Application of Clavien–Dindo Classification System for Complications of Minimally Invasive Percutaneous Nephrolithotomy

Objective. To investigate the clinical applications of the Clavien–Dindo classification system (CDCS) in the assessment of perioperative complications in minimally invasive percutaneous nephrolithotomy (MPCNL). Methods. Totally, 390 patients with renal stones in our hospital from March 2015 to March 2020 were included for this study and then were divided into observation group (complication group, 78 cases) and control group (noncomplication group, 312 cases) according to the incidence of perioperative complications in CDCS. Single factor analysis and multivariate logistic regression analysis were used to analyze the risk factors of the perioperative complications of MPCNL. Results. The total incidence of complication in the 390 cases with MPCNL was 20.00% (78 cases) according to CDCS, among which the incidence of complications at grades I, II, III, IV, and V was 6.92% (27 cases), 8.21% (32 cases), 2.82% (11 cases), 1.79% (7 cases), and 0.26% (1 case), respectively. The proportion of patients, that aged >60 years, complicated with comorbidities, sophisticated calculi, the preoperative albumin level (<35 g/L), the operation time (>180 minutes), intraoperative bleeding volume (>300 mL), and hospitalization time (>7 days) in the observation group was significantly higher than that in the control group ((75.64% vs. 61.86%, 38.46% vs. 24.36%, 83.33% vs. 69.55%, 83.33% vs. 69.55%, 70.51% vs. 30.76%, 53.85% vs. 36.54%, and 60.26% vs. 43.27%), all P < 0.05). Multivariate logistic regression analysis showed that gender, associated comorbidities, preoperative albumin level, calculus complexity, operation time, and intraoperative bleeding volume (>300 mL) were correlated with the occurrence of complications ( P ≤ 0.001, 0.001, 0.001, 0.001, 0.003, and 0.001 respectively). Conclusion. The CDCS can give standard and more comparative criteria for the assessment of perioperative complications, which will provide reference data for reducing complications and ensuring safety profiles in these high-risk patients.

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Application value of minimally invasive percutaneous dilational tracheostomy for ICU critical patients

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.2.594 ◽

2019 ◽

Vol 36 (2) ◽

Author(s):

Hongmei Gan ◽

Aihong Dong ◽

Haiyan Xu

Keyword(s):

Heart Rate ◽

Minimally Invasive ◽

Operation Time ◽

Healing Time ◽

Control Group ◽

Observation Group ◽

Percutaneous Dilational Tracheostomy ◽

Intraoperative Bleeding ◽

Incision Length ◽

Critical Patients

Objective: To find out the application value of minimally invasive percutaneous dilational tracheostomy in critically ill patients in intensive care unit (ICU). Methods: One hundred and forty critically ill patients who underwent tracheostomy in ICU of our hospital were included in the study from August 2016 to December 2017. They were divided into an observation group and a control group by random number table method, 70 in each group. The control group received conventional tracheotomy, while the observation group received percutaneous dilational tracheostomy. The operation time, incision length, amount of intraoperative bleeding and healing time of incision were compared between the two groups, and the changes of vital signs and complications after operation were recorded. The family members of the patients signed the informed consent. Results: The operation time, healing time and incision length of the observation group were (9.92±4.13) min, (1.31±0.21) cm and (6.91±0.72) respectively, shorter than (24.09±6.82) min, (3.40±0.65) cm and (67.48±0.61) d in the control group, and the differences were statistically significant (P<0.05). The amount of intraoperative bleeding of the observation group was (7.81±1.83) mL, less than (16.34±2.83) mL in the control group; the difference was statistically significant (P<0.05). The heart rate and oxygen saturation of the observation group before and during the operation were not significantly different (P>0.05). The heart rate of the control group during the operation was significantly higher than that before the operation (P<0.05); the oxygen saturation of the control group before and during the operation had no significant difference (P>0.05). The incidence of complications in the observation group was 24.3%, which was significantly lower than that in the control group (55.7%, X2=8.279, P=0.014). Conclusion: Minimally invasive percutaneous dilational tracheostomy has advantages of small trauma, less infection and beautiful incision, and it will not increase postoperative complications. It is of great value in the treatment of ICU critical patients. doi: https://doi.org/10.12669/pjms.36.2.594 How to cite this:Gan H, Dong A, Xu H. Application value of minimally invasive percutaneous dilational tracheostomy for ICU critical patients. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.594 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A Simple and Effective Method for Bleeding Control During Percutaneous Dilatational Tracheostomies

