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The neutrophil-to-lymphocyte ratio (NLR), the ratio of inflammatory cell counts in the blood, reflects the changes of neutrophils and lymphocytes in the inflammatory system in the peripheral blood. More and more scholars have found that NLR increases in patients with bone and joint injury, which can be used to predict postoperative mortality, infection, deep vein thrombosis, pain and other complications. This article is intended to review the application of NLR in bone and joint injury and related complications, providing reference for clinical application of NLR.
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Objective:To compare the biomechanical properties of triangular supporting fixation and Gamma nail fixation for intertrochanteric fractures of the femur.Methods:The femoral CT imaging data provided by a healthy adult male volunteer aged 40 years, height 172 cm, and weight 75 kg were used to reconstruct the femur model using Mimics 21.0 software and Geomagics 2013 software. Evans type I intertrochanteric fracture models were established using UG12.0 software, and Gamma nail and triangular supporting intramedullary nail models were reconstructed to simulate intertrochanteric fracture internal fixation, respectively. In Abaqus software, two internal fixation models of Gamma nail and triangular supporting intramedullary nail in standing state are simulated, and the stress peaks of the main nail, fixation screw and bone substance were collected, also the stress peak of supporting screw of the triangular supporting intramedullary nail is obtained. Additionally, the maximum displacement of the fracture model fixed by Gamma nail and triangular supporting intramedullary nail is measured.Results:Under the load of 1 200 N, the peak stress of the two fracture internal fixation models was located in the main nail, in which the peak stress of the triangular supporting intramedullary nail was 233.73 MPa, which was 11.9% lower than that of the Gamma nail (265.21 MPa); the peak stress of the fixation screw was located in the contact area between the pressure screw and the main nail, which was 23.2% lower in triangular supporting intramedullary nail than that of the Gamma nail (138.86 MPa vs. 180.75 MPa); the peak stress of the bone model was located in the medial cortex of the femur, which was 61.67 MPa and 32.38 MPa, respectively, 47.5% lower in the triangular supporting intramedullary nail than that of the Gamma nail; the peak stress of the supporting screw in the triangular supporting intramedullary nail was 92.04 MPa. The maximum displacement of the fracture model fixed with triangular supporting intramedullary nail was 17.34 mm, which was 10.5% less than the maximum displacement of the fracture model fixed with Gamma nail (19.37 mm). Conclusion:Compared with Gamma nail, triangular supporting intramedullary nail fixation can significantly improve the stability of intertrochanteric fractures and stress distribution as well as reduce stress peak and stress concentration area, which is helpful to improve the efficacy of intertrochanteric fractures.
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Objective:To compare the biomechanical properties between triangular supporting fixation and conventional dynamic hip screw (DHS) fixation in the treatment of femoral intertrochanteric fractures.Methods:Eight pairs of 16 femoral specimens with an average death age of 51.9 years were used in this study. After thawing, they were randomly divided into an experimental group ( n=8) and a control group ( n=8) according to the left or right laterality. They were made models of femoral intertrochanteric fracture of AO 31-A1 type with strain gauges pasted. The experimental group was subjected to fixation with double triangu-lar supporting and the control group conventional DHS fixation to achieve anatomical reduction. The specimens were then mounted onto a biomechanical testing machine and subjected to loading till 400 N at a rate of 10 N/s. The values of overall deformation of the specimens and strain at 16 selected sites were recorded and compared between the 2 model groups. Results:Under the load of 400 N, the overall deformation was (0.31±0.13) mm for the experimental group and (0.49±0.21) mm for the control group, showing a significant difference ( t=-2.456, P=0.023). The strain values in front of femoral neck, upon front fracture line, at inferior-lateral, inferior-median and inferior-interior sites of front fracture line, at the root of anterior fixation screw, below medial femoral neck fracture line, behind femoral neck, at superior-lateral, superior-median and superior-interior sites of posterior fracture line, below posterior fracture line, at superior and inferior roots of posterior fixation screw, at points parallel to the fixation screw in front of and behind femoral shaft were, respectively, -244.90, 13.16, -71.77, -124.38, -366.89,121.62, -10.94, -166.00, -54.93, -367.38, -608.93, -69.09, 326.50, 133.14, 52.97, and -185.82 in the experimental group and -24.62, -40.39, -36.99, -120.97, -486.38, 99.20, 35.36, -205.67, -74.30, -566.01, -1, 085.40, -77.41, 334.34, 114.08, 38.50, and -235.74 in the control group. Internal fixation failure occurred in one specimen in the control group after 1,759 cycles of loading but in none in the experimental group. Conclusion:For femoral intertrochanteric fractures, double triangular supporting fixation may result in less overall deformation and is more consistent with the normal biomechanical conduction of the femur than conventional DHS fixation.
