SILENT extra-adrenal retroperitoneal paragangliomas (PGLs) arise from dispersed paraganglias which tend to be symmetrically distributed in close relation to the aorta and sympatheticnervous system. They are rarely enc...SILENT extra-adrenal retroperitoneal paragangliomas (PGLs) arise from dispersed paraganglias which tend to be symmetrically distributed in close relation to the aorta and sympatheticnervous system. They are rarely encountered in everyday surgical practice.展开更多
The primary objective of this study is to assess the impact of a pharmacist-implemented protocol on number of post-operative alvimopan doses. The secondary objective of this study is to assess LOS （length of stay）, ...The primary objective of this study is to assess the impact of a pharmacist-implemented protocol on number of post-operative alvimopan doses. The secondary objective of this study is to assess LOS （length of stay）, in days, before and after protocol implementation. A retrospective chart review was conducted from October 2015 through March 2016 for all laparoscopic colorectal surgeries. Number of post-operative alvimopan doses received and LOS was recorded for each patient that received at least one dose of alvimopan. Comparative data, before protocol implementation, from November 2014 through June 2015 were analyzed against the study data. Number of post-operative alvimopan doses and LOS were recorded. The mean number of doses was 6.41 in the comparator group and 4.25 in the study group （probability size P 〈 0.001）, which did meet statistical significance. Although the secondary objective was not statistically significant, LOS slightly decreased as the mean LOS was 5.01 days in the comparator group versus 4.49 days in the study group （P = 0.256）. At the current price of $120 per capsule, close to $30,000 was saved during the study period, projecting an annual cost savings of approximately $68,000. Results from this study show that pharmacists can play a vital role in cost savings and ensuring appropriate use of certain high-risk medications, like alvimopan, without increasing overall length of stay.展开更多
Objective： To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures. Methods： A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation fro...Objective： To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures. Methods： A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to December 2005, including 11 patients with bony avulsion of the anterior cruciate ligament and 19 with meniscal injury. There were 4 cases of type Ⅰ fracture, 12 type Ⅱ, 9 type Ⅲ, 12 type Ⅳ and 2 type Ⅴ according to Schatzker criteria. Firstly, the combined injuries were treated. Then the plateau fractures with the displacement over 3 mm or more were reduced and fixed. Finally, the internal fixation was observed by X-ray equipment. Postoperative management was early motion and delayed weight bearing. Results： All the fractures healed in 3 or 4 months. All patients were followed up for 1 to 5 years after operation.No case had severe complications, such as poor wound healing, infection, osteofascial compartment syndrome and osteoarthfitis. According to the Rasmussen scoring system, 36 cases obtained excellent or good results and the other 3 cases had moderate clinical results. The average score was 26 ± 3. Conclusions： As an adjuvant treatment of intraarticular fractures such as tibial plateau fracture, arthroscopy has many advantages. It can treat associated intraarticular soft tissue components, visualize the chondral surface reduction, lavage the hematoma and smaller loose fragments, decrease soft tissue dissection, reduce the risk of scarring and promote rapid recovery.展开更多
Objective To observe the efficacy of mild moxibustion combined with arthroscopic meniscal repair in the treatment of meniscal injury and to explore its action mechanism.Methods Ninety-eight patients with meniscal inju...Objective To observe the efficacy of mild moxibustion combined with arthroscopic meniscal repair in the treatment of meniscal injury and to explore its action mechanism.Methods Ninety-eight patients with meniscal injury were divided into a surgery group and a moxibustion plus surgery group by the random number table method,with 49 cases in each group.Both groups received arthroscopic meniscal repair,and the moxibustion plus surgery group was treated with add-on mild moxibustion.The Lysholm score,visual analog scale(VAS)score,and mobility of the affected knee were measured before and after treatment,and transforming growth factor(TGF)-β1 and platelet-derived growth factor(PDGF)levels were measured in the fluid of the affected knee joint.The healing of the meniscus was recorded at a follow-up visit 3 months after the surgery.Results After treatment,the Lysholm score increased,the VAS score decreased in both groups,and the intra-group differences in both groups were statistically significant(P<0.05).The Lysholm score was higher in the moxibustion plus surgery group than in the surgery group,and the VAS score was lower in the moxibustion plus surgery group than in the surgery group.The differences between groups in both scores were statistically significant(P<0.05).The mobility of the affected knee joint increased in both groups(P<0.05),and it was greater in the moxibustion plus surgery group than in the surgery group(P<0.05).When compared with pretreatment,the levels of TGF-β1 and PDGF in the fluid of the knee joint increased in both groups(P<0.05),and the levels of TGF-β1 and PDGF in the fluid of the affected knee joint were higher in the moxibustion plus surgery group than in the surgery group(P<0.05).The healing of the meniscus in the moxibustion plus surgery group was significantly better than that in the surgery group at the follow-up visit 3 months after the surgery(P<0.05).Conclusion The effect of mild moxibustion combined with arthroscopic meniscal repair is better than the surgery alone in improving knee function,relieving pain,increasing mobility of the affected knee,and promoting meniscal healing,which may be related to the up-regulation of TGF-β1 and PDGF levels in the fluid of knee joint.展开更多
文摘SILENT extra-adrenal retroperitoneal paragangliomas (PGLs) arise from dispersed paraganglias which tend to be symmetrically distributed in close relation to the aorta and sympatheticnervous system. They are rarely encountered in everyday surgical practice.