10.21203/rs.3.rs-136108/v1 ◽

2020 ◽

Author(s):

Xiuyu Du ◽

Xiaodong Zhai ◽

Zhi Liu ◽

Jinliang Teng ◽

Chunyan Liu

Keyword(s):

Prospective Study ◽

Operation Time ◽

Intradermal Injection ◽

Control Group ◽

Injection Technique ◽

Observation Group ◽

Intraoperative Bleeding ◽

Significant Difference ◽

The Mean ◽

A Prospective Study

Abstract Objectives: This study describes an intradermal injection technique for reducing bleeding during a percutaneous dilatation tracheotomy (PDT).Methods: Fifty-two consecutively recruited patients who underwent PDTs were analysed in a prospective study that was conducted between May 2019 and January 2020. This is a prospective study and fifty-two patients who underwent PDT were recruited from May 2019 to January 2020. They were randomly divided into an observation group and a control group. The patients in the observation group accepted the execution of the intradermal injection technique during their local anaesthesia. A comparison was made between the two groups’ intraoperative bleeding, postoperative bleeding, operation time and length of incision.Results: A total of 52 patients were enrolled in this study, 33 males (63.5%) and 19 females. The mean age was 63.0±9.9 years, with the patients’ age ranging from 45 to 80 years. The mean BMI was 29.2±5.1 kg/m2. There was no significant difference in gender, age, BMI index and whether they had an endotracheal tube between the two groups (P > 0.05). The observation group’s intraoperative bleeding was less than that of control group (χ2 = 8.308, P = 0.009). There was no significant difference in operation time between the two groups (t = -0.904, P = 0.372). There was no PDT-related death.Conclusion: The intradermal injection technique can be used to effectively and safely reduce bleeding during PDTs. This technique provides a lower intraoperative bleeding grade without increased the procedure’s duration.

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Clinical Efficacy and Safety of Silicone Elastomer Sheet during Decompressive Craniectomy: Anti-Adhesive Role in Cranioplasty

Brain Sciences ◽

10.3390/brainsci11010124 ◽

2021 ◽

Vol 11 (1) ◽

pp. 124

Author(s):

Young Ha Kim ◽

Chi Hyung Lee ◽

Chang Hyeun Kim ◽

Dong Wuk Son ◽

Sang Weon Lee ◽

...

Keyword(s):

Decompressive Craniectomy ◽

Fluid Collection ◽

Multivariate Logistic Regression Analysis ◽

Operation Time ◽

Silicone Elastomer ◽

Control Group ◽

Estimated Blood Loss ◽

Adhesion Tissue ◽

Skull Bone Defect ◽

Epidural Adhesion

(1) Background: Cranioplasty is a surgery to repair a skull bone defect after decompressive craniectomy (DC). If the process of dissection of the epidural adhesion tissue is not performed properly, it can cause many complications. We reviewed the effect of a silicone elastomer sheet designed to prevent adhesion. (2) Methods: We retrospectively reviewed 81 consecutive patients who underwent DC and subsequent cranioplasty at our institution between January 2015 and December 2019. We then divided the patients into two groups, one not using the silicone elastomer sheet (n = 50) and the other using the silicone elastomer sheet (n = 31), and compared the surgical outcomes. (3) Results: We found that the use of the sheet shortened the operation time by 24% and reduced the estimated blood loss (EBL) by 43% compared to the control group. Moreover, the complication rate of epidural fluid collection (EFC) in the group using the sheet was 16.7%, which was lower than that in the control group (41.7%, p < 0.023). Multivariate logistic regression analysis showed the sheet (OR 0.294, 95% CI 0.093–0.934, p = 0.039) to be significantly related to EFC. (4) Conclusions: The technique using the silicone elastomer sheet allows surgeons to easily dissect the surgical plane during cranioplasty, which shortens the operation time, reduces EBL, and minimizes complications of EFC.