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@#Objective To investigate the optimal treatment scheme for the first primary spontaneous pneumothorax (PSP) in young patients. Methods The clinical data of 171 patients with the first PSP were retrospectively analyzed who were treated in Huaihe Hospital of Henan University between November 2011 and October 2017. There were 157 males and 14 females with a median age of 18 years at onset and a median body mass index of 18.51 kg/m2. According to the treatment methods, they were classified into two groups, a conservative treatment group (a non-surgical group, n=86) and a surgical group (n=85). The characteristics including clinical data, efficacy evaluation criteria, complications and recurrence of the two groups were analyzed. Results As a result, 73.68% of the patients suffered PSP in their daily routine. The drainage duration in the non-surgical group was longer than that in the surgical group (4 d vs. 3 d, P=0.008). There was no statistical difference in the success rate of lung re-expansion between the two groups (98.85% vs. 100.00%, P=1.000). The proportion of the surgical group using postoperative analgesic drugs was higher than that in the non-surgical group (48.23% vs. 10.46%, P=0.000). The recurrence rate of the surgical group was lower than that of the non-surgical group (3.53% vs. 46.51%, P=0.000). No relationship between smoking and recurrence of pneumothorax was found in both groups (P=0.301, P=1.000). The success rate of lung re-expansion in the non-surgical group was not statistically different between the 24F subgroup and the 12F subgroup (39/39 vs. 33/34, P=0.458). No advantage of intraoperative pleural fixation was found in the surgical group (P=0.693). Conclusion Thoracoscopic surgery is the first choice for the treatment of the first PSP in young patients.
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Objective:To understand and verify the biomechanical mechanism of tibial plateau Hoffa (coronal) fracture by simulating high-altitude falls and traffic injuries using knee joint specimens.Methods:Ten specimens of lower limb knee joint were used. They were from 6 males and 4 females, with an average age of 57.4 years (from 42 to 65 years). They were divided into 2 equal groups: one subjected to simulation of high-altitude falls (fall group) and the other to simulation of traffic injury (traffic injury group). After injury simulation, standard orthographic and lateral X-ray examinations and CT scans were performed of the knee joints in the extended position to observe whether there was a fracture, where the fracture occurred, and how the fracture line went.Results:A tibial plateau coronal fracture was successfully simulated in 6 cases, but not in the other 4 cases. The failure was attributed to femoral fractures and other types of tibial plateau fracture. In the 3 successful fractures simulated by high-altitude fall, the fracture line was located all on the posterior medial side, involving the posterior 1/3, 2/5, and 1/2 of the tibial plateau, respectively. The fracture line and the coronal plane formed angles of 21°, 19° and 12°, respectively. The fracture was not shown on X-ray film in one case which was a posterior medial fracture on CT. In the other 3 successful fractures simulated by traffic injury, the fracture line involved 1/6, 1/4 and 1/3 of the posterior tibial plateau, respectively. The angles between the fracture line and the coronal plane were 47°, 56° and 63°, respectively. One case showed no obvious fracture signs on the X-ray but a coronal fracture on CT.Conclusions:This study has confirmed for the first time that both high-altitude falls and traffic injuries can cause coronal fractures of the tibial plateau which vary significantly in the extent of involvement and morphology. X-rays are not sufficient to fully diagnose this type of fractures, suggesting that patients with a clear history of knee flexion or axial violence injury should be routinely scanned by CT to reduce risks of missed diagnosis and insufficient treatment.
