BACKGROUND Fixed esotropia in high myopia,characterized by irreversible inward ocular deviation and abduction limitation,presents unique therapeutic challenges for athletes requiring precise binocular coordination.The...BACKGROUND Fixed esotropia in high myopia,characterized by irreversible inward ocular deviation and abduction limitation,presents unique therapeutic challenges for athletes requiring precise binocular coordination.The combination of Yokoyama surgery and medial rectus muscle recession has been proposed as an advanced technique addresses both myopia-induced globe displacement and muscular imbalance offering potential advantages over conventional strabismus surgery in this population.AIM To investigate the effects of the modified Yokoyama surgery coupled with medial rectus muscle recession in restoring ocular motility and correcting esotropia among athletes with high myopia and fixed esotropia.METHODS A retrospective study analyzed 30 highly myopia athletes(57 eyes)with fixed esotropia treated at our hospital from January 2022 to April 2024.The participants were allocated into two groups based on the surgical method:The traditional group(n=15,29 eyes)received conventional strabismus surgery,and the combined group(n=15,28 eyes)underwent modified Yokoyama surgery in combination with medial rectus muscle recession.Eye movement improvement,esotropia alleviation,and complications were compared preoperatively and at 1,3,and 6 months post-treatment.RESULTS Both surgical groups exhibited similar baseline scores(traditional:-4.04±0.38 vs combined:-4.12±0.45,P>0.05),showing severe preoperative limitations in ocular motility.Following the intervention,the combined group achieved significantly better outcomes at both 1 month(combined:-2.25±0.28 vs traditional:-2.67±0.32)and 3 months(combined:-1.48±0.28 vs traditional:-1.76±0.43),with statistically significant improvements(P<0.05).However,by 6 months,no significant difference was observed between the two groups(combined:-0.93±0.13;traditional:-1.03±0.18;P>0.05).Prior to treatment,all patients in both groups exhibited a compensatory head posture(CHP).Following treatment,the incidence of CHP decreased to 6.67%in the combined group and 20.00%in the traditional group,both reductions being significant compared to pretreatment levels(P<0.05).Nevertheless,the difference in CHP incidence between the two groups after treatment was not significant(P>0.05).The rates of improvement in esotropia showed an increasing trend in both groups at 1 month(46.43%vs 34.48%),3 months(78.57%vs 51.728%),and 6 months(100.00%vs 89.66%)post-treatment.Notably,the combined group had a significantly higher improvement rate than the traditional group at the 3-month follow-up(P<0.05).No significant difference was observed in the esotropia improvement rates between the two groups at 1 and 6 months post-treatment(P>0.05).The combined group experienced slightly lower but not significant(combined group:0.00%vs traditional:3.45%)as opposed to the traditional group(3.45%;P>0.05).CONCLUSION The combination of modified Yokoyama surgery and medial rectus muscle recession provides effective and safe approach to improving in eye movement and esotropia in athletes with high myopia and fixed esotropia,offering reliable clinical benefits.展开更多
To evaluate the therapeutic effect of a modified Devine procedure with a subcutaneous sliding fixation method for the treatment of congenital concealed penis,we retrospectively selected 45 patients with congenital con...To evaluate the therapeutic effect of a modified Devine procedure with a subcutaneous sliding fixation method for the treatment of congenital concealed penis,we retrospectively selected 45 patients with congenital concealed penises who were admitted to General Hospital of Ningxia Medical University(Yinchuan,China)between September 2020 and November 2023.In all cases,the penis was observed to be short,and retracting the skin at the base revealed a normal penile body,which immediately returned to its original position upon release.All patients underwent the modified Devine procedure with subcutaneous sliding fixation and completed a 12-week postoperative follow-up.A statistically significant increase in penile length was observed postoperatively,with the median length increasing from 4.0(interquartile range[IQR]:3.5–4.8;95%confidence interval[CI]:3.9–4.4)cm to 8.0(IQR:7.8–8.0;95%CI:7.7–7.9)cm,with P<0.001.The parents were satisfied with the outcomes,including increased penile length,improved hygiene,and enhanced esthetics.Except for mild foreskin edema in all cases,no complications(such as infections,skin necrosis,or penile retraction)were observed.The edema was resolved within 4 weeks after the operation.This study demonstrates that the modified Devine procedure utilizing the subcutaneous sliding fixation method yields excellent outcomes with minimal postoperative complications,reduced penile retraction,and high satisfaction rates among patients and their families.展开更多
