ObjectiveTo summarize the research progress of osteonecrosis of femoral head (ONFH) following femoral intertrochanteric fractures in adults.MethodsRelevant literature at home and abroad was extensively reviewed to summarize the pathogenesis, high-risk factors, and treatment of ONFH after femoral intertrochanteric fracture in adults.ResultsONFH after femoral intertrochanteric fracture mostly occurs within 2 years after operation, with a lower incidence. At present, it is believed that comminuted and large displacement fractures caused by high-energy injuries, fracture line close to the base of neck, excessive external rotation deformity, improper intramedullary nail entry points, and rough intraoperative manipulating may injury the deep branch of the medial circumflex femoral artery, causing ONFH. Hip replacement is the main treatment for necrosis, which can achieve good results.ConclusionAddressing the above risks, excessive external rotation, overstretching, and rough manipulating should be avoided. Anatomical reduction should be performed during the operation, the nail entry point should be accurate and avoid repeated drilling and thermally bone necrosis.
ObjectiveTo explore the risk factors of recurrence of incisional hernia following incisional hernia tension-free repair.
MethodsThe clinical data of 162 patients with incisional hernia underwent tension-free repair were retrospectively analyzed in this hospital from January 2005 to January 2011. The relationships of incisional hernia recur-rence to gender, age, body mass index, hernia size, abdominal wall defect site, preoperative chronic comorbidities, type of tension-free repair, operation time, and wound healing disorders were analyzed by univariate and multivariate analysis.
ResultsOne hundred and sixty-two patients were followed up 7-70 months with mean 34.5 months. The rate of recur-rence following incisional hernia tension-free repair was 9.26% (15/162). The results of univariate analysis showed that recurrence following incisional hernia tension-free repair was associated with the age (P < 0.05), body mass index (P < 0.05), type of tension-free repair (P < 0.05), hernia size (P < 0.05), and wound healing disorders (P < 0.05). The results of multivariate logistic regression revealed that the body mass index, type of tension-free repair, hernia size, and wound healing disorders were the independent risk factors associated with recurrence following incisional hernia tension-free repair. Fifteen recurrent patients were reperformed successfully. There was no recurrence following up with an average 23 months.
ConclusionsIt is necessary to become familiar with the risk factors for recurrence of incisional hernia in order to eliminate or decrease their effects on the positive outcome of incisional herniorrhaphy. The patients with fat, hernia ring bigger, incorrect opera-tion or wound healing disorders might be easy to relapse. Surgical approach should be individualized for recurrence.
Objective To observe the high-risk histopathological feature (HRF) and their correlation with prognosis in children with intraocular retinoblastoma (RB) in the intraocular stage after failed eye-preserving treatment and enucleation surgery. MethodsA single-center retrospective case study. From August 2018 to January 2023, 64 children (64 eyes) with advanced intraocular RB who were diagnosed in Department of Ophthalmology of Beijing Children's Hospital and underwent enucleation surgery after failed eye-preserving treatment were included in the study. The median follow-up time was 51 months. The gender of the children patients, the age of visit and enucleation, International Intraocular Retinoblastoma Classification (IIRC), the initial chemotherapy regimen (hereinafter referred to as "chemotherapy"), the time of enucleation surgery, pathological results, post-enucleation treatment methods and prognosis were collected. The Mann-Whitney U test was used for comparison between groups. Survival analysis was performed using the Kaplan-Meier method, and the log-rank test was used for comparison between groups. ResultsAmong 64 cases and 64 eyes, 37 were male and 27 were female. The age of seeking medical treatment was 20 (11-31) months. The age at which the surgery was performed was 29 (16-40) months. The number of eyes in IIRC stage D and E was 16 and 48 respectively. The initial chemotherapy regimens simply applied (hereinafter referred to as "alone") intravenous systemic chemotherapy (IVC) and ophthalmic artery infusion chemotherapy (IAC) in 40 cases and 11 cases, 13 cases of IVC+IAC. All patients with positive HRF received systemic adjuvant chemotherapy after surgery. There were 37 eyes (57.8%, 37/64) positive for HRF. There was no statistically significant difference in the positive rate of HRF between children in IIRC stage D and stage E (χ2=0.021, P=0.884). Among the 37 eyes with HRF, the numbers of eyes with extensive choroidal invasion, posterior lamina cribrosa optic nerve invasion, scleral invasion and optic nerve stump involvement were 17 (45.9%, 17/37), 16 (43.2%, 16/37), 3 (8.1%, 3/37) and 3 (8.1%, 3/37), respectively. During the follow-up period, there were 5 cases (7.8%, 5/64) of extraocular metastasis of the tumor and death, all of which were stage E and had HRF. Among them, the initial treatment plan was IAC for 4 cases, one case of IVC. The survival rates of children among the IVC, IAC or IVC+IAC regimens were 97.5% (39/40), 63.6% (7/11), and 100.0% (13/13), respectively. The comparison of survival rates among different chemotherapy regimens showed statistically significant differences (χ2=14.233, P＜0.001). The results of survival analysis showed that the cumulative survival rate of those with extensive choroidal invasion, posterior lamina cribrosa optic nerve infiltration, and those who received IAC was significantly lower than that of those without extensive choroidal invasion, posterior lamina cribrosa optic nerve infiltration, and those who received IVC+IAC and IVC (P＜0.05). ConclusionsEye-preserving treatment for children with advanced intraocular RB may increase the positive rate of HRF and the risk of extraocular metastasis. The IVC+IAC eye-protecting treatment plan can improve the survival rate of children.
