The Profile of Secondary Glaucoma in China: A Study of Over 10,000 Patients
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Few studies have investigated the epidemiology of secondary glaucoma (SG) in China. This study analyzed the current profile of admitted patients with SG at the largest ophthalmic center in China.SG cases were retrieved retrospectively by International Classification of Disease-10 clinical coding data from January 2010 to December 2019. Demographic data, etiologies, and the management of SG were analyzed. The ratios of the etiologies were compared with previously reported data from other regions. The etiologies and management between the 2010 to 2014 group and the 2015 to 2019 group were compared.A total of 11,730 cases were enrolled. The mean age of the patients with SG was 44.45±19.45 years old. Men (66.94%) were more vulnerable than women (33.06%). The etiologies of SG in 2010 to 2019 were trauma (28%), vascular disease (18%), lens-induced (9%), inflammation (11%), drug-induced (2%), anterior segment surgery (7%), posterior segment surgery (11%), syndrome-associated (4%), and tumors (1%). Compared with other regions, our data have a higher proportion of trauma and vascular disease-associated SG. Compared with 2010 to 2014, trauma-induced SG declined, and drug-induced SG, anterior segment surgery, and syndrome-associated SG increased in 2015 to 2019 (P<0.001). Vascular disease-associated SG cases were older than trauma-induced SCs and had a higher percentage in retired patients (P<0.001), whereas trauma-induced SGs were more prevalent in pediatric patients than vascular disease-related SGs (P<0.001). In addition, the application of drainage device implantation, cataract surgery, and cyclophotocoagulation increased, whereas trabeculectomy and anterior chamber paracentesis and cyclocryotherapy decreased in 2015 to 2019 (P<0.005).Although the etiology spectrum has changed during the last 10 years, trauma and vascular disease are still common causes of SG in southern China. Traditional antiglaucoma surgery decreased gradually, and more advanced treatments emerged for its treatment. Up-to-date knowledge of SGs reflects the impact of economic development and ophthalmic service improvement on SGs and is of great value for ophthalmologists to detect SGs early and manage them in a timely manner.Keywords:
Etiology
We reviewed 37 neck dissections done via the MacFee or double horizontal cervical incision to excise neoplasms located in the oral cavity and oropharynx, with draining cervical lymph nodes. One half of the patients had immediate reconstruction with myocutaneous flaps. Approximately 70% of the patients had advanced tumors and many were malnourished at presentation. Three wound complications involving the MacFee incision occurred in patients who were malnourished and required reconstruction. These wound complications were corrected with conservative therapy. Preoperative radiotherapy was a morbid cofactor. None of the patients had carotid artery involvement, wound dehiscence, or deep cervical infections. The MacFee incision can be used in major head and neck resections, with operative morbidity comparable to that of other techniques.
Wound dehiscence
Presentation (obstetrics)
Neck dissection
Cervical lymph nodes
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OBJECTIVE: To investigate perioperative features and results of surgical treatment of spinal tuberculosis in aged. METHODS: Review the clinical data of 36 aged with spinal tuberculosis from May 1998 to June 2005 retrospectively. The average age was 70.2 years. The sites of infection included 3 cervical, 9 thoracic, 13 thoracolumbar and 11 lumbar. 28 patients suffered 1 or more complications at least and among of them, there were 18 patients have cerebral or heart vascular disease, 16 patients have diabetes mellitus. Before operation, all patients consulted with internal stuff for the proper treatment of concomitant disease. The surgical procedures include: CT guided percutaneous catheter drainage in 3 patients, anterior debridement and bony grafting with anterior instrumentation fixation in 12 patients, anterior debridement and bony grafting with posterior fixation in 5 patients, posterolateral costotransversectomy debridement and interbody fusion with posterior fixation in 7 patients, posterior debridement and posterior fixation in 9 patients. The mean followed-up period was 3 years and 10 months (from 1.5 to 6 years). RESULTS: One died at two week after the operation. Tuberculous infection was controlled in other patients and no recurrence. Two patients died because of myocardial infarction and cerebral hemorrhage respectively at 1.5 and 2.5 years after operation. Bone fusion was achieved in 31 patients. The deformity was partial corrected at the final follow-up. Among 20 cases with neurologic deficit, 11 cases were completely recovered, 5 cases were partly improved. CONCLUSIONS: If the associated disorders and postoperative complications are properly handled, aged patients can endure surgical treatment for spinal tuberculosis. Instrumentation fixation provides adequate stability and promote recovery.