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Objective To compare the clinical outcomes between percutaneous minimally invasive suture versus conventional open suture for acute closed rupture of Achilles tendon.Methods A prospective study was performed in the 68 patients who had been treated for acute occlusive rupture of Achilles tendon from November 2010 to November 2013 at Department of Orthopedic Trauma, The Third Affiliated Hospital to Soochow University. They were randomly assigned by the sequence of medical attention to receive percutaneous minimally invasive suture or conventional open suture. In the conventional group, there were 31 men and 3 women with an average age of 37.0 ± 10.0 years; in the minimally invasive group, there were 30 men and 4 women with an average age of 36.4 ± 9.4 years. The 2 groups were compared in terms of operation time, intraoperative bleeding, postoperative wound infection, postoperative skin necrosis and ankle-hindfoot score of American Orthopaedic Foot and Ankle Society ( AOFAS ) . Results All the 68 cases were fol-lowed up for an average of 21.26 months ( from 6 to 36 months ). There were no significant differences between the 2 groups in operation time ( 75.0 ± 5.3 min versus 64.8 ± 3.8 min ) or in rate of postoperative local in-fection [ 2.9% ( 1/34 ) versus 14.7% ( 5/34 ) ] ( P ＞ 0.05 ). The minimally invasive group had significantly less intraoperative bleeding ( 12.0 mL ) , a significantly lower rate of skin necrosis [ 2.9% ( 1/34 ) ] and significantly higher AOFAS scores at 6 ( 90.5 ) , 12 ( 91.5 ) and 24 months ( 93.5 ) postoperatively than the conventional group did ( 80.0, 81.0 and 82.5, respectively ) ( all P ＜0.05 ). Conclusion Percuta-neous minimally invasive suture is recommendable for treatment of acute closed rupture of Achilles tendon because it leads to less intraoperative bleeding, better postoperative functional recovery and lower incidence of postoperative skin necrosis.
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Objective To investigate the diagnostic value of pleural effusion cell block (PECB) immunohistochemical examination in patients with suspected lung cancer.Methods Eighty-six patients with suspected lung cancer and pleural effusion were selected from December 2014 to December 2016 in the First People's Hospital of Zaoyang City.Liquid based cytology (LBC) smear was used for the diagnosis of cell morphology.Immunohistochemical detection of cell blocks was carried out,including CK7,CK5/6,p53,thyroid transcription factor-1 (TTF-1),calretinin,CD56,estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor-2 (HER-2),carcinoembryonic antigen (CEA),cancer antigen 125 (CA 125)and calretinin.Immunologic marker staining was further carried out according to the cell morphology and clinical data.Results LBC smear test showed that there were 61 cases of metastatic adenocarcinoma,11 cases of metastatic poorly differentiated carcinoma,3 cases of metastatic small cell carcinoma,2 cases of metastatic large cell carcinoma,3 cases of metastatic squamous cell carcinoma,2 cases of malignant tumor and 4 cases of suspicious malignant tumor in the 86 cases.Immunohistochemical results showed that there were 69 cases of primary lung metastases (including 61 cases of pulmonary adenocarcinoma,2 cases of lung squamous cell carcinoma,one case of lung adenosquamous carcinoma and 5 cases of small cell lung cancer),5 cases of metastatic adenocarcinoma of extrapulmonary origin (including 2 cases of breast cancer,one case of prostatic cancer,one case of ovarian cancer and one case of pancreatic cancer),3 cases of metastatic squamous cell carcinoma(including 2 cases of esophageal carcinoma and one case of cervical cancer),2 cases of metastatic adenosquamous carcinoma(including one case of adenosquamous carcinoma of cervix and one case of adenosquamous carcinoma of rectum),2 cases of metastatic large cell carcinoma,3 cases of large cell neuroendocrine carcinoma,1 case of mesothelioma,and 1 case without definite diagnosis in the 86 cases.In the 69 cases of primary lung tumor metastasis,there were 63 cases with positive expression of TTF-1 and CK7 protein,2 cases with positive expression of CK20 protein and 2 cases with positive expression of p53 protein.The expression of CK5/6,CD56 and calretinin protein was negative in the 69 cases.In the 5 cases of metastatic adenocarcinoma of extrapulmonary origin,there was 1 case of breast carcinoma with positive expression of ER,PR and HER-2 protein,1 cases of breast carcinoma with positive expression of ER and PR protein,1 cases of prostatic cancer with positive expression of CK5/6 protein,1 cases of ovarian cancer with positive expression of ER protein and 1 cases of pancreatic cancer with positive expression of CEA and CA125 protein.In the 3 cases of metastatic squamous cell carcinoma,there were 2 cases of esophageal cancer with positive expression of CEA and p53 protein and 1 case of cervical cancer with positive expression of ER protein.In the 2 metastatic adenosquamous carcinoma,there was 1 case of adenosquamous carcinoma of cervix with positive expression of PR and TTF-1 protein and 1 case of adenosquamous carcinoma of rectum with positive expression of CK7 and CEA protein.Conclusion PECB immunohistochemical examination can accurately diagnose primary focus and subtype lung cancer,and further help to determine the location of the exogenous tumor.
