Reason and prevention of decreased free fat mass after Roux-en-Y gastric bypass / 中华消化外科杂志

With the increase of obese people around the world,the complications associated with obesity are endangering human health,it has became an important factor affecting the quality of life and increasing social and economic burdens.Rouxen-Y gastric bypass (RYGB) is an effective surgical tool for the treatment of obesity and metabolic-related complications,meanwhile,it can also improve or cure the obesity-related metabolic diseases with reducing the body mass of patients.Free fat mass (FFM) is the main component of the human body and plays an important role in metabolic surgery for the prevention of bone loss,control of weight and alleviation of insulin resistance and so on.The loss of body mass is one of the manifestations of the changes in body composition and distribution after RYGB,and its performance is common after metabolic surgery.This article will summary the findings and investigate the reason of decreased FFM after RYGB and the preventive strategy for different reasons,and it will also provide to the principle of individualized management of patients and guide the clinical practice.

Clinical value of dual-energy X-ray absorptiometry in evaluating the improvement of metabolic indexes after laparoscopic sleeve gastrectomy / 中华消化外科杂志

Objective To observe the changes of pre-and post-operative body fats of obese patients undergoing laparoscopic sleeve gastrectomy which were evaluated by dual-energy X-ray absorptiometry (DEXA) and investigate the correlation of the changes between body fat and insulin resistance.Methods The cohort study was conducted.The clinical data of 10 obese patients who were admitted to the Fourth Affiliated Hospital of China Medical University from October 2015 to February 2017 were collected.Ten obese patients received laparoscopic sleeve gastrectomy (LSG).The pre-and post-operative body fat masses in the different parts and regions of the whole body [whole body,upper limbs,lower limbs,trunk,region of android (region A) and region of gynoid (region G)] were measured by DEXA and pre-and post-operative indexes of insulin resistance (HOMA-IR) were calculated.Observation indicators:(1) fat parameters evaluated by DEXA and test results of other obesity related indicators;(2) test results of insulin sensitivity index.The patients were followed up by the professional team of metabolic surgery using telephone interview,outpatient and inpatient examinations up to February 2017,and DEXA using outpatient and inpatient examinations was performed at 6 months postoperatively.The measurement data with normal distribution were represented as-x ±s,and repeated measurement data were analyzed by the repeated measures ANOVA.The correlation analysis was performed by the Pearson,and the degree of correlation was analyzed by the factor analysis and multiple linear regression.Results (1) Fat parameters evaluated by DEXA and test results of other obesity related indicators:all the 10 patients were followed up.The fat masses and percentages of the whole body,upper limbs,lower limbs,trunk,region A and region G,BMI,waist circumference and HOMA-IR were respectively (55.6± 13.7) kg,(6.2± 1.9) kg,(17.8± 3.6) kg,(31.7± 12.7) kg,(5.6±2.4)kg,(8.8±1.5)kg,50％±3％,54％±5％,50％±4％,52％±3％,57％±4％,52％±4％,(42± 8) kg/m2,(123±23) cm,8.7 ± 5.6 before operation and (37.4± 11.3) kg,(4.0± 1.2) kg,(11.2± 3.0) kg,(20.4±9.6) kg,(3.5± 1.7) kg,(5.1± 1.4) kg,43％±5％,46％±5％,42％±5％,46％±5％,48％±6％,46％ ± 5％,(30 ± 6) kg/m2,(101 ± 20) cm,3.5 ± 2.4 at 6 months postoperatively,with statistically significant differences between pre-and post-operations (F =11.282,6.308,15.789,6.083,7.836,9.027,5.485,7.743,8.620,3.743,4.704,5.421,13.281,14.258,4.465,P＜0.05).The waist-hip ratio and percentage of region A/ percentage of region G (A/G) were 0.94±0.09,1.10±0.09 before operation and 0.93±0.12,1.05±0.13 at 6 months postoperatively,with no statistically significant difference between pre-and post-operations (F=0.324,1.361,P＞0.05).(2) Test results of insulin sensitivity index:there was a positive correlation in the fat masses of the whole body,trunk,region A and region G,BMI,waist circumference and HOMA-IR (r =0.873,0.874,0.894,0.696,0.843,0.816,P＜0.05),and no correlation between the fat masses of the upper and lower limbs and HOMA-IR (r =0.442,0.242,P＞0.05).The principal component of F1 and F2 were constructed by the factor analysis,F1 (trunk for the most) reflected the fat mass of the different parts of the whole body and F2 reflected the fat mass of peripheral limbs,the model of F1 was reasonable (t =5.033,P＜0.05).The contribution rate of the whole body,upper and lower limbs,trunk,region A,region G,BMI and waist circumference were respectively 0.994,0.633,0.487,0.887,0.900,0.897,0.959,0.897 in the F1 and -0.030,0.716,0.829,-0.446,-0.405,0.423,-0.201,-0.283 in the F2,and the whole body fat mass (BFM) made a largest contribution rate for the preoperative HOMA-IR (0.994).There was a positive correlation between decrease of fat mass in region G and improvement of HOMA-IR at 6 months postoperatively (r =0.717,P＜0.05).Conclusion BFM is an important index to evaluate the insulin resistance in female patients,and the decrease of fat mass in the region G is an important factor for the early remission of insulin resistance in female patients after laparoscopic sleeve gastrectomy.

MRI Reveals Edema in Larynx (But Not in Brain) During Anaphylactic Hypotension in Anesthetized Rats

PURPOSE: Anaphylactic shock is sometimes accompanied by local interstitial edema due to increased vascular permeability. We performed magnetic resonance imaging (MRI) to compare edema in the larynx and brain of anesthetized rats during anaphylactic hypotension versus vasodilator-induced hypotension. METHODS: Male Sprague Dawley rats were subjected to hypotension induced by the ovalbumin antigen (n=7) or a vasodilator sodium nitroprusside (SNP; n=7). Apparent diffusion coefficient (ADC) and T2-relaxation time (T2RT) were quantified on MRI performed repeatedly for up to 68 min after the injection of either agent. The presence of laryngeal edema was also examined by histological examination. Separately, the occurrence of brain edema was assessed by measuring brain water content using the wet/dry method in rats with anaphylaxis (n=5) or SNP (n=5) and the non-hypotensive control rats (n=5). Mast cells in hypothalamus were morphologically examined. RESULTS: Mean arterial blood pressure similarly decreased to 35 mmHg after an injection of the antigen or SNP. Hyperintensity on T2-weighted images (as reflected by elevated T2RT) was found in the larynx as early as 13 min after an injection of the antigen, but not SNP. A postmortem histological examination revealed epiglottic edema in the rats with anaphylaxis, but not SNP. In contrast, no significant changes in T2RT or ADC were detectable in the brains of any rats studied. In separate experiments, the quantified brain water content did not increase in either anaphylaxis or SNP rats, as compared with the non-hypotensive control rats. The numbers of mast cells with metachromatic granules in the hypothalamus were not different between rats with anaphylaxis and SNP, suggesting the absence of anaphylactic reaction in hypothalamus. CONCLUSION: Edema was detected using the MRI technique in the larynx during rat anaphylaxis, but not in the brain.

MRI Reveals Edema in Larynx (But Not in Brain) During Anaphylactic Hypotension in Anesthetized Rats

PURPOSE: Anaphylactic shock is sometimes accompanied by local interstitial edema due to increased vascular permeability. We performed magnetic resonance imaging (MRI) to compare edema in the larynx and brain of anesthetized rats during anaphylactic hypotension versus vasodilator-induced hypotension. METHODS: Male Sprague Dawley rats were subjected to hypotension induced by the ovalbumin antigen (n=7) or a vasodilator sodium nitroprusside (SNP; n=7). Apparent diffusion coefficient (ADC) and T2-relaxation time (T2RT) were quantified on MRI performed repeatedly for up to 68 min after the injection of either agent. The presence of laryngeal edema was also examined by histological examination. Separately, the occurrence of brain edema was assessed by measuring brain water content using the wet/dry method in rats with anaphylaxis (n=5) or SNP (n=5) and the non-hypotensive control rats (n=5). Mast cells in hypothalamus were morphologically examined. RESULTS: Mean arterial blood pressure similarly decreased to 35 mmHg after an injection of the antigen or SNP. Hyperintensity on T2-weighted images (as reflected by elevated T2RT) was found in the larynx as early as 13 min after an injection of the antigen, but not SNP. A postmortem histological examination revealed epiglottic edema in the rats with anaphylaxis, but not SNP. In contrast, no significant changes in T2RT or ADC were detectable in the brains of any rats studied. In separate experiments, the quantified brain water content did not increase in either anaphylaxis or SNP rats, as compared with the non-hypotensive control rats. The numbers of mast cells with metachromatic granules in the hypothalamus were not different between rats with anaphylaxis and SNP, suggesting the absence of anaphylactic reaction in hypothalamus. CONCLUSION: Edema was detected using the MRI technique in the larynx during rat anaphylaxis, but not in the brain.