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Efficacy of carprostol tromethamine combined with mifepristone in the treatment of uterine fibroids

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v3i1.697 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Jun Wang ◽

Xian Zhang

Keyword(s):

Estrogen Receptor ◽

Progesterone Receptor ◽

Treatment Effect ◽

Uterine Fibroids ◽

Operation Time ◽

Clinical Treatment ◽

Control Group ◽

Observation Group ◽

Significant Difference ◽

Better Than

ã€Abstractã€‘Objective: To investigate the clinical efficacy of carboprost tromethamine combined with mifepristone in the treatment of uterine fibroids. METHODS: A total of 66 patients with uterine fibroids admitted to our hospital between April 2018 and January 2019 were selected as subjects. According to the two different treatment methods, patients were divided equally. The observation group and the control group, each group of 33 people. The oxytocin drug treatment was medicated to the control group, and the prostaglandin tromethamine combined with mifepristone was medicated to the observation group. The treatment effect, adverse reaction, operation, and uterine muscle before and after surgery were observed in these two groups. Tumor tissue progesterone receptor and estrogen receptor levels. Results: The clinical treatment effect of the observation group was 93.94%, and the clinical treatment effect of the control group was 60.61%. The clinical treatment effect of the observation group was significantly higher than that of the control group; also the incidence of adverse reactions in the observation group in terms of rash, fatigue, nausea and vomiting was much lower than the control group, and could observe a significant difference. Finally in observation group, the amount of intraoperative blood loss, operation time and hospitalization time were better than those of the control group. The progesterone receptor and estrogen receptor levels in the uterine fibroid tissue after surgery should also be better than the control group, it is worth to make further comparison. Conclusion: Carprostol tromethamine combined with mifepristone is effective in the treatment of uterine fibroids and can be further developed.

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Increased Serum Levels of Asymmetric Dimethylarginine and Symmetric Dimethylarginine and Decreased Levels of Arginine in Sudanese Patients with Essential Hypertension

Kidney & Blood Pressure Research ◽

10.1159/000508695 ◽

2020 ◽

Vol 45 (5) ◽

pp. 727-736

Author(s):

Sahar Gamil ◽

Jeanette Erdmann ◽

Edzard Schwedhelm ◽

Khalid Hussein Bakheit ◽

Ihab B.B. Abdalrahman ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Essential Hypertension ◽

Amino Acid ◽

Asymmetric Dimethylarginine ◽

Multivariate Logistic Regression Analysis ◽

Serum Levels ◽

Control Group ◽

Multivariate Logistic Regression ◽

Symmetric Dimethylarginine

Introduction: Essential hypertension (EH) is a disease caused by various environmental and genetic factors. Nitric oxide (NO) is important for the functional integrity of the endothelium. It is produced in endothelial cells by endothelial NO synthase (eNOS) that mediates the conversion of the amino acid arginine into NO and citrulline. Asymmetric dimethylarginine (ADMA) acts as an inhibitor of eNOS. In contrast, symmetric dimethylarginine (SDMA) has no direct effect on eNOS but plays an important role competing with arginine for transport across the amino acid transporter. ADMA and SDMA have been found to play a central role in the development of cardiovascular diseases. Serum ADMA levels may serve as a future diagnostic marker and a target of therapy in hypertensive patients in the Sudanese population. This study aimed to investigate the relation between serum arginine, ADMA, and SDMA levels with EH in the Sudanese population. Methods: Patients (n = 260) with established hypertension and controls (n = 144) with normal blood pressure were included in this case-control study. Serum blood samples were analyzed for arginine, ADMA, and SDMA, using high-performance liquid chromatography-tandem mass spectrometry. Other laboratory data were measured using routine methods. Mann-Whitney’s U test and χ2 tests were used for continuous and categorical data, respectively. A multivariate logistic regression analysis was conducted to investigate the independent effect of multiple variables on the development of hypertension. Results: Serum arginine levels were significantly lower in the patient group than in the control group (p < 0.001). ADMA and SDMA levels were significantly higher in the patient group than the control group (p < 0.001, p = 0.001, respectively). Multivariate logistic regression analysis showed that only older age, being a male, and arginine levels are independent factors controlling the development of hypertension (p < 0.001, p < 0.001, and p = 0.046, respectively). ADMA and SDMA levels were not independent factors for the development of hypertension. Conclusions: This study demonstrated increased serum levels of ADMA and SDMA and decreased arginine levels in Sudanese patients with EH. Lowering serum ADMA levels or increasing the arginine levels might be a novel therapeutic target in these individuals.