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Objective To investigate the two kinds if thoracic cavity closed drainage contrast analysis and evaluate the pigtail catheter for treatment of spontaneous pneumothorax in adolescents.Methods This study included 53 adolescent patients with the first spontaneous pneumothorax in Huaihe Hospital of Henan University between January 2013 and December 2015.According to the different operation ways,they were divided into two groups:silicone tube and pigtail catheter group.The following post-operative data was evaluated:pain,subcutaneous emphysema,drainage time,hospital stay,new drain insertion,and wound healing at the site of insertion.Results There were 32 patients in the silicone tube group and 21 ones in the other group.The data revealed a significantly reduced the operation time and pain in the pigtail catheter group compared to the chest tube group(P ＜ 0.05).However,no statistical differences in success rate,postoperative hospital stay and complications incidence were found between the 2 groups.Conclusion Compared to common chest tube,the employment of pigtail catheter in the adolescent patients with pneumothorax significantly reduces the operation time and pain.Nevertheless,no statistically significant differences were discovered in success rate,postoperative hospital stay and the incidence of complications between the two corresponding groups.Thus pigtail catheter is competent in terms of closed thoracic drainage in adolescents who are the first diagnosed as spontaneous pneumothorax.
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<p><b>OBJECTIVE</b>To investigate the changes of relative telomere length (RTL) of peripheral blood (PB) CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺T lymphocytes, CD19⁺B lymphocytes and bone marrow (BM) CD34⁺ cells and its association with disease severity in untreated patients with immuno-related pancytopenia (IRP).</p><p><b>METHODS</b>The PB CD3⁺ , CD3⁺ CD4⁺ , CD3⁺ CD8⁺ T lymphocytes, CD19⁺ B lymphocytes, and BM CD34⁺ cells were purified by magnetic activated cell sorting (MACS), and RTL were measured with flow-fluorescence in situ hybridization (FLOW-FISH).</p><p><b>RESULTS</b>The RTL of CD3⁺, CD3⁺CD4⁺ , and CD3⁺CD8⁺T lymphocytes in untreated IRP patients were (27.754 ± 16.323)%, (7.526 ± 3.745)% and (25.854 ± 14.789)%, respectivly, which were significantly shorter than those in healthy-controls (54.555 ± 19.782)%, (12.096 ± 2.805)%, and (38.367 ± 4.626)% (P<0.05). The RTL of CD19⁺ lymphocytes in untreated IRP patients was (22.136 ± 16.142)%, which was significantly shorter than that in healthy controls (42.846 ± 16.353)% (P<0.01). There was no significant difference of BM CD34⁺ cells RTL between the untreated IRP patients (22.528 ± 21.601)% and the healthy controls (23.936 ± 19.822)% (P>0.05). There were significantly positive correlations between the RTL of B lymphocytes and the count of white blood cell (r=0.706, P=0.015). There were negative correlations between RTL of B lymphocytes and the clinical symptoms (r=-0.613, P=0.045) and positive correlations with therapeutic effect (r=0.775, P=0.005).</p><p><b>CONCLUSION</b>The shorter RTL of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺, CD19⁺ lymphocytes, and the normal RTL of BM CD34⁺ cells in untreated IRP patients were identified, which might imply that IRP is a type of acquired autoimmune diseases.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , B-Lymphocyte Subsets , Allergy and Immunology , Lymphocytes , Pancytopenia , Allergy and Immunology , Pathology , T-Lymphocyte Subsets , Allergy and Immunology , TelomereABSTRACT
