Value of protective stoma in intersphincteric resection for ultra-low rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the value of protective stoma in intersphincteric resection (ISR) for ultra-low rectal cancer.</p><p><b>METHODS</b>Clinical data of 56 ultra-low rectal cancer patients without involvement of external anal sphincter treated during January 1999 to July 2009 with trans-anal ISR plus trans-abdominal total mesorectum excision and coloanal anastomosis were retrospectively analyzed. The patients were divided into two groups based on whether they received protective ostomy: ostomy group (16 cases) and ostomy-free group (40 cases). The postoperative complications as well as anal functional restoration were compared between the two groups.</p><p><b>RESULTS</b>Sixteen cases (32.1%) of the 56 patients received protective stoma. The complication rate of anastomosis and anus complication rate in the ostomy-free group were significantly higher than those in ostomy group [35.0% (14/40) and 40.0% (16/40) vs. 1/16 and 1/16; P < 0.05]. In the ostomy-free group, one patient developed anastomotic dehiscence and tumor recurrence, the patients was given permanent colostomy, and the other three patients with lesions in the anastomosis and anus received ostomy and secondary surgical treatment, with a reoperation rate of 10.0% (4/40). The anal function of patients in the two groups were both decreased after the operation. The rate of patients got Kirwan grade I anal sphincter function in the 3rd, 6th and 12th month after protective stoma operation was 11/16, 13/15 and 11/13 in the ostomy group, respectively; and those were 30.0%, 37.5% and 45.0% in the ostomy-free group, respectively. Anal function was significantly better in the ostomy group than that in the ostomy-free group during the same postoperative period (P < 0.05).</p><p><b>CONCLUSION</b>Protective stoma can avoid anastomotic leakage following ISR for ultra-low rectal cancer, and alleviate the suffering of anal incontinence in the early postoperative period, and is conducive to the restoration of anal function.</p>

Application of Altemeier procedure in the emergent management of acute incarcerated rectal prolapse / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the perineal rectosigmoidectomy(Altemeier procedure) in the emergent management of acute incarcerