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Gastrointestinal fistula patients may suffer from complicated intra-abdominal infection and sepsis with improper treatment, which is characterized by high mortality ranging from 20% to 60%, as well as high medical costs. Gastrointestinal fistula patients with complicated intra-abdominal infections are not often diagnosed early, and proper treatment remains an unsolved problem. Therefore it is a great challenge for surgeons to repair broken intestines under complicated intra-abdominal infection conditions and to repair ruptured intestines under conditions of severe abdominal adhesions and swelling of the intestinal wall and mesentery. After the open abdominal approach was first adopted to treat complicated intra-abdominal infection patients by Duff and Moffat in 1981, it gradually began to be used more widely. However, some investigators have reported that the open abdomen approach has not been effective in controlling controlled mortality, instead, it may even increase mortality. For this reason, the approach has only been used in large medical centers rather than having been widely popularized. In this review, the effect, timing, indications of open abdomen approach and the principles for the open abdominal wound management are summarized, and the reason for the various efficacy among different centers is also analyzed. We provide a new perspective for clinicians to manage the gastrointestinal fistula patients with complicated intra-abdominal infection.
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Humans , Abdominal Cavity , General Surgery , Digestive System Fistula , General Surgery , Intraabdominal Infections , General Surgery , Sepsis , General SurgeryABSTRACT
Objective To systemically review andquantify the incidence of oral feeding intolerance in acute pancreatitis. Methods Randomized controlled trials that reported the oral feeding intolerance rates of acute pancreatitis were searchedfrom PubMed, EMBASE, Medline, Cochrane Library, WanFang, CNKI, CMCC and VIP dal,abase wilh the" Acute pancreatitis " " Feeding intolerance" " Incidence" " Meta- analysis "from January 2002 to May 2017. Date were analyzed by using R 3. 4. 0 software. The heterogeneity of data were analyzed using 12test. Results Eleven randomized controlled trials including 658 cases were enrolled in Meta-analysis. The incidence of oral feeding of intolerance was 12. 2% . The result of subgroup analysis showed that there were no significant difference in the incidence of oral feeding intolerance when region, sample size and published year were taken into analysis (P > 0. 05). The oral feeding intolerance rate of mild acute pancreatitis was lower than that when moderately severe acute pancreatitis and severe acute pancreatitis were, included (8. 2% and 19. 9% , respectively; P = 0. 002 7). Conclusion Oral feeding intolerance affects approximately l in 8 patients with acute pancreatitis. The incidence of oral feeding intolerance of patients with severe acute pancreatitis is higher than that of patients with mild acute pancreatitis
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Objective To evaluate the preoperative nutritional status of patients with gastric cancer by using patient-generated subjective global assessment (PG-SGA) its relationship with postoperative results.Methods Make a preoperative nutrition assessment by using PG-SGA for 87 patients with gastric carcinoma who can be treated with operation.Analyze the effects of the postoperative complication,survival rate and the hospitalization time on patients.Results The number of patients of this group who can process the preoperative nutrition assessment by using PG-SGA accounts for 100％ of the total.There are 37 patients with moderate or severe malnutrition before operation (account for 39.1％).The complication incidence of patients with moderate or severe malnutrition before operation and the patients with no or mild malnutrition are 52.9％ and 5.7％ separately (P ＜ 0.01).The sensitivity and specificity of PG-SGA score for predicting complications are 85.7％ and 75.8％ respectively.And we should implement the analysis of regression to verify that the PG-SGA grade is the independent risk factor of postoperative complication by applying multiple Logistic(P ＜ 0.01).The average hospital stays of patients with moderate or severe malnutrition before operation and the patients with no or mild malnutrition are (21 ± 6) d and (16 ± 4) d separately (P ＜ 0.01).Conclusion According to the PC-SCA results,patients with moderate or severe malnutrition before operation have increased susceptibility to complication and the extension of hospital stays after the operatiou.Therefore,it is important to supply the proper nutrition support to these patients.