<p><b>OBJECTIVE</b>To investigate the mechanisms underlying bone marrow damage by iron overload in pancytopenic patients with positive BMMNC-Coombs test (IRP).</p><p><b>METHODS</b>Twenty-one iron overloading, 26 non-iron overloading IRP patients and 10 normal controls were enrolled in this study. The expressions of ROS, Bcl-2, Caspase-3 and apoptosis of BMMNC were analyzed by flow cytometry (FCM). Antioxidants were added to iron overloading IRP BMMNC, and then the changes of indices above were detected by FCM. The number and apoptosis of T lymphocytes of IRP patients were also detected.</p><p><b>RESULTS</b>ROS and apoptosis of BMMNC, myelocytes, erythrocytes and stem cells of iron overloading IRP patients were significantly higher than that of non-iron overloading IRP ones and normal controls (P < 0.05). The expressions of Bcl-2 on BMMNC, erythrocytes and stem cells of iron overloading IRP patients were significantly lower than those of non-iron overloading IRP ones (P < 0.05). The levels of Caspase-3 on myelocytes, erythrocytes and stem cells of iron overloading IRP patients were significantly higher than those of non-iron overloading IRP ones and normal controls (P < 0.05). After treatment with antioxidants, the expressions of ROS, Caspase-3 and apoptosis of iron overloading IRP BMMNC significantly decreased, but opposite for Bcl-2. The percentages of CD4(+) lymphocytes [ ( 40.86 ± 8.74）%] and CD4(+)/CD8(+) (1.44 ± 0.36) in PB of iron overloading IRP patients were significantly higher than that of non-iron overloading IRP ones [(35.96 ± 7.03)% and 1.14 ± 0.37] and normal controls [(28.00 ± 6.73)% and 0.79 ± 0.21], respectively (P < 0.05), as opposite for CD8(+) lymphocytes (P < 0.05). The apoptosis of CD8(+) lymphocytes [(27.35 ± 10.76)%] and the ratio of CD8(+) apoptosis/CD4(+) apoptosis (2.51 ± 0.81) in BM of iron overloading IRP patients were significantly higher than those of non-iron overloading IRP ones [(15.47 ± 8.99)%] and normal controls (1.39 ± 0.47), respectively (P < 0.05). The apoptosis of erythrocytes and stem cells coated with auto-antibodies in BM of iron overloading IRP patients were significantly higher than those of non-iron overloading IRP and normal controls.</p><p><b>CONCLUSION</b>Mechanisms underlying bone marrow damage by iron overload might be through the follows: ①The increased ROS induced by excessive iron deposition affected the expressions of Caspase-3 and Bcl-2, which caused more BMMNC apoptosis; ②The abnormal number and ratio of T lymphocytes caused by iron overload aggravated the abnormality of immunity of IRP; ③Iron overload may increase the damage to erythrocytes and stem cells coated with auto-antibodies.</p>
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Bone Marrow , Pathology , Case-Control Studies , Caspase 3 , Metabolism , Coombs Test , Iron Overload , Pancytopenia , Allergy and Immunology , Pathology , Proto-Oncogene Proteins c-bcl-2 , Metabolism , Reactive Oxygen Species , MetabolismABSTRACT
OBJECTIVES: The spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity. Patients typically present with sudden onset back pain followed by neurological deficits. METHODS: Diagnosis of SSEH is usually made with MRI and standard treatment is surgical evacuation. In 1996, Groen published the most comprehensive review on the SSEH in which he analyzed 333 cases. We review 104 cases of SSEH presented in the English literature since the last major review and add three of our own cases, for a total of 107 cases. RESULTS: Our patients presented with back pain and neurologic deficits. Two made excellent functional recovery with prompt surgical decompression while one continued to have significant deficits despite evacuation. Better postoperative outcome was associated with less initial neurological dysfunction, shorter time to operation from symptom onset and male patients. CONCLUSION: We discuss the etiology of SSEH and report current trends in diagnosis, treatment, and outcome.
