Objective To detect the operative technique and aesthetic problem of reconstruction to deformity of bilateral cleft lip． Methods From March 2003 to December 2004, 26 patients with bilateral cleft lip were treated, aged 10 months to 11 years. Of 26 patients, there were 13 bilateral complete cleft lip and palate, 9 bilateral incomplete cleft lip and 4 mixed cleft lip with unilateral complete cleft palate. The chief design principle was keeping the length of prolabium. During operation, sufficient dissociation was made in the base of the ala base and orbicularis oris muscle to reconstruct these structures．The circle suture was made for the bilateral orbicularis oris muscle. The shape of vermilion was achieved by lateral red lip muscle flap and simultaneous simple rhinoplasty was performed. Results Primary healing of the incisions was achieved in all cases. After the 10 days-3 months follow-up, the results were satisfactory in thewidth and chubbiness of the nose bottom,the shapes of nostril and Cupid’s bow were good without whistle deformity. Theapperance of upper lip was good in either dynamic or static state． Conclusion Excellent shapes and function of the nose and lip， and opportunity for twostage repair could be obtained with this method，which being believed important methods for the primary repair of bilateral cleft lip．
ObjectiveTo summarize the use of harmonic scalpel to harvest bilateral internal mammary artery in coronary artery bypass grafting (CABG). MethodsThe clinical data of 54 patients of bilateral skeletonized internal mammary artery harvesting for CABG in our hospital from January 2016 to May 2020 were analyzed retrospectively. There were 51 males and 3 females with a mean age of 62.37±9.56 years. ResultsAll patients went through the procedure unevently and discharged from hospital. The number of grafts was 4.07±0.85 per patient, the operation time was 267.21±47.00 min, mechanical ventilation time was 342.43±132.17 min and hospital stay was 12.21±4.43 d. ConclusionIt is safe and effective to use harmonic scalpel to harvest skeletonized bilateral internal mammary artery in CABG.
Objective To study the effect of simultaneous bilateral total hip arthroplasty in a single procedure. Methods From October 1999 to March 2004, 15 patients (30 hips) underwent simultaneous sequential bilateral total hip arthroplasty (THAs) in a single procedure. Of the 15 patients, 11 were male (22 hips) and 4 were female (8 hips). Their ages ranged from 35 to 70 years. Their courses of disease ranged from 1 year to 50 years (4.8 years on average). The Harris scores of the joint function before the operation ranged from 12 to 45 points (27 points on average). Five were done with Smith-Peterson and 10 were done with Moore. Results The operative time was 3 hours and 25 minutes to 5 hours (4 hours and 10 minutes on average). The volume of blood transfusion during operation was 400 to 2 400 ml (1 160 mlon average). All the 15 patients were followed up for 3 to 35 months (18 monthson average). The Harris scores of the joint function after the operation rangedfrom 70 to 100 points (86 points on average). There was significant difference in the scores between before and after operations (Plt;0.05). There was only 1death within 1 months of the operation and no serious between complications such as infection, pulmonary embolism, and deep vein plug. All the patients were still ambulant in the community and gained significant pain relief. Conclusion Simultaneous bilateral total hip arthroplasty in a single procedure is a safe and effective method. However, the decision of performing singlestage bilateral total hip arthroplasty should be carefully made and preoperative preparation should be sufficiently made.
Objective To investigate the optimal surgical approach for bilateral inguinal hernias and complex (recurrent and compound) inguinal hernia. Methods Data of eighty patients with bilateral inguinal hernias and (or) complex inguinal hernias treated by tension less hernia repair between Feb. 2007 and Jun. 2010 in Sichuan Provincial People’s Hospital were analyzed. Preperitoneal approach through inferior abdominal median incision was applied in the repair with local, lumbar or epidural anesthesia. Results Operation time was （30±10.2） min in unilateral hernia, （50±17.5） min in bilateral hernia. There was no ischemic orchitis or pain case after operation. Within 3 months following up, no recurrence occurred. Conclusion The preperitoneal approach through inferior abdominal median incision for inguinal hernia repair is proved to be effective, safe, and convenient, and especially fit for bilateral hernias and complex hernia.
