Retinal leakage is not only a very common pathological phenomenon but also a common pathological feature of many retinal diseases, its pathogenesis is very complex. The application of ultra-wide-angle fluorescein angiography is one of the main means to observe and evaluate retinal leakage. Leakage index is a new index for evaluating retinal leakage. Studies have explored its correlation in diabetic retinopathy, retinal vein occlusion, uveitis and other diseases, evaluating treatment effects and predicting prognosis. However, the number of related studies is small and the conclusions are inconsistent. In the future, it is still necessary to further advance the quantitative analysis of leakage, the application of leakage in more diseases, and the clinical trials of leakage rate to explore its role in predicting and evaluating treatment effects in retinal diseases.
In a series of experiments on rats,we have observed that the tensile strength and hydroxyproline content of left colonic anastomosis presented the lowest level on the 3rd and 4th postoperative days. Aprotinin,dimethyl sulfoxide,superoxide dismutase and vitamin A could improve the early coures of healing of colonic anastomosis;hydroxycortisone could retard the early course of healing of anastomosis and vitamin A antaonize the deleterious effect as mentioned above. Perioperative chemotherapy did not impair the early coures of healing of colonic anastomosis. The primary rasection and anastomosis of left colon for complete obstruction could be safety done if colonic content was decompressed before performing anastomosis and abdominal cavity was irrigated with antibiotic solutions afterwards. The mechanism of some factors influencing the healing of colonic anastomosis is discussed.
ObjectiveTo reduce the incidence of peritoneal dialysis (PD) catheter complications through a continuous quality improvement (CQI) process. MethodsTwenty-nine patients with catheters inserted (from January 2011 to March 2011) before CQI, and another 41 patients with catheters inserted (between April 2011 and January 2012) after CQI were observed and analyzed. The possible causes of complications of catheter were summarized, and then on the basis of that, a PDCA four-step (plan-do-check-act) method was designed with a view to reducing the incidence of postoperative complications. ResultsPD catheter dysfunction decreased from 6.90% to 2.44%. The incidence of leakage decreased from 44.83% to 9.76%. ConclusionCQI is a useful method to reduce the incidence of postoperative complications of PD catheter in peritoneal dialysis.
Objective To investigate the causes and preventive methods of the bone cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fracture (OVCF). Methods From April 2003 to November 2007, 116 patients with OVCF were treated with PKP, including 57 males and 59 females aged 65-92 years old (average 67.7 years old). All the patients suffered from trauma and the course of disease was 1-14 days (average 5.7 days). There were 159compressed and fractured vertebral bodies, including one vertebral body in 83 cases, two vertebral bodies in 24 cases, three vertebral bodies in 8 cases, and four vertebral bodies in 1 case. The diagnosis of OVCF was confirmed by imaging examination before operation. All the patients had intact posterior vertebral walls, without symptoms of spinal and nerve root injury. During operation, 3.5-7.1 mL bone cement (average 4.8 mL) was injected into single vertebral body. Results The operation time was 30-90 minutes (average 48 minutes). Obvious pain rel ief was achieved in all the patients after operation. X-rays examination 2 days after operation revealed that the injured vertebral bodies were well replaced without further compression and deformation, and the bone cement was evenly distributed. Fourteen vertebral bodies had bone cement leakage (4 of anterior leakage, 4 of lateral leakage, 3 of posterior leakage, 2 of intervertebral leakage, 1 of spinal canal leakage). The reason for the bone cement leakage included the individual ity of patient, the standardization of manipulation and the time of injecting bone cement. During the follow-up period of 12-30 months (average 24 months), all the patients got their normal l ife back, without pain, operation-induced spinal canal stenosis, obvious height loss of injured vertebral bodies and other compl ications. Conclusion For OVCF, PKP is a mini-invasive, effective and safe procedure that provides pain rel ief and stabil ization of spinal stabil ity. The occurrence of bone cement leakages can be reduced by choosing the suitable case, improving the viscosity of bone cement, injecting the proper amount of bone cement and precise location during operation.
