PURPOSE: To investigate the clinical course in patients who underwent surgical correction of consecutive esotropia. METHODS: The medical records of 13 patients who underwent surgical correction of consecutive esotropia were reviewed retrospectively. The authors investigated the deviation and surgical method at the time of exotropia surgery. During the follow up period, the authors also studied incidence of amblyopia development, the effect of occlusion therapy, surgical methods for consecutive esotropia, and postoperative change of deviation. RESULTS: The average exodeviation was 27.1 prism diopter (PD). Bilateral lateral rectus muscle recession was performed in all patients. In all patients, alternate occlusion was tried from 2 weeks after development of consecutive esotropia. However, there was no effect on 7 patients. None of the patients developed amblyopia. Surgery for consecutive esotropia was performed on the average 15.3 months after exotropia surgery. The average esodeviation was 21.1PD. Medial rectus muscle recession was performed in 10 patients and lateral rectus muscle advancement in 3 patients. The average deviation of the subject group immediately after surgery was 1.2PD esodeviation, 0.9PD esodeviation one month after surgery, 2.4PD exodeviation 6 months after surgery, and 4.7PD exodeviation at the last follow up, and it showed a tendency to progress to exodeviation as the follow up period increased. Ten patients (76.9%) showed deviation within 8PD at the last follow up. CONCLUSIONS: The success rate of surgical correction for consecutive esotropia was a favorable outcome. But, careful decisions of the surgical method and amount is needed because the conversion of exodeviation during long-term follow-up is possible.
Adolescent ; Child ; Child, Preschool ; Esotropia/epidemiology/*etiology/physiopathology ; Exotropia/physiopathology/*surgery ; Eye Movements/*physiology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Oculomotor Muscles/physiopathology/*surgery ; Ophthalmologic Surgical Procedures/*methods ; Postoperative Complications ; Retrospective Studies ; Time Factors ; Treatment Outcome

PURPOSE: Anastomotic airway complications are a major cause of morbidity and mortality after lung transplantation (LTx). In this study, the authors identified types and clinical outcomes of airway complications after LTx. MATERIALS AND METHODS: All bronchial anastomotic complications were analyzed in a total of 94 LTx cases involving 90 recipients who underwent surgery between July 2006 and May 2014. Fifteen LTx cases (14 recipients) with incomplete medical records for fiberoptic bronchoscopy (FBS) and three cases underwent heart-lung transplantation (HLT) were excluded. Postoperative FBS at 24-48 hours, 1, 3, 6, and 12 months, and then yearly after the transplantation were performed. RESULTS: A total of 76 LTx cases (75 recipients) were analyzed. The mean age of the recipients was 49.55 years (range, 18-71 years), and 38 (49.4%) were male. Twenty-one out of 76 cases (27.6%) experienced early anastomotic complications, and 12 (15.8%) presented late anastomotic complications. The early anastomotic airway complications presented in various forms: stenosis, 1 case; narrowing, 1; necrosis & dehiscence, 3; fistula, 4; granulation, 10; and infection, 2. Late complications almost entirely presented in the form of bronchial stenosis; five recipients showed stenosis at the anastomosis site, and one of them showed improvement after ballooning. Five others were found to have stenosis at the bronchus intermedius, distal to the anastomosis site. Three of these patients showed improvement after ballooning or bronchoplasty. CONCLUSION: By serial surveillance via FBS after LTx, we detected anastomotic airway complications in 42.9% of cases, which were successfully managed with improved clinical outcomes.
Adolescent ; Adult ; Aged ; Analysis of Variance ; Anastomosis, Surgical/*adverse effects/methods ; Bronchi/blood supply/physiopathology/*surgery ; Bronchial Diseases/epidemiology/*etiology/physiopathology ; Bronchoscopy ; Female ; Humans ; Incidence ; *Lung Transplantation ; Male ; Middle Aged ; Postoperative Complications/epidemiology/*etiology/physiopathology ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Treatment Outcome

OBJECTIVEWe retrospectively analyzed the cause and death risk of 114 postoperative respiratory failure patients found in 3519 patients with esophageal cancer and 1495 patients with carcinoma of gastric cardia surgically treated between January 1992 and May 2003.