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Humans , Male , Back Pain , Decompression, Surgical , Hematoma, Epidural, Spinal , Neurologic Manifestations , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To study the validity of transplanting transverse colon to replace esophagus in treating cicatricial stricture resulting from severe esophageal chemical burns in children.</p><p><b>METHODS</b>A retrospective study was carried out on the clinical data of 46 patients with severe chemical esophageal burns who were treated from November 1972 to September 2008. The transverse colon with the ascending branch of the left colic artery was brought through a retrosternal tunnel to replace strictured esophagus. Thirty-two patients underwent colon-esophageal anastomosis and 14 patients underwent colon-pharyngeal anastomosis.</p><p><b>RESULTS</b>All patients survived after surgery, but complications occurred in 7 cases, including leakage of anastomosis in cervical region in 4 cases, stenosis of anastomosis in 2 cases, and dyspnea in 1 case, and they were cured after due treatment. Follow-up study (1 - 26 years) in 39 patients revealed that there was no difference in growth, development and diet between the patients and the normal children of the same age.</p><p><b>CONCLUSIONS</b>Esophageal reconstruction with transverse colon together with the ascending branch of the left colic artery through a retrosternal tunnel is a valuable method for treating cicatricial stricture of the esophagus secondary to severe chemical burns of the esophagus in children.</p>
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Child , Child, Preschool , Female , Humans , Infant , Male , Burns, Chemical , General Surgery , Cicatrix , Colon, Transverse , Transplantation , Esophageal Stenosis , General Surgery , Esophagus , General Surgery , Postoperative Complications , General Surgery , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To summarize the clinical experiences in percutaneous endoscopic gastrostomy (PEG)/percutaneous endoscopic jejunostomy (PEJ).</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 578 patients who received either PEG or PEJ from July 2001 to December 2007 in our hospital. The data analyzed included the type, aim, duration, success rate, and complications of these procedures.</p><p><b>RESULTS</b>Of 578 patients, 247 patients underwent PEG, 293 patients underwent percutaneous endoscopic gastrojejunostomy (PEGJ), 4 patients received percutaneous endoscopic duodenostomy (PED), 4 patients underwent direct percutaneous endoscopic jejunostomy (DPEJ), 4 patients underwent percutaneous endoscopic colostomy (PEC), and 26 patients received PEG/J combined stents. These procedures were performed in different clinical conditions, including enteral nutrition (n = 329), decompression combined enteral nutrition (n = 133), decompression of the gastrointestinal tract (n = 103), enteral nutrition combined bile refeeding (n = 5), perioperative applications (n = 4), and coloclysis (n = 4). Tubes were successfully placed in 578 patients (98.0%) in an average time of (7.5 +/- 1.9) min in PEG, (17.7 +/- 4.2) min in PEGJ, (14.8 +/- 2.1) min in DPEJ, (12.3 +/- 2.5) min in PED, (11.3 +/- 2.6) min in PEC, and (30.2 +/- 5.2) min in PEG/J combined stent, respectively. No procedure-related complications were observed. Major complications were found in 6 patients (1.04%) and minor complications in 36 patients (6.23%). The duration of tube functioning was (168.37 +/- 198.64) d.</p><p><b>CONCLUSIONS</b>PEG/PEJ are easy to handle, effective, safe, and convenient for nursing. The endoscopic method of tube placement can be performed at the bedside and allow for enteral feeding, gastrointestinal decompression, and internal biliary drainage to be rapidly and efficiently achieved.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Enteral Nutrition , Methods , Gastroscopy , Methods , Gastrostomy , Methods , Jejunostomy , Methods , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of compression anastomosis clip(CAC) for small bowel anastomosis.</p><p><b>METHODS</b>Forty gastric cancer patients undergoing total gastrectomy were randomly divided into two groups and received side-to-side Roux-en-Y small bowel anastomosis with CAC or stapler. The following parameters were recorded: small bowel anastomotic complication, first post-operation flatus and bowel movement, extrusion of clip device.</p><p><b>RESULTS</b>Neither group had small bowel anastomotic complications such as leakage or obstruction. The clip was expelled with stool within 9-16 days. Two groups had the similar results in recovery of bowel function.</p><p><b>CONCLUSION</b>CAC is safe and simple for small bowel anastomosis.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Adenocarcinoma , General Surgery , Anastomosis, Roux-en-Y , Methods , Gastroenterostomy , Intestine, Small , General Surgery , Nickel , Stomach Neoplasms , General Surgery , TitaniumABSTRACT