Surgical therapy for anorectal malignant melanoma / 中华普通外科杂志

Objective To evaluate clinical features, diagnosis and treatment of anorectal malignant melanoma (ARMM).Methods The clinical data of 15 patients of ARMM in our hospital and 18 patients in the First Affiliated Hospital of China Medical University from 1990 to 2010 were reviewed.Twenty-five patients underwent curative surgical resection, 14 patients underwent abdominoperineal excision of the rectum (APR), and 11 patients underwent local excision (LE).Survival analysis was carried out.Fisher's exact test and Log-rank test was used to compare the effects of these two different surgical procedures.Results ARMM had a female predominance, the mean age was 22 -77(54.5 ± 7.6) years.The major clinical signs included hematochezia, anus pain.The misdiagnosis rate was 67% (22/33).The average tumor size was (3.5 ±1.7) cm.Thirty-one petients(94% ,31/33) had ARMM within 5 cm from anus margin.Mean survival time was (14.0 ± 6.5)months.The overall 1-,3-,and 5-year survival rates were 48% ,22% , and 10% , respectively.Local recurrence after curative LE was higher than APR (LE,64% vs APR, 21% , P = 0.049) , The overall 3-year disease-specific survival rates after curative LE was not significantly different from that of APR (LE, 28% vs APR ,31%, x2 = 0.268, P = 0.582).Conclusions Anorectal malignant melanoma has a high rate of misdiagnosis.Radical resection could not prolong the survival time significantly in anorectal malignent melanoma patients.

Perioperative management of procedure for prolapse and hemorrhoids in elderly patients with serious hemorrhoids / 中华老年医学杂志

Objective To evaluate the perioperative management and therapeutic efficacy of procedure for prolapse and hemorrhoids (PPH) in elderly patients with serious hemorrhoids. Methods The clinical data of 52 elderly patients (aged 60 years or over) with serious hemorrhoids treated by PPH from March 2005 to November 2007 were analyzed restrospectively. Results All the operations were successfully completed. The average operation time was (15.3±3.2) min, the average blood loss was (15±1.7) ml and the average hospitalization time was (4.5±2.6) days.Patients were followed for 1-20 months with (14.2±2.4) months for average. The follow-up rate was 92.3%(48/52). Complications included urinary retention in 18 cases(37.5%), anastomotic bleedings in 2 cases (4.2%), postoperative pain of anus in 4 cases (8.4%), recurrence in 1 case (2.1%),hypoglycemia in 1 case(2.1%), and 1 case (2.1%)was found stricture in rectum at 2 months after the procedure and no case developed rectovaginal fistula. Conclusions Old age is not the contraindication for PPH treatment of the serious hemorrhoids. Proper perioperative management may decrease the postoperative complications and improve the life quality of the patients.

Influence of anal sphincterotomy to anorectal dynamics in the treatment of hemorrhoids / 中国医师进修杂志

Objective To observe the difference of anoreetal dynamics between Milligan-Morgan hemorrhoidectomy plus internal sphinctemtomy and simple Milligan-Morgan bemorrhoidectomy in the treatment of annulus mixed hemorrhoids.Method Measured the anal resting pressure,maximal anal contractive pressure,rectal sensation thresholds,maximal rectal tolerable dose and maximal rectal compliance 1 day before and 3 months after Milligan-Morgan hemorrhoidectomy plus internal sphincterotomy (therapy group,50 cases)and simple Milligan-Morgan bemorrhoidectomy(control group,52 cases)by anorectal manometric device made in Sweden.Results The anal resting pressures of therapy group and eontrol group reduced signifieanfly 3 months after operation compared with that 1 day before operation(P＜ 0.01 or ＜ 0.05),but there was significant difference between the two groups in 3 months after operation(P＜0.05).The maximal anal contractive pressure,reetal sensation thresholds,maximal rectal tolerable dose and maximal rectal compliance were no significant difference between the two groups in 3 months after operation (P ＞0.05).Conclusion Anal sphineterotomy can change the high anal pressure significantly in the treatment of annulus hemorrhoids without copracrasia,it is a proper operation method.

