efficacy, to draw definitive conclusions, and high-level clinical researches with a large number of patients and long-term follow-up should be initiated.

The efficacy of different surgical methods for secondary macular epiretinal membrane

Objective To observe the efficacy of different surgical methods for secondary macular epiretinal membrane(SEM). Methods Clinical data of 52 eyes of 52 cases with SEM who underwent surgical treatment were retrospectively analysed. Patients in group A (26 eyes) underwent pars plana vitrectomy+ membrane peeling + intravitreal injection of luncentis(0.5 mg/ 0.05 ml) .Patients in group B (26 eyes) underwent pars plana vitrectomy+ membrane peeling + fluid-air exchange + C3F8(20%) gas tamponade. Postoperative changes in best corrected visual acuity (BCVA), macular morphology and the complications were observed. Results The follow-up time was 4-14 months. In group A, the BCVA improved in 20 eyes after the operation, it was unchanged in 5 eyes and decreased in 1 eye, the post-operative BCVA improved comparing with the preoperative one (t=4.125, P=0.00035). In group B, the BCVA improved in 18 eyes after the operation, unchanged in 6 eyes and decreased in 2 eyes, the post-operative BCVA improved comparing with the preoperative one(t=3.817, P=0.00052). The difference in vision improvement between the two groups was not statistically significant(z=0.661, P=0.24). The thickness of neuroepithelium in the central macular area ( CMT) was statistically improved after the surgery in both the two groups. But the improvement of CMT was faster in group A. In group A, small amount of retinal hemorrhage happened in 6 eyes during the surgery, and vitreous hemorrhage occurred in 1 eye after the surgery. Prepheral retinal hole occurred in 3 eyes , in which one eye was cured by laser treatment, and the other two eyes needed secondary surgery. In group B, small amount of retinal hemorrhage happened in 8 eyes during the surgery, and vitreous hemorrhage occurred in 4 eyes after the surgery. Prepheral retinal hole occurred in 3 eyes, and were cured in all 3 eyes by laser treatment. Epiretinal membrane(EM)was seen in 2 eyes during follow-up time in group B, which ocurred after vitreous hemorrhage absorption. Conclusion Both the two kinds of operation can cure SEM effectively. The surgical method of group A can improve the CMT faster, reduce the risk of vitreous hemorrhage and epiretinal membrane recurrence. The surgical method of group B can cure the tractional retinal hole effectively. Key words: Macular epiretinal membrane, secondary; Surgery; Thickness, neuroepithelium, central macular area; Complications

Comparison on the efficacy of different surgical methods for rhegmatogenous retinal detachment with high risk of proliferative vitretinopathy

Objective To compare the clinical efficacy of using pars plana vitreoretinal surgery (PPVR) combined with scleral encircling operation and PPVR alone in patients of rhegmatogenous retinal detachment with high risk of postoperative proliferative vitreoretinopathy (PVR). Methods A retrospective study.Seventy-four eyes of 74 patients of rhegmatogenous retinal detachment with high risk of PVR were collected including retinal detachment more than two quadrants, retinal tears range more than 1 clock, preoperative PVR, or vitreous hemorrhage.The patients were randomly divided into two groups: 23 G PPVR alone group (36 cases)and PPVR combined with scleral encircling groups (38 cases). The conditions of patients in two groups were similar.The follow-up time was more than 3 months.The reattachment rates by single surgery between two groups were compared. Results The reattachment rate by single surgery in combined surgery group was 78.95%which was significantly higher than 44.44% in PPVR alone group (F=0.026, P=0.025). Conclusion For patients with high risk of PVR, PPV combined with scleral encircling has higher success rate of anatomical reattachment compared with PPV alone. Key words: Retinal detachment, rhegmatogenous; Vitreoretinal surgery; Scleral encircling

