简介：Coronaryarterybypassgrafting(CABG)isenteringaneweraasminimallyinvasivetechniques,off-pumpsurgeryandtotal'arterialrevascularizationhavefotmdrolesinthesurgicaltreatmentofpatientswithcoronaryarterydisease.Thecontinueddevelopmentofthetechniquesofpercutaneouscoronaryintervention(PCI)isalsohavinganimpactonthetypeofpatientreferredforCABG.

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简介：Treatmentofpancreaticcancerismultimodalandsurgeryisanessentialpart,mandatoryforcurativepotential.Alsochemotherapyisessential,andseriouspostoperativecomplicationsorrapiddiseaseprogressionmayprecludecompletionofmultimodaltreatment.Thesequenceoftreatmentinterventionshasthereforebecomeanimportantconcern,andnumerousongoingrandomizedcontrolledtrialscompareclinicaloutcomeafterupfrontsurgeryandneoadjuvanttreatmentwithsubsequentresection.Inpreviousyears,borderlineresectableandlocallyadvancedpancreaticcancerwasmostoftenconsideredunresectable.Moreeffectivechemotherapytogetherwiththelatestimprovementsinsurgicalexpertisehasresultedinextendedoperations,pushingthebordersofresectability.Multivisceralresectionswithorwithoutresectionofmajormesen-tericvesselsarenowperformedinnumerouspatients,resultinginbetteroutcome,recordedasoverallsurvivaland/orpatientreportedoutcome.Butpostoperativemorbidityincreasesconcurrently,andclinicalbenefitmustbecarefullyevaluatedagainstriskofpotentialharm,associatedwithnewcomprehensivemultimodaltreatmentsequences.Eventhoughcost/utilityanalysesaredeficient,extendedsurgeryhasresultedinsignifi-cantlylongerandbetterlifeformanypatientswithnoothertreatmentalternative.Improvedselectionofpatientstosurgeryand/orchemotherapywillinthenearfuturebepossible,basedonbettertumorbiologyinsight.Clinicallyavailablebiomarkersenablingpersonalizedtreatmentareforthcoming,buttheseoptionsarestilllimited.Theimportanceofsurgicalresectionforeachpatient’sprognosisispresentlyincreasing,justifyingsustainedexpansionofthesurgicaltreatmentmodality.

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简介：精索静脉曲张在临床的实践被认出了为在一个世纪。原来，这些过程为疼痛的管理被利用，但是自从1952，修理主要为男不孕的处理。然而，因为pathophysiology不是清楚的，精索静脉曲张的诊断和治疗是争论的，研究的入口标准在中心之中变化了，并且有很少使随机化的临床的试用。不过，临床医生们继续为精索静脉曲张的修正开发技术，基本科学家在精索静脉曲张的pathophysiology上继续调查，并且从未来的使随机化的试用的新结果数据出现在世界的文学。因此，Andrology的亚洲杂志的这个特殊版本被建议报导许多与精索静脉曲张有关的新信息，作为这个工程的特定的部分，现在的文章作为进化的全面评论和校正过程的精炼被开发。

简介：比较在主要debulking外科(PDS)和neoadjuvant化疗之间的幸存和perioperative病态的目的在与先进上皮的卵巢的癌症(EOC)对待病人由间隔debulking外科(NAC/IDS)列在后面。我们回顾地与阶段IIIC或IVEOC考察了67个病人的方法从2006年1月在北京大学癌症医院对待到2009年6月。在那里，37和30个病人分别地经历了PDS和NAC/标志。结果在全面幸存(OS)或没有前进的幸存(PFS)的差别都没在NAC/IDS组和PDS组之间被观察(OS：41.2对39.1个月，P=0.23；PFS：27.1对24.3个月，P=0.37)。最佳的debulking率在NAC/IDS组是60%，它在PDS组(32.4%)(P=0.024)比那显著地高。NAC/IDS组显著地有比PDS的肠的功能的估计的血损失和输送，更低的nasogastricintubation率，和更早的移动和恢复组织的更少的intraoperative(P<0.05)。结论NAC/IDS不比PDS侵略，并且关于最佳的cytoreduction率，intraoperative血损失，和手术后的恢复提供优点，没有显著地损害与在对待有阶段IIIC或IVEOC的病人的PDS相比的幸存。因此，NAC/IDS可以是为EOC病人的一种珍贵治疗选择。

