Diagnosis and treatment of duodenal injury and fistula / 中华胃肠外科杂志

Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis, Crohn's disease etc. are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.

Research on the bacteroides of patients with AIDS and the healthy control / 实用医学杂志

Objective To investigate the bacteroides of patients with AIDS and the healthy control by real-time quantitative PCR in order to reveal the role and significance of gut microflora in the AIDS-associated molecular pathogenesis. Methods The feces of the preoperative AIDS patients (n = 30) and the healthy control (n = 30) were collected. According to the sequences of target genes, specific PCR primers were designed. Bacterial genome DNA extracted from fecal samples was quantified by real-time quantitative PCR to analyze the bacterial amounts. Results In the patients with AIDS, the level of B.fragilis (3.23 ± 1.59; 4.05 ± 1.65), B.uniformis (5.69 ± 0.95;6.70 ± 2.18), B.thetaiotaomicron (5.01 ± 1.61; 6.41 ± 2.34), B.ovatus (5.78 ± 1.03; 7.07 ± 1.75), B.distasonis (4.21 ± 1.21; 5.53 ± 2.46) and B.vulgatus (2.92 ± 1.30; 4.48 ± 1.32) were significantly higher than those of healthy controls (P < 0.05). Conclusion The amount of fecal bacteroides of AIDS patients are significantly higher than those of the healthy control. These data indicate that the gut microflora of AIDS patients was disordered.

Effect of aescuven forte treatment on the postoperative complications of breast cancer / 中国综合临床

Objective To investigate the treatment effect of aescuven forte on the postoperative complications of breast cancer.Methods One hundred and twenty patients with breast cancer radical surgery were randomly divided into control group(n =60) and treatment group(n =60).Patients in control group were given postoperative routine treatment,while in treatment group were administrated aescuven forte pills at 300 mg orally,2 times/day for 4 weeks beside the conventional treatment.Results (1)After the 1st,2nd weeks therapy,the flap congestion disappear rate in the treatment group were 80.0％ (48/60) and 93.3％ (56/60),better than that in the control group 60.0％ (36/60) and 71.6％ (43/60),the difference was statistically significant (P ＜ 0.05).However this trend was not seen in third weeks treatment (P ＞ 0.05).(2) The total efficiency of remission of upper limb edema was 93％ (56/60),higher than that in control group 77％ (46/60),the difference was statistically significant(x2 =5.17,P ＜ 0.05).(3) Visual analogue scale(VAS) pain score in treatment group were decreased form (8.87 ±0.74) in before treatment to (3.21 ±0.92) at after treatment.And the VAS score in control was from (8.91 ±0.85) down to (4.87 ± 1.34),the difference was statistically significant (P ＜ 0.05).Moreover VAS score in treatment group was lower than that in control group (P ＜ 0.05).(4) There was no adverse effect of the medication process.Conclusion Aescuven forte showed a ability to reduce congestion disappear time of breast cancer and shorten the recovery time of upper limb swelling and pain and other symptoms.

Progress on breast cancer stem cells as a new target for the studies and treatment of breast cancer / 中国癌症杂志

Since the study of the mechanism of breast cancer occurrence and development deepens, breast cancer stem cells are receiving more and more attention. Studies have shown that a group of breast cancer stem cells were undifferentiated, with self-renewal and multi-differentiation potential. These cells have a resistance to chemotherapy, radiotherapy, hypoxic, high tumorigenic, high invasion and metastasis. In breast cancer's recurrence,development, and even metastasis, they play an extremely important role. In-depth study of breast cancer stem cell related signal transduction pathways and the regulation of microenvironment are meaningful for clinical targeted treatment of breast cancer. Therefore, we summarized the latest development on breast cancer stem cells in the treatment of breast cancer.