METHODSTo analyze the reasons causing postoperative respiratory failure in surgically treated esophageal or gastric cardia cancer patients, and the correlation between the death risk of postoperative respiratory failure and preoperative pulmonary function tests, postoperative complications, operation modes, history of preoperative accompanying diseases and so on using Binary Logistic Regression analysis and Chi-square tests (chi(2)) in SSPS statistics software.

RESULTSIn this series, postoperative respiratory failure developed in 97 of 3519 (2.76%) esophageal cancer patients and 17 of 1495 (1.14%) gastric cardia cancer patients, which were mainly caused by severe respiratory tract infection (37.7%, 43/114) and operative complications (35.1%, 40/114) such as: anastomotic leakage or perforation of thoracic stomach, extensive bleeding during operation, chylothorax, etc, totally accounting for 72.8% (83/114). In contrast with lung cancer patients, most of the postoperative respiratory failure (69.3%) occurred in the patients who had perioperative complications but almost always normal preoperative pulmonary function tests. Other reasons to cause postoperative respiratory failure were: extubation in unconscious patients at the end of general anesthesia; over-infusion during operation; pulmonary artery embolism; severe arrhythmia and so on. All patients except 2 were treated in ICU by mechanic ventilation through intubation and/or tracheotomy. Eighty patients (70.2%) were intubated and/or had tracheotomy within 3 days postoperatively. Seventy patients (61.4%) were rescued successfully, whereas 44 cases (38.6%) died of postoperative respiratory failure and/or other postoperative complications. Univariate analysis and multivariate analysis by binary logistic regression indicated that: severe perioperative complications, more postoperative complications, poor preoperative pulmonary function, radical preoperative radiotherapy, intubation and/or tracheotomy after the second postoperative day and long period of mechanic ventilation were the major risk factors leading to death once the postoperative respiratory failure developed. The former 3 factors were independent risk factors leading to death with OR of 2.50, 2.37, 1.68, respectively. Age, sex, operation modes, history of preoperative accompanying disease, prophylactic antibiotics were not demonstrated as statistically significant risk factors correlated with death.

CONCLUSIONSevere perioperative complications and respiratory tract infection are the two major causes of postoperative respiratory failure in patients with cancer of esophagus and gastric cardia. Patients with severe perioperative complications or poor preoperative pulmonary function or association with more than two kinds of postoperative complications have much higher death risk than other patients when they develop postoperative respiratory failure. Careful manipulation during operation and effective perioperative management are the most important measures to avoid postoperative respiratory failure and high mortality.

Adult ; Aged ; Aged, 80 and over ; Cardia ; China ; epidemiology ; Esophageal Neoplasms ; physiopathology ; surgery ; Esophagectomy ; adverse effects ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications ; etiology ; prevention & control ; Respiratory Function Tests ; Respiratory Insufficiency ; epidemiology ; etiology ; prevention & control ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; physiopathology ; surgery

OBJECTIVETo study the effect of Yiqi Bufei Recipe ([see text], YBR) on surgical tolerability, pulmonary compensatory function and post-operation rehabilitation in patients with pulmonary incompetence (PI) after pneumonectomy.

METHODSYBR intervention was applied to 60 patients with PI after pneumonectomy (as test group), the pulmonary and cardiac functions changes before and after operation, occurrence of postoperative complications, mortality, and the number of hospitalization days and intensive care unit (ICU) confinement period were observed. Meantime, for the negative and positive controls, the same parameters were observed comparatively in 60 patients with normal lung function, and in 60 patients with PI undergoing a similar operation but untreated with Chinese herbs.

