Assessing the Impact of General Anesthesia and Bronchial Intubation in Conjunction with Thoracic Paravertebral Nerve Block on Cellular Immunity and Surgical Management in Tuberculous Pyothorax Patients

Objective:This study aims to investigate the impact of combining general anesthesia with bronchial intubation and thoracic paravertebral nerve block during surgery for patients with tuberculous pyothorax.Methods:Eighty patients diagnosed with tuberculous pyothorax,admitted to the hospital between January 2023 and September 2023,were randomly selected for this study.The patients were divided into control and study groups using a numerical table method.The control group underwent general anesthesia with bronchial intubation,while the study group received general anesthesia with bronchial intubation in conjunction with thoracic paravertebral nerve block.Subsequently,the patients were monitored to assess mean arterial pressure,heart rate variations,and adverse reactions to anesthesia.Results:The study group exhibited significantly lower mean arterial pressure and heart rate levels during the post-surgical incision,immediate end of surgery,and immediate extubation periods compared to the control group(P<0.05).Furthermore,the Ricker and Ramsay scores in the study group were significantly lower than those in the control group(P<0.05).Conclusion:The combined use of general anesthesia via bronchial intubation and thoracic paravertebral nerve block has been found to stabilize mean arterial pressure and heart rate while providing effective sedation for surgical treatment in patients with tuberculous septic thorax.

SURGICAL TREATMENT OF METASTATIC SPINAL TUMOR

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Retroperitoneal laparoscopic partial resection of the renal pelvis for urothelial carcinoma:A case report

BACKGROUND The standard treatment of transitional cell carcinoma of the upper urinary tract consists of radical nephroureterectomy with bladder cuff removal,which can be performed either in open or laparoscopy or robot-assisted laparoscopy.Treatment of chronic renal insufficiency patients with upper urothelial tumor is in a dilemma.Urologists weigh and consider the balance between tumor control and effective renal function preservation.European Association of Urology guidelines recommend that select patients may benefit from endoscopic treatment,but laparoscopic treatment is rarely reported.CASE SUMMARY In this case report,we describe a case of 79-year-old female diagnosed with urothelial carcinoma of the renal pelvis and adrenal adenoma with chronic renal insufficiency.The patient was treated with retroperitoneal laparoscopic partial resection of the renal pelvis and adrenal adenoma resection simultaneously.CONCLUSION Retroperitoneal laparoscopic partial resection of the renal pelvis is an effective surgical procedure for the treatment of urothelial carcinoma of the renal pelvis.

Improved Epicanthus Correction Combined with Double Eyelid Surgery

Objective:To explore the clinical effect of improved epicanthus correction combined with double eyelid surgery.Methods:From February 2019 to February 2020,70 patients with epicanthus who underwent surgical treatment were treated as study participants.The computer 1:1 grouping method was adopted.Thirty-five patients in the reference group were treated with epicanthus correction,and 35 patients in the experimental group were treated with improved epicanthus correction combined with double eyelid surgery.The operation efiect was compared.Results:The satisfaction scores of morphological aesthetics and prognosis recovery in the experimental group were higher than those in the reference group(P<0.05).The recurrence rate of scar hyperplasia and epicanthus in the experimental group was lower than that in the control group(P<0.05).Conclusion:The improved epicanthus correction combined with double eyelid surgery can engender ideal correction effect and reduce postoperative adverse outcomes.Therefore,the combined operation scheme is feasible.