简介：AbstractPrecision medicine requires coordinated and integrated evidence-based combinatorial approaches so that diagnosis and treatment can be tailored to the individual patient. In this context, the treatment approach to mild obstructive sleep apnea (OSA) is fraught with substantial debate as to what is mild OSA, and as to what constitutes appropriate treatment. As such, it is necessary to first establish a proposed consensus of what criteria need to be employed to reach the diagnosis of mild OSA, and then examine the circumstances under which treatment is indicated, and if so, whether and when anti-inflammatory therapy (AIT), rapid maxillary expansion (RME), and/or myofunctional therapy (MFT) may be indicated.

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简介：<正>Theskullbasegenerallyreferstotheanterior,middleandposteriorcranialfossaandstructuresontheoutsidesideoftheseskullareas.Thecranialroofandskullbaseareseparatedbyalineconnectingtheexternaloccipitalprotuberance,parietalnotchandsupraorbitalridge[1].Theskullbasesupportsthebrainabove,isconnectedto

简介：AbstractEndoscopic endonasal orbital surgery is evolving. With increasing knowledge, expertise, and technology, the historical limits of the endonasal endoscopic approach to the orbit have been redefined. This review discusses the clinical presentation and etiology, and highlights the pertinent anatomy, and discusses the diagnostic workup and surgical approach to orbital tumors and post-operative care. The role of the multidisciplinary team is not to be underestimated. The introduction of a classification system to ensure standardization of technical difficulty and outcome data will assist with international collaboration and further consolidate our attainment of knowledge in this developing field.

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简介：摘要尽管近年来胰腺癌的手术切除率与手术安全性显著提高，但患者远期预后仍无显著改善。在目前多学科诊断与治疗的背景下，胰腺癌作为系统性疾病，传统“surgery first”的治疗策略面临质疑与挑战。对于局部进展期、交界可切除及合并有高复发风险的可切除胰腺癌，提倡先行系统治疗即“surgery last”的治疗策略；对于生物学行为良好的可切除胰腺癌，宜行“surgery first”治疗策略。

简介：静脉的thromboembolism(VTE)作为深静脉血栓(DVT)和肺的栓塞(PE)被表明，代表死亡，残疾，和不快的一个重要原因。他们是各种各样的外科的过程的经常的复杂并发症。变老的人口和更严重地受伤的病人的幸存可以在损伤病人建议thromboembolism的增加的风险。在风险挑战医生扩展了人口的理解小心地检验风险因素让VTE识别能得益于预防的高风险的病人。基于证据的风险因素的精确知识在预言并且阻止手术后的DVT是重要的，并且能为appropriatethromboprophylaxis使用被合并到一个决定支持系统。在一张高风险的损伤人口的DVT预防的标准使用在下导致DVT的发生。VTE的发生在亚洲是普通的。评估包括实验室测试，Doppler测试和phlebography。屏蔽Dopplersonography应该在所有非常受伤的病人上为监视被执行识别DVT。D暗淡是一个有用标记在损伤外科病人监视预防。开始预防的最佳的调子以前在2hours之间并且在外科以后的10个小时，而是PE的风险继续因为几weeks.Thromboprophylaxis为预防包括毕业压缩袜子和抗凝剂。抗凝剂包括Warfarin，它属于维生素K对手，unfractionatedheparin，低分子的重量肝磷脂，因素Xa间接禁止者Fondaparinux，和口头的IIainhibitorMelagatran和ximelagatran。Recombinant人的solublethrombomodulin是一个新、高度有效的antithrombotic代理人。在选择损伤病人的venacaval过滤器的预防放置可以减少PE的发生。为预防劣等的静脉cava过滤器插入的指示与多重损害，关上的头损害，骨盆的破裂，脊骨破裂，多重长骨头破裂，和出席谨慎包括延长固定。多重损伤的病人在为DVT的增加的风险，但是也在流血，和肝磷脂的使用的增加的风险可以被禁忌。连续压缩设备(SCD)是为DVT预防的一种选择。压缩设备向足够的DVTprophylaxis提供低失败率和没有设�

简介：AbstractParotidectomy is the mainstay treatment for tumors of the parotid gland. In an effort to improve clinical outcomes, several modern surgical techniques and perioperative interventions have been evaluated and refined. This review discusses current and actively debated perioperative interventions aimed at improving patient safety and the quality of parotidectomy. Relevant high-impact literature pertaining to preoperative diagnostic modalities, intraoperative surgical techniques, and postoperative care will be described.

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简介：AbstractThe current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease (AERD), who present with the clinical triad of chronic rhinosinusitis with nasal polyposis (CRSwNP), bronchial asthma, and aspirin/nonsteroidal anti-inflammatory drug intolerance. To further define the effectiveness of sinus surgery in treating AERD patients, this review article discusses current evidence regarding outcomes associated with more extensive surgery, the benefits of frontal sinus surgery on polyposis, and the role of Draf III intervention. Numerous studies suggest that Draf III frontal sinusotomy may be an efficacious early intervention due to increased neo-ostial patency and subsequent distribution of topical therapies. Future studies that further investigate the efficacy and safety of extensive surgery in AERD patients are warranted.

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简介：Esophagealandgastriccancer(GC)arerelatedtoobesityandbariatricsurgery.Riskfactors,suchasgastroesophagealrefluxandHelicobacterpylori,mustbeinvestigatedandtreatedinobesepopulation.Aftersurgery,GCreportsareanecdotalandtreatmentisnotstandardized.ThisreviewaimstodiscussGCrelatedtoobesitybeforeandafterbariatricsurgery.

简介：·AIM:Toevaluateandcompareaspherictoricintraocularlens(IOL)implantationandasphericmonofocalIOLimplantationwithlimbalrelaxingincisions(LRI)tomanagelowcornealastigmatism(1.0-2.0D)incataractsurgery.·METHODS:Aprospectiverandomizedcomparativeclinicalstudywasperformed.Therewererandomlyrecruited102eyes(102patients)withcataractsassociatedwithcornealastigmatismanddividedintotwogroups.ThefirstgroupreceivedtoricIOLimplantationandthesecondonemonofocalIOLimplantationwithperipheralcornealrelaxingincisions.Outcomesconsideredwere:visualacuity,postoperativeresidualastigmatism,endothelialcellcount,theneedforspectacles,andpatientsatisfaction.Todeterminethepostoperativetoricaxis,allpatientswhounderwentthetoricIOLimplantationwerefurtherevaluatedusinganOPDScanIII(NidekCo,Japan).Follow-uplasted6mo.·RESULTS:Themeanuncorrecteddistancevisualacuity(UCVA)andthebestcorrectedvisualacuity(BCVA)demonstratedstatisticallysignificantimprovementaftersurgeryinbothgroups.Attheendofthefollow-uptheUCVAwasstatisticallybetterinthepatientswithtoricIOLimplantscomparedtothosepatientswhounderwentimplantationofmonofocalIOLplusLRI.Themeanresidualrefractiveastigmatismwasof0.4DforthetoricIOLgroupand1.1DfortheLRIgroup(P<0.01).Nodifferencewasobservedinthepostoperativeendothelialcellcountbetweenthetwogroups.·CONCLUSION:Thetwosurgicalproceduresdemonstratedasignificantdecreaseinrefractiveastigmatism.ToricIOLimplantationwasmoreeffectiveandpredictablecomparedtothelimbalrelaxingincision.