RESULTSLung function in the test group showed insignificant change before and after operation (P >0.05), while significant decrease was seen in the two control groups (P<0.05). Furthermore, the incidences of post-operation complications and mortality as well as the number of hospitalization days and the ICU confinement period in the test group were significantly lower than those in the positive control group respectively (P <0.05).

CONCLUSIONYBR could relieve lung injury after pneumonectomy, improve surgical tolerability, reduce the length of postoperative hospitalization days and ICU confinement period, and lower the incidence of postoperative complications and mortality in patients with PI after pneumonectomy.

Blood Gas Analysis ; China ; epidemiology ; Drugs, Chinese Herbal ; pharmacology ; Female ; Heart Function Tests ; drug effects ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Lung ; drug effects ; physiopathology ; surgery ; Male ; Middle Aged ; Pneumonectomy ; adverse effects ; Postoperative Complications ; epidemiology ; etiology ; Respiratory Function Tests ; Treatment Outcome

OBJECTIVETo investigate the effects of Chinese herbs for supplementing qi, nourishing yin and activating blood circulation on heart function of patients with acute coronary syndrome (ACS) after successful percutaneous coronary intervention (PCI).

METHODSOne hundred patients with ACS after successful PCI were randomly assigned to a Western medicine (WM) treatment group (WMG) and a combined treatment group (CMG) treated by Chinese herbs for supplementing qi, nourishing yin and activating blood circulation, besides Western medicine treatment, with 50 cases in each group. Both treatment courses were 6 months. The followup was scheduled at baseline, 6 months and 1 year after PCI, and New York Heart Association (NYHA) functional class, Chinese medicine (CM) symptom scores, blood stasis syndrome scores, and major adverse cardiovascular events (MACE) were observed, serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and hyper-sensitivity C-reactive protein (Hs-CRP) were measured, an echocardiogram was conducted to examine left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), inter-ventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), and ventricular wall motion index (VWMI).

RESULTSCompared with the baseline, LVEF significantly increased (P<0.01), and CM symptom scores, blood stasis syndrome scores, VWMI, LVEDV, LVESV, NT-proBNP, and Hs-CRP all decreased (P<0.01) in both groups at 6 months and at 1 year after PCI. There were no significant differences in all the above parameters at 1 year vs those at 6 months after PCI (P>0.05). VWMI, LVEDV, LVESV, NT-proBNP, Hs-CRP, LVEF, and CM symptom and blood stasis syndrome scores were all improved obviously in CMG than those in WMG (P<0.05 or P<0.01) at 6 months and at 1 year after PCI. There were no significant differences in NYHA functional class between CMG and WMG at different follow-up timepoints; it was notable that value was 0.054 when comparing the cases of NYHA functional class between the two groups at 1-year follow-up. During the 1-year follow-up, 3 MACE and 11 MACE occurred in CMG and WMG, respectively; the MACE rate in CMG was lower than that in WMG (6% vs 22%, P<0.05).

CONCLUSIONChinese herbs for supplementing qi, nourishing yin and activating blood circulation could improve heart function, reduce the CM symptom scores and blood stasis syndrome scores, and decrease the incidence of MACE in patients with ACS after successful PCI.

Acute Coronary Syndrome ; blood ; drug therapy ; physiopathology ; surgery ; C-Reactive Protein ; metabolism ; Cardiotonic Agents ; adverse effects ; pharmacology ; therapeutic use ; China ; epidemiology ; Coronary Circulation ; drug effects ; Drugs, Chinese Herbal ; adverse effects ; pharmacology ; therapeutic use ; Female ; Heart Function Tests ; drug effects ; Humans ; Incidence ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; New York ; Peptide Fragments ; blood ; Percutaneous Coronary Intervention ; adverse effects ; Postoperative Complications ; epidemiology ; etiology ; Qi ; Societies, Medical ; Syndrome ; Ultrasonography ; Yin-Yang