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Objective To investigate the diagnosis and treatment of acute intestinal obstruction in aged patients over 80.Methods Data of 151 patients over 80 with acute intestinal obstruction admitted from January 2010 to March 2014 were retrospectively analyzed.Results 136 of 151 cases were mechanical intestinal obstruction,including 95 cases of adhesive ileus,13 cases of tumorous ileus,11 cases of bezoar ileus,4 cases of abdominal internal hernia,3 cases of intestinal volvulus,2 cases of incarcerated oblique hernia,1 cases of duodenal stenosis,1 case of sigmoid stenosis,1 case of anastomotic obstruction after radical resection of rectal cancer because of barium,the cause of ileus was unknown in 5 cases.14 of 151 were dynamic obstruction and 1 of 151 was vascular intestinal obstruction.Conservative treatment was performed in 114 cases and 1 patient died.30 cases received operation,including 14 cases of enterodialysis,6 cases of enterostomy,4 cases of enterotomy,3 cases of enterectomy,1 case of right hemicolectomy,1 case of reduction of volvulus of intestine,1 case of gastronesteostomy,and 1 patient died.7 of 151 were against-advice discharged.12 cases of complications occurred after surgery,including 5 cases of incisional wound infection,2 cases of heart failure,1 case of pulmonary infection,1 case of anastomotic fistula,1 case of infective shock,1 case of early postoperative inflammatory bowel obstruction and 1 case of postoperative delirium.Conclusion Adhesive ileus is the most common cause in aged patients over 80 with acute intestinal obstruction.Rational treatment should be carried out according to different conditions.Conservative treatment is often performed and with active perioperative management,most patients will have satisfied results of surgery.
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Objective To summarize the experience of diagnosis, treatment and prognosis of solid pseudopapillary tumors of the pancreas (SPT) in China. Methods The Chinese literature from January 1992 to April 2009 in Chinese Journal Full-text Database was systematically searched and a total of 439 cases of SPT from 42 reports were found. Clinical data of these cases were retrospectively analyzed. Results Among 439 was 28 years old (range 8 ～76 yrs). The clinical symptoms were recorded in 377 cases, including abdominal pain (35. 3%), mass (31. 3%), discomfort (7. 7%). 101 patients (26. 8%) were completely asymptomatic, and the lesions were detected during routine check-up. All of the patients underwent surgical resection. The preoperative misdiagnosis rate was 65.4% ( 161/246 ). The rate of curative resection was 97.3% (427/439). Mean diameter of the tumor was 7.8 cm ( range 1.5 ～ 25.0 cm). Among 394 patients with information on metastases or invasions, 80 patients(20.3% ) were positive. In all patients, 418(95.2% )were followed up and the mean follow-up period was 34 months ( range 1 month to 25 years ). During the follow-up period, 403 ( 96. 4% ) patients were alive with no evidence of recurrence or metastases, local recurrence developed in 4 patients, the liver metastases developed in 6 patients, 4 patients died from the disease. Conclusions SPT is a rare and potentially low-grade malignant tumor, and predominantly affect young women. The correct diagnosis depends on the histopathological examination. Radical surgical resection is the only effective treatment for SPT, which usually has an excellent prognosis.
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Objective To evaluate a new TNM staging system inclusive of intraperitoneal free cancer cells in terms of postoperative survival of patients with gastric cancer. Methods Free cancer cells (FCC) in the peritoneal washes of gastric cancer patients were estimated by measuring CEA mRNA levels using real-time RT-PCR. After 5-year follow-up, we get the cut-off value of CEA mRNA level by using MedCalc software to analyze the ROC curve. When CEA levels are more than the cut-off value, it may considered as FCC(+), and then using FCC(+) as distant metastasis (MI) to make a new TNM staging and analyze patients life-span. Results (1) Under the ROC curve analysis, when the cut-off value of CEA mHNA level was at 31.21 copies/ml, the Youden's index is the highest. (2) When FCC (+) considered as M1 to make a new TNM staging, the 5-year survival rate showed as below: Ⅰ-Ⅱ, P=0. 134; stage Ⅱ-Ⅲ P=0.004 and Ⅲ-Ⅳ P=0.022,repecetively. Conclusion (1) The best cut-off value of CEA mRNA levels for FCC in peritoneal washes is 31.2 copies/ml. (2) Our study demonstrated that application of FCC(+) in the TNM staging may have a better estimation of prognosis of patients suffering from advanced gastric cancer.
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Objective To establish a more sensitive method to detect free cancer cells in peritoneal washings of gastric cancer cases during surgery. Methods The CEAmRNA levels in peritoneal washings in 65 cases of gastric cancer were detected by Real-time RT-PCR. PLC was applied simultaneously to detect free cancer cells. Negative controls included the peritoneal washings from 5 cases of benign gastric diseases and the blood samples from 5 cases of healthy adult volunteers. Results (1)CEAmRNA was not found in peritoneal washings in benign gastric diseases and in blood of healthy adult volunteers. (2)The positive percentage of free cancer cells detected by Real-time RT-PCR was 47.7%, while PLC′s was only 12.3%.(3)The positive rate of CEAmRNA showed a significant difference between gastric cancer with serosal invasion and without serosa invasion groups, between peritoneal metastasis group and no peritoneal metastasis groups, and also between stages I+II and III+IV diseases(all P