Sinistral portal hypertension: clinical features and surgical treatment of chronic splenic vein occlusion

Sinistral, or left-sided, portal hypertension [SPH] is a rare cause of upper gastrointestinal hemorrhage. This retrospective analysis summarizes the clinical features of SPH and the results of surgical treatment. Between 2000 and 2009, patients from our hospital diagnosed with SPH were identified. Diagnosis of SPH was based on evidence of isolated splenic vein thrombosis, splenomegaly, gastroesophageal varices and exclusion of other causes of portal hypertension. Eight males and 5 females were included in the study, with a mean age of 43.5 +/- 6.4 years [range: 31-68 years]. Liver function was normal in all patients. Causes of SPH were chronic pancreatitis [n=7], pancreatic cancer [n=3], pancreatic cysts [n=2] and neuroendocrine tumor [n=1]. The main clinical manifestations were gastrointestinal hemorrhage in 7 cases [53.8%], upper abdominal pain in 10 [76.9%] and hypersplenism in 12 [92.3%]. All patients had splenomegaly and gastroesophageal varices. Twelve patients underwent splenectomy and 1 received surgical removal of a pancreatic cyst. No major gastrointestinal tract rebleed occurred after a mean follow-up of 46 months [ +/- 7 months]. Two patients died of pancreatic cancer and 1 of acute myocardial infarction during follow-up. SPH should be suspected in patients with upper gastrointestinal varices as well as unexplained splenomegaly with normal liver function. Surgical intervention such as splenectomy offers a good long-term outcome in symptomatic patients

Surgical treatments of preoperative unsuspected gallbladder carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the surgical treatment of preoperative unsuspected gallbladder carcinoma (UGC) and its prognosis.</p><p><b>METHODS</b>Eighteen patients of UGC admitted in our hospital from January 1996 to December 2003 were analyzed retrospectively. The clinicopathological characters and surgical treatment of UGC patients were compared with the preoperative diagnosed gallbladder carcinoma (DGC) patients admitted in the same period. The cumulative survival rate of the patients received radical resection in two groups was analyzed by Kaplan-Meier method.</p><p><b>RESULTS</b>The serous layer was not invaded by tumor in 10 patients of UGC group (55.5%, 10/18), while the serous layer invaded and regional lymph node metastasis were detected in 39 patients of DGC group (90.7%, 39/43). Radical resection rate was 72.2% (13/18) in UGC group and 39.5% (17/43) in DGC group, and 5-year survival rates in those with radical resection were 54.6% and 23.5%, respectively (chi(L)(2) = 16.33, P < 0.01). Compared with the patients underwent palliative operation, the patients with radical resection has a longer median survival time (43.3 months vs 10.5 months, chi(L)(2) = 31.10, P < 0.01).</p><p><b>CONCLUSIONS</b>The prognosis of UGC is better than that of DGC generally. Reoperation for UGC should be performed as soon as possible, and the prognosis can be improved by radical resection.</p>

Effect of branch chain amino acid enriched formula on postoperative fatigue and nutritional status after digestive surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of branch chain amino acid (BCAA) enriched formula on nutritional status and postoperative fatigue for digestive surgery patients.</p><p><b>METHODS</b>Forty patients who underwent digestive surgery were randomly received parenteral nutrition with either BCAA enriched (study group, n=20) or routine amino acid (control group, n=20) for seven consecutive days. Nitrogen balance,serum total protein, albumin, prealbumin, transferrin, retinol binding protein and postoperative fatigue score were monitored during the postoperative period.</p><p><b>RESULTS</b>The cumulative postoperative fatigue scores were lower in BCAA group than that in the control group at the 4th, 5th and 7th day after operation (P< 0.05). Patients achieved positive nitrogen balance 2 days earlier in the study group than that in the control group, but there was no significant difference in cumulative nitrogen balance between the two groups. There was no significant difference in elevation of serum total protein, albumin, prealbumin, transferrin at the 7th day after operation between the two groups (P > 0.05), compared with those at the first day after operation. The serum level of retinol binding protein was higher in BCAA-enriched group than that in the control group (P=0.004).</p><p><b>CONCLUSION</b>TPN with BCAA enriched formula can reduce postoperative fatigue score and improve the nutritional status for digestive surgery patients.</p>