Lung Injury Resulting from Fluted Silastic Soft Drain Extraction under Negative Pressure Suction

We experienced two cases of lung injury resulting from fluted silastic drain extraction under reservoir-generated negative pressure suction. In the first case, a 67-year-old man underwent coronary artery bypass grafting. A 19 Fr BLAKE drain was placed at the pericardial cavity, the mediastinum, and the left thoracic cavity. All three drains were connected to J-VAC reservoirs. After removing the drains (which maintained the negative pressure), subcutaneous emphysema and hemopneumothorax occur. A trocar catheter was inserted. Bleeding and the air leak terminated within a day. In the second case, a 73-year-old man underwent aortic valve replacement. Right pneumothorax occurred after the removal of the pleural cavity drain, which maintained the negative pressure generated by the reservoir. We inserted a trocar catheter, and the air leak terminated within a day. We hypothesized that the reservoir-generated negative pressure causes the pleura to enter the groove of the drain and become damaged during extraction. We stopped using a reservoir to connect to the fluted silastic drain placed at the pleural cavity and removed the negative pressure when extracting the pleural cavity drain. Since implementing this change, we have not experienced a similar lung injury in more than 500 cardiac surgery patients.

陶氏宣布将在中国推出适用于汽车涡轮增压管的新型SILASTIC^(TM)氟硅橡胶

位于浙江省余姚市的浙江峻和橡胶科技有限公司是首批使用新型SILASTIC^（TM）氟硅橡胶（FSR）的中国客户之一,其为标致雪铁龙（中国）公司生产汽油车用涡轮增压管。关于新型氟硅橡胶的报告陶氏高性能有机硅事业部有机硅弹性体大中华区高级技术服务经理石卿博士于7月12日在ATC举办的2018第二届汽车管路系统创新技术峰会上发表题为《陶氏氟硅橡胶用于涡轮增压管的解决方案》的主题报告。

Novel double-layer Silastic testicular prosthesis with controlled release of testosterone in vitro, and its effects on castrated rats

Testicular prostheses have been used to deal with anorchia for nearly 80 years. Here, we evaluated a novel testicular prosthesis that can controllably release hormones to maintain physiological levels of testosterone in vivo for a long time. Silastic testicular prostheses with controlled release of testosterone （STPT） with different dosages of testosterone undecanoate （TU） were prepared and implanted into castrated Sprague-Dawley rats. TU oil was applied by oral administration to a separate group of castrated rats. Castrated untreated and sham-operated groups were used as controls. Serum samples from every group were collected to measure the levels of testosterone （T）, follicle-stimulating hormone and luteinizing hormone （LH）. Maximum intracavernous penile pressure （ICPmax） was recorded. The prostates and seminal vesicles were weighed and subjected to histology, and a terminal dexynucleotidyl transferase-mediated UTP nick end labeling （TUNEL） assay was used to evaluate apoptosis. Our results revealed that the weights of these tissues and the levels of T and LH showed significant statistical differences in the oral administration and TU replacement groups compared with the castrated group （P 〈 0.05）. Compared with the sham-operated group, the ICPmax, histology and TUNEL staining for apoptosis, showed no significant differences in the hormone replacement groups implanted with medium and high doses of STPT. Our results suggested that this new STPT could release TU stably through its double semi-permeable membranes with excellent biocompatibility. The study provides a new approach for testosterone replacement therapy.

Development and clinical application of a new testicular prosthesis

A new type of testicular prosthesis made of silastic with an elliptical shape to mimic a normal testis was developed by our team and submitted for patenting in China. The prosthesis was produced in different sizes to imitate the normal testis of the patient. To investigate the effects and safety of the testicular prosthesis, 20 patients receiving testicular prosthesis implantation were recruited for this study. Follow-up after 6 months revealed no complications in the patients. All the patients answered that they were satisfied with their body image and the position of the implants, 19 patients were satisfied with the size and 16 patients were satisfied with the weight. These results show that the testicular prosthesis used in this study can meet patient＇s expectations. Patients undergoing orchiectomy should be offered the option to receive a testicular prosthesis implantation. The dimensions and weight of the available prosthetic implants should be further addressed to improve patient satisfaction.

Congenital Laryngeal Web: <br/>A Laryngology Rarity

Congenital laryngeal web is an otolaryngology rarity, which occurs due to incomplete recanalization of the larynx. We report a case of a 22 year-old patient who presented with a congenital anterior laryngeal web. We shall discuss the presentation, diagnosis, management and postoperative follow up of the case.

Prevention of laryngeal webs through endoscopic keel placement for bilateral vocal cord lesions

Transoral microresection for treatment of vocal cord lesions involving the anterior commissure may result in anterior glottic webs. In this study, we retrospectively reviewed 54 patients who underwent microsurgery for bilateral lesions involving the anterior commissure and categorized them into two groups. The keel placement and control groups received endoscopic keel placement and mitomycin C, respectively. During the follow-up of at least 1 year, the laryngeal web formation rate significantly decreased in the keel placement group compared with that in the control group （18.6% versus 54.5%, P 〈 0.05）. Furthermore, the voice handicap index-10 scores for patients without web formation decreased in both the keel placement and control groups （P 〈 0.0001 and P 〈 0.001, respectively）. A pseudomembrane covering the vocal cords was detected in 16.3% （7 of 43） cases after keel removal. A total of 100% （7 of 7） of these cases and 2.8% （1 of 36） of the other cases formed laryngeal webs （P 〈 0.0001）. Endoscopic keel placement could be an effective method for preventing anterior glottic webs after surgery for bilateral vocal cord diseases involving the anterior commissure. The pseudomembrane observed at the time of keel removal may imply a high risk of web formation.

Current concept in first metatarsophalangeal joint replacement

First metatarsophalangeal joint （MTPJ） degenerative diseases are not rare pathological changes in adult forefoot.1,2 It mainly includes hallux rigidus,hallux limitus and hallux valgus.3 Its progressive nature makes it hardly respond well to conservative treatment.4 Traditional surgical techniques,such as cheilectomy,Keller resection and arthrodesis are effective procedures but remain controversial due to none of them can achieve excellent results in all patients especially the end-stage conditions.5-7 Thus,great amount of efforts have been dedicated in MTPJ replacement despite many negative reports.This technique has aroused many controversies over the past decades due to its prematurity.Nevertheless,it has been improved in many aspects such as prosthesis material,design as well as surgical indications.This review would not only update the advancements and recognitions in recent years,but also presented the major disputed areas.