Revascularization of arteriosclerosis obliterans of the lower extremity / 中华普通外科杂志

Objective To evaluate traditional surgical treatment, intraluminal strategy and hybrid operation on revascularization of atherosclerosis obliterans (ASO) of the lower extremity. Methods Clinical data of 197 ASO cases receiving revascularization from January, 1998 to December, 2008 were retrospectively analyzed. Seventy-seven cases underwent surgical treatment, 82 cases received intraluminal therapy, and 38 cases were treated by hybrid operation. The indications, clinical effect, complication and perioperational mortality of these three strategies were evaluated. Results 71% patients (164 cases) were followed up from 2 to 112 months. Surgical and intraluminal method had no statistical difference on long-term patency of aortic-iliac and femoral-popliteal artery (57% vs. 51%;48% vs. 42%). Hybrid procedure led to higher patency on multi-level lesion and concurrent thrombosis. The complications after surgery was higher than intraluminal on aortic- iliac and femoral-popliteal artery (31% vs. 12%;31% vs. 11%), and higher than intraluminal and hybrid on multi-level lesion (36% vs. 12% vs. 15%). The perioperative mortality of surgical group was 1.5% and 2.0% on aortic-iliac and multilevel lesion and 0% on other site;and that of intraluminal and hybrid procedure was 0%. Conclusion For aortic-iliac and femoral-popliteal artery revascularization, surgery was preferred in cases of long occlusive lesion and intervention was preferred for cases with short non-occlusive lesion. Hybrid procedure was the best for multi-level and concurrent thrombosis.

Non-surgical therapy for 412 patients with early lower extremity deep venous thrombosis / 中华全科医师杂志

Objective This report was to discuss the efficacy and complications of non-surgical therapy for patients with early lower extremity deep vein thrombosis.Methods A total of 412 patients were treated with thrombolysis or anticoagulation in our department during January 2000 and December 2006.Their clinical data were retrospectively analyzed.Results All patients were followed up for 12 to 83 months (mean,41 months).After treatment,42 patients(10.2%)were completely recovered,331 patients (80.3%)experienced large improvement,32 patients(7.8%)had mild improvement and 7 patients (1.7%)were failed,resulting in total effective rate of 98.3%.In comparison with long clinical course group(>7 days),the recovery rate and improvement rate of short clinical course group(≤7 days)was significantly increased(11.0% vs 5.4%,χ2=4.17,P<0.05;8.7%vs 1.8%,χ2=4.96,P<0.05).Complications included bleeding(2.2%),pulmonary embolism(1.9%),cerebral accident(0.7%),post-thrombotic syndrome(84.0%)and recurrence(6.1%).Bleeding rate in patients≥60 years was significantly higher(4.3%vs 0.8%,χ2=6.82,P<0.01).Incidence of post-thrombotic syndrome was significantly increased in long clinical course group(98.2% vs 81.7%,χ2=3.67,P<0.05).Condusions Non-surgical therapy,including thrombolysis and anticoagulation,might be safe and effective for patients with early lower extremity deep vein thrombosis.Early identification and management would be helpful to improve outcomes and reduce post-thrombotic syndrome.

Diagnosis and treatment of acute portal vein thrombosis / 中华普通外科杂志

Objective To discuss the diagnostic methods and therapeutical measures on acute portal vein thrombosis. Method Clinical data of 13 cases of acute portal vein thrombosis were retrospectively analyzed and its diagnosis and therapy were evaluated.Results In this group,8 cases were male and 5 were female.The average age was(54±26)years old and 6 of which had identified inducement.Diagnosis was made with enhanced CT or MRI/MRA in all cases,Among which 5 cases were treated with non-surgical method(anticoagulation and thrombolysis)and 2 died.The other 8 cases were cured with surgical procedures (thrombectomy and tube insertion for anticoagulation and thrombolysis though superior mesenteric vein).Segmental small intestinal necrosis necessitated small bowel resection in 5 cases.Conclusion Surgical procedures remain the important therapy of choice for acute portal vein thrombosis especially when bowel necrosis is suspected.

Repeated intestinal bleeding for 7 years in an adult case of small intestinal cavernous hemangioma / 重庆医科大学学报

Objective:To discuss the diagnosis and treatment of small intestinal cavernous hemangioma.Methods:To review the case of small intestinal avernous hemangioma and the associated literatures.Results:Small intestinal cavernous hemangioma,with extremely low incidence,has always no marked symptoms and signs,so it's difficult to be diagnosed with traditional methods.Capsule endoscopy and enteroscopy not only are useful in diagnosis of small intestinal cavernous hemangioma pre-operation,but also has instruction value in-operation.Conclusion:Capsule endoscopy and enteroscopy have comparative higher sensitivity and specificity in diagnosis of small intestinal cavernous hemangioma and are worth of being generalized.

