Microstructural morphology and visual acuity outcome in eyes with epiretinal membrane before,during,and after membrane peeling in intraoperative optical coherence tomography assisted macular surgery

AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity(BCVA)outcome and postoperative CMT development.METHODS:A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed.Videos with intraoperative optical coherence tomography(OCT)were recorded.Difference of intraoperative CMT before,during,and after peeling was measured.Pre-and postoperatively obtained BCVA and spectral-domain OCT images were analyzed.RESULTS:Mean age of the patients was 70±8.13y(range 46-86y).Mean baseline BCVA was 0.49±0.27 log MAR(range 0.1-1.3).Three and six months postoperatively the mean BCVA was 0.36±0.25(P=0.01 vs baseline)and 0.38±0.35(P=0.08 vs baseline)log MAR respectively.Mean stretch of the macula during surgery was 29%from baseline(range 2%-159%).Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery(r=-0.06,P=0.72).However,extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis(r=-0.43,P<0.01)and 1 mm nasal and temporal from the fovea(r=-0.37,P=0.02 and r=-0.50,P<0.01 respectively)3mo postoperatively.CONCLUSION:The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness,though there is no correlation with visual acuity development within the first 6mo postoperatively.

Surgical treatment of severe anterior capsular organized hard core cataract: A case report

BACKGROUND Complicated cataract surgery is challenging,especially in cases of hard nuclear cataract with severe anterior capsule organization.It is important to avoid the risk of surgery and improve the surgical skills of surgeons.CASE SUMMARY A 60-year-old man presented with severe cataract and visual impairment.The anterior capsule of the lens was irregularly organized and pulled to the surrounding capsule,and white porcelain organized cord and brown-black lens nucleus were clearly visible.In phacoemulsification,maintaining the anterior capsule round and intact plays a key role in a successful surgery.In this case,if the conventional capsule treatment method was used,the anterior capsule would be torn.Therefore,we adopted a segmented anterior capsule treatment method,and a blasting method to release energy when dealing with the lens nucleus,and achieved good surgical results.CONCLUSION Complicated cataract surgery is challenging and requires precise skills.Operation plans should be made reasonably to predict the risk of surgery,and improve the visual quality of the patients.

The causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenomas surgery

Objective To analyze the causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenoma surgery. Methods Retrospective study of 260 cases of microscopic transsphenoidal surgery and 274 cases of endoscopic surgery for resection of the pituitary adenomas was performed. CSF leak occurred

Viscocanalostomy combined with trabeculotomy and mitomycin C in the treatment of primary congenital glaucoma

AIM： To evaluate the long-term outcome of viscocanalostomy combined with trabeculotomy and mitomycin C in the treatment of primary congenital glaucoma. METHODS： This is a retrospective study. Forty-two eyes of 26 patients with primary congenital glaucoma were enrolled, Intraocular pressure （lOP）, corneal diameter （mm） and cup/disc （C/D） were measured before and after the surgery respectively. Follow-up period was 30mo. RESULTS： The mean preoperative lOP was 30.6：1：7.35 mm Hg. Of the 42 eyes, 2 eyes were required conversion to trabeculectomy for the absence of Schlemm＇s canal. Of remained 40 eyes, 38 eyes （95%） achieved successful lOP control. The average postoperative lOP was 11.69±4.18 mm Hg at 12mo. The mean reduction was 18.91 mm Hg （P〈0.00Ol）. Eighteen （75%） eyes presented a reduction in corneal diameter, and 25 （62.5%） eyes presented a C/D ratio reversal after the surgery. There was no serious complication in any patients over the follow-up period. CONCLUSION： Viscocanalostomy combined with trabeculotomy and mitomycin C is useful in the management of primary congenital glaucoma,

Short-term outcomes of laparoscopic total mesorectal excision compared to open surgery

AIM:To investigate the short-term outcome of laparoscopic total mesorectal excision(TME) in patients with mid and low rectal cancers.METHODS:A consecutive series of 138 patients with middle and low rectal cancer were randomly assigned to either the laparoscopic TME(LTME) group or the open TME(OTME) group between September 2008 and July 2011 at the Department of Colorectal Cancer of Shanghai Cancer Center,Fudan University and pathological data,as well as surgical technique were reviewed retrospectively.Short-term clinical and oncological outcome were compared in these two groups.Patients were followed in the outpatient clinic 2 wk after the surgery and then every 3 mo in the first year if no adjuvant chemoradiation was indicated.Statistical analysis was performed using SPSS 13.0 software.RESULTS:Sixty-seven patients were treated with LTME and 71 patients were treated with OTME(sex ratio 1.3:1vs 1.29:1,age 58.4 ± 13.6 years vs 59.6 ± 9.4 years,respectively).The resection was considered curative in all cases.The sphincter-preserving rate was 65.7%(44/67) vs 60.6%(43/71),P = 0.046;mean blood loss was 86.9 ± 37.6 mL vs 119.1 ± 32.7 mL,P = 0.018;postoperative analgesia was 2.1 ± 0.6 d vs 3.9 ± 1.8 d,P = 0.008;duration of urinary drainage was 4.7 ± 1.8 d vs 6.9 ± 3.4 d,P = 0.016,respectively.The conversion rate was 2.99%.The complication rate,circumferential margin involvement,distal margins and lymph node yield were similar for both procedures.No port site recurrence,anastomotic recurrence or mortality was observed during a median follow-up period of 21 mo(range:9-56 mo).CONCLUSION:Laparoscopic TME is safe and feasible,with an oncological adequacy comparable to the open approach.Further studies with more patients and longer follow-up are needed to confirm the present results.

Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females

BACKGROUND Internal rectal prolapse(IRP)is one of the most common causes of obstructive constipation.The incidence of IRP in women is approximately three times that in men.IRP is mainly treated by surgery,which can be divided into two categories:Abdominal procedures and perineal procedures.This study offers a better procedure for the treatment of IRP.AIM To compare the clinical efficacy of laparoscopic integral pelvic floor/ligament repair(IPFLR)combined with a procedure for prolapse and hemorrhoids(PPH)and the laparoscopic IPFLR alone in the treatment of IRP in women.METHODS This study collected the clinical data of 130 female patients with IRP who underwent surgery from January 2012 to October 2014.The patients were divided into groups A and B.Group A had 63 patients who underwent laparoscopic IPFLR alone,and group B had 67 patients who underwent the laparoscopic IPFLR combined with PPH.The degree of internal rectal prolapse(DIRP),Wexner constipation scale(WCS)score,Wexner incontinence scale(WIS)score,and Gastrointestinal Quality of Life Index(GIQLI)score were compared between groups and within groups before surgery and 6 mo and 2 years after surgery.RESULTS All laparoscopic surgeries were successful.The general information,number of bowel movements before surgery,DIRP,GIQLI score,WIS score,and WCS score before surgery were not significantly different between the two groups(all P>0.05).The WCS score,WIS score,GIQLI score,and DIRP in each group 6 mo,and 2 years after surgery were significantly better than before surgery(P<0.001).In group A,the DIRP and WCS score gradually improved from 6 mo to 2 years after surgery(P<0.001),and the GIQLI score progressively improved from 6 mo to 2 years after surgery(P<0.05).In group B,the DIRP,WCS score and WIS score significantly improved from 6 mo to 2 years after surgery(P<0.05),and the GIQLI score 2 years after surgery was significantly higher than that 6 mo after surgery(P<0.05).The WCS score,WIS score,GIQLI score,and DIRP of group B were significantly better than those of group A 6 mo and 2 years after surgery(all P<0.001,Bonferroni)except DIRP at 2 years after surgery.There was a significant difference in the recurrence rate of IRP between the two groups 6 mo after surgery(P=0.011).There was no significant difference in postoperative grade I-III complications between the two groups(P=0.822).CONCLUSION Integral theory–guided laparoscopic IPFLR combined with PPH has a higher cure rate and a better clinical efficacy than laparoscopic IPFLR alone.

Clinical trial of three treatment methods for pterygium

Objective:To study the effect of simple excision, amniotic membrane transplantation(AMT)and limbal-conjunctival autograft transplantation(LCAT)for treating pterygium. Methods: Forty-eight cases (48 eyes) with pterygium were randomly assigned to 3 groups:16 cases (16 eyes) with pterygium underwent simple excision (group A), 16 eyes underwent amniotic membrane transplantation (AMT) (group B), and 16 eyes with pterygia underwent limbal- conjunctival transplantation (group C).Results: With follow-up of 3 months to 25 months, 5 cases (31%) of pterygia in group A and 1 case (6.2%) of pterygia in group B showed recurrence. No patients in group C developed recurrence. Conclusion: The recurrent rate of pterygium after amniotic membrane transplantation and limbal-conjunctival autograft transplantation were much lower, but the latter was more simple, safe and no rejection .So limbal - conjunctival autograft transplantation is the best surgery method for pterygium.

SURGICAL TREATMENT OF METASTATIC SPINAL TUMOR

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WOUND INFECTION AFTER SCOLIOSIS SURGERY:AN ANALYSIS OF 15 CASES

OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.