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P692Chemoradiation therapy to patients with lung cancer exacerbates thoracic aortic calcification

European Heart Journal ◽

10.1093/eurheartj/ehz747.0297 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Miki ◽

T Miyoshi ◽

K Ichikawa ◽

S Miyauchi ◽

J Soh ◽

...

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Cardiovascular Events ◽

Multivariate Logistic Regression Analysis ◽

Aortic Calcification ◽

Control Group ◽

Multivariate Logistic Regression ◽

Annual Percent Change ◽

Percent Change ◽

Thoracic Aortic Calcification

Abstract Introduction Development of chemoradiation therapy (CRT) has improved mortality in patients with cancer. Whereas, it is emerging problem that cancer-survivors suffer from cardiovascular diseases, and the association between modern CRT and the increase in future cardiovascular events is suggested. Meanwhile, previous studies showed that thoracic aortic calcification (TAC) detected by computed tomography (CT), a marker of atherosclerosis, was associated with all-cause mortality and cardiovascular events. However, the influence of CRT on TAC progression remains unclear. Purpose The purpose of this study was to evaluate whether CRT would exacerbate TAC. Methods A total of 68 patients who treated lung cancer at our hospital between 2011 and 2015 were retrospectively analyzed (mean 62 year-old, male 78%): 35 patients underwent surgical treatment after induction CRT (CRT group) and 33 patients underwent surgical treatment alone (control group), extracted by propensity score matching by age, sex, smoking status, and diseased side. The volume of TAC between 2nd and 12th thoracic vertebrae was quantitatively measured with CT imaging, at baseline and at 1 year follow-up. The annual percent change in TAC was compared between the CRT and the control group. Moreover, the independent relationship between implementation of CRT and the progression of TAC was assessed by multivariate logistic regression analysis, adjusting for age, gender, conventional atherosclerotic risk factors and baseline aortic calcification volume. Results Patients in the CRT group received radiation (mean 47.3±4.0 Gy) and chemotherapy: 2 courses of cisplatin with docetaxel (34 cases) or vinorelbine (1 case). The prevalence of dyslipidemia, taking statins and diabetes drugs were significantly higher in the control groups (17% vs. 39%; p=0.041, 11% vs. 33%; p=0.029, 3% vs. 18%; p=0.044, respectively). Baseline C-reactive protein level was significantly higher in the CRT group (0.255 vs. 0.115; p=0.034). In univariate analysis, the annual percent change in TAC volume was significantly increased in the CRT group compared with the control group (37.6% vs. 23.3%; p=0.006). Multivariate logistic regression analysis demonstrated that CRT was an independent factor associated with the progression of TAC volume, even after adjustment for baseline calcification volume and coronary risk factors (OR, 3.90; 95% CI, 1.32–11.47; p=0.014). Conclusion CRT to patients with lung cancer exacerbates thoracic aortic calcification, which may result in future cardiovascular events.

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Clinical Characteristics of Patients Infected With the Novel 2019 Coronavirus (SARS-Cov-2) in Guangzhou, China

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa187 ◽

2020 ◽

Vol 7 (6) ◽

Cited By ~ 7

Author(s):

Yaping Wang ◽

Baolin Liao ◽

Yan Guo ◽

Feng Li ◽

Chunliang Lei ◽

...

