Special surgical approaches during peri-COVID-19 pandemic: Robotic and transanal minimally invasive surgery

During the peri-coronavirus disease 2019 pandemic, the need of special care has raised, not only for our patients but also for health care workers. These needs are different regarding the procedure and the approach performed. This is a dynamic review in the use of robotics and transanal approaches for colorectal diseases. We searched PubMed and KSREvidence.com for studies related to coronavirus disease and robotic surgery/transanal mesorectal excision/transanal surgery(primary and systematic reviews). From 147 results in PubMed, 11 were selected for full text screening, and 11 were included in this paper. From 3 results in KSREvidence, no relevant systematic reviews were identified. We also checked the references in identified papers for further relevant studies. European Society of Coloproctology guidelines were including as part of the recommendations available. Robotic and transanal MIS can be performed safely during the pandemic, but particular characteristics of these procedure need to be taken into consideration.     

Aortic homograft implantation after Ozaki procedure: Case report

Introduction and importanceThe infective endocarditis incidence data for patients undergoing aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium (Ozaki procedure) are rare, and the optimal surgical treatment strategy remains unclear.Case presentationThis is the first case report of surgical treatment of infective endocarditis of aortic valve with cryopreserved homograft in an athlete with previously performed Ozaki procedure.Clinical discussionThe choice of homograft was dictated by the young age of the patient; professional activity as an athlete; refusal of anticoagulants and the need for wide excision of compromised tissues to mitigate potential risk of spread of infection as well as its recurrence.ConclusionThe use of the aortic homograft allowed us to radically remove the infected tissues and achieve hemodynamic characteristics similar to the native valve. This is probably the first case report of use of homograft to treat aortic valve endocarditis following Ozaki procedure.     

A rare case of a laryngeal leiomyosarcoma with a lymph node metastasis

IntroductionLeiomyosarcoma is a rare mesenchymal tumor that originates from smooth muscle cells. Head and neck LMSs represent only 3% of all leiomyosarcomas with less than 50 cases of laryngeal LMS reported in the literature till now.Case presentationWe report a case of 50-year-old male presented at our ENT department for a chronic hoarseness. Clinical examination investigations found small submucosal lesion in the right vocal cord. Treatment consisted of CO2 Laser excision of the lesion. The evolution was marked by the appearance of a tumefaction in the left submandibular region and a severe dyspnea requiring an emergency tracheotomy. Paraclinical examination investigations found a supraglottis–glottis-subglottis tumor. A total laryngectomy with bilateral functional neck dissection was performed and the histopathological examination found a laryngeal leiomyosarcoma.ConclusionLMS of the larynx a very rare malignancy. The accurate diagnosis is histological. Surgery is the mainstay of treatment. Its prognosis is correlated to local recurrence and distant metastases.     

Stone extraction with loop ureteral catheter versus ureteroscopy in small distal ureteral stones—retrospective comparison of 547 consecutive patients

BackgroundTo evaluate whether stone extraction with a loop ureteral catheter (LUC) in distal ureteral stones is associated with a higher frequency of ureteral strictures compared to treatment with primary ureteroscopic stone removal (p-URS) or ureteroscopic laser lithotripsy (l-URS).MethodsFive hundred and forty-seven consecutive patients were primarily endourologically treated for distal ureteral stones in our department between 2005 and 2019 and included in the study protocol. Data was retrospectively obtained from the patients’ charts and medical reports as well as from office-based urologists. Data analysis was performed using Fisher’s exact test, Mann-Whitney test or Student’s t-test as appropriate. A level of P<0.05 was assigned statistical significance.ResultsFour hundred and twelve patients were treated by URS (p-URS n=304, l-URS n=108) and another 135 by LUC stone extraction. Median follow-up was 41 [2–159] months. There was no difference between the groups concerning age, gender, proportion of patients with ureteral stenting, operating time, hospitalization or readmission rates. The number of ureteric strictures was small in all procedures [n=3 (1.0%) in p-URS, n=2 (1.9%) in l-URS and n=2 (1.5%) in LUC] and there was no difference between the groups concerning this serious complication (p-URS vs. LUC: P=0.6465; l-URS vs. LUC: P=0.9999).ConclusionsIn small distal stones, LUC stone extraction still is an alternative to URS procedures in stone management with comparable results concerning postinterventional ureteral strictures. In experienced hands, it still has its value in accurately selected patients.     

