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The treatment strategy for infected acute necrotizing pancreatitis is that enables recovery but at the same time limits the morbidity and mortality.The current gold standard remains open necrosectomy.Recent literature contains scattered reports of percutaneous drainage,endoscopic,and laparoscopic approaches to managing patients with this condition.This review addresses the role of minimally invasive approaches and treatment strategy in patients with infected acute necrotizing pancreatitis.
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Objective To study the efficacy and safety magnesium sulfate for the treatment of adult severe tetanus.MethodsTwenty-seven inpatients with adult severe tetanus during April 2005 - October 2010 were retrospectively analysed.ResultsThe total serum magnesium more than 4 mmol/L was found in 2 patients ( 2/27,7.40％ ).The tracheotomy was performed in 25 Patients (25/27,92.6％),22 of which (22/25,88.0％) run mechanical ventilation with the mean mechanical ventilation time (7.5 ± 3.7 ) days,(4 to 16 days).Pulmonary infection occurred in 25 cases (25/27,92.6％).Twenty-three of 27 (23/27,85.2％ ) cases were cured except 4 cases died,and the mean hospital stay was (32.22 ± 18.78) days,(25to 48) days.Conclusions20％ magnesium sulfate is safe for treatment of the patients of adult severe tetanus.It can control not only muscle rigidity and spasms but also autonomic instability efficaciously,and lower the dosage of sedative such as diazepam and chlorpromazine.This method is worth popularizing in clinical practice for its easy operation and low cost.
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Procalcitonin is a biomarker to diagnose the extent and severity of systemic bacterial infection.Procalcitonin is applied in diagnosis and treatment of systemic inflammatory response syndrome and severe acute pancreatitis.The article reviews application of procalcitonin in clinical surgery and guides use of anti-bacterial agents.
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Objective To discuss the effect of the interval between neoadjuvant therapy and surgery on downstaging for local advanced rectal cancer.Method s From May 2003 to December 2008 as earlier period,32 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 4 -6 weeks.From January 2009 to December 2010 as later period,21 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 8 weeks.Dworak classification,TNM stage and clinical outcome after surgery were compared between two group paitents.Results All patients with local advanced rectal cancer received R0 resection.No surgical complications and mortality were observed in all cases.Pathological results showed that 0 and 2 cases were Dworak classification Ⅳ,5 cases were Dworak classification Ⅲ,3 and 6 cases were Dworak classification Ⅱ and 24 and 8 cases were Dworak classification Ⅰ in earlier period and later period,respectively (x2 = 9.109,P = 0.028).The postoperative staging showed that 6 and 13 cases were ypT1N0M0,22 and 6 cases were ypT2N0M0,1 case was ypT3 N0M0,3 and 1 cases were ypT3N1 M0,respectively (x2 = 10.909,P = 0.012).There were 65.6% or 81.0% cases reserved anus in earlier period and later period,respectively(x2 = 1.468,P = 0.226).Conclusions The neoadjuvant therapy followed by surgery after 8 weeks is associated with a more significant downstaging effect for local advanced rectal cancer.However,the effect of an extended interval between neoadjuvant therapy and surgery on clinical outcome still needs further investigation.
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Ionized calcium is a divalent cation involved in many critical cellular processes,such as regulating intracellular enzyme activity,signal transduction,gland secretion,hormone-receptor bind and activating clotting mechanism,but ionized hypocalcaemia is commonly found in critically illness,for instance serious trauma,major operation,sepsis and severe pancreatitis.The article reviews ionized hypocalcaemia with correlation of the prognosis and ill severity of surgical serious patients.
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This article analyzes the characteristics of lymph node metastasis in proximal advanced gastric cancer,in order to guide the extent of stomach resection (proximal or total gastrectomy) and the resection of spleen or splenic preservation. The metastasis of lymph node in proximal advanced gastric cancer has certain characteristics, which can provide a significant guidance for lymphadenectomy. Total gastrectomy plus splenectomy is a feasible radical surgery for proximal advanced gastric cancer, because of the requirement of lymphadenectomy.
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Objective To investigate the effects of Dangshen (DS) extract saponins alleviating apoptosis in ischemia-reperfusion injury (I/R) of renal grafts and the mechanism. Methods The I/R injury model in SD rats was established after kidney transplantation. The SD rats were randomly divided into the following 3 groups (n = 20): sham operation group, I/R model group, DS saponin intervention group. Blood urea nitrogen (Bun) and creatinine (Scr) levels were determined at the 24th h after operation; apoptosis index (AI) was detected by using TUNEL method; the expression of Bcl2 and bax mRNA was detected by RT-PCR. Results As compared with the sham operation group,the blood Bun and Scr levels were significantly increased in the I/R model and DS saponin intervention groups (P＜0. 05). As compared with the DS saponin intervention group, the blood Bun and Scr levels were significantly increased in the I/R group (P＜0.05). The AI was significantly increased in the I/R model group and DS saponin intervention group. After DS saponin intervention, the AI was decreased from 40. 28 % in the I/R model group to 28. 45 % in the DS saponin intervention group (P＜0. 05). The expression of Bcl-2 mRNA in DS saponin intervention group and I/R model group was significantly decreased as compared with the sham operation group (P＜0. 05), but that of Bax mRNA was significantly increased in the I/R model group and DS saponin intervention group as compared with the sham operation group (P＜0. 05). After DS saponin intervention, the expression of Bcl-2mRNA was increased from 0. 25 in the I/R model group to 0. 391 (P＜0. 05), and that of Bax mRNA was decreased from 0. 565 in the I/R model group to 0. 473 (P＜0. 05). Conclusion DS extract saponin could significantly alleviate apoptosis in the I/R injury of renal grafts possibly by up-regulating the expression of Bcl-2 mRNA and down-regulating the expression of Bax gene.
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Tetanus is a potentially fatal but largely preventable disease through immunisation.Despite efforts by the World Health Organization to eradicate the disease,tetanus(particularly severe tetanus)remains a worldwide cause of morbidity and mortality.Timely diagnosis and appropriate intensive care management are essential to ensure survival.Recently,with progress in the treatment of severe tetanus,the mortality has been decreased significantly.
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Microalbuminuria is regarded as a reflection of increased capillary permeability associated with the systemic inflammatory response syndrome. It is obversed that many medical diseases such as diabetes,kidney disease and cardiovascular disease may result in microalbuminuria and reported microalbuminuria with correlation of the prognosis of the serious patients. This article reviews ,microalbuminuria with correlation of the prognosis of the serious patients, the value of predicting illness severity in the serious patients.
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Forecasting the colorectal cancer prognosis mainly based on the accurate pathological stages,the primary carcinoma infiltrated depth,the cell differentiation degree and the capillaries infiltrated in histology result,and the outcome can be obtained latter 3-7 days after the opemtion.But in traditional lymph node inspection method,identifying the quantity and the anatomy locality of metastasized lymph node normally costs long time,sometimes cannot obtain the result.M addition,to identify the stage of the cancer is a key point to determine the assistant chemotherapy is useful or not,for both doctor and patient,because the excessive treatment and the insufficient treatment are both harmful to the patient.Now overseas has an abvoad study showes that regional lymph node metastasis have something to do with the concentration of(Carcinembryonic,CEA)in the lymph node.The CEA concentration can be obtained simply and directly.So,testing the CEA concentration in lymph node may become a new method in the diagnosis of lymph node metastasis for patients with colorectal cancer.
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Objective:To study the perioperative anticoagulant therapy for patients in prevention of moderate or high risk of pulmonary embolism(PE)after general surgery.Method:1146 patients who had undergone major general surgery were divided into a non-anticoagulant therapy group and an anticoagulant therapy group.There were 743 patients without the anticoagulant therapy during Jan.2005 to Aug.2008,a preventive anticoagulant therapy was performed on 403 patients who recived 5 000IU(142 patients at moderate risk of PE)or 10 000IU(261 patients at high risk of PE)low molecular weight heparin(LWMH)subcutaneous injection after major general surgery during Jan.2006 to Nov.2008.Result: Five cases died and 2 survived among 7 PE patients.Hemorrhage occurred in 3 out of 403 cases(0.7%),but no PE occurred among 403 patients administered with the LWMH anticoagulant therapy.The incidence of PE in the patients reciving LWMH decreased from 0.9%to 0(P
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or ≤50 in each patient. 5-year survival curves were estimated with the Kaplan-Meier method and compared by the log-rank test. ResultsWT5”BZ Analysis revealed that among node-negative patients, the 5-yerar's survival rate was 23% higher in patients with more than 50 nodes removed than those with less than 50. For node-positive patients, the difference of 5-year′s survival rate between the related two subgroups reached 36%.WT5”HZConclusion The number of lymph node resected has great impact on the long term survival of patients with colorectal cancer.
