Balloon dilation of congenital perforated duodenal web in newborns: Evaluation of short and long-term results

BACKGROUND Incomplete congenital duodenal obstruction(ICDO)is caused by a congenitally perforated duodenal web(CPDW).Currently,only six cases of balloon dilatation of the PDW in newborns have been described.AIM To present our experience of balloon dilatation of a perforated duodenal memb-rane in newborns with ICDO.METHODS Five newborns who underwent balloon dilatation of the CPDW along a prein-stalled guidewire between 2021 and 2023 were included.Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group.RESULTS In all cases,good anatomical and clinical results were obtained.In three cases,a follow-up study was conducted after 1 year.The average time to start enteral feeding per os was significantly earlier in the study group(4.4 d)than in the laparotomic group(21.2 days;P<0.0001).The time spent by patients in the intensive care unit and hospital after balloon dilatation was also significantly shorter.We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows:(1)Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web;(2)presence of endoscopic signs of CPDW;(3)successful cannulation with a guidewire performed parallel to the endoscope,with holes in the congenital duodenal web;and(4)successful positioning of the balloon performed along a freestanding guidewire on the web.CONCLUSION Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.

A Simple Egg Membrane Patch Bridging Method for Repairing Tympanic Membrane Perforation

Objective:To analyze the clinical effect of a simple egg membrane patch bridging method in repairing tympanic membrane perforation.Methods:A total of 93 tympanic membrane perforation patients admitted to the hospital between September 2022 and October 2023 were selected and divided into two groups according to the random number table method.The control group implemented the conventional treatment(n=46 cases),and the patch group adopted the simple egg membrane patch bridging method(n=47 cases).The healing rate of the tympanic membrane,the air-bone gap,the air conduction hearing threshold,the dry ear rate,and the incidence of complications in both groups were compared before and after treatment.Results:The healing rate of the tympanic membrane in the patch group was significantly higher than that of the control group(95.75%vs.76.09%),with P<0.05;there was no difference in the air-bone gap and air conduction hearing threshold levels between the two groups before treatment(P>0.05),and the hearing indexes of the patch group were significantly lower than those of the control group 3 months after treatment(P<0.05);the dry ear rate in the patch group was significantly higher than that of the control group after treatment(85.11%vs.67.39%),and the total incidence of complications was also significantly lower than that of the control group(6.38%vs.21.74%),with P<0.05.Conclusion:The simple egg membrane patch bridging method is effective in repairing tympanic membrane perforation,which can effectively improve patients’hearing levels and reduce the occurrence of post-treatment complications.Thus,it is worth popularizing and applying in the clinic.

Postoperative complications of concomitant fat embolism syndrome, pulmonary embolism and tympanic membrane perforation after tibiofibular fracture: A case report

BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms.No studies on FES with pulmonary embolism(PE)and tympanic membrane perforation have been reported to date.Here,we report a rare case of concomitant FES,PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture.CASE SUMMARY A 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road.X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification.A successful minimally invasive operation was performed 3 d after the injury.Postoperatively,the patient developed sudden symptoms of respiratory distress and hearing loss.Early diagnosis was made,and supportive treatments were used at the early stage of FES.Seven days after surgery,he presented a clear recovery from respiratory symptoms.The outcome of fracture healing was excellent,and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo.CONCLUSION Concomitant FES,PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms.Early diagnosis and treatment can reduce the mortality of FES,and prevention is better than a cure.

Comparison of endoscopic tympanoplasty to microscopic tympanoplasty in anterior tympanic membrane perforation

