Intraoperative awake anesthesia applied for tumor excision in cerebral functional areas

Objective:To observe the feasibility and safety of awake anesthesia for tumor excisions in pa- tients with brain tumors involving cerebral functional areas.Methods:Fifty patients with brain tumors in- volving cerebral functional areas,ASAⅠ-Ⅱgrade,were enrolled in this study.Propofol and remifentanil were used for total intravenous anesthesia,and a laryngeal mask airway(LMA)was inserted for the air- way opening and synchronized intermittent mandatory ventilation(SIMV).At the surgeon's request for an intraoperative wake-up test,the propofol infusion was stopped advance of 10-15 min,the remifentanil in- fusion rate was decreased to 0.050-0.075μg/kg from 0.10-0.20μg/kg per min for easing surgical pain. The LMA was removed until the patient awakened.The anesthesiologist then kept up an on-going neuro- logical examination.After that,anesthesia was re-deepened and LMA was re-inserted until the whole surgery was accomplished.Results:Forty-six of 50 patients(92%)were successfully awakened and 4 (8%)failed to complete the intraoperative wake-up test because of dyspnea,over-sedation,or severe hy pertension.No severe complications occurred during the whole process.Conclusions:During the awake anesthetic period,the intraoperative wake-up test combined with navigation,evoked potential and ultra- sound techniques can help surgeons excise maximumly and precisely the brain tumors near to or in the functional areas.

腹壁硬纤维瘤的治疗

探讨自体阔筋膜移植或结合腹直肌前鞘翻转成形加自体阔筋膜移植，在修复硬纤维瘤切除后腹壁大缺损的作用。方法：在大腿外侧面作平行的二个皮肤纵形切口，皮下潜行分离后用切割器切除阔筋膜，并进行0．5厘米重叠的褥式缝合修补缺损。腹直肌前鞘翻转成形可补充修补巨大缺损。结果：11例直径大于3厘米的硬纤维瘤切除后，5例直接缝合腹壁缺损的有3例局部肿瘤复发，而6例用自体阔筋膜修补的无一例复发。结论：扩大腹壁硬纤维瘤的切除是防止局部复发的有效手段，而自体阔筋膜修补腹壁缺损为扩大切除肿瘤提供安全保证。

Balloon overtube-guided colorectal endoscopic submucosal dissection

AIM:To evaluate the usefulness of a balloon overtube to assist colorectal endoscopic submucosal dissection(ESD)using a gastroscope.METHODS:The results of 45 consecutive patients who underwent colorectal ESD were analyzed in a single tertiary endoscopy center.In preoperative evaluation of access to the lesion,difficulties were experienced in the positioning and stabilization of a gastroscope in 15 patients who were thus assigned to the balloonguided ESD group.A balloon overtube was placed with a gastroscope to provide an endoscopic channel to the lesion in cases with preoperatively identified difficulties related to accessibility.Colorectal ESD was performed following standard procedures.A submucosal fluid bleb was created with hyaluronic acid solution.A circumferential mucosal incision was made to marginate the lesion.The isolated lesion was finally excised from the deeper layers with repetitive electrosurgical dissections with needle knives.The success of colorectal ESD,procedural feasibility,and procedure-related complications were the main outcomes and measurements.RESULTS:The overall en bloc excision rate of colorectal ESD during this study at our institution was 95.6%.En bloc excision of the lesion was successfully achieved in 13 of the 15 patients(86.7%)in the balloon overtube-guided colorectal ESD group,which was comparable to the results of the standard ESD group with better accessibility to the lesion(30/30,100%,not statistically significant).CONCLUSION:Use of a balloon overtube can improve access to the lesion and facilitate scope manipulation for colorectal ESD.

Bioreactance-guided fluid therapy for excision of a giant brain tumor in an infant under general anesthesia:A case report and literature review

Pediatric patients are more likely to suffer from brain tumors.Surgical resection is often the optimal treatment.Perioperative management of pediatric brain tumor resection brings great challenges to anesthesiologists,especially for fluid therapy.In this case,the infant-patient was only 69-day-old,weighed 6 kg,but she was facing a gaint brain tumor(7.9 cm×8.1 cm×6.7 cm)excision.The infant was at great risks such as hemorrhagic shock,cerebral edema,pulmonary edema,congestive heart failure,coagulation dysfunction,etc.However,we tried to use the parameters obtained by bioreactance-based NICOM^(■)device(Cheetah Medical)to guide the infant’s intraoperative fluid therapy,and successfully avoided these complications and achieved a good prognosis.

Reconstruction of eyelid defects using the diplene adhesive membrane

Background The abundance of closely packed vital structures in the periocular and palpebral regions makes resection and subsequent reconstructive interventions extremely difficult.Methods In this novel article,we described a method for closing lower eyelid defects after tumor excision using a skin-muscle flap from the upper eyelid along with the use of an adhesive diplene biodegradable membrane.The membrane was used for seamless fixation of the flap and to prevent the development of lower eyelid deformity.Results The case presented herein demonstrated that using diplene adhesive biodegradable membranes has excellent functional and aesthetic results.Conclusion Our findings suggest that an adhesive biodegradable diplene membrane can be used for the reconstruction of the lower eyelid to prevent the occurrence of retraction,for the surgical treatment of ectropion including recurrent cases,and for seamless fixation of flaps to wound surfaces in patients with a tendency to form keloids and hypertrophic scars.

超声引导真空辅助旋切与局部扩大切除治疗乳腺良性叶状肿瘤的疗效比较

目的比较超声引导真空辅助旋切术(vacuum-assisted excisional biopsy,VAB)与传统局部扩大切除术(wide local excision,WLE)治疗3 cm以下乳腺良性叶状肿瘤(phyllodes tumor,PT)的疗效。方法回顾性分析2014年7月~2020年3月94例乳腺良性叶状肿瘤资料,其中VAB组22例,WLE组72例。结果94例均顺利完成手术,共切除叶状肿瘤103枚,超声均确认病灶完全切除,无术中并发症。排除9例伴不典型增生及3例伴原位癌,VAB组19例中位随访47个月(14~80个月),局部复发率15.8%(3/19);WLE组63例中位随访33个月(12~80个月),局部复发率11.1%(7/63)。2组局部复发率差异无统计学意义(log-rankχ^(2)=0.214,P=0.644)。WLE组切缘阴性者局部复发率为9.4%(3/32),切缘阳性者为12.9%(4/31),差异无统计学意义(χ^(2)=0.002,P=0.964)。结论超声引导VAB治疗乳腺良性叶状肿瘤安全有效。