Surgical treatment for pelvic organs prolapse

Aim. To estimate and compare the features and efficacy of different surgical methods of pelvic organ prolapse correction. Methods. 120 patients with stage 4 of pelvis organ prolapse were included in the study. The different types of surgical procedures were performed («Manchester» surgery, vaginal hysterectomy, sacropexy, laparoscopic ventrosuspension). Surgical method was selected accounting the patient’s age, desire to save the uterus, presence of uterine or adnexal pathology and concomitant diseases. For long-term outcomes evaluation, patients were followed up for 6-36 month after surgery. Results. The long-term outcomes of the different types of surgeries performed in patients with stage 4 of pelvis organ prolapse were comparable. Minimal surgery time, blood loss and the hospital stay were registered in patients, in whom laparoscopic ventrosuspension combined with colpoperineorrhaphy and levatorplasty was performed, compared to «Manchester» surgery, vaginal hysterectomy and sacropexy with colpoperineoplasty. No cases of serious complications were registered. Patients with stress incontinence observed before surgery reported improvement in urination, although 6 patients (10%) still reported rare episodes of incontinence. Conclusion. In elderly patients with stage 4 of pelvis organ prolapse, laparoscopic ventrosuspension of uterus or vaginal stump with further colpoperineorrhaphy and levatorplasty could be performed; this type of surgery is technically simple, not time-consuming, and it’s results are comparable with the effectiveness of sacropexia. Thus, it could be recommended to under-trained young surgeons.

The clinical study of the optimalization of surgical treatment and the traditional Chinese medicine intervention on palmar hyperhidrosis.

To analyze the efficacy of different surgical methods in treating palmar hyperhidrosis and the compensatory hyperhidrosis after surgery and to observe the efficacy of "Energy-boosting and Yin-nourishing anti-perspirant formula" on postsurgical hyperhidrosis patients. Two-hundred patients were randomly assigned to groups A (Chinese and Western medicine, T4 transection plus "Energy-boosting and Yin-nourishing anti-perspirant formula") and B (Western medicine, T4 transection). The surgical efficiency, recurrence rate, compensatory hyperhidrosis, and the long-term life quality were compared. Another 100 cases (group C, T2 transection) were analyzed as a control group. After surgery, the palmar hyperhidrosis and armpit sweating were relieved in all the three group patients and in 34 % of patients combined with plantar hyperhidrosis, the symptoms were relieved. Transient palmar hyperhidrosis was found in three cases at day 2 to day 5 postoperatively. One case of Horner's syndrome and one case recurrence were found in group C patients. The compensatory sweating of various degrees occurred in all the three groups. There were 25, 24, and 43 cases in groups A, B, and C, respectively. There is a significant difference between groups C, A, and B. The compensatory sweating in 13 cases of group A and four cases of group B had different degrees of improvement in the follow-up 6 months after surgery. There is a significant difference. Thoracoscopic bilateral T4 sympathetic chain and the Kuntz resection are the optimized surgical treatments for the palmar hyperhidrosis. "Energy-boosting and Yin-nourishing anti-perspirant formula" is effective in treating the postoperative compensatory sweating.

Comparison of different methods in the management of posterior segment intraocular foreign body

Objective To compare the clinical efficacy of different surgical methods in the management of posterior segment intraocular foreign body (IOFB),which include IOFBs are removed through wall of eyeball (from scleral wound,scleral incision or pars plana) or IOFBs are removed by vitrectomy (from pars plana or limbus).Methods The medical records of 62 cases (62 eyes) of posterior segment IOFB were retrospectively analyzed.Results Follow up was 6 ～ 12 months.In all cases,the IOFBs were removed in one surgery.Nine cases underwent removal of IOFBs through the wall of eyeball,2 cases of which from scleral wound,3 cases of which from scleral incision,4 cases of which from pars plana.In these 9 cases,visual acuities increased in 8 eyes and decreased in one eye which caused by retinal detachment and treated by vitrectomy.The IOFBs are removed by vitrectomy in 53 cases,22 cases of which from pars plana and 31 cases of which from limbus.In these 53 cases,visual acuities increased in 45 eyes,were no change in 6 eyes and decreased in 2 eyes which caused by ocular atrophy and treated by enucleation.Conclusion The posterior segment IOFBs can be removed by different surgical methods which depends on the size and location of IOFBs.Correct choice of surgical methods can restore the anatomic structure of eyeball and avoid the surgical complications. Key words: Body, foreign, intraocular; Removal; Methods, different

Treatment Strategy for Combined Carotid Artery Stenosis and Coronary Artery Disease: Staged or Simultaneous Surgical Procedure?