Keyword(s):

Incubation Period ◽

Severe Disease ◽

Clinical Manifestations ◽

Multivariate Logistic Regression Analysis ◽

Albumin Level ◽

Older Age ◽

The Novel ◽

Multivariate Logistic Regression ◽

Factors Associated ◽

Male Sex

Abstract Background The clinical manifestations and factors associated with the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections outside of Wuhan are not clearly understood. Methods All laboratory-confirmed cases with SARS-Cov-2 infection who were hospitalized and monitored in Guangzhou Eighth People’s Hospital were recruited from January 20 to February 10. Results A total of 275 patients were included in this study. The median patient age was 49 years, and 63.6% had exposure to Wuhan. The median virus incubation period was 6 days. Fever (70.5%) and dry cough (56.0%) were the most common symptoms. A decreased albumin level was found in 51.3% of patients, lymphopenia in 33.5%, and pneumonia based on chest computed tomography in 86%. Approximately 16% of patients (n = 45) had severe disease, and there were no deaths. Compared with patients with nonsevere disease, those with severe disease were older, had a higher frequency of coexisting conditions and pneumonia, and had a shorter incubation period (all P < .05). There were no differences between patients who likely contacted the virus in Wuhan and those who had no exposure to Wuhan. Multivariate logistic regression analysis indicated that older age, male sex, and decreased albumin level were independently associated with disease severity. Conclusions Most of the patients infected with SARS-CoV-2 in Guangzhou, China are not severe cases and patients with older age, male, and decreased albumin level were more likely to develop into severe ones.

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A NEW MIXED SURGICAL TREATMENT FOR GRADES III AND IV HEMORRHOIDS: MODIFIED SELECTIVE HEMORRHOIDECTOMY COMBINED WITH COMPLETE ANAL EPITHELIAL RETENTION

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020210002e1594 ◽

2021 ◽

Vol 34 (2) ◽

Author(s):

Hua HUANG ◽

Yunfei GU ◽

Lijiang JI ◽

Youran LI ◽

Shanshan XU ◽

...

Keyword(s):

Anal Canal ◽

Anal Incontinence ◽

Treatment Satisfaction ◽

Operation Time ◽

Controlled Study ◽

Anal Stenosis ◽

Control Group ◽

Observation Group ◽

Canal Diameter ◽

Significant Difference

ABSTRACT Background: Varicose veins appear above and below the dentate line in mixed hemorrhoids, which seriously affects anal function and quality of life. Aim: To propose an improvement in tissue-selecting therapy repair of anal pad combined with complete anal canal epithelial retention comparing with Milligan-Morgan surgery. Methods: A prospective randomized controlled study was designed enrolling 200 patients with grade III and IV hemorrhoids. They were divided into control and observation groups. The control received Milligan-Morgan surgery, and the observation the modified tissue-selecting therapy stapler combined with complete anal canal preservation surgery. All patients were followed for six months to evaluate the treatment differences. Results: In final, control group included 82 and observation 87. The average operation time of the control group was significantly lower than that of the observation, while the bleeding volume was significantly lower in control group. The control group VAS score was 3 (1, 4), and observation 4 (2, 5). There was no significant difference in the incidence of urinary retention, bleeding and wound margin edema after surgery at one month postoperatively. Digital incidence of anal stenosis in the observation group was significantly lower than in control; the same occurred with residual anal margins. The postoperative anal canal diameter was significantly larger than the control group. Wexner anal incontinence score showed that no anal incontinence occurred in both groups, and the control group scored was significantly higher than observation. In final six months follow-up, the observation group did not experience any relapse and four cases were found among controls. The treatment satisfaction of the observation group was better. Conclusions: In grades III and IV hemorrhoids, modified tissue-selecting therapy combined with complete anal canal preservation had better prognosis and treatment satisfaction than Milligan-Morgan procedure, and it is a new surgical method for patients with advanced mixed hemorrhoids.