Objective:Tympanoplasty aims to eradicate lesions and restore middle ear function in chronic otitis media.This study was conducted to compare the surgical and functional outcomes of endoscopic tympanoplasty(ET)and microscopic tympanoplasty(MT)in anterior tympanic membrane perforation.Methods:The clinical data of 42 patients undergoing tympanoplasty with anterior quadrants tympanic membrane perforation between January 2018 and July 2019 were retrospectively analyzed.Patients were classified into the ET group(n?22)or the MT group(n?20).Patients’demographics,clinical characteristics,surgical and functional outcomes were assessed between the two groups.Results:External auditory canal widening was not necessary in the ET group and was performed in 55.0%of patients in the MT group.The operation time of the ET group was significantly shorter than that of the MT group(61.23±11.48 min vs.78.65±11.79 min,p=0.034).The pain scale score of the ET group at 24 hours after surgery was significantly lower than that of the MT group(0.86±0.64 vs.2.40±1.14,p=0.029).The grafting success rate was 95.5%(21/22)in the ET group and 95.0%(19/20)in the MT group.In the ET group,the pre-and postoperative air-bone gap were 35.60±8.43 dB and 18.79±5.80 dB,respectively,which was a significant improvement(p=0.016).The respective values in the MT group(33.33±7.88 dB and 19.58±6.24 dB)also represented a significant improvement(p=0.004).Conclusion:ET is more beneficial for patients with anterior tympanic membrane perforations,which helps minimize the surgical trauma and reduces operation time and postoperative pain.

创伤性单纯鼓膜穿孔患者治疗前后心理状况评估

目的评估创伤性单纯鼓膜穿孔患者治疗前后的心理状态,分析患者治疗前后心理变化。方法对2015年1月~2017年1月西安交通大学第二附属医院耳鼻咽喉科门诊初诊的创伤性单纯鼓膜穿孔患者108例进行前瞻性研究,所有患者于初诊时及治疗2个月后填写抑郁自评量表(self-rating depression scale,SDS)及焦虑自评量表(self-rating anxiety scale,SAS),对比治疗前后量表评分有无差异,并分析引起抑郁及焦虑症状的可能因素。结果108例创伤性单纯鼓膜穿孔患者治疗前SDS评分、SAS评分均明显高于治疗后评分(tSDS=3.056,tSAS=2.797,P<0.05),其中穿孔愈合组患者在治疗后评分明显低于治疗前,差异有统计学意义(tSDS=3.376,tSAS=2.945,P<0.05)。治疗后伴有抑郁及/或焦虑的例数下降,其中愈合组患者治疗后伴有抑郁及/或焦虑的例数下降明显,差异有统计学意义(χ^2抑郁=8.270,χ^2焦虑=7.296,P<0.05)。他伤、高听力的职业需要、伴有耳鸣耳闷以及头晕是抑郁和/或焦虑症状的危险因素。结论在治疗创伤性单纯鼓膜穿孔患者躯体疾患的同时也应关注患者的抑郁及焦虑情绪,尽早促进穿孔愈合,改善躯体症状有助于减轻患者的抑郁及焦虑症状。

透明质酸钠棉片贴补联合小牛血去蛋白提取物治疗早期创伤性鼓膜穿孔

目的 观察透明质酸钠棉片贴补联合小牛血去蛋白提取物对早期创伤性鼓膜穿孔愈合的促进作用。方法选取南通大学附属医院附属如皋医院2017年1月~2020年1月初诊创伤性鼓膜穿孔病例101例(102耳)。根据患者治疗意愿分为47例治疗组(透明质酸钠棉片贴补联合小牛血去蛋白提取物注射),54例对照组(保守治疗)。比较两组愈合率及愈合时间。结果 治疗组47耳在2周内全部愈合,对照组在2周内仅有6例愈合,16例随访3个月仍未愈合。治疗组在早期创伤性鼓膜穿孔愈合率(P<0.0001)及愈合时间(P<0.0001)均明显好于对照组。鼓膜穿孔面积≤30%和30%~50%的患者,治疗组治愈率(P=0.0216,P=0.0006)和治愈时间(P<0.0001,P<0.0001)均显著优于对照组。鼓膜穿孔面积≥50%的患者(仅8耳,例数较少),治疗组与对照组相比,治愈率(P=0.4286)和治愈时间(P=0.1652)均略优,但两者差距无统计学意义。结论 透明质酸钠棉片贴补联合小牛血去蛋白提取物治疗早期创伤性鼓膜穿孔疗效显著。