Hemorrhoid sclerotherapy with the complication of abdominal compartment syndrome: report of a case / 中华医学杂志(英文版)

The complications of injection sclerotherapy for hemorrhoid are always local. Herein, we report a case in which a female patient with abdominal compartment syndrome developed after receiving a local injection of a sclerosing agent for hemorrhoid.

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>

Effects of traditional Chinese medicine on intestinal mucosal permeability in early phase of severe acute pancreatitis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Traditional Chinese medicine has been used widely for many years in China to treat acute pancreatitis. We have investigated the effects of Dachengqi decoction on intestinal mucosal permeability and outcome in patients with severe acute pancreatitis (SAP).</p><p><b>METHODS</b>Forty patients with sustained SAP that required admission to the surgical intensive care unit were enrolled prospectively in the study. All of these patients were divided randomly into the Dachengqi decoction group (n = 20) and control group (n = 20) on admission. Intestinal permeability was assessed by measuring absorption of two metabolically inert markers, lactulose (L) and mannitol (M), which were administered orally. Serum concentrations of endotoxin (lipopolysaccharide, LPS) and the ratio of lactulose to mannitol in urine (L/M) were detected in all patients.</p><p><b>RESULTS</b>Compared with those in the control group, urinary L/M ratio decreased significantly in the Dachengqi decoction group on the 7th day after admission (P = 0.001). Also, serum concentrations of LPS were reduced on the 5th and 7th day after admission (P = 0.006, P = 0.008, respectively). Incidence of multiple organ dysfunction syndrome (MODS) and pancreatic infection was significantly lower in the Dachengqi decoction group compared with those in the control group (P = 0.038,P = 0.025, respectively).</p><p><b>CONCLUSION</b>Dachengqi decoction may promote the recovery of intestinal mucosal permeability and decrease the incidence of MODS and pancreatic infection in patients with SAP.</p>

Preliminary research on the pathological role of cathepsin-B in subcutaneous heteroplastic pancreatic carcinoma in nude mice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cathespin-B (cath-B) is an important proteolytic enzyme involved in the disease course of invasion in many types of cancer. Cath-B expression in subcutaneous heteroplastic pancreatic carcinoma in nude mice has not been studied. We investigated the role of cath-B in a model of heteroplastic pancreatic carcinoma in BALB/c nude mice.</p><p><b>METHODS</b>Thirty-two six-week-old female BALB/c nude mice were equally divided into four groups. PANC-1 cells were inoculated subcutaneously in the left axillary region. Besides volume, weight of subcutaneous tumor, and change in body weight, cath-B expression in each group was measured by immunohistochemical staining, PCR and Western blotting. Its relationship to microvessel density (MVD), CD44v6, and placenta growth factor (PLGF) was also examined. CA-074Me, a specific inhibitor of cath-B, was injected intraperitoneally (i.p.) at different stages of tumor growth in group B and C. Gemcitabine (GEM), was also injected (i.p.) in group D to compare anti-tumor efficacy with CA-074Me.</p><p><b>RESULTS</b>Expression of cath-B at different levels was related to tumor growth, MVD, and PLGF expression. In group A (control group), cath-B expression was enhanced more than that seen in other groups. CA-074Me clearly inhibited cath-B expression and tumor growth in group B. There was no difference between group C and D with respect to anti-tumor effect.</p><p><b>CONCLUSIONS</b>Cath-B correlates with the growth and angiogenesis of tumors, but not with the adhesion induced by CD44v6. CA-074Me clearly inhibited cath-B expression and demonstrated an anti-neoplastic and anti-angiogenesis effect.</p>

The management of bleeding pseudoaneurysms in patients with severe acute pancreatitis / 中华外科杂志

<p><b>OBJECTIVE</b>To report the experience in diagnosis and management of bleeding pseudoaneurysms associated with severe acute pancreatitis (SAP).</p><p><b>METHODS</b>The medical records of 12 patients with bleeding pseudoaneurysms associated with SAP treated between October 1990 and October 2006 were retrospectively reviewed. The etiologies of the 12 patients were gallstones in 6 patients, hyperlipidemia in 3 patients, hyperparathyroidism in 1 patient and the other 2 patients had no definitive causes.</p><p><b>RESULTS</b>Abdominal computed tomography revealed bleeding pseudoaneurysms in 6 of 9 patients. Angiography determined correct diagnosis in 12 patients (12/12). The most involved vessels were peripancreatic arteries. Eight patients were managed by trans-catheter arterial embolization (TAE) as "one point" (a proximal point of the pseudo-aneurysm). Two patients were treated by TAE as "two points" (both distal and proximal to the pseudo-aneurysm). The last two cases were treated by surgery as suture and ligation. Four of the "one point" TAE patients were re-bleeding 4 to 7 days later, and 2 of them were treated with surgery, the other 2 patients were controlled with "two points" TAE. Three patients were died of infection and multiple organ dysfunction syndromes. Overall mortality rate was 25% (3/12).</p><p><b>CONCLUSIONS</b>Angiography is the main diagnostic methods for bleeding pseudoaneurysms in SAP patients. "Two points" embolization and emergency surgery are an effective treatment options in these patients.</p>

