BACKGROUND Subarachnoid-pleural fistula(SPF)is a complex and rare condition characterized by a pathological shunt between the subarachnoid and pleural spaces.It can lead to the accumulation of cerebrospinal fluid(CSF)...BACKGROUND Subarachnoid-pleural fistula(SPF)is a complex and rare condition characterized by a pathological shunt between the subarachnoid and pleural spaces.It can lead to the accumulation of cerebrospinal fluid(CSF)in the pleural space,pneumocephalus,and the development of central nervous system infection.Trauma or thoracic spinal surgery are common causes of SPF,with symptoms including postural headache,consciousness status changes,and dyspnea.The combination of SPF and subdural hygroma is a severe and rare condition,with little existing literature on its clinical correlation.CASE SUMMARY We report a case of an 83-year-old male patient with traumatic SPF and bilateral frontal subdural hygroma following a fall from height.The patient initially presented with severe lower back and buttock pain.During admission,the patient developed worsening lower limb weakness and pleural effusion.Further investigation revealed the presence of subdural hygromas with mass effect,requiring emergency bilateral subdural drainage.A multidisciplinary approach was undertaken to manage this complex condition,including intervention for hypovolemic CSF status and subdural hygroma management.The pleural effusion eventually resolved and the patient attained a higher level of con-sciousness after bilateral hygroma drainage surgery.We also reviewed the present literature relating to this rare combination of medical conditions.CONCLUSION Traumatic SPF with subsequent subdural hygroma is a rare but serious combination.Although the optimal treatment strategy for this complex condition remains uncertain,our literature review suggested that a multidisciplinary approach,including intervention for hypovolemic CSF and management of the subdural hygroma,is the most beneficial.展开更多
Double-walled orbital fractures involving the floor and medial wall are commonly encountered in instances of significant midface trauma.Operative intervention is indicated in the presence of persistent diplopia,signif...Double-walled orbital fractures involving the floor and medial wall are commonly encountered in instances of significant midface trauma.Operative intervention is indicated in the presence of persistent diplopia,significant enophthalmos,or muscle entrapment.Surgical repair of these injuries may be challenging due to large fracture sizes or loss of bony supports.The transconjunctival and transcaruncular approaches have been popularized to reconstruct isolated floor and medial wall fractures,respectively.However,surgical approaches for fractures involving both these walls have not been well described in the literature.In this technical note,we detail a combined transcaruncular-transconjunctival approach that is safe,effective,and aesthetically sensitive.展开更多
Currently in lower blepharoplasty, the transconjunctival approach indication has been limited to young patients without skin excess and prominence of bags;in our practice this access has become the preferred technique...Currently in lower blepharoplasty, the transconjunctival approach indication has been limited to young patients without skin excess and prominence of bags;in our practice this access has become the preferred technique in most of our cases because it is simpler, faster, prevents bad scarring, produces less orbicularis muscle trauma, and decreases postoperative edema and possible retractions (ectropion) in patients with decreased lower palpebral tone. Objective: To identify important concepts when deciding this approach. Material and Methods: Retrospective review of 177 patients who underwent lower blepharoplasty by a single surgical group. Regarding techniques, the transconjunctival approach was selected in 42% of patients while the transcutaneous technique was preferred in 58%. Results: A lower rate of complications was observed by the transconjunctival approach, with greater patient satisfaction. Conclusions: In our experience, due to its simplicity and less traumatic effect on the patient, the transconjunctival approach is an ideal technique, except in cases where there is lower eyelid weakness and surgical resolution is needed.展开更多
The swinging eyelid procedure is a versatile technique to approach orbital and periorbital surgical fields with less visible scar. Although mainly used in orbital surgeries, this procedure can also be used to expose t...The swinging eyelid procedure is a versatile technique to approach orbital and periorbital surgical fields with less visible scar. Although mainly used in orbital surgeries, this procedure can also be used to expose the zygomatic arch and periorbital areas. The swinging eyelid procedure, therefore, enables appropriate reduction of zygomaticomalar fracture under direct visualization. We used this technique for a 27 years old man with a displaced zygomaticomalar fracture that pushed on the lateral rectus muscle. Good functional and cosmetic results were obtained postoperatively without ocular motility impairment.展开更多
Objective: To prevent unnecessary laparotomies by evaluating the effectiveness of conservative approach in abdominal trauma cases due to drilling-cutting instruments.Methods: Demographic data, effected region of the b...Objective: To prevent unnecessary laparotomies by evaluating the effectiveness of conservative approach in abdominal trauma cases due to drilling-cutting instruments.Methods: Demographic data, effected region of the body, additional findings of trauma, hemodynamic parameters, duration of admission, diagnostic methods and treatment modalities were retrospectively evaluated in 217 cases with abdominal injury (lower thoracic region, abdominal wall and back) among 1128 victims with drilling-cutting instrument injuries between January 1, 2012 and December 31, 2017. The conservative approach was based on physical examination, hemogram follow-up and hemodynamic evaluation.Results: Totally 177 (81.6%) cases of 217 patients were followed conservatively while 25 cases were operated at early (1-8 hours) and 15 were operated at late (9-48 hours) periods. Two patients who underwent surgery in the early period and two patients who underwent surgery in the late period were accepted as negative laparotomy while 1 patient in the late operated group was regarded as non-therapeutic laparotomy. Diagnostic laparoscopy was performed in 81 cases. Complications developed in 7 patients who were operated in the early period and 10 patients who were operated in the late period. The mean hospital stay period was 5.3 days (1-33) in all cases, 4.5 days (2-20) in conservative treatment group and 8.4 days (3-33) in the operated patients;and the difference was statistically significant.Conclusions: Detailed physical examination, accurate assessment and effective use of different diagnostic methods reduce the frequency of negative and non-therapeutic laparotomies in abdominal stab wound injuries.展开更多