<p><b>OBJECTIVE</b>To report clinical experience of percutaneous endoscopic gastrostomy, duodenostomy, jejunostomy in 120 patients, focusing on its technique and indications.</p><p><b>METHODS</b>One hundred and twenty patients received percutaneous endoscopic gastrostomy, duodenostomy, jejunostomy from May 2001 to April 2004, including 75 percutaneous endoscopic gastrostomy (PEG), 42 percutaneous endoscopic jejunostomy (PEJ), 2 percutaneous endoscopic duodenostomy (PED), 1 direct percutaneous endoscopic jejunostomy (DPEJ). All tubes established by traditional pull technique.</p><p><b>RESULTS</b>The average duration of PEG was (9 +/- 4) min, PEJ (17 +/- 6) min, DPEJ 20 min, and PED was 10 and 12 min for 2 patients, respectively. Success rate of the technique was 98.4% (120/122). Major complication rate was 0.8% (1/120), and minor complication rate was 7.5% (9/120). Clinical indications: PEG, PED and PEJ were applied for long-term enteral nutritional support in 88 patients, gastrointestinal decompression in 25 patients, and transfusing external drainage bile to gastrointestinal tract in 5 patients. Two radiation enteritis patients used PEG for gastrointestinal decompression preoperatively and long-term enteral nutritional support postoperatively.</p><p><b>CONCLUSION</b>PEG, PED PEJ and DPEJ are easily handled, effective and safe, and may be widely used in clinical practice.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Duodenostomy , Methods , Endoscopy, Gastrointestinal , Enteral Nutrition , Gastrostomy , Methods , Jejunostomy , MethodsABSTRACT
In recent years,some investigations show that gut barrier dysfunction induced by severe acute pancreatitis was an important factor to determine the prognosis. Consequently, pathogenesis, monitoring standard was and treament of pancreatitis associated gut barrier dysfunction are becoming hot spots.
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Objective To investigate the feasibility and technique of laparoscopic subtotal cholecystectomy(LSC).Methods Totally 168 patients were converted to LSC because of failure in laparoscopic cholecystectomy(LC).During the LSC,the Calot's triangle was separated and then the Hartmann's pouch was incised to decreased the intracystic pressure for the removal of the stones.Results Among the cases,5 patients were converted to open surgery for subtotal resection of the gallbladder.LSC was completed after clipping the cystic duct and artery in 122 patients;in the other 41 cases,the gallbladder was cut at the Hartmann's pouch to clip the bile duct and artery or suture the neck of the gallbladder,and then LSC was performed.The median operation time was(65.5?15.2)min,and the intraoperative blood loss was(71.5?15.5)ml.The time to resume the diet was(20.4?6.3)h postoperation.After the operation,7 patients developed local complications(4.2%),and the mean postoperative hospital stay was(4.2?2.6)d.Of the patients,105 were followed up for(25.5?6.5)months,during this period,5 patients had dyspepsia,3 had right shoulder pain,and 9 had right hypochondrium pain.Conclusions LSC is feasible for patients with complicated cholecystitis.It is important to control the perioperative hemorrhage and bile leakage.
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Objective:To observe the role of enteral nutritional support in treating superior mesenteric artery syndrome. Methods: Enteral nutritional support was used in two patients with superior mesenteric syndrome after percutanous endoscopic jejunostomy.Enteral nutrition was used for 69 days and 180 days.The symptoms were observed.Body weight and index of nutrition were measured.Results: After enteral nutritional support,symptoms of two patients disappeared.Body weight and fibronectin and prealnumin increased.Conclution: Enteral nutritional support is one of effective methods of treating superior mesenteric artery syndrome.
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Objective To evaluate percutaneous endoscopic gastrostomy (PEG) for long-term enteral nutrition in patients with cancers of head and neck. Methods PEGs were performed for 12 patients with head and neck cancers, the indication for which included serious buccal mucositis, difficulty in swallowing, anorexia, and obstruction of the digestive tract. Before PEG and 8 weeks after PEG, serum concentrations of total protein and albumin of the patients were measured, body composition including body weight, free fat mass, and fat mass were measured by bioelectric impedance analysis (BIA), and Karnofsky performance score ( KPS) was evaluated. Results After enteral nutrition for 8 weeks through PEG, the serum concentrations of total protein and albumin of the patients increased significantly (63.8?0.3g/L vs 57.4?0.2g/L, P