简介：Percutaneousendoscopicgastrostomy（PEG）isawidelyusedmethodofnutritiondeliveryforpatientswithlongterminsufficiencyoforalintake.ThePEGcomplicationratevariesfrom0.4%to22.5%ofcases,withminorcomplicationsbeingthreetimesmorefrequent.Buriedbumpersyndrome（BBS）isaseverecomplicationofthismethod,inwhichtheinternalfixationdevicemigratesalongsidethetractofthestomaoutsidethestomach.ExcessivecompressionoftissuebetweentheexternalandinternalfixationdeviceofthegastrostomytubeisconsideredthemainetiologicalfactorleadingtoBBS.IncidenceofBBSisestimatedataround1%（0.3%-2.4%）.Inabilitytoinsert,lossofpatencyandleakagearoundthePEGtubeareconsideredtobeatypicalsymptomatictriad.GastroscopyisindicatedinallcasesinwhichBBSissuspected.Thedepthofdiscmigrationinrelationtothelaminamuscularispropriaofthestomachiscriticalforfurthertherapyandcanbeestimatedbyendoscopicortransabdominalultrasound.BBScanbecomplicatedbygastrointestinalbleeding,perforation,peritonitis,intra-abdominalandabdominalwallabscesses,orphlegmon,andthesecomplicationscanleadtofataloutcomes.Themostimportantpreventivemeasureisadequatepositioningoftheexternalbolster.Aconservativeapproachshouldbeappliedonlyinpatientswithhighoperativeriskanddismalprognosis.ChoiceofthemethodofreleaseisbasedonthetypeofthePEGsetanddepthofdiscmigration.Adiscretainedinsidethestomachandcompletelycoveredbytheovergrowingtissuecanbereleasedusingsometypeofendoscopicdissectiontechnique（needleknife,argonplasmacoagulation,orpapillotomethroughthecannula）.Properpatientselectionanddissectionoftheovergrowingtissuearethemajordeterminantsforsuccessfulendoscopictherapy.Adisclocalizedoutofthestomach（laminamuscularispropria）shouldbetreatedbyasurgeon.

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简介：AbstractA 19-year-old male patient who suffered from sudden and repeated multiple organ dysfunction syndrome one month after the bar removal procedure of Nuss surgery for pectus excavatum was admitted to our department. With organ function supportive treatment, the etiology was finally identified to be a bone spur located at the inner border of the left costa due to repeated friction between the implanted steel bar and the rib, which damaged the heart repeatedly and induced the consequent acute cardiac tamponade. After operation, the patient was successfully managed and discharged. Follow-ups till three years indicated a good recovery.

简介：AbstractIncidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.

简介：Transperineal前列腺活体检视是能被用来从前列腺获得组织学的样品的一个过程。两个都改进活体检视核心样品和前列腺癌症察觉的质量，我们当前正在执行比较用18G针获得到用16G针获得的那些的前列腺活体检视样品的未来的、使随机化的试用。这初步的研究的目的是在两个组评估疼痛和复杂并发症率以便估计与一根更大的口径针执行前列腺活体检视是否是一个可行过程。经历transperineal前列腺活体检视的187个病人有希望地被评估并且把组划分了成二。第一个组(94个病人，组织A)用16G针和第二个组收到了transperineal前列腺活体检视(93个病人，组织B)与18G针经历了transperineal前列腺活体检视。麻醉在所有题目在prostatic顶与单个会阴的注射被获得。视觉类似物规模(管)和面部表情规模(FES)被用来在每个组在过程的多重步期间估计疼痛。因为它能潜在地影响病人们经历了的疼痛和复杂并发症，一张详细问询表被用来关于药使用获得信息。在过程以后的二个星期，早、迟了的复杂并发症被评估。统计分析用非参量的测试被执行。前列腺特定的抗原(PSA)和药使用在在二个组之间的基线是类似的。疼痛没在18-和16个G针组之间显著地在前列腺活体检视，与VAS和FES仪器一起被测量，期间不同，并且没有重要差别处于在这些组之间的早或迟了的复杂并发症率被发现。有16G针的Transperineal前列腺活体检视以疼痛和复杂并发症率是一个可行过程。有更大的耐心的人口的进一步的研究被要求估计这个过程是否能改进前列腺癌症察觉率。

简介：AbstractIntertrochanteric fractures have become a severe public health problem in elderly patients. Proximal femoral nail anti-rotation (PFNA) is a commonly used intramedullary fixation device for unstable intertrochanteric fractures. Pelvic perforation by cephalic screw is a rare complication. We reported an 84-year-old female who fell at home and sustained an intertrochanteric fracture. The patient underwent surgery with PFNA as the intramedullary fixation device. Routine postoperative examination revealed medial migration of the helical blade that eventually caused pelvic perforation. We performed a cemented total hip arthroplasty as the savage procedure. At the latest follow-up of 12 months after total hip arthroplasty, the patient had no pain or loosening of the prosthesis in the left hip. Pelvic perforation should be considered when choosing PFNA as the intramedullary fixation device, especially in patients with severe osteoporosis wherein the helical blade can be easily inserted during the operation. The lack of devices to avoid oversliding of the helical blade in PFNA is an unreported cause of this complication and should be considered in such cases.