OBJECTIVE To evaluate the clinical application of a right-thoracic approach with or without laparotomy for mid-upper esophageal cancer. METHODS We retrospectively reviewed the data of 34 esophageal cancer patients who...OBJECTIVE To evaluate the clinical application of a right-thoracic approach with or without laparotomy for mid-upper esophageal cancer. METHODS We retrospectively reviewed the data of 34 esophageal cancer patients who received Belsey surgery or a modified Ivor-Lewis surgery from November 1992 to April 2007. Twenty of the patients underwent a Belsey prodecdure （Group A） from November 1992 to January 2001 and 14 underwent a modified Ivor-Lewis prodecdure （Group B） from May 2001 to April 2007. RESULTS Twenty patients with esophageal cancer received an esophagectomy through an exclusive right-thoracic approach （Belsey surgery）, and 14 patients received an esophagectomy through a right-thoracic approach combined with a laparotomy （modified IvorLewis surgery）. The complication rate was 15% （3/20） and 7.1% （1/14） respectively. The survival rate was 42.9% （5-year survival） and 38.7% （5-year survival） respectively for these two groups. CONCLUSION An exclusive right-thoracic approach （Belsey surgery） is associated with more complications. It is not a routine surgery for cancer of the mid-upper thorax of the esophagus, but can be selectively used as palliative esophagectomy for esophageal cancer patients with poor pulmonary function. Modified Ivor-Lewis surgery can simultaneously be utilized to resect the primary tumor and dissect lymph nodes of the thorax and abdomen. With a shorter time period of surgery and postoperative recovery period, modified Ivor-Lewis surgery can achieve better effects with patients who have midupper esophagus cancer.展开更多
BACKGROUND： Animal models of brachial plexus root avulsion are required for the study of brachial plexus root injuries. The established ventral approach results in slight injuries, and is similar to mechanisms underl...BACKGROUND： Animal models of brachial plexus root avulsion are required for the study of brachial plexus root injuries. The established ventral approach results in slight injuries, and is similar to mechanisms underlying human brachial plexus root avulsion.OBJECTIVE： To analyze the effects of weight, age, and species on the success rate of brachial plexus root avulsion, and to determine the perfect method for establishing models of brachial plexus root avulsion.DESIGN, TIME AND SETTING： A randomized, block design was performed at the Laboratory of Professor Lihua Zhou, Zhongshan School of Medicine, Sun Yat-sen University, China from June 2008 to June 2009.MATERIALS： Sprague Dawley （SD） rats, golden hamsters, and BALb/C mice were used in the present study.METHODS： All animals were randomly subjected to classical brachial plexus root avulsion and modified brachial plexus root avulsion.MAIN OUTCOME MEASURES： Success rate of brachial plexus root avulsion. RESULTS： The success rate of brachial plexus root avulsion was greater in the modified group than in the classical group （P〈0.01）. Moreover, the difference was significant in 15-day-old SD rats, 5-week-old SD rats, and 3-month-old BALb/C mice （P〈0.01）. The success rate of brachial plexus root avulsion was greater in the same weight, 15-day-old juvenile SD rats, than in the 3-month-old BALb/C mice （classical group, P〈0.01; modified group, P〈0.05）. The success rate of brachial plexus root avulsion was significantly greater in 3-month-old golden hamsters than in 5-week-old SD rats in the classical group （P〈0.05）. The success rate of brachial plexus root avulsion was significantly lower in the 15-day-old SD rats compared with the 5-week-old and 3-month-old SD rats in the classical group （P〈0.01）. However, there was no significant difference in the success rate of brachial plexus root avulsion between various ages of SD rats in the modified group （P〉0.05）.CONCLUSION： Modified surgery to induce brachial plexus root avulsion significantly increases the success rate of model establishment. Species, age, and weight affect the success rate of brachial plexus root avulsion, and species plays an important role in the success rate.展开更多
BACKGROUND Double outlet right ventricle(DORV)is a rare and complex congenital heart defect,and the surgical repairs vary with type and pathophysiology consequences.Due to prolonged progressive hypoxemia,severe polycy...BACKGROUND Double outlet right ventricle(DORV)is a rare and complex congenital heart defect,and the surgical repairs vary with type and pathophysiology consequences.Due to prolonged progressive hypoxemia,severe polycythemia is common in patients with DORV,which ultimately leads to coagulation dysfunction and increases the risk of thrombosis and infarction.Consequently,the anesthetic management is challenging and how to manage severe polycythemia and avoid hypoxia-related complications in such patients is of great significance.CASE SUMMARY Herein,we report the anesthetic management of a 10-year-old female patient with a DORV.She lived in the low-oxygen Qinghai-Tibet Plateau,and presented with severe polycythemia(hemoglobin,24.8 g/dL;hematocrit,75%).She underwent a modified Fontan surgery,which was satisfactory and without any perioperative complications.Our anesthetic management highlights the importance of perioperative hemodilution in decreasing the risk of thromboembolism and the importance of correcting coagulopathy in preventing hemorrhage.CONCLUSION Anesthetic management is challenging in rare cyanotic congenital heart disease patients with severe polycythemia.It is important to adopt perioperative hemodilution and correction of coagulopathy in preventing thrombosis and hemorrhage.展开更多