Surgical management for rectal carcinoid / 中华普通外科杂志

Objective To investigate the clinical and pathological features of rectal carcinoid and factors influencing the prognosis. Methods Clinical data of 29 cases with postoperative pathology identified diagnosis of rectal carcinoid from May 1998 to May 2008 in the two hospitals were retrospectively reviewed. Endoscopic submucosal resection of the tumor was conducted in 5 cases,local resection in 14 cases, local expanded resection of the tumor in 4 cases, transsacral local wide resection in 2 cases, radical operation in 4 cases. Results Median age at treatment was 32～71 (54±11) years. Median follow-up was (61±4) months (3 months-10 years), follow-up rate was 76%. During a follow-up, there were no cases with recurrence among the 13 patients with tumor size<1 cm, 1 case recurred in the 5 patients with turmor size between 1 to 2 cm, and 3 cases died from postoperative liver metastasis among the 4 patients with tumor size > 2 cm. The 5-, 10-year disease-specific survival rates were 87% and 80% respectively. Conclusions Surgery is the best therapy for rectal carcinoid, the choice of operative mode must be made according to the size,infiltration of the tumor, the condition of infiltrated lymph node and hepatic metastasis.

Reasons and countermeasure of complications after procedure for prolapse and hemorrhoids / 中国医师进修杂志

Objective To explore the reasons and countermeasure of the complications after proce-dure for prolapse and hemorrhoids(PPH).Methods From March 2006 to November 2007,a total of 78 patients with Ⅲ-and Ⅳ-degree hemorrhoids underwent PPH.The reasons and countermeasure of the complications were analyzed retrospectively.Results The average operation time time was(16.8±3.4)rain,the average blood loss was(12.0±2.1)ml,and the average hospitalization was(4.0±2.7)days.Patients were followed up for 1-20 months and(13.4±1.7) months for average,follow-up rate time was 92.3% (72/78).Comptications included urinary retention in 24 cases(33.3%),anastomotic bleedings in 5 cases (6.9%),reopelative hemostasis in 1 case(1.4%),postoperative pain of anal in 7 cases(9.7%),severe pain in 1 case(1.4%),slight encopresis in 1 case(1.4%),recurrence in 1 case(1.4%),2 cases(2.8%)were found stricture in rectum at 2,4 months after the procedure and no case appeared rectovaginal fistula.Con-clusion PPH forⅢ-and Ⅳ degree hemorrhoids is effective with fewer complications,which can be pre-vented by standard and skillful operation.

Analysis on long-term outcomes of laparoscopic versus open surgery for colon cancer / 中国现代普通外科进展

0.05). The 5-year survival rates were 77.4% in LS group and 75.7% in OS group for stage Ⅰ/Ⅱ (P=0.626), and 71.8% in LS group and 65.6% in OS group for stage Ⅲ(P=0.517), respectively. Conclusion: Long-term effect of laparoscopic resection is similar to that of open resection for colon cancer, but laparoscopic surgery has less long-term complications.

Male breast cancer:a report of 38 cases / 中国普通外科杂志

Objective To explore the clinical characteristics,diagnosis,treatment,and prognosis of male breast cancer.Methods The clinical data of 38 cases of male breast cancer,who were treated in the two hospital during the past 10 years,were analyzed retrospectively.The diagnosis was mainly based on preoperative B-ultrasound,radiography with molybdenum target tube and fine needle aspiration.Among the 38 cases,radical mastectomy was conducted in 3 cases,modified radical mastectomy in 27 cases,simple mastectomy in 5 cases,and operation was refused in 3 cases.Postoperatively,radiotherapy was adopted in 4 cases,simple endocrinotherapy in 7 cases,radiotherapy plus chemotherapy in 9 cases,and chemotherapy plus endocrinotherapy in 8 cases.Results Median age at treatment was 58.5(53-82)years.TNM staging included stageⅠin 13 cases,stageⅡ in 19 cases,stageⅢ in 4 cases,and stageⅣ in 2 cases.Median follow-up was 73.8 months(2 months-10 years),and follow-up rate was 73.6%(28/38).During the follow-up,13 cases died including 8 cases died of local recurrence and metastasis,and 5 cases died of heart and brain disease.The 5-and 10-year overall survival rate was 71.6% and 55.3% respectively;5-and 10-year disease-specific survival of stageⅠ,Ⅱ was 92.6% and 78.9% respeoively;among 6 cases of stageⅢ,Ⅳ 4 were followed,and all 4 cases died with in 3 years.Conclusions Male breast cancer has a long course,poor prognosis and low survival rate.Combined therapy with modified radical mastectomy,as its basis,is the treatment of choice for male breast cancer.There is a certain correlation between the prognosis of male breast cancer and clinical stage of the disease.