Feasibility and Surgical Effect of Annulus Sparing in Consecutive Patients with Tetralogy of Fallot:A Retrospective Cohort Study

Objective:Annulus-sparing(AS)repair for tetralogy of Fallot(TOF)with a dysplastic pulmonary valve annulus(PVA)is a challenging procedure and is controversial.This study aimed to assess the feasibility and surgical effect of AS repair versus transannular patch enlargement(TAPE)repair,especially in individuals with dysplastic pulmonary valves.Methods:This retrospective cohort study included 375 pediatric patients with a primary diagnosis of TOF in the Center for Pediatric Cardiac Surgery of Fuwai hospital from January 2014 to June 2017.Among them,60 consecutive and nonselective patients underwent 1-stage repair of TOF with aggressive PVA-preserving strategies performed by a single surgeon were enrolled in AS cohort.In AS cohort,patients were divided into AS,PVA z-score≥−2 group(33 patients)and AS,PVA z-score<−2 group(27 patients).During the same period,315 patients underwent TAPE repair by other surgeons were enrolled as TAPE cohort,of these,87 patients with PVA z-score≥−2 were excluded.From the 228 patients in the TAPE group,27 cases were selected as TAPE,PVA z-score<−2 group according to the propensity score and 1:1 ratio with AS,PVA z-score<−2 group.The primary outcome was a composite of reintervention,significant pulmonary regurgitation,and significant annular peak gradient(APG).Kaplan-Meier curve was plotted to show the survival rate of severe pulmonary regurgitation.Results:One death occurred after the TAPE operation in TAPE group,and 1 patient in the AS z≥−2 group needed reintervention with a balloon.After a median follow-up of(30.3±11.6)months,compared with AS z≥−2 group,there was no difference in the technical performance score for severe pulmonary stenosis(APGs>20 mmHg)in the AS z<−2 group.Compared with TAPE,AS repair was often accompanied by a postoperative APGs over 20 mmHg(P=0.001).More patients underwent TAPE suffered from moderate or severe pulmonary regurgitation than those who received AS repair(20(74.1%)vs.7(26.0%),P<0.001).AS repair was associated with a shorter duration of mechanical ventilation(20 vs.29 hours,P=0.039),faster discharge from the intensive care unit(2.0 vs.4.0 days,P=0.022)and shorter postoperative hospitalization(8.0 vs.11.0 days,P=0.008)compared with TAPE.Conclusions:APG demonstrated an upward trend in the TAPE group and a downtrend in the AS group after discharge from hospital.AS repair had an acceptable surgical effect in TOF patients,even in those with a dysplastic PVA.A higher APG remained upon hospital discharge in dysplastic patients with AS,but a downward trend was observed over time.

Lateral tarsal strip procedure for involutional ectropion: A retrospective analysis of 85 cases and a comprehensive literature review

Purpose:To evaluate the postoperative effect of the lateral tarsal strip(LTS)procedure in treating lower eyelid involutional ectropion.Methods:A retrospective study was performed on 85 eyelids in 67 patients with involutional ectropion who underwent LTS procedure.Pre-and postoperative lower eyelid laxity and ocular symptoms as well as perioperative complications were evaluated.Snap back test was performed to evaluate the elasticity of lateral canthal tendon loosening and,a lower lid distraction test was performed to evaluate the degree of severity before surgery.Ocular surface diseases were evaluated by the Ocular Surface Disease Index(OSDI),and symptoms including conjunctivitis,corneal ulcer,dry eye syndrome,and ocular pain were recorded.All patients were evaluated within one week and during the follow-up period of 4.2
8.3 months.Furthermore,we reviewed the studies that also investigated the surgical effect of the LTS procedure in the literature from 1979 to 2019.Results:The success rate was 95%.Only four eyelids required a second surgical intervention.Seventy-three(86%)eyelids had an excellent position after surgery,9(11%)only little improvement,and three had no improvement.No significant difference was found in the postoperative effects between different degrees of ectropion(p>0.05).No statistical correlation was found between surgical improvements and the ectropion severity(P>0.05).Fiftytwo out of 85 eyes had no discomfort after the surgery.Mild complications included epiphora in 13 eyes(three cases caused by lacrimal punctum eversion),ocular pain in 12 eyes,wound hemorrhage in 12 eyes,and edema in 9 eyelids immediately after surgery,in which 91.2%(n=21)disappeared within one week and did not need any further treatment.Conclusions:The lateral tarsal strip procedure can provide an aesthetically pleasing result for correcting the mild to moderate lower eyelid ectropion while maintaining decent eyelid function.