Objective To explore the advantage of transection the cervical muscles at sternal end and flip fixed in therapeutic bilateral huge thyroid surgery. Methods The transection of the cervical muscles at sternal end and flip fixed in 53 cases was observation group， 44 cases of the neck white line incision thyroid surgery completed for the control group. The completion of the surgery by the same group of physicians. The operative time， operation field of exposing effect， amount of bleeding in operation， postoperative complications， and postoperative drainage volume were compared between two groups. Results There was no statistically differences of sex， age， disease composition， and tumor size between two groups （P＞0.05）. Operative time， amount of bleeding， and postoperative drainage volume in observation group were shorter （less） than that in control group （P＜0.01）. The postoperative complication rate in observation group was lower than that in control group（P=0.04）. Surgical field exposure in observation group was better than that in control group （P＜0.01）. Conclusions The huge bilateral thyroid surgery with the sternal end approach is feasible and simple. The operation field exposure is better than the white line neck incision， complications after operation is less. It is worthy of clinical application.
ObjectiveTo compare the cerebral protective effect of unilateral and bilateral antegrade selective cerebral perfusion during total aortic arch replacement, particularly with respect to neuropsychological outcome.MethodsFrom June 2003 to March 2004, 16 patients who underwent total aortic arch replacement were randomly allocated to one of two methods of brain protection: unilateral antegrade selective cerebral perfusion (unilateral group, n =8) or bilateral antegrade cerebral perfusion (bilateral group, n =8). Preoperative and postoperative neurological examination, brain computed tomography(CT) scan, and cognitive function tests were performed.ResultsAll patients survived the operations and were discharged from hospital. No new brain infarction occurred. Transient neurologic dysfunction occurred in 1 patient of each group. There were no intergroup differences in the scores of preoperative and post operative cognitive function ( P gt;0.05).ConclusionBoth methods of brain protection for patients undergoing total aortic arch replacement result in favorable and similar effect of brain protection in term of cognitive function provided the circle of Willis is patent and collateral flow is adequate.
Accurate segmentation of pediatric echocardiograms is a challenging task, because significant heart-size changes with age and faster heart rate lead to more blurred boundaries on cardiac ultrasound images compared with adults. To address these problems, a dual decoder network model combining channel attention and scale attention is proposed in this paper. Firstly, an attention-guided decoder with deep supervision strategy is used to obtain attention maps for the ventricular regions. Then, the generated ventricular attention is fed back to multiple layers of the network through skip connections to adjust the feature weights generated by the encoder and highlight the left and right ventricular areas. Finally, a scale attention module and a channel attention module are utilized to enhance the edge features of the left and right ventricles. The experimental results demonstrate that the proposed method in this paper achieves an average Dice coefficient of 90.63% in acquired bilateral ventricular segmentation dataset, which is better than some conventional and state-of-the-art methods in the field of medical image segmentation. More importantly, the method has a more accurate effect in segmenting the edge of the ventricle. The results of this paper can provide a new solution for pediatric echocardiographic bilateral ventricular segmentation and subsequent auxiliary diagnosis of congenital heart disease.
ObjectiveTo monitor the diaphragm function of mechanical ventilated patients in the intensive care unit. MethodsA prospective study was conducted on mechanical ventilation patients who had been evaluated by ventilation weaning screening test and planning to underwent spontaneous breathing trial between May 2013 and November 2013. A newly designed multi-function esophageal electrode was used to record the phrenic nerve conduction time (PNCT),diaphragm compound muscle action potential (CMAP) and twitch transdiaphragmatic pressure (TwPdi) elicited by bilateral anterolateral magnetic phrenic nerve stimulation. Results14 patients were recruited in this study. 1 case exited because of intolerance of repetitive magnetic stimulation,2 cases had no diaphragmatic electromyographic signals nor twitch signals,1 case had diaphragmatic electromyographic signal but could not be elicited by magnetic stimulation,1 case had no available TwPdi value with PNCT of 7.2 ms and CMAP of 1.26 mV. In the rest 9 cases,the PNCT,CMAP and TwPdi were (8.5±1.5)ms,(1.01±0.35)mV,(11.2±4.7)cm H2O,respectively. ConclusionNewly designed multi-function esophageal electrode catheter combined with bilateral anterolateral magnetic phrenic nerve stimulation can be used for non-volitional comprehensive assessment of diaphragm in critically ill patients,but not suitable for all subjects.