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Factors associated with medial meniscal subluxation in knees with medial meniscus tears: a cross-sectional study

10.21203/rs.3.rs-35269/v2 ◽

2020 ◽

Author(s):

Xinguang Liu ◽

Ran Ding ◽

Chen Liu ◽

Bin Yang ◽

Weiguo Wang

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Medial Meniscus ◽

Multivariate Logistic Regression Analysis ◽

Control Group ◽

Independent Factor ◽

Multivariate Logistic Regression ◽

Factors Associated ◽

Meniscus Tears

Abstract Background Previous studies have indicated that medial meniscal subluxation (MMS) is associated with special types of medial meniscus tears (MMT) and chondral lesions. However, most of these studies lacked arthroscopic findings and did not adjust for possible confounders. The purpose of this study was to explore factors associated with MMS in patients with MMT using multivariate logistic regression analysis. Methods A retrospective analysis of 115 patients who underwent arthroscopic surgery for MMT was conducted. The medial meniscal extrusion (MME) distance was measured on a single mid-coronal magnetic resonance (MR) image, and the MMS group included patients with MME distance ≥3 mm (55 patients with 55 knees). Other patients were included as the control group (60 patients with 60 knees). Demographic and clinical data were collected as variates. A multivariate logistic regression analysis was performed to identify factors associated with MMS. Results In a univariate analysis, the Outerbridge classification (P=0.002) and the type of MMT (P<0.001) were significantly different between the MMS group and the control group. According to unadjusted and age- and body mass index (BMI)-adjusted multivariate logistic regression analysis, the type of MMT was an independent factor associated with MMS. Compared with horizontal tears, radial tears, posterior medial meniscus root tears (PMMRT) and complex tears had approximately 6-fold (adjusted OR 6.468, 95% CI 1.509–27.718, P=0.012), 10-fold (adjusted OR 10.324, 95% CI 1.719–61.989, P=0.011) and 4-fold (adjusted OR 4.458, 95% CI 1.602–12.408, P=0.004) higher associations with MMS, respectively. Conclusion The type of MMT was an independent factor associated with MMS in knees with MMT. Radial tears, PMMRT and complex tears were more likely than horizontal tears to result in MMS. The results suggest that MMT combined with MMS should be noted when managing MMT, especially radial tears, PMMRT and complex tears. Moreover, the results indicate that we must not only preserve the meniscus as much as possible but also restore its position to as close to normal as possible.

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Effects of Modified Subxiphoid Thoracoscopic Surgery and Traditional Surgery On Pain Mediators and Pain Stress Levels in Patients With Anterior Mediastinal Teratoma

10.21203/rs.3.rs-910430/v1 ◽

2021 ◽

Author(s):

Panpan Zhang ◽

Dan Liu ◽

Dong Luo ◽

Fuli Pang

Keyword(s):

Thoracoscopic Surgery ◽

Operation Time ◽

Control Group ◽

Observation Group ◽

Mediastinal Teratoma ◽

Extubation Time ◽

Significant Difference ◽

Stress Levels ◽

Grouping Method ◽

Better Than

Abstract Background To investigate the effects of modified subxiphoid thoracoscopic surgery and traditional surgery on pain mediators and pain stress levels in patients with anterior mediastinal teratoma. Method Eighty patients with anterior mediastinal teratoma who underwent surgery in our hospital from May 2019 to May 2021 were selected as the subjects of this prospective study. According to the random residue grouping method, they were divided into a control group and observation group with 40 cases each. Among them, the control group underwent traditional surgery, and the observation group underwent modified subxiphoid thoracoscopic surgery. Observe and compare the surgical indicators, pain-causing mediators, and pain stress levels of the two groups of patients. Result The intraoperative blood loss, postoperative extubation time, and total drainage volume of the observation group were significantly lower than those of the control group, while the operation time was significantly higher than that of the control group, which was statistically significant (P < 0.05). There was no statistically significant difference in the pain-causing mediators of the two groups before surgery (P > 0.05), while the NPY, PGE2 and 5-HT at 1 day after surgery were significantly different, and the observation group was better than the control group. The comparison was statistically significant. Significance (P < 0.05). There was no statistically significant difference in pain stress levels between the two groups before surgery (P > 0.05), while NO, IL-6, and IL-β 1 day after surgery were significantly different, and the observation group was better than the control group. Statistically significant (P < 0.05). Conclusion The modified subxiphoid thoracoscopic surgery has a significant effect, reduces the level of peripheral blood pain-causing factors, relieves the pain of the patient, and promotes the recovery of the patient. It provides a certain reference for the mediastinal teratoma before the clinical operation.

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