文摘BACKGROUND Subarachnoid-pleural fistula(SPF)is a complex and rare condition characterized by a pathological shunt between the subarachnoid and pleural spaces.It can lead to the accumulation of cerebrospinal fluid(CSF)in the pleural space,pneumocephalus,and the development of central nervous system infection.Trauma or thoracic spinal surgery are common causes of SPF,with symptoms including postural headache,consciousness status changes,and dyspnea.The combination of SPF and subdural hygroma is a severe and rare condition,with little existing literature on its clinical correlation.CASE SUMMARY We report a case of an 83-year-old male patient with traumatic SPF and bilateral frontal subdural hygroma following a fall from height.The patient initially presented with severe lower back and buttock pain.During admission,the patient developed worsening lower limb weakness and pleural effusion.Further investigation revealed the presence of subdural hygromas with mass effect,requiring emergency bilateral subdural drainage.A multidisciplinary approach was undertaken to manage this complex condition,including intervention for hypovolemic CSF status and subdural hygroma management.The pleural effusion eventually resolved and the patient attained a higher level of con-sciousness after bilateral hygroma drainage surgery.We also reviewed the present literature relating to this rare combination of medical conditions.CONCLUSION Traumatic SPF with subsequent subdural hygroma is a rare but serious combination.Although the optimal treatment strategy for this complex condition remains uncertain,our literature review suggested that a multidisciplinary approach,including intervention for hypovolemic CSF and management of the subdural hygroma,is the most beneficial.
文摘Double-walled orbital fractures involving the floor and medial wall are commonly encountered in instances of significant midface trauma.Operative intervention is indicated in the presence of persistent diplopia,significant enophthalmos,or muscle entrapment.Surgical repair of these injuries may be challenging due to large fracture sizes or loss of bony supports.The transconjunctival and transcaruncular approaches have been popularized to reconstruct isolated floor and medial wall fractures,respectively.However,surgical approaches for fractures involving both these walls have not been well described in the literature.In this technical note,we detail a combined transcaruncular-transconjunctival approach that is safe,effective,and aesthetically sensitive.
文摘Currently in lower blepharoplasty, the transconjunctival approach indication has been limited to young patients without skin excess and prominence of bags;in our practice this access has become the preferred technique in most of our cases because it is simpler, faster, prevents bad scarring, produces less orbicularis muscle trauma, and decreases postoperative edema and possible retractions (ectropion) in patients with decreased lower palpebral tone. Objective: To identify important concepts when deciding this approach. Material and Methods: Retrospective review of 177 patients who underwent lower blepharoplasty by a single surgical group. Regarding techniques, the transconjunctival approach was selected in 42% of patients while the transcutaneous technique was preferred in 58%. Results: A lower rate of complications was observed by the transconjunctival approach, with greater patient satisfaction. Conclusions: In our experience, due to its simplicity and less traumatic effect on the patient, the transconjunctival approach is an ideal technique, except in cases where there is lower eyelid weakness and surgical resolution is needed.
文摘The swinging eyelid procedure is a versatile technique to approach orbital and periorbital surgical fields with less visible scar. Although mainly used in orbital surgeries, this procedure can also be used to expose the zygomatic arch and periorbital areas. The swinging eyelid procedure, therefore, enables appropriate reduction of zygomaticomalar fracture under direct visualization. We used this technique for a 27 years old man with a displaced zygomaticomalar fracture that pushed on the lateral rectus muscle. Good functional and cosmetic results were obtained postoperatively without ocular motility impairment.
文摘Objective: To prevent unnecessary laparotomies by evaluating the effectiveness of conservative approach in abdominal trauma cases due to drilling-cutting instruments.Methods: Demographic data, effected region of the body, additional findings of trauma, hemodynamic parameters, duration of admission, diagnostic methods and treatment modalities were retrospectively evaluated in 217 cases with abdominal injury (lower thoracic region, abdominal wall and back) among 1128 victims with drilling-cutting instrument injuries between January 1, 2012 and December 31, 2017. The conservative approach was based on physical examination, hemogram follow-up and hemodynamic evaluation.Results: Totally 177 (81.6%) cases of 217 patients were followed conservatively while 25 cases were operated at early (1-8 hours) and 15 were operated at late (9-48 hours) periods. Two patients who underwent surgery in the early period and two patients who underwent surgery in the late period were accepted as negative laparotomy while 1 patient in the late operated group was regarded as non-therapeutic laparotomy. Diagnostic laparoscopy was performed in 81 cases. Complications developed in 7 patients who were operated in the early period and 10 patients who were operated in the late period. The mean hospital stay period was 5.3 days (1-33) in all cases, 4.5 days (2-20) in conservative treatment group and 8.4 days (3-33) in the operated patients;and the difference was statistically significant.Conclusions: Detailed physical examination, accurate assessment and effective use of different diagnostic methods reduce the frequency of negative and non-therapeutic laparotomies in abdominal stab wound injuries.