【摘要】 目的 探討腹部非胃、十二指腸手術后胃癱綜合征（postoperative gastroparesis syndrome，PGS）發生的高危因素。 方法 回顧分析2004年9月-2010年3月2 559例腹部非胃、十二指腸術后患者的臨床資料，將患者分為PGS組和非PGS組，其中PGS組23例，非PGS組2 536例。 結果 比較PGS組和非PGS組間年齡、性別、術后開始進食時間、手術持續時間、是否為腫瘤晚期、有無貧血低蛋白血癥、既往有無腹部手術史、術后早期有無營養支持等因素，χ2值分別為:19.687、0.018、0.346、48.243、21.801、16.803、24.679、0.870，P值分別是:lt;0.01、gt;0.05、gt;0.05、lt;0.01、lt;0.01、lt;0.01、lt;0.01、gt;0.05。 結論 年齡gt;65歲、手術持續時間gt;4 h、腫瘤晚期、既往有腹部手術史及貧血低蛋白血癥是腹部非胃、十二指腸手術后PGS發生的高危因素。【Abstract】 Objective To analyze the risk factors of postoperative gastroparesis syndrome (PGS) after non-gastroduodenal abdominal surgery. Methods We retrospectively analyzed the clinical data of 2 559 patients who underwent non-gastroduodenal abdominal surgeries in our hospital between September 2004 and March 2010. We divided them into the PGS group with 23 patients and the non-PGS group with 2 536 patients. Results By comparing the age, the gender, the starting time of eating after surgery, the duration of surgery, whether the patients had advanced cancer, whether anemia or hypoproteinemia existed, whether the patients had a history of previous abdominal surgery, and whether nutritional support was provided early after operation between the PGS group and the non-PGS group, we found that the chi-square value was 19.687, 0.018, 0.346, 48.243, 21.801, 16.803, 24.679, 0.870 and the P value waslt;0.01, gt;0.05, gt;0.05, lt;0.01, lt;0.01, lt;0.01, lt;0.01, gt;0.05 respectively. Conclusion Over 65 years of age, the duration of surgery over four hours, advanced cancer, the history of previous abdominal surgery and anemia or hypoproteinemia are the risk factors of PGS after non-gastroduodenal abdominal surgery.
ObjectiveTo explore risk factors of pneumonia of patients after esophagectomy and its preventive measures.
MethodsClinical data of 258 patients undergoing esophagectomy in Guangyuan Central Hospital between 2009 and 2012 were retrospectively analyzed. According to whether they had pneumonia after esophagectomy, all the 258 patients were divided into 2 groups. In the pneumonia group, there were 86 patients including 62 males and 24 females with their age of 65.1 (45-84)years, who all had pneumonia after esophagectomy. In the control group, there were 172 patients including 124 males and 48 females with their age of 60.2 (43-78)years, who didn't have pneumonia after esophagectomy. Preoperative pulmonary function, age, smoking history, anastomotic location, intraoperative blood loss, pneumonia and other perioperative complications were compared between the 2 groups. Multivariate logistic regression was performed to analyze risk factors of pneumonia after esophagectomy.
ResultsUnivariate analysis showed that incidences of moderate or severe pulmonary dysfunction, smoking history (≥400 cigarettes per year), old age (≥65 years), laryngeal recurrent nerve injury, perioperative blood loss (≥1 000 ml), operation time longer than 4 hours, and preoperative diabetes mellitus of the pneumonia group were significantly higher than those of the control group (P < 0.05). Multivariate logistic regression analysis showed that moderate or severe pulmonary dysfunction (P=0.022), smoking history (≥400 cigarettes per year, P=0.000), old age (≥65 years, P=0.026), laryngeal recurrent nerve injury (P=0.002), and perioperative blood loss (≥1000 ml, P=0.020)were main risk factors of pneumonia after esophagectomy.
ConclusionsModerate or severe pulmonary dysfunction, smoking history (≥400 cigarettes per year), old age (≥65 years), laryngeal recurrent nerve injury and perioperative blood loss (≥1 000 ml)are main risk factors of pneumonia after esophagectomy. Preoperative smoking cessation, pulmonary function exercise, airway preparation, careful hemostasis, and avoidance of laryngeal recurrent nerve injury are helpful to prevent pneumonia after esophagectomy.
Objective To identify the high risk factors related to postpartum suicide. Methods A total of 40 women with postpartum depression who had suicidal act or ideation were included in the study. They were evaluated by the Edinburgh Postpartum Depression Scale (EPDS), the Life Events Scale (LES) and the Social Support Rate Scale (SSRS), and compared with healthy postpartum women. The multi-element gradual regression analysis was performed to identify the high risk factors. Results Such factors as prior history of depression, negative life events within the previous half year, absence of social support, disease of mothers or infants, and conjugal relationship were significantly correlated with postpartum suicide. Conclusion It might be helpful to reduce the incidence of postpartum suicide by prenatal mental intervention and postpartum crisis intervention.
