Comparison between primary anastomosis after intraoperative colonic defecation and Hartmann procedure in patients with obstructive left colon cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare primary anastomosis after intraoperative colonic defecation and Hartmann procedure for obstructive left colon cancer.</p><p><b>METHODS</b>Clinical data of 68 patients who underwent emergent laparotomy for left colon cancer with acute bowel obstruction between January 2000 and January 2008 were analyzed retrospectively.</p><p><b>RESULTS</b>Primary resection and anastomosis with intraoperative defecation was performed in 43 patients and Hartmann's procedure in 25 cases. Patients in both groups were comparable in terms of age, gender, nutritional status, underlying diseases, tumor location and stage, etc. The morbidity and mortality in the two groups were 25.6% vs 28.0% (P=0.761) and 2.3% vs 4.0% (P=0.369), respectively, and the differences were not statistically significant. The length of hospital stay (including first resection operation and second admission for colostomy closure) was (16.6+/-7.8) d in the primary anastomosis group and (24.6+/-9.4) d in the Hartmann procedure group, and the difference was statistically significant (P=0.002). The costs of hospitalization in the two groups were CNY 50,192.8+/-39,727.4 and CNY 58,382.1+/-30,304.9 (P=0.020).</p><p><b>CONCLUSION</b>Primary resection with intraoperative colonic defecation is safe and effective, and should be considered as an alternative to Hartmann procedure for obstructive left colon cancer in selected patients.</p>

Radiofrequency ablation combined with transarterial chemoembolization for unresectable primary liver cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Radiofrequency ablation (RFA) followed by transarterial chemoembolization (TACE) for unresectable primary liver cancer (PLC) has not been widely discussed. In this study, the outcome of the combination of RFA with TACE was retrospectively evaluated.</p><p><b>METHODS</b>From May 2003 to March 2008, 127 consecutive PLC patients with a median age of 56.4 +/- 8.8 years underwent RFA plus TACE. All patients were deemed to have unresectable PLC based on their tumor characteristics. The maximal diameter of the tumor was between 1.5 cm and 10.0 cm. Twenty-six cases with small (<or= 3.0 cm), 33 with medium (3.1 - 5.0 cm), and 68 with large (> 5.0 cm) tumors were included in this study. RFA was performed using a RITA Medical Systems expandable electrode device, which was followed by first-time TACE administration one to two months later.</p><p><b>RESULTS</b>Technical success of RFA was achieved in all 127 patients with no severe treatment-related complications. RFA was performed percutaneously in 16 (13.5%) cases, by laparoscopic approach in 19 (15.7%), and through laparotomy in the remaining 92 (72.4%). RFA response was classified as complete ablation in 48 cases, nearly complete ablation in 28, and partial ablation in 51. The total 1-, 2-, and 3-year survival rates after RFA were 83.1%, 55.7%, and 43.7%, respectively. The survival rates at 3 years were 78.6%, 28.1%, and 0 for complete ablation, nearly complete ablation, or partial ablation groups, respectively. Three-year disease-free survival rates for the complete ablation and nearly complete ablation groups were 50.3% and 21.3%, respectively. RFA response and liver function were significant variables influencing survival time as analyzed using the Cox regression model.</p><p><b>CONCLUSION</b>RFA could be the first-line exterminate treatment for unresectable PLC, and TACE following RFA may assist in eradicating the peripheral viable tissue and micro-metastasis.</p>

A 10-year-review (1998-2007) on 3449 cases of osteoporotic hip fractures: trend of hospitalization and inpatient casts / 中华流行病学杂志

Objective The purpose of this retrospective research was to analyze the trend of hospitalized prevalence in the past 10 years (1998 -2007) and to estimate resource utilization associated with osteoporotic hip fractures, including hospital length of stay and inpatient costs in Guangzhou,China. Methods 3449 patients aged 50 years and older,hospitalized for primary diagnose of hip fractures in both hospitals in the past ten years were included in our study. Completed data was obtained retrospectively from the hospital medical records. Clinical parameters such as sex-specifics, hospital length of stay, inpatient costs and the constitutions of the inpatient costs were analyzed with multiple statistics methods and regrcssions Results Over the 10-year study period, the number of hospitalizations for hip fractures increased with a curve model. Male and female ratio was 1:1.95 with an average age of the patients as76.32±9.52 years old. Average hospital length of stay was 23.59±13.48 days with no significant difference between males and females, years of admission and the different diagnoses. The number of hospitalization went to the top at the age of 70 to 79 years old (38.45%), followed by 80-89 years old(33.08 % ). Femoral neck fractures was significantly more than that of inter-trochanteric fractures in those patients aged 50 to 79 years (P<0.01 ) but less than those intertrochanteric fractures aged 90 years and older (P<0.05). Average inpatient costs is about 23.52±17.00 thousand Yuan (RMB) (femoral neck fractures is about 25.09±17.62 thousand Yuan and intertrochanteric fracture is 21.44±15.92 thousand Yuan) of which treatment costs (included implants, materials used in the theatre and routinely care of the wound) contributed 52 %, pharmacy intervention 25 %, operation 6 %, ward expenditure 5 %, radiology and physical investigation 5 %, and chemistry test 4 %. The inpatient cost went to a peak at the age of 60-69 years old and were significantly correlated with the hospital length of stay. The coat increased every year in the past 10 years by 6.18%. Conclusion These results emphasized that the growing economic impact arising from the inpatient treatment of ostcoporotic hip fractures and most of which related to treatment cost(include implants, materials used in the theatre and routinely care of the wound), and drugs and always correlated to length of hospital stay. Cost control should be paid more attention to the implants and drugs.