文摘BACKGROUND Fixed esotropia in high myopia,characterized by irreversible inward ocular deviation and abduction limitation,presents unique therapeutic challenges for athletes requiring precise binocular coordination.The combination of Yokoyama surgery and medial rectus muscle recession has been proposed as an advanced technique addresses both myopia-induced globe displacement and muscular imbalance offering potential advantages over conventional strabismus surgery in this population.AIM To investigate the effects of the modified Yokoyama surgery coupled with medial rectus muscle recession in restoring ocular motility and correcting esotropia among athletes with high myopia and fixed esotropia.METHODS A retrospective study analyzed 30 highly myopia athletes(57 eyes)with fixed esotropia treated at our hospital from January 2022 to April 2024.The participants were allocated into two groups based on the surgical method:The traditional group(n=15,29 eyes)received conventional strabismus surgery,and the combined group(n=15,28 eyes)underwent modified Yokoyama surgery in combination with medial rectus muscle recession.Eye movement improvement,esotropia alleviation,and complications were compared preoperatively and at 1,3,and 6 months post-treatment.RESULTS Both surgical groups exhibited similar baseline scores(traditional:-4.04±0.38 vs combined:-4.12±0.45,P>0.05),showing severe preoperative limitations in ocular motility.Following the intervention,the combined group achieved significantly better outcomes at both 1 month(combined:-2.25±0.28 vs traditional:-2.67±0.32)and 3 months(combined:-1.48±0.28 vs traditional:-1.76±0.43),with statistically significant improvements(P<0.05).However,by 6 months,no significant difference was observed between the two groups(combined:-0.93±0.13;traditional:-1.03±0.18;P>0.05).Prior to treatment,all patients in both groups exhibited a compensatory head posture(CHP).Following treatment,the incidence of CHP decreased to 6.67%in the combined group and 20.00%in the traditional group,both reductions being significant compared to pretreatment levels(P<0.05).Nevertheless,the difference in CHP incidence between the two groups after treatment was not significant(P>0.05).The rates of improvement in esotropia showed an increasing trend in both groups at 1 month(46.43%vs 34.48%),3 months(78.57%vs 51.728%),and 6 months(100.00%vs 89.66%)post-treatment.Notably,the combined group had a significantly higher improvement rate than the traditional group at the 3-month follow-up(P<0.05).No significant difference was observed in the esotropia improvement rates between the two groups at 1 and 6 months post-treatment(P>0.05).The combined group experienced slightly lower but not significant(combined group:0.00%vs traditional:3.45%)as opposed to the traditional group(3.45%;P>0.05).CONCLUSION The combination of modified Yokoyama surgery and medial rectus muscle recession provides effective and safe approach to improving in eye movement and esotropia in athletes with high myopia and fixed esotropia,offering reliable clinical benefits.
基金supported by the National Natural Science Foundation of China(No.81860268,and No.82201000)Ningxia Natural Science Foundation(No.2021AAC02025)+2 种基金Ningxia science and technology innovation leading talent training project(No.2020GKLRLX06 and No.2020GKLRLX11)Ningxia Medical University research project(No.XTJKF240315)Ningxia Key Research and Development Project(No.2023BEG03021 and No.2021BEB04034).
文摘To evaluate the therapeutic effect of a modified Devine procedure with a subcutaneous sliding fixation method for the treatment of congenital concealed penis,we retrospectively selected 45 patients with congenital concealed penises who were admitted to General Hospital of Ningxia Medical University(Yinchuan,China)between September 2020 and November 2023.In all cases,the penis was observed to be short,and retracting the skin at the base revealed a normal penile body,which immediately returned to its original position upon release.All patients underwent the modified Devine procedure with subcutaneous sliding fixation and completed a 12-week postoperative follow-up.A statistically significant increase in penile length was observed postoperatively,with the median length increasing from 4.0(interquartile range[IQR]:3.5–4.8;95%confidence interval[CI]:3.9–4.4)cm to 8.0(IQR:7.8–8.0;95%CI:7.7–7.9)cm,with P<0.001.The parents were satisfied with the outcomes,including increased penile length,improved hygiene,and enhanced esthetics.Except for mild foreskin edema in all cases,no complications(such as infections,skin necrosis,or penile retraction)were observed.The edema was resolved within 4 weeks after the operation.This study demonstrates that the modified Devine procedure utilizing the subcutaneous sliding fixation method yields excellent outcomes with minimal postoperative complications,reduced penile retraction,and high satisfaction rates among patients and their families.