心导纳环检测慢性心瓣膜病心功能的临床研究

目的 :研究利用心导纳环检测慢性心瓣膜病引起的心血管系统血流动力学改变和心功能状态变化的临床应用价值。方法 :利用自动心功能检测仪分别对 30例风湿性心瓣膜病患者和1 0 0例健康人进行左、右心导纳环检测 ,并对两组数据进行统计学分析。结果 :检测分析表明 :显示左心功能的主要指标 ADL、ADL3/ADL、ADL5 /ADL、PEP/LVET、CI及显示右心功能的主要指标 HA/HZ、 HC/HZ在两组人群比较均有明显的差异性 ( P<0 .0 1 )。结论 :利用心导纳环测定慢性心瓣膜病患者的血流动力学改变和心功能状态 ,其指标反应敏感、客观、特异性较强、有实用价值     

急性重症胆管炎的救治体会

目的：探讨急性重症胆管炎的有效治疗方法。方法：回顾性分析１５４例急性重症胆管炎（ＡＣＳＴ）的临床资料。结果：单纯胆总管外引流术９２例,死亡１０例（１０．９％）;胆总管外引流附加胆囊造瘘或胆囊切除或肝脓肿引流术共３２例,死亡６例（１８．８％）;胆道内引流术３０例（胆肠吻合２４例,奥狄括约肌切开成形术６例）,死亡８例（２６．７％）。全组治愈１３０例,死亡２４例,总病死率为１５．６％。结论：ＡＣＳＴ诊断明确后及早手术是提高疗效的关键,手术方式的选择以简单、有效为原则,积极防治休克和多器官功能衰竭是改善预后的重要措施。     

囊肿切除治疗婴儿先天性胆总管囊肿

目的探讨囊肿切除、胆道重建治疗婴儿胆总管囊肿的疗效.方法1984年6月～1999年6月共有15例婴儿先天性胆总管囊肿患儿在我科接受了囊肿切除、胆道重建手术治疗,并对这些患儿进行了随访,随访资料包括症状、体征、B超.钡餐及肝功能检查.结果随访资料完整者12例,除1例术后3个月死于肝功能衰竭外,其余11例成活的患儿生长发育均正常;2例未行套叠瓣的患儿偶有上腹疼痛,但腹痛可自行缓解,钡餐检查见钡剂返流;全组病例肝功均正常,未见胆道结石、消化道溃疡、食道下端静脉曲张.结论囊肿切除、胆道重建治疗婴儿先天性胆总管囊肿可取得满意的疗效.     

头部电导纳图的导纳微分环及功率谱分析

通过多例头部电纳图的导纳微分环面积和功率谱分析,发现陡直型和转折型波形,其功率谱中的某些指标有显著性差异（P＜0．05）,导纳微分环中的Ⅰ,Ⅱ,Ⅳ相面积也有显著性差异（P＜0．05）。     

改良Bjork手术治疗三尖瓣闭锁12例

目的 观察改良Ｂjord手术治疗三尖瓣闭锁的效果。方法 自１９９６年３月至１９９９年６月,对１２例三尖瓣闭锁患儿实施了改良Ｂjord手术,即应用剖开的带瓣肺动脉片作前壁的右房右室连接术。结果 术后患儿中心静脉压（ＣＶＰ）低、胸液量少;术后血流动力学监测肺动脉为搏动性血流;超声心动图发现残存的右心室腔有收缩功能、右室腔有所增大、同种瓣叶有一定的抗反流作用。结论 改良Ｂjord手术 ,术后同种瓣有一定的抗反流作用     

Percutaneous retrieval of an impacted ureteric T-tube

An impacted ureteric T-tube was removed percutaneously, using an Amplatz goose-neck snare. This new snare has advantages over conventional snares, particularly in situation where atraumatic manipulation is essential. Correspondence to: R. D. Edwards