Effects of duration of early organ dysfunction and therapeutic strategy on outcomes in patients with severe acute pancreatitis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of early organ dysfunction in patients with severe acute pancreatitis (SAP) and therapeutic regimens.</p><p><b>METHODS</b>A total of consecutive 74 patients with a confirmed diagnosis of SAP admitted between January 2000 and June 2005 were divided into two groups, transient group (<or=72 h, n = 20) and persistent group (>72 h, n = 54). The differences in local complications and mortality were compared between the two groups.</p><p><b>RESULTS</b>Among the seventy-four SAP patients, the incidence rate of cardiovascular dysfunction was 80%, respiratory dysfunction 47%, hepatic dysfunction 37% and renal dysfunction 20%. The incidence of multiple organ dysfunction in transient group was much lower than that in persistent group (P < 0.01). The local complications and death in transient group patients were less than that in persistent group (P = 0.038, P = 0.054, respectively), irrespective of onset of organ dysfunction on admission or later during the first week.</p><p><b>CONCLUSIONS</b>The important determinant of risk of death from SAP is the persistence of early organ dysfunction for more than 72 h. Consequently, aggressively ameliorating the blood perfusion and the oxygenation in tissue is the priority in reducing organ dysfunction or shortening the duration of organ dysfunction.</p>

Abdominal compartment syndrome at patients with severe acute pancreatitis at early stage / 中华急诊医学杂志

25 mmHg) had no response to conservative management, and,therefore,had to be decompressed by invasive procedure,including 6 patients performed by decompression laparotomy,2 patients by laparoscopic decompression and 5 patients by ultrasound/computed tomography location and needle paracentesis drainage.These 13 ACS patients had obvious amelioration in physiological variables (hemodynamic,respiratory and tissue perfusion) after 24 hour post-decompression (P

Surgical treatment of pancreatic head carcinomas / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the outcomes of patients undergoing surgical treatment for pancreatic head carcinomas during different time course over 40 years in one hospital.</p><p><b>METHODS</b>Totally 346 cases of pancreatic head carcinoma in one hospital were retrospectively analyzed during the periods of 1958-1976, 1977-1987, 1988-1998, and 1999-2003.</p><p><b>RESULTS</b>During the period of 1958-1976, 79 patients with pancreatic head carcinoma were diagnosed and the rate of pancreaticoduodenectomy (PD) was 20.6% (21/79). During the period of 1977-1987, 60 patients with pancreatic head carcinoma were diagnosed and the PD rate was 26.7% (16/60). During the period of 1988-1998, 109 patients with pancreatic head carcinoma were diagnosed and the resection rate was 20.18% (22/109). During the period of 1999-2003, 98 patients with pancreatic head carcinoma were diagnosed and the resection rate was 22.4% (20/98). The total resection rate of pancreatic head carcinomas was 22.8% (79/346). The complication rate of the operation was 42.3% (9/21) during 1958-1976, 37.5% (6/16) during 1977-1987, 27.3% (6/22) during 1988-1998, and 10.0% (2/20) during 1998-2003. The perioperative mortality was 19.0% (4/21) during 1958-1976 (2 cases of pancreatic fistula and 1 case of liver and renal failure), 12.5% (2/16) during 1977-1987 (1 case of multiple organ failure and 1 case of bleeding), and 4.5% (1/22) during 1988-1998 (1 case of multiple organ failure). One patient with bile duct fistula during 1977-1987 and one patient with pancreatic fistula during 1988-1998 were cured by non-operative treatment. There was no perioperative death during 1999-2003. During the period of 1958-1976, the survival rate of patients undergoing PD was 55.5% by 1 year, 23.1% by 3 year, and 11.0% by 5 year. During 1977-1987, it was 56.3% by 1 year, 25.0% by 3 year, and 12.5% by 5 year. During 1988-1998, it was 59.1% by 1 year, 27.2% by 3 year, and 13.6% by 5 year.</p><p><b>CONCLUSIONS</b>Remarkable improvement have been achieved in perioperative preparation and care after surgical treatment of pancreatic head cancer in the past decades. However, the resection rate and prognosis of PC were still poor, although the accuracy of early diagnosis is increasing, and the complications and perioperative mortality of PD are decreasing.</p>

