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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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0.05) when all cases were put together. But the observed morbidity in group B (20%) was less than that in group A (40%) with the difference being statistically significant (?~2=4.41,P=0.036). ConclusionsThe POSSUM methodology allows satisfactory prediction of mortality and morbidity rates in patients undergoing colorectal tumor surgery.
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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 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 sum up the experience on the diagnosis and treatment of abdominal compartment syndrome(ACS). Methods In this report, ACS was diagnosed by special clinical features in all 5 patients. Following emergency decompressive celiotomy, the abdominal viscera were covered with a 3 L sterile plastic bag for nutrition support. Results The first case died despite abdominal decompression through uper midline incision. 4 cases underwent decompressive celiotomy through incision from xiphoid to symphysis, one died postoperatively. The overall mortality in this series was 40% (2 / 5). Conclusions Close attention paid to the abdominal and systemic signs facilitates the diagnosis of ACS.Emergent decompressive celiotomy through a incision from xiphoid to symphysis is effective in treating ACS. Temporary abdominal closure could be fulfiled with 3L sterile plastic bag for nutrition support.
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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.