Debridement (dental)
Bone grafting
Concomitant
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Seroma
Wound dehiscence
Incisional Hernia
Fat necrosis
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We reviewed a consecutive series of 16 patients above 60 years of age (mean age 71 years) who underwent reconstruction with pedicled flaps in the lower extremity. The soft tissue defects ranged from 9 to 50 cm and were caused in 11 patients (70%) by surgical complications from previous surgeries. Of these, 5 patients underwent a total joint replacement of the knee (4 cases) and of the ankle (1 case). Surgery consisted of 19 muscular flaps, and 3 fasciocutaneous flaps. Six patients were treated with a combination of 2 flaps. The overall surgical complication rate after reconstruction was 44%. There was no perioperative mortality and there were no medical complications. One patient required an above-the-knee amputation because of uncontrollable postoperative bleeding. A thrombectomy was performed in another patient to treat a postoperative popliteal artery occlusion with critical ischemia of the leg. Other complications included recurrent total joint replacement infections (2 cases), marginal flap necrosis (4 cases), and skin necrosis at the donor site (1 case). The mean hospitalization stay was 46 days. All patients but 1 completely healed, although secondary surgery was performed in 7 patients. The occurrence of complications was not correlated with the preoperative morbidity or an age above 75 years. The local complication rate was higher than reported for free flap in the same age category, but the lack of perioperative mortality and medical complications make it a low-risk option for reconstruction of small- to middle-sized defects in the elderly.
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Abstract Some 114 patients (median age 52 years) underwent laparoscopic hernia repair as a day-case procedure. Twenty-one patients had bilateral and 11 recurrent hernias. Some 113 patients underwent transabdominal preperitoneal mesh repair but one required conversion to open operation. Mean operating time was 24 min for unilateral and 38 min for bilateral repair. In an operating session of 3·5 h, up to five patients (mean 4·4) underwent surgery and as many as seven hernias were repaired. More than 10 per cent of patients were found to have a previously undiagnosed hernia on the opposite side. A total of 111 patients were discharged home on the day of surgery. Major complications included one omental bleed and one small bowel obstruction. Seroma was the commonest minor complication and occurred in 7 per cent of patients. More than 35 per cent of patients needed no postoperative analgesia. To date there has been one recurrence (follow-up range 2–18 months).
Seroma
Bleed
Hernia Repair
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Objective To investigate the causes, the indications and operative procedures of reoperation for postoperative recurrence of hyperthyroidism. Method Clinical data of 34 cases of postoperative recurrence of hyperthyroidism received reoperation were analyzed retrospectively .Results The reoperative procedures including bilateral subtotal thyroidectomy in 29 cases, unilateral thyroidectomy in 5. All the 34 patients were cured by reoperation.The incidence of postoperative complication was 5.9%,which was not significantly different compared with primary operation treatment during the same time in our hospital.All the 34 case were followed up for 1～10 years,the results showed that all patients were alive well without recurrence or hypothyroidism .Conclusions Extension of the resected thyoid is not enough in the primary surgery is the main cause of postoperative recurrence of hyperthyroidism.Reoperation is the choise of therapy in selective patients with postoperative hyperthyroidsm recurrence .Careful intraoperative dissection can help to avoid injuries of recurrent nerve and parathyroid,and to prevent massive bleeding.
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Chylothorax
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There are different etiologies related to glaucoma, with the involvement of different systems in the origin and development of the disease.We performed a literature review.The data is divided, with an emphasis on five main topics: systemic disease, neurodegenerative disease, genetic disease, immunological disease, and aging of the trabecular meshwork. Older and recent important findings of each subject are reported to establish a relationship with glaucoma, and mention is made of some of the current research lines.Glaucoma is a multifactorial disease with complex interaction of events at various levels of the organism. Study of the etiology should guide the search for new therapies.
Etiology
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Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients (16M:19F) have been treated. The original operation was bowel related in 19 cases, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic aneurysm repair in 2 and involved a thoraco-laparotomy in 3. The incisions were midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one patient. The hernias were considered subjectively to be large in 15, medium in 14 and small in 6 of the patients. A proforma was completed for each patient noting intra-operative and post-operative complications, post-operative hospital stay and analgesic requirements. Post-operative complications included seroma formation in 6 patients, deep vein thrombosis in one and a non-fatal pulmonary embolism in another. One patient developed a wound haematoma and one had a superficial wound infection. Post-operative in-hospital stay ranged from 1 to 27 days with a mean of 6.2 days. Of the 35 patients 33 were available for follow-up. Follow-up was for a median of 20.3 months (range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent lump and one (3%) reported persistent pain but none of the remaining 33 was found to have a recurrence. We advocate this technique because it is applicable to all hernias, most of the mesh is behind the rectus sheath and has 2 points of fixation, it is relatively pain-free allowing early mobilisation, has a modest complication rate and a low recurrence rate.
Seroma
Incisional Hernia
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