ObjectiveTo observe the changes of choroidal blood perfusion in the macular area and the leakage point of acute central serous chorioretinitis (CSC). MethodsA non-randomized controlled clinical study method was adopted. From March 2022 to March 2023, 70 patients (70 eyes) with monocular acute CSC diagnosed in the Eye Center of the Second Hospital of Hebei Medical University (CSC group) were included in this study. There were 49 male patients with 49 eyes and 21 female patients with 21 eyes. The mean age was (46.70±8.45) years. The duration of disease from symptom onset to presentation was ≤3 months. The contralateral eye of the CSC patient was set as the contralateral eye group. A total of 70 eyes of 70 age-and gender-matched healthy volunteers without systemic diseases were selected as normal control group during the same period. The best corrected visual acuity (BCVA) and swept frequency source optical coherence tomography angiography (SS-OCTA) were performed. BCVA was performed using the international standard visual acuity chart, and was converted to log minimum angle of resolution (logMAR) visual acuity. SS-OCTA examination of macular area was performed using VG200D of Vision Micro Imaging (Henan) Technology Co., LTD. Scanning mode Angio 6 mm×6 mm. According to the classification of diabetic retinopathy Treatment Study Group, the choroid within 6 mm of the macular fovea was divided into three concentric circles centered on the macular fovea, which were the central area with a diameter of 1 mm, the inner ring with a diameter of 1-3 mm, and the outer ring with a diameter of 3-6 mm. The three-dimensional choroidal vascular index (3D-CVI), choroidal vascular volume (3D-CVV), choroidal capillary layer (CCL) and choroidal great vascular layer (CL) perfusion area, choroidal thickness (ChT), and subretinal fluid (SRF) height were recorded by the built-in software of the equipment in the central area, inner ring area, and outer ring area. The Kruskal-Wallis rank sum test was used for comparison between multiple groups. ResultsThe logMAR BCVA was 0.19±0.07 in the CSC group. The subfoveal SRF height was (129±121) μm. Compared with the contralateral eye group and the normal control group, the CCL perfusion area in the central area and the inner ring area of the affected eye in the CSC group was significantly decreased, and the CL perfusion area in the central area was significantly increased (P＜0.05). Compared with the normal control group, 3D-CVI was significantly decreased and 3D-CVV was significantly increased in the CSC group, and the differences were statistically significant (P＜0.05). The difference of 3D-CVV between the contralateral eye group and the normal control group was statistically significant (P＜0.05). The ChT of the central, inner and outer ring regions in the CSC group and the contralateral eye group were significantly higher than those in the normal control group (P＜0.05). The CCL and CL perfusion areas at the leakage point in the CSC group were significantly lower than those in the surrounding area, and the 3D-CVI was higher than that in the surrounding area, the differences were statistically significant (P＜0.05). ConclusionCompared with normal healthy eyes, choroidal thickening and vascular dilatation are found in both the affected and contralateral eyes of patients with acute CSC, and the choroidal capillary hypoperfusion and medium and large vascular dilatation are more obvious in the leakage point of the affected eye than in the surrounding area.
ObjectiveTo explore the value of maxillofacial osseous reconstruction in one-stage operation combined with craniotomy for moderate craniocerebral injury. MethodsA retrospective study was conducted by analyzing the clinical and radiographic results of 13 patients treated between January 2008 and February 2015. Among them, 7 patients admitted into the hospital between January 2008 and December 2009 were regarded as the control group. Among the 7 patients, 5 were males and 2 were females, aged between 22 and 66 years old, averaging (44.3±15.9) years old. The patients of the control group underwent craniotomy within 24 hours after admission, and accepted the second stage operation for maxillofacial reconstruction 3 to 5 weeks later. The other 6 patients including 4 males and 2 females aged between 27 and 57 years old, averaging (40.2±10.7) years old, admitted into the hospital between January 2010 and February 2015 were designated into the observation group. They underwent maxillofacial osseous reconstruction in one-stage operation combined with craniotomy within 24 hours after admission. The treatment effect, leakage of cerebrospinal fluid, intracranial infection and average length of stay were analyzed and compared. ResultsIn the control group, there were 5 cases of cerebrospinal rhinorrhea preoperatively, and all were cured after craniotomy. During the second stage operation for maxillofacial reconstruction, bone callus and scar tissue presented in all cases and poor reconstruction occurred to 3 cases. After reconstruction, cerebrospinal rhinorrhea recurred in 2 cases. The average length of stay was (43.4±4.5) days. For the observation group there were 3 cases of cerebrospinal rhinorrhea preoperatively, and one of them remained after the operation and cured 7 days later. The average length of stay was (22.7±2.7) days. None of the 13 patients suffered intracranial infection. ConclusionMaxillofacial osseous reconstruction should be considered in one-stage operation combined with craniotomy for moderate craniocerebral injury