SYBR GreenⅠ Real-Time Fluorescence Quantitative PCR Analysis of Variation of Intestinal Microflora in Patients with Colorectal Cancer / 中国普外基础与临床杂志

Objective To analyze the variation of intestinal microflora in patients with colorectal cancer by SYBR GreenⅠreal-time fluorescence quantitative PCR and reveal the role and significance of intestinal microflora in the colorectal cancer-associated molecular pathogenesis.Methods A set of 16S rRNA gene group of species-specific primers for Bifidobacterium spp.,Lactobacillus group,Escherichia coli,and ddl gene-targeted species-specific primers for Enterococcus faecalis and feces Enterococcus were designed.Patients with colorectal cancer(colorectal cancer group,n=30) and healthy volunteers(normal control group,n=30) were included and whose feces were collected to extract bacterial genome DNA.SYBR GreenⅠ real-time fluorescence quantitative PCR was used to analyze the five mentioned bacterial amounts.Results Level of Bifidobacterium spp.(4.52?0.49) and Lactobacillus group(5.46?0.12) in colorectal cancer group were significantly lower than those(9.25?0.83 and 7.45?0.37) of normal control group(P

A clinical study on the treatment of acute deep vein thrombosis of lower extremities / 中国微创外科杂志

Objective To study the treatment of deep vein thrombosis (DVT) of lower limbs. Methods A series of 82 patients with DVT treated in this hospital from July 1995 to July 2002 were retrospectively analyzed. Sixty-two patients underwent conservative therapy while 20 patients underwent thrombectomy. Results Oedema on diseased limbs subsided in varying degrees in all the patients. However, complete re-perfusion was achieved in only 15 patients, and partial re-perfusion in 9 patients. In the rest of 58 patients, thrombosis was unimproved or recurred, leaving behind the post-thrombotic syndrome. Conclusions Early treatment for acute DVT, conservative therapy or surgical intervention, is effective. Surgery is advisable in most early central type or mixed type patients, whereas conservative therapy in late central type or peripheral type patients. The intravenous interventional therapy is a relatively novel and favorable vascular technique.

Complications and recurrence following sphincter preserving procedure for rectal cancer: Analysis on causes and prevention thereof / 中国微创外科杂志

Objective To discuss causes and prevention of complications and recurrence following sphincter preserving procedure(SPP) for rectal cancer.Methods A retrospective study on clinical and follow-up data of 375 cases of rectal cancer treated by SPP from January 2000 to January 2006 was carried out.Factors relating complications and recurrence after the operation were analyzed with the Logistic regression.Results A follow-up was conducted for 1～60 months(mean,37 months).The 5-year survival rate was 75.77%,and 79 cases of those followed died.Postoperative complications included anastomotic leakage in 14 cases(3.73%),anastomotic stenosis in 37 cases(9.87%),and anastomotic bleeding in 13 cases(3.47%).Anastomotic tumor recurrence was seen in 25 cases.Logistic regression analysis showed that the distance between the tumor and the dentate line was the most important factor for postoperative complications(P=0.017),and the distance and patient's age were the most important factors for recurrence(P=0.040,P=0.041). Conclusions The distance of tumor and patient's age are the most important factors for complications and recurrence following sphincter preserving procedure for rectal cancer.Strict selection of patients for surgery,normative procedure performance,and proper peri-operative management are essential for the prevention of complications and recurrence.

Study of cotransfection of B7-1 gene and CD1_D gene in pancreatic carcinoma cell and its anti-tumor responses in mice / 中国普通外科杂志

Objective To study the cotransfection mB7-1 and mCD1D gene into pancreatic cancer cells of rats and to observe its anti-tmor responses.Methods Recombinant retroviral vectors expressing mB7-1and mCD1D gene were packaged into GP2-293 cell lines and transfected.The expressions of mB7-1 and mCD1D were detected with PCR and Western blot.The positive cells of mB7-1 and mCD1D were used to induce the anti-tumor immunity in vitro.Results Anti-tumor immunity was induced after B7-1 and CD1D positive cells were coinoculated in syngeneic mice.Furthermore,the growth of tumor was inhibited.Conclusions Cotransfection of B7-1 and CD1D could induce anti-tumor effect.This study provide a foundation for the application of B7-1 and CD1D gene therapy in tumor.