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Objective In this study we reported our experiences for patients with unresectable advanced hilar cholangiocarcinoma by intracavitary irradiation therapy and discussed some problemsin practice.Method 15 cases with unresectable advanced hilar cholangiocarcinoma were treated with laparotomy and operative dilatation of malignant stenosis and cathetenizing and then followed by intracavitary irradiation therapy.Result 15 cases treated by intracavitary irradiation therapy diedfrom liver function failure with biliary cirrhosis 3～18 months (average 8 months) later. None of the case died from cancer dissemination. Conclusion The patients with advanced holar cholangiocarcinoma could well tolerant of the intracavitary irradiation therapy, but they deteriolated from biliary cirrhosis about 8 months later,not from tumor dissemination.
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Objective To study the relation between the surgical extent and number of lymph node dissection and the effect of metastatic lymph node number on the prognosis of proximal gastric cancer. Method Thirty-one patients with proximal gastric cancer underwent D_2 or D_3 operation, and lymph node were harvested from specimen. The number of lymph node dissection in proximal gastrectomy was compared with that in total gastrectomy. Results A total of 1971 lymph nodes were obtained from the 31 specimens, the mean was 63 per case. There were 57 lymph nodes per case for patients with proximal gastrectomy and 71 per case with total gastrectomy,64 per case with left half pancreaticosplenectomy and 63 per case with splenectomy. According to the new 5th N stage system, the 5 year survival of N_1,N_2,N_3 were 36%, 11%, and 0 respectively. Conclusion Along with the wide invasion of the carcinoma wide resection with extended lymph node dissection is mandatory, reserved left half of the pancreas has no influence on the number of harvested lymphnode, the new quantitative N staging is superior to the old in predicting the prognosis.
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Objective To sum up the experience of diagnosis and management of postoperative abdominal bile collection of biliary fluid .Methods Analysis of 36 cases admitted in our department with postoperative abdominal biliary fluid collection were studied and treated in our department.Clinically,these cases can be divided into three groups according to their manisfestation,including asymptomatic cases,acute diffuse peritonitis and cases with obscure clinical course.The clinical feature and morbidities of these three groups were compared.Result The morbidities of cases detected collections of biliary fluid and managed in time were significant lower than that of the cases detected and managed out of time.Conclusions Clinically postoperative collection of abdominal biliary fluid might be divided into asymptomatic cases,acute diffuse peritonitis and cases with obscure course by us,it is for the sake of early diagnosis and immediate management.The diagnosis in time and immedate aspiration or drainage will save the patient from adverse morbidities.
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Objective To investigate the effects of 7 5% hypertonic saline (HS) on fluid balance after elective major abdominal surgery Methods Twenty two patients undergoing elective major abdominal surgery were assigned to receive either Ringer lactate solution followed by 4 ml/kg of 7 5% HS (study group, n =11) or Ringer lactate solution (control group, n =11) during the early postoperative period in ICU We compared fluid infusion volumes and urine outputs, fluid balance, and body weight change between the 2 groups Results Urine outputs in the operative day and the first postoperative day in study group were significantly more than in control group [(2?650?531)ml vs (2?046?572)ml, t =2 551?7, P
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Objective To explore the relationship between the histological alterations of Oddi sphincter lesions and clinical manifestations. MethodsFrom October 1995 to May 2003, biopsies of Oddi sphincter were undertaken during transduodenal sphincteroplasty (TSP) in 32 cases. Specimens were stained with Van Gieson Mason staining. ResultsThirty one out of 32 specimens were found with histological alterations in Oddi sphincter including diffuse fibrosis in 87 1% (27/31) , adenomyosis in 2 cases and chronic inflammatory infiltration in 2 cases. Impacted stone in the terminal common bile duct, benign papillary stenosis and visible postpancreatitis parenchymal changes were all found accompanying severe fibrosis of Oddi sphincter. ConclusionIn patients with impacted stones in the ampulla, intracholedochal sludge with recurrent cholangitis, and relapsing pancreatitis, endoscopic sphincterotomy is recommended.
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ObjectiveTo analyze the cause of and the prevention for the postoperative complications in adult patients undergoing Lichtenstein herniorrhaphy for inguinal hernia. Methods Retrospective review was made on 334 inguinal hernia cases receiving Lichtenstein repair in our hospital. Results Recurrence was found in 1 case(0 3%). Significant postoperative pain occurred in 5 patients. Four cases (1 2%) suffered from superficial wound infection, and 5 cases(1 5%) were complicated with subcutaneous seroma. Conclusions Lichtenstein′s tension free repair for the treatment of adult inguinal hernia has the advantage of less postoperative pain and low recurrence.