文摘OBJECTIVE To evaluate the clinical application of a right-thoracic approach with or without laparotomy for mid-upper esophageal cancer. METHODS We retrospectively reviewed the data of 34 esophageal cancer patients who received Belsey surgery or a modified Ivor-Lewis surgery from November 1992 to April 2007. Twenty of the patients underwent a Belsey prodecdure （Group A） from November 1992 to January 2001 and 14 underwent a modified Ivor-Lewis prodecdure （Group B） from May 2001 to April 2007. RESULTS Twenty patients with esophageal cancer received an esophagectomy through an exclusive right-thoracic approach （Belsey surgery）, and 14 patients received an esophagectomy through a right-thoracic approach combined with a laparotomy （modified IvorLewis surgery）. The complication rate was 15% （3/20） and 7.1% （1/14） respectively. The survival rate was 42.9% （5-year survival） and 38.7% （5-year survival） respectively for these two groups. CONCLUSION An exclusive right-thoracic approach （Belsey surgery） is associated with more complications. It is not a routine surgery for cancer of the mid-upper thorax of the esophagus, but can be selectively used as palliative esophagectomy for esophageal cancer patients with poor pulmonary function. Modified Ivor-Lewis surgery can simultaneously be utilized to resect the primary tumor and dissect lymph nodes of the thorax and abdomen. With a shorter time period of surgery and postoperative recovery period, modified Ivor-Lewis surgery can achieve better effects with patients who have midupper esophagus cancer.
基金a Grant from Health Department of Guangdong Province in China,No. A2007169
文摘BACKGROUND： Animal models of brachial plexus root avulsion are required for the study of brachial plexus root injuries. The established ventral approach results in slight injuries, and is similar to mechanisms underlying human brachial plexus root avulsion.OBJECTIVE： To analyze the effects of weight, age, and species on the success rate of brachial plexus root avulsion, and to determine the perfect method for establishing models of brachial plexus root avulsion.DESIGN, TIME AND SETTING： A randomized, block design was performed at the Laboratory of Professor Lihua Zhou, Zhongshan School of Medicine, Sun Yat-sen University, China from June 2008 to June 2009.MATERIALS： Sprague Dawley （SD） rats, golden hamsters, and BALb/C mice were used in the present study.METHODS： All animals were randomly subjected to classical brachial plexus root avulsion and modified brachial plexus root avulsion.MAIN OUTCOME MEASURES： Success rate of brachial plexus root avulsion. RESULTS： The success rate of brachial plexus root avulsion was greater in the modified group than in the classical group （P〈0.01）. Moreover, the difference was significant in 15-day-old SD rats, 5-week-old SD rats, and 3-month-old BALb/C mice （P〈0.01）. The success rate of brachial plexus root avulsion was greater in the same weight, 15-day-old juvenile SD rats, than in the 3-month-old BALb/C mice （classical group, P〈0.01; modified group, P〈0.05）. The success rate of brachial plexus root avulsion was significantly greater in 3-month-old golden hamsters than in 5-week-old SD rats in the classical group （P〈0.05）. The success rate of brachial plexus root avulsion was significantly lower in the 15-day-old SD rats compared with the 5-week-old and 3-month-old SD rats in the classical group （P〈0.01）. However, there was no significant difference in the success rate of brachial plexus root avulsion between various ages of SD rats in the modified group （P〉0.05）.CONCLUSION： Modified surgery to induce brachial plexus root avulsion significantly increases the success rate of model establishment. Species, age, and weight affect the success rate of brachial plexus root avulsion, and species plays an important role in the success rate.
基金The 1.3.5.Project for Disciplines of Excellence,No.2018HXFH046West China Hospital,Sichuan University and the National Natural Science Foundation of China,No.81971806.
文摘BACKGROUND Double outlet right ventricle(DORV)is a rare and complex congenital heart defect,and the surgical repairs vary with type and pathophysiology consequences.Due to prolonged progressive hypoxemia,severe polycythemia is common in patients with DORV,which ultimately leads to coagulation dysfunction and increases the risk of thrombosis and infarction.Consequently,the anesthetic management is challenging and how to manage severe polycythemia and avoid hypoxia-related complications in such patients is of great significance.CASE SUMMARY Herein,we report the anesthetic management of a 10-year-old female patient with a DORV.She lived in the low-oxygen Qinghai-Tibet Plateau,and presented with severe polycythemia(hemoglobin,24.8 g/dL;hematocrit,75%).She underwent a modified Fontan surgery,which was satisfactory and without any perioperative complications.Our anesthetic management highlights the importance of perioperative hemodilution in decreasing the risk of thromboembolism and the importance of correcting coagulopathy in preventing hemorrhage.CONCLUSION Anesthetic management is challenging in rare cyanotic congenital heart disease patients with severe polycythemia.It is important to adopt perioperative hemodilution and correction of coagulopathy in preventing thrombosis and hemorrhage.