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Objective:To establish a method for the simultaneous determination of chlorphenamine maleate and ephedrine hydro-chloride in chlorphenamine maleate and ephedrine nasal drops by HPLC. Methods:An HPLC method was performed on a column of Purospher STAR RP18(150 mm × 4. 6 mm,5 μm)with the mobile phase of acetonitrile -potassium dihydrogen phosphate buffer(pH 3. 0 ± 0. 1)(18:82 v/v)at the detection wavelength of 210 nm(adjusting the flow rate and column temperature to 1. 0 ml·min-1 and 35℃,respectively). The injection volume was 20 μl. Results:A good linear relationship was established between the peak response and the concentration of ephedrine hydrochloride and chlorphenamine maleate over the range of 19. 81-118. 85μg·ml-1(r=0. 999 6) and 6. 21-37. 25 μg·ml-1(r=0. 999 8),respectively. The mean recovery of ephedrine hydrochloride and chlorphenamine maleate was 100. 39%(RSD=0. 69%,n=9)and 100. 11%(RSD=0. 60%,n=9),respectively. Conclusion:The proposed method shows high repeatability,good durability and promising accuracy. It can be employed for the determination of two components in chlorphena-mine maleate and ephedrine nasal drops.
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Objective To explore the efficacy of radiofrequency ablation (RFA) combined with splenectomy in patients with small hepatocellular carcinoma (sHCC) associated with hypersplenism.Metheds The data of 100 patients with sHCC associated with hypersplenism who received RFA or hepatectomy combined with splenectomy were analyzed retrospectively.The patients were divided into the observation group and the control group based on the intraoperative approach.Fifty-three patients who received RFA and splenectomy were in the observation group,and the remaining 47 patients who received hepatectomy and splenectomy were in the control group.Multiple intraoperative and postoperative factors were compared between the two groups.Results There were significant differences between the two groups in warm ischemia time,operation time,intraoperative blood loss,hospital stay,and amount of blood transfusion (P ＜ 0.05).The postoperative complication rate of the observation group (7.6％,4/53) was significantly lower than the control group (44.7 ％,21/47) (P ＜ 0.05).There were no significant differences in 1-,3-,and 5-year survival (respectively,100.0％,75.5％,and 67.9％ vs 97.9％,76.6％,and 68.1％) and in disease free survival (96.2％,57.5％,and 41.7％ vs 93.5％,58.3％,and 43.8％ respectively) between the two groups (P ＞ 0.05).Conclusion RFA combined with splenectomy can be considered as an alternative treatment for patients with sHCC associated with hypersplenism.
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Objective To explore the feasibility of nasolabial fold wrapped perforator flap in repairing pinna defects to produce the relative perfect appearance.Methods We treated 10 cases of pinna nasi defects by the nasolabial fold wrapped perforator flap.We examined the blood vessel distribution and exit of the blood vessel before surgery,and designed the nasolabial fold wrapped perforator flap according to the pinna defects.The flap with reasonable thickness was able to repair the both sides of defect after being cut properly.Meanwhile,the flap could be folded to form a local flap covered or lined with skin,and rotately transfered to repair nasal alar defect.Results All the flaps survived with incisions of donor sites healed primarily.Following up for 4 to 24 months showed that the color,texture and thickness of the flaps were similar to those of recipient sites.The scar in donor site was concealed and not obvious.Those cases who kept neurocutaneous branch had good sense.Satisfactory appearance was received without secondary repair.Conclusions The nasolabial fold wrapped perforator flap has abundant blood circulation and easily survives.It can also afford ample tissues to repair major area of pinna nasi defects,The blood vessel peduncle is too long to be survived easily.And the donor has not clear scar.Second reconstruction can be avoided in this procedure.The nasolabial fold wrapped perforator flap is one of the best choices to repair pinna defects.
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Objective To observe the effect of Xinjia-Liangfu(XJLF)formula on human gastric cancer(SGC-7901)tumor growth in nude mice and its impact on survivinand Caspase-3 expression in tumor tissue. Methods The animal model of SGC-7901 xenografted nude mice was established, and all the mice were randomly divided into 6 groups, namely model control group, 5-Fu group, XJLF formula high-dose group, XJLF formula medium-dose group , XJLF formula low-dose group and drug combination group(XJLFformula medium-dose and 5-Fu). After 10 days of continuous treatment, tumor inhibition rate was calculated and the expression of Survivin and Caspase-3 was detected by immunohistochemistry techniques. Results The tumor inhibition rates of 5-Fu group, XJLF formula high-dose group, XJLF formula medium-dose group, XJLF formula low-dose group and drug combination group were 55.03%, 56.38%, 41.23%, 23.09%and 60.28%respectively, and the tumor inhibition rate of drug combination group was significantly increased compared to the model control group(P<0.05), 5-Fu group(P<0.05)and XJLF high-dose group(P<0.05) Meanwhile, the Caspase-3 expression was significantly up-regulated and the Survivin expression was significantly down-regulated in drug combination group(Caspase-3 was 77 539.74±50 912.5, Suvivin was 35 709.1±10404.4)compared to the model control group(Caspase-3 was 18 464.71±7 537.01,Suvivin was 63 449.4±50 498.8), P<0.05 or 0.01, 5-Fu groupCaspase-3 was (47 198.89±10 751.2), Suvivin was(37 016.8±6 024.4), P<0.05 or 0.01and XJLF formula high-dose groupCaspase-3was (44213.57±7041.6), Suvivin was (38811.1±7313.0)respectively. Conclusion The tumor inhibition rate of drug combination group was higher than XJLF formula high-dose group and 5-Fu group. Also combination group hadstronger effect compared to model control group in terms of down-regulation of Caspase-3 expression and up-regulation of Survivin expression, which indicates a benefit ofXJLF and 5-Fu combination treatment.