ObjectiveTwitch transdiaphragmatic pressure is used to evaluate the diaphragm function of mechanical ventilated chronic obstructive pulmonary disease patients before weaning in the intensive care unit, and compared with healthy normal values.MethodsPatients were recruited if they were with acute exacerbation of chronic obstructive pulmonary disease, admitted between May to November in 2013 and December 2014 to February 2016 to the intensive care unit in the First Affiliated Hospital of Guangzhou Medical University, intubated and mechanical ventilated more than 72 hours, and recovered to the clinical stability states after passing the readiness to wean, getting ready for spontaneous breathing test. The newly designed esophageal electrode catheter and bilateral anterolateral magnetic phrenic nerves stimulation were utilized to detect the twitch transdiaphragmatic pressure. At the same time, the function of diaphragm was detected in 10 healthy adults for comparison.ResultsTwenty-two patients were recruited in this study. Two cases had no twitch signals. In the rest 20 cases, the twitch transdiaphragmatic pressure was (7.6±2.5) cm H2O. In 10 healthy adults, twitch transdiaphragmatic pressure was (26.7±4.9) cm H2O. There was significant difference between the patients and the health control subjects (P<0.05).ConclusionTwitch transdiaphragmatic pressure is significantly decreased in weaning chronic obstructive pulmonary disease patients compared with healthy adults.
ObjectiveTo explore clinical outcomes of simutaneous video-assisted thoracoscopic surgery (VATS) for bilateral giant bullae (GB). MethodsClinical data of 160 GB patients who received surgical treatment in the First Affiliated Hospital of Xinjiang Medical University from March 2011 to April 2013 were retrospectively analyzed. According to GB location and surgical strategies, all the patients were divided into 3 groups. In group A, there were 108 patients with spontaneous pneumothorax (SP) and unilateral GB who underwent unilateral GB resection with VATS, including 88 male and 20 female patients with their age of 31.36±16.14 years. In group B, there were 40 patients with SP and bilateral GB who underwent unilateral GB resection in the SP side with VATS, including 36 male and 4 female patients with their age of 37.63±18.84 years. In group C, there were 12 patients with SP and bilateral GB who underwent simultaneous bilateral GB resection with VATS, including 9 male and 3 female patients with their age of 32.58±16.06 years. Postoperative morbidity and SP recurrence rates were analyzed. ResultsAll the operations were successfully performed, and patients were followed up for 20 months after discharge. In group A, postoperative complications included acute pulmonary edema in 1 patient, pleural adhesion in 11 patients, respiratory failure in 2 patients, and pulmonary air leak in 5 patients. During follow-up, SP recurred in 5 patients including 2 patients with SP recurrence at the same side and 3 patients with SP recurrence at the other side of thorax. In group B, postoperative complications included pleural adhesion in 4 patients, respiratory failure in 1 patient, and pulmonary air leak in 3 patients. During follow-up, SP recurred in 18 patients including 3 patients with SP recurrence at the same side and 15 patients with SP recurrence at the other side of thorax. In group C, postoperative complications included pleural adhesion in 2 patients and pulmonary air leak in 1 patient. During follow-up, SP recurred in 1 patient at the same side of thorax. SP recurrence rates of group A and C were significantly lower than that of group B (P=0.000 and P=0.031 respectively). ConclusionSimultaneous VATS is safe, efficacious and reliable for the treatment of bilateral GB, and can effectively prevent SP recurrence at the other side of thorax.