Safety and efficacy of surgery combined with bleomycin irrigation for complex cervical-facial lymphatic malformations of children.
- 作者列表："Wang Y","Tang W","Li X
BACKGROUND:In this retrospective study, we compare the safety and efficacy of surgery combined with bleomycin intra-operatively with intralesional sclerotherapy alone for the management of head and neck lymphatic malformations in children. MATERIALS AND METHODS:The patients with cervical-facial lymphatic malformations were reviewed in Shanghai Children's Hospital from August 2014 to August 2018. Data analysis was performed using SPSS17.0. Pearson X2 test and t-test were used, and the significance level was fixed at 5%. RESULTS:72 patients in all of which 63 patients underwent surgical excision combined with bleomycin irrigation and 9 patients underwent sclerotherapy alone as the primary treatment. The surgical excision group had a significantly higher rate of an excellent response compare to the sclerotherapy group (P < 0.05). In regards to postoperative complications, the surgical group had no higher rate of temporal facial paralysis and other nerve injures compare to the sclerotherapy group (P = 0.624). CONCLUSIONS:we recommend surgery combined with Bleomycin for microcystic disease with focal and less infiltrative lesions and for lesions located in the oropharynx, parapharynx, retropharynx, or hypopharynx.
背景: 在这项回顾性研究中，我们比较了术中手术联合博莱霉素与单纯皮损内硬化治疗儿童头颈部淋巴管畸形的安全性和有效性。 材料和方法: 回顾性分析 2014 年 8 月至 2018 年 8 月上海市儿童医院收治的颈面部淋巴管畸形患者的临床资料。使用spss17.0 进行数据分析。采用Pearson X2 test t test，显著性水平固定为 5%。 结果: 72 例患者中，63 例患者行手术切除联合博莱霉素冲洗，9 例患者行硬化剂治疗。与硬化治疗组相比，手术切除组的优良反应率显著较高 (p <0.05)。术后并发症方面，手术组颞侧面瘫及其他神经损伤的发生率与硬化剂组比较无显著性差异 (p = 0.624)。 结论: 我们建议手术联合博莱霉素治疗局灶性和浸润性病变较少的微囊性疾病，以及位于口咽、咽旁、咽后或下咽部的病变。
METHODS::Impairments in social cognition have been frequently described in 22q11.2 deletion syndrome (22q11.2DS) and are thought to be a hallmark of difficulties in social interactions. The present study addresses aspects that are critical for everyday social cognitive functioning but have received little attention so far. Sixteen children with 22q11.2DS and 22 controls completed 1 task of facial expression recognition, 1 task of attribution of facial expressions to faceless characters involved in visually presented social interactions, and 1 task of attribution of facial expressions to characters involved in aurally presented dialogues. All three tasks have in common to involve processing of emotions. All participants also completed two tasks of attention and two tasks of visual spatial perception, and their parents completed some scales regarding behavioural problems of their children. Patients performed worse than controls in all three tasks of emotion processing, and even worse in the second and third tasks. However, they performed above chance level in all three tasks, and the results were independent of IQ, age and gender. The analysis of error patterns suggests that patients tend to coarsely categorize situations as either attractive or repulsive and also that they have difficulties in differentiating emotions that are associated with threats. An isolated association between the tasks of emotion and behaviour was found, showing that the more frequently patients with 22q11.2DS perceive happiness where there is not, the less they exhibit aggressive behaviour.
METHODS:BACKGROUND:We describe the first radiographic clinic in the literature for DDH and how this novel clinic can significantly improve the efficiency and cost-effectiveness of service in a tertiary referral centre. AIMS:A radiographic clinic for the management of developmental dysplasia of the hip was introduced in 2017 in our institution. We performed a detailed cost analysis to assess the economic savings made with the introduction of this new clinic. We assessed the efficiency of the service by identifying how many unnecessary outpatient visits were prevented. We also assessed the difference in times from referral to review between the two clinics. METHODS:Analysis of the clinic activity in 2017 was possible as all data was collected prospectively by the DDH CNS and stored in our database. Cost analysis was performed, and the savings made per patient along with the financial benefit to our institution was recorded. RESULTS:The new radiographic clinic reduced the cost of reviewing one patient by €162.51 per patient. There was a 73% discharge rate from the clinic which prevented 251 unnecessary patient visits to the outpatient department over the course of the year. There was a significant 11-day reduction in waiting times between referral and review when comparing the radiographic to the conventional clinic (p < 0.05). CONCLUSIONS:A radiographic clinic for the management of developmental dysplasia of the hip has a significant effect on the efficiency and overall cost-effectiveness of service provision in a tertiary referral centre.
METHODS:INTRODUCTION:Triple pelvic osteotomy (TPO) involves periacetabular osteotomies of the ilium, ischium, and pubis to reorient the acetabulum. This operation is indicated in certain situations for the treatment of developmental dysplasia of the hip, dysplastic neuromuscular hips, and for containment of the femoral head in cases of Legg-Calvé-Perthes disease. METHODS:This retrospective cohort study compares radiographic outcomes of patients who underwent TPO using two different techniques and describes a novel single-incision direct lateral approach. TPO was performed on 22 patients by the senior author. The first 10 patients underwent TPO through a single-incision anterolateral approach. The last 12 patients underwent TPO using the direct lateral approach. Preoperative and postoperative pelvic radiographs were reviewed for each patient, and the migration index and center-edge angle were recorded. RESULTS:The migration index and center-edge angle were evaluated and were not found to be significantly different between the anterolateral and direct lateral groups. The direct lateral approach is described. CONCLUSION:The direct lateral approach for TPO is equivalent to the anterolateral approach on radiographic evaluation. Advantages of the direct lateral approach include direct visualization of the ischial osteotomy, effective mobilization of the acetabulum, and safety of the sciatic nerve.