Laparoscopic splenectomy: a surgeon's experience of 302 patients with analysis of postoperative complications.

BACKGROUND: This study aimed to evaluate the operative and clinical outcomes in a series of 302 consecutive laparoscopic splenectomies and to analyze the risk factors of postoperative complications. METHODS: The study retrospectively reviewed 302 consecutive patients who underwent laparoscopic splenectomy. The patients were classified into three disease groups: benign spleen-related disease (group 1, n = 196), malignant spleen-related disease (group 2, n = 42), and portal hypertension (group 3, n = 64). The three groups were compared in terms of perioperative data. Postoperative complications were classified into three complication groups according to the Clavien-Dindo Classification of Surgical Complications and Severity: no complication, mild complications, and severe complications. Multivariate logistic regression was used to analyze the independent risk factors of postoperative complications. RESULTS: The patients in group 1 were younger and had a higher body mass index, a lower American Society of Anesthesiology (ASA) score, and a smaller spleen than the patients in groups 2 and 3. Fewer patients in group 1 required hand-port assistance than in the other two groups. Group 1 had shorter operative times, required fewer transfusions, presented a lower incidence of complications, and had shorter postoperative stays than groups 2 and 3. In the analysis of complications, high ASA score was an independent risk factor for the occurrence of complications. Both high ASA score and larger spleen size were independent risk factors for the occurrence of severe complications. Compared with total laparoscopic splenectomy, the data including the hand-assisted cases showed a reduction in odds ratio for both the occurrence of complications and the occurrence of severe complications. CONCLUSIONS: The treatment of malignant spleen-related disease and portal hypertension with laparoscopic splenectomy is more challenging than the treatment of benign disease. High ASA score is an independent risk factor for the occurrence of complications, whereas high ASA score and larger spleen size are both independent risk factors for the occurrence of severe complications. The appropriate introduction of the hand-assisted technique may facilitate the laparoscopic procedure and reduce postoperative complications.

Epidemiologic investigation of burns in the elderly in Sichuan Province.

OBJECTIVE: This study analysed the epidemiology of burns in the elderly in Sichuan Province, China, with the objective of formulating a prevention programme. METHODS: A retrospective review of elderly patients admitted to the Burn Centre of West China Hospital during 2003-2009 was performed, including patient demographics, education and burn aetiology. RESULTS: A total of 103 patients, mean age 69.5 years (range 60-95 years; 58 male, 45 female) were admitted. The most common causes of burn were flames (51.5%), scalding (37.9%), electrical (4.9%) and chemical (2.9%), respectively. The majority occurred at home (68.9%), principally in the kitchen (35.9%), while 19.4% occurred in the workplace. Burns with total body surface area (TBSA) of 0-10% accounted for 52.5% of those admitted for treatment; 10-30% TBSA burns accounted for 20.3%; 30-50% TBSA burns accounted for 15.5%; and burns with a TBSA >50% accounted for 11.7%. Only 6% of patients received appropriate first aid, and 32% did not receive treatment until more than 24h after injury. The education level was lower in the rural group. Both urban and rural groups had little knowledge of first aid for burns. CONCLUSIONS: Burn-prevention programmes should promote improved living conditions and medical insurance, with prevention education for the elderly, especially in rural areas.

Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures.

PURPOSE: The aim of this study was to compare the results of a new technique for low, multidirectional locked nailing with closed reduction and minimally invasive plating in the treatment of distal tibial metadiaphyseal fractures. METHODS: Forty-six matched patients were divided according to age, gender, Injury Severity Score, and fracture pattern into group A (expert tibial nailing) and group B (minimally invasive plating). Then, the patients were followed up, and the clinical and radiographic results were retrospectively analysed. RESULTS: The mean followed-up was 24.7±2.7 months in group A and 25.8±2.8 months in group B. No patient had nonunion, shortening, hardware breakdown, or deep-seated infection. Patients in group A had a significantly shorter mean operating time, hospital stay, full weight-bearing time and union time (76±16.6 vs. 90±20.3 minutes, p=0.000; 5.8±2.1 vs. 8.9±3.1 days, p=0.000; 9.0±1.4 vs. 11.1±1.7 weeks, p=0.000; and 21.3±3.5 vs. 23.1±3.6 weeks, p=0.047, respectively). Three patients in group A and one patient in group B presented with malalignment (p=0.608). The mean Olerud-Molander Ankle score was 89.0±7.1 in group A and 87.6±8.4 in group B (p=0.478). CONCLUSIONS: Distal tibia metadiaphyseal fractures may be treated successfully with low, multidirectional locked nails or plates. However, low, multidirectional locked nailing may represent a superior surgical option, since it offers advantages in terms of mean operating time, hospital stay, full weight-bearing time and union time.

Serum levels of TNF-α, IL-1ß, COMP, and CTX-II in patients with Kashin-Beck disease in Sichuan, China.

The aim of the study was to detect differences in serum levels of interleukin-1ß (IL-1ß), tumor necrosis factor-α (TNF-α), cartilage oligomeric matrix protein (COMP), type II collagen (CTX-II) between patients with Kashin-Beck disease (KBD) or osteoarthritis (OA) and to assess the correlation between these differences with the clinical grade of KBD. A total of one hundred fifty adult serum samples were collected; these samples belonged to the KBD group (n = 64), the OA group in KBD-prevalent areas (n = 47) and a healthy control group in non-KBD area (n = 39). Serum levels of TNF-α, IL-1ß, COMP, and CTX-II were determined by a sandwich enzyme-linked immunosorbent assay, and the results were compared among the 3 groups (KBD/OA/normal) and between the different grades of KBD as well. The serum levels of IL-1ß, TNF-α, COMP, and CTX-II were significantly higher in the KBD and OA group than the healthy adult group (P < 0.001), and TNF-α and IL-1ß levels in the KBD group were similar to the OA group (for TNF-α, 14.38 ± 7.42 pg/ml vs. 12.61 ± 4.00 pg/ml, respectively, [P = 0.29]; for IL-1ß, 141.53 ± 71.35 pg/ml vs. 135.61 ± 68.60 pg/ml, respectively, [P = 0.63]). However, the COMP level was significantly lower and the CTX-II level was higher in the KBD group than in the OA group (for COMP, 7.03 ± 3.11 ng/ml vs. 9.20 ± 3.51 ng/ml, respectively, [P = 0.003]; for CTX-II, 2.23 ± 0.79 ng/ml vs. 1.80 ± 0.87 ng/ml, respectively, [P = 0.026]). Moreover, no significant correlations were found between clinical grade and serum levels of TNF-α, IL-1ß, COMP, and CTX-II for the 3 grades of KBD patients (P = 0.645, 0.481, 0.832, and 0.270, respectively). This study showed that serum levels of COMP in KBD patients decreased and CTX-II levels increased compared with the levels in OA patients, but TNF-α and IL-1ß levels in KBD and OA group were similar. In addition, increased serum levels of TNF-α, IL-1ß, COMP, and CTX-II were not associated with the KBD grade.