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Objective To explore the elasticity of carotid artery in children with simple obese by echo tracking imaging technique.Methods Intima-media thickness (IMT), resistent index (RI), pulsatility index(PI ), the ratio of systolic phase and diastolic phase(S/D ) of common carotid artery (GCA) were detected differently in 50 simple obese children (obese group) and 50 normal children (control group) by CDFI.Internal systolic diameter (Ds), internal diastolic diameter (Dd),pressure-strain elastic moduhs(E ρ ), stiffness parameter ( β ), arterial compliance (AC), augmentation index (AI), pulse wave velocity ( PWV β ) were calcuhted automatically by means of echo tracking system.Results There was no significant difference in Ds,Dd,RI, PI,S/D and AI'between two groups (P >0.05).In obese group, IMT was significantly thicker,E ρ,β, PWV β were significantly higher,and AC was significantly lower thon those in control group (P < 0.05).Conclusions It has alteration of early atherosele in carotid artery of simple obese children.Echo tracking imaging technique is a quick, noninvasive, accurate and quantitative evaluating method for the elasticity of carotid artery.
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Physical and Chemical Analysis of Food is one of the important courses of hygiene quarantine speciality,food science and engineering speciality,food quality and safety speciality,and so on. The application of concept center method on the teaching of the course was discussed in the article. The prolegomenon of the course and the eleventh chapter of the course--Determination of Gene Modified Food had been worked as two examples.
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Food Testing was the experimental and applied basic courses for Prevent Medicine.According as the problems in teaching,some advice on teaching content,teaching method,and laboratory construction and management was discussed in order to cultivate the innovative specialties and develop the students' experimental ability.
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Objective To investigate the effect of salvia miltiorrhiza (SM) on the expression of Bcl 2?Bax and hepatocyte apoptosis in hepatic preservation and reperfusion in a murine model.Methods The model of the preservation reperfusion of isolated rat liver was established. Bcl 2?Bax expression of the liver tissue and hepatocyte apoptosis were studied respectively by flow cytometry and in situ terminal deoxynucleotidyl transferase mediated dUTP FITC nick end labeling (TUNEL) technique. Results In SM treated group levels of Bcl 2 expression was significantly increased ( P
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Objective To study the risk factors of early complications and methods of treatment after pancreaticoduodenectomy(PD).Methods There were 79 patients who undercoent PD at our hospital between January 1998 and December 2007.All of the patients were divided into complication group and non-complication group according to the outcomes.Their clinical features,preoperative tests,and surgical factors were retrospectively analyzed.Results The postoperative complication rate was 58.2%,and the hospital mortality was13.9%.Logistic regression showed that the level of total bilirubin and liver function classification were the independent risk factors(P0.05).Conclusions The early complications after PD are closely related to the preoperative level of serum bilirubin and liver function.Proper periopertive management can effectively decrease the occurrence of pancreatic leakage and other postoperative compliccations.
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Objectve To probe the effect of treating the trauma soft tissue defects of the leg by microsurgical technique. Methods Ninety-nine cases of the trauma soft tissue defects of leg were treated by used 12 kinds of microsurgical flaps.Result All cases with soft tissue defects of the leg were repaired successfully.Follow-up 6 months to 10 years,the results were satisfactory and function improvement in 99 cases. Conclusions Accoding to soft tissue defects of size,the section and the technique of the operator to select the different microsurgical flap could be suitable and resolvable problem of soft tissue defects.
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Objective To investigate the effect of portal hypertension (PH) on the activity of local renin angiotensin system(LRAS). Method The expression of local renin and local angiotensinogen mRNA in liver,splenic artery and vein of PH patients was detected with RT-PCR. Result Expression of local renin mRNA in the liver in control group was 0.19?0.12, significantly lower than that of splenic artery (0.45?0.12) and splenic vein (0.39?0.12) respectively(P