Combined subfascial endoscopic perforator surgery and endovenous laser treatment without impact on the great saphenous vein for management of lower-extremity varicose veins

Background Conventional high ligation and stripping of the great saphenous vein （GSV） has a good curative effect but is highly traumatic with a considerable relapse rate. Subfascial endoscopic perforator surgery （SEPS） plus endovenous laser treatment （EVLT） could be applied as individual therapy. This study aimed to evaluate the feasibility of performing combined SEPS and EVLT without impacting GSV in the management of valvular insufficiency of the lower-limb venous perforators. Methods Placement of lower-limb venous perforator insufficiency was marked by ascending phlebography in 83 affected limbs from September 2010 to June 2011. After randomization, SEPS was performed on 41 limbs to address the insufficiency of the venous perforators under the deep fascia, in combination with EVLT to close the superficial varicose veins without impacting the GSV. The remaining 42 limbs were treated using traditional GSV phlebectomy as controls. Results Postoperatively, all varicose veins were resolved, with lightening of the pigmentation and healing of the ulcer. Within a follow-up period of 5-11 months, no symptoms had recurred. Compared with the control group, the operation time, the number of incisions sutured, and the in-hospital time decreased on average by 1.5 hours, 4.7, and 6.8 days, respectively （P 〈0.01 in all cases）. Conclusion Combined SEPS and EVLT for treatment of valvular insufficiency of the lower-limb venous perforators offer the advantages of microtrauma and rapid cure.

Classification and surgical management of benign biliary strictures

Objective:To summarizeandanalyzethecauses,typesandsurgicaltreatmentforbenignbiliarystrictures(BBS).Methods:A totalof568patientswithBBSwerediagnosedandtreatedat ourcenterfrom1975to1998.A-mongthem,352werefemalesandthemeanagewas48.5.Thetypesof biliarystricturewereproposedaccordingto theirsitesanddegrees.Thecausesof BBSwereanalyzedanddifferentprocedureswereperformedinrelationto the typesof strictures.Results:Inlineswiththeclassification,all568patientsweredividedinto6types,thatis, TypeⅠ,papillarystricture(n=71);TypeII or III,strictureof commonbileor hepaticductwithcommonhepatic ductlonger(n=79)or shorter(n=82)than2cm respectively;TypeIV,commonhepaticductabsencebutwithintactconfluence(n=35);TypeV,strictureof theconfluence(n=102);andTypeVI,strictureof leftor rightmainintrahepaticduct(n=199).Themajorcausesof BBS werelithiasis(54.58%),operativestrictures(44.96%)andpostoperativelyin-flammatorystrictures(2.28%).Of568patients,546underwentvariedoperations.In278followedpatients,excellent resultswereachievedin210(75.53%).Themortalityratewas1.69%(9patients).Theincidencerateof complica-tionswas14.29%(78patients).Conclusion:Thelithiasis,operativeandpostoperativeinflammatorystricturesare3majorcausesof BBS.Differentproceduresshouldbe usedaccordingto thedifferenttypesof BBS,andbilio-enteric anastomosisisthemostcommontreatmentforthecases.

Retrospective analysis of 67 consecutive cases of pure ovarian immature teratoma

To investigate the development regularity, treatment methods and prognosis of ovary immature teratoma (POIT) Methods Sixty seven patients with POIT, admitted from 1958 to 1998, were retrospectively analyzed There were 31 patients with stage Ⅰ, 4 with stage Ⅱ, 2 with stage Ⅲ and 1 with stage Ⅳ lesions Twenty seven patients had recurrences and 2 had distant metastases Unilateral adnexectomy was performed for stage Ⅰ lesions From the 1980s, this was followed by four cycles of combination chemotherapy (VAC, PVB or BEP×3 cycles) as post operative adjuvant therapy Combined chemotherapy and multiple operations were performed for advanced and recurrent lesions Results The overall survival rate was 75% (50/67) However, there was a remarkable difference in the results from the various periods From 1958 to 1983, the 5 year survival rate was 40% (6/15), and it was raised to 79% (26/33) from 1984 to 1993 In the period 1994 to 1998, 95% (18/19)of patients were rescued Thirty five patients who had early lesions (stage Ⅰ and Ⅱ) had a 5 year survival rate of 91 4% (32/35) Thirty two patients with recurrent or advanced lesions had a 5 years survival rate of 56% (18/32) There were 8 patients with grade Ⅲ tumors and their 5 year survival rate was only 25% (2/8) The chief prognostic factors for this disease are clinical stage, pathological grade and adequate treatment Conclusion POIT is a potentially curable disease in today’s practice It is characterized by the fact that recurrent tumors may be converted back to mature ones as time goes on With chemotherapy, these is a good opportunity to rescue those patients with recurrent tumors At present, treatment of POIT gives the most satisfactory results among all malignant ovarian germ cell tumor types Tests of serum specific tumor markers (CA19 9, AFP, CA125, CEA) performed preoperatively or before chemotherapy and during follow up have been found helpful in the evaluation of prognosis