Patients with combined carotid and coronary arterial diseases pose a high risk of cerebrovascular events, and the treatment of choice with either a simultaneous or a staged surgical procedure remains controversial. The literature of combined carotid and coronary arterial diseases of a recent decade in English was retrieved. Totally 41,901 patients undergoing simultaneous or staged carotid and coronary procedures from 53 reports were included. As a result, carotid endarterectomy plus coronary artery bypass remained the most commonly used procedure for the intervention of combined carotid artery stenosis and coronary artery disease, and was associated with higher incidences of perioperative transient ischemic attack, stroke and hospital mortality, but with less perioperative myocardial infarction comparing with the staged procedures. Patients with a simultaneous carotid endarterectomy and coronary artery bypass were generally related more to an advanced atherosclerotic coronary artery disease, so that a pure comparison between the two strategies was not always possible. To compare the efficacy of different surgical methods for combined carotid and coronary arterial diseases is of pronounced importance. The new hybrid approach consisting of the simultaneous carotid artery stenting and subsequent on-pump coronary artery bypass can be a safe approach, with the aim to reduce the surgical trauma as compared to surgical procedures, and to reduce the risk of myocardial infarction in the interval period required for the staged operations. Thus, for patients with combined carotid artery stenosis and coronary artery disease, the simultaneous surgical procedure, rather than the staged procedure, is recommended.

Surgical methods for first trimester termination of pregnancy.

Different surgical methods for termination of pregnancy have evolved over the years: Dilatation and curettage, power operated vacuum aspiration, manual vacuum aspiration (MVA) or hysterotomy. Local or general anaesthesia is used for all methods. Preabortion medical or mechanical cervical preparation may reduce the incidence of cervical or uterine injuries. To compare the safety and efficacy of different surgical methods for first trimester abortion. The Cochrane Controlled Trials Register has been searched. A search of the reference lists of identified trials was performed. An additional MEDLINE search was done using the Internet search service Pub Med. Randomised controlled trials comparing different surgical methods for first trimester abortion were eligible. Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Three trials were included, resulting in 2 comparisons: vacuum aspiration versus dilatation and curettage and flexible versus rigid vacuum aspiration cannula. Results are reported as odds ratio for dichotomous data and weighted mean differences for continuous data. There were no reports of maternal deaths and cases of uterine perforation in the trials identified. Vacuum aspiration versus dilatation and curettage: There were no statistically significant differences for excessive blood loss, blood transfusion, febrile morbidity, incomplete or repeat uterine evacuation procedure, re-hospitalisation, post operative abdominal pain or therapeutic antibiotic use. Duration of operation was statistically significantly shorter with vacuum aspiration compared to D&C in both gestational age subgroups : < 9 weeks: weighted mean difference (WMD) -1.84 minutes, 95% confidence interval (CI) [-2.542,-1.138]; =/> 9 weeks: WMD -0.600 minutes, 95% CI [-1.166,-0.034]). Flexible versus rigid vacuum aspiration cannula: There were no statistically significant differences with regard to cervical injuries, febrile morbidity, blood transfusion, therapeutic antibiotic use, or incomplete or repeat uterine evacuation procedure. The included studies do not indicate a preference of providers for one or the other method. The trials included are small and lack power to to present meaningful differences for rare outcomes between the groups. outcomes such as women's satisfaction, the need for pain relief or surgeons preference for the instrument have been inadequately addressed. No data outcomes, such as fertility after surgical abortion, are available.