Surgical treatment of 475 patients with periampullary carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare of the outcome of all patients who received surgical treatment in one institute for periampullary carcinoma during different intervals over the past 40 years.</p><p><b>METHODS</b>Retrospective review of 475 patients suffering from periampullary carcinoma in intervals 1958 approximately 1976, 1977 approximately 1987, 1988 approximately 1998 and 1999 approximately 2003 is presented.</p><p><b>RESULTS</b>In interval 1958 approximately 1976, for 128 patients, the tumor resection rate was: pancreatic carcinoma (PC) 26.6% (21/79), ampullary carcinoma (AC) 86.2% (25/29), distal bile duct cancer (DBDC) 38.5% (5/13), and duodenal cancer (DC) 57.1% (4/7). In interval 1977 approximately 1987, for 70 patients, the tumor resection rate was: PC 26.7% (16/60), AC 66.7% (4/6), DBDC 100% (1/1), and DC 66.7% (2/3). In interval 1988 approximately 1998, for 147 patients, the tumor resection rate was: PC 20.2% (22/109), AC 75.0% (12/16), DBDC 50.0% (2/4), and DC 66.7% (12/18). In interval 1999 approximately 2003, for 130 patients, the tumor resection rate was: PC 20.4% (20/98), AC 100% (4/4), DBDC 75.0% (12/16), and DB 83.3% (10/12). Cumulatively, from 1958 to 2003, the incidence of DBDC has become significantly higher, and the average of total bilirubin level (TBIL) has gradually been going downward, the average of blood transfusion during operation and the diameter of resected tumor has been becoming smaller. From 1999 to 2003, none of the 130 periampullary carcinoma patients had received biliary drainage before operation.</p><p><b>CONCLUSION</b>Mortality and complication have become significantly lower because of effective improvement in the perioperative preparation and the care after surgery of periampullary cancer in the recent years. Even though the accurate diagnosis has become increasing earlier than before, the resection rate and prognosis of periampullary carcinoma remain poor.</p>

Effects of ethanol on the function of cultured hepatocytes / 中华外科杂志

<p><b>OBJECTIVE</b>To develop a novel culture system to investigate the effects of ethanol on the function of cultured hepatocytes.</p><p><b>METHODS</b>Sandwich configuration was used to culture hepatocytes and the effects of ethanol on functions of bile excretion and protein synthesis as well as the morphology of cultured hepatocytes were observed.</p><p><b>RESULTS</b>Bile canaliculi-like structures decreased and anastomatic networks disappeared in ethanol treated hepatocytes. The ability for hepatocytes to internalize, metabolize and excrete compounds into bile was indicated by FDA metabolizing in the hepatocytes. In hepatocytes without ethanol, the bile excretion was showed clearly, but in ethanol-interfered hepatocytes, no bile excretion was observed. After ethanol was given, the level of protein secretion decreased and with the time going, it became lower and lower.</p><p><b>CONCLUSION</b>Hepatocytes can be seriously damaged by ethanol. The study provides a new model to investigate the mechanism of some liver diseases caused by ethanol.</p>

The expression of Cyclin D1 modulated by somatotropin on human pancreas cancer cell lines Bxpc-3 / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the growth effect of somatostapin on human pancreas cancer lines Bxpc-3.</p><p><b>METHODS</b>The Bxpc-3 pancreas cancer cells were treated with Somatotropin. The cells hyperplasia were detected by MTT and were observed apoptosis cells determinated quantitatively by TUNEL, quantify immune fluoresence double marked the proliferation cells and apoptosis cells, the expression of Cyclin D1 detected by immunohistochemical.</p><p><b>RESULTS</b>The growth effect of pancrea cancer cells were limited by 10(-7) M, 10(-8) M, 10(-9) M Somatotropin on 2 day. The limited effect was decreased from 3 day. The cells proliferation were increased by somotostapin on 4day to 5day. The relationship between the expression of Cyclin D1 and apoptosis was negative correlation and the cells hyperplasia was positive correlation in Bxpc-3 cell line.</p><p><b>CONCLUSION</b>From the cell study we knew the expression of Cyclin D1 reflected the prolefiration of pancreas cancer cells.</p>