文摘The primary objective of this study is to assess the impact of a pharmacist-implemented protocol on number of post-operative alvimopan doses. The secondary objective of this study is to assess LOS （length of stay）, in days, before and after protocol implementation. A retrospective chart review was conducted from October 2015 through March 2016 for all laparoscopic colorectal surgeries. Number of post-operative alvimopan doses received and LOS was recorded for each patient that received at least one dose of alvimopan. Comparative data, before protocol implementation, from November 2014 through June 2015 were analyzed against the study data. Number of post-operative alvimopan doses and LOS were recorded. The mean number of doses was 6.41 in the comparator group and 4.25 in the study group （probability size P 〈 0.001）, which did meet statistical significance. Although the secondary objective was not statistically significant, LOS slightly decreased as the mean LOS was 5.01 days in the comparator group versus 4.49 days in the study group （P = 0.256）. At the current price of $120 per capsule, close to $30,000 was saved during the study period, projecting an annual cost savings of approximately $68,000. Results from this study show that pharmacists can play a vital role in cost savings and ensuring appropriate use of certain high-risk medications, like alvimopan, without increasing overall length of stay.
文摘Objective： To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures. Methods： A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to December 2005, including 11 patients with bony avulsion of the anterior cruciate ligament and 19 with meniscal injury. There were 4 cases of type Ⅰ fracture, 12 type Ⅱ, 9 type Ⅲ, 12 type Ⅳ and 2 type Ⅴ according to Schatzker criteria. Firstly, the combined injuries were treated. Then the plateau fractures with the displacement over 3 mm or more were reduced and fixed. Finally, the internal fixation was observed by X-ray equipment. Postoperative management was early motion and delayed weight bearing. Results： All the fractures healed in 3 or 4 months. All patients were followed up for 1 to 5 years after operation.No case had severe complications, such as poor wound healing, infection, osteofascial compartment syndrome and osteoarthfitis. According to the Rasmussen scoring system, 36 cases obtained excellent or good results and the other 3 cases had moderate clinical results. The average score was 26 ± 3. Conclusions： As an adjuvant treatment of intraarticular fractures such as tibial plateau fracture, arthroscopy has many advantages. It can treat associated intraarticular soft tissue components, visualize the chondral surface reduction, lavage the hematoma and smaller loose fragments, decrease soft tissue dissection, reduce the risk of scarring and promote rapid recovery.
文摘Objective To observe the efficacy of mild moxibustion combined with arthroscopic meniscal repair in the treatment of meniscal injury and to explore its action mechanism.Methods Ninety-eight patients with meniscal injury were divided into a surgery group and a moxibustion plus surgery group by the random number table method,with 49 cases in each group.Both groups received arthroscopic meniscal repair,and the moxibustion plus surgery group was treated with add-on mild moxibustion.The Lysholm score,visual analog scale(VAS)score,and mobility of the affected knee were measured before and after treatment,and transforming growth factor(TGF)-β1 and platelet-derived growth factor(PDGF)levels were measured in the fluid of the affected knee joint.The healing of the meniscus was recorded at a follow-up visit 3 months after the surgery.Results After treatment,the Lysholm score increased,the VAS score decreased in both groups,and the intra-group differences in both groups were statistically significant(P<0.05).The Lysholm score was higher in the moxibustion plus surgery group than in the surgery group,and the VAS score was lower in the moxibustion plus surgery group than in the surgery group.The differences between groups in both scores were statistically significant(P<0.05).The mobility of the affected knee joint increased in both groups(P<0.05),and it was greater in the moxibustion plus surgery group than in the surgery group(P<0.05).When compared with pretreatment,the levels of TGF-β1 and PDGF in the fluid of the knee joint increased in both groups(P<0.05),and the levels of TGF-β1 and PDGF in the fluid of the affected knee joint were higher in the moxibustion plus surgery group than in the surgery group(P<0.05).The healing of the meniscus in the moxibustion plus surgery group was significantly better than that in the surgery group at the follow-up visit 3 months after the surgery(P<0.05).Conclusion The effect of mild moxibustion combined with arthroscopic meniscal repair is better than the surgery alone in improving knee function,relieving pain,increasing mobility of the affected knee,and promoting meniscal healing,which may be related to the up-regulation of TGF-β1 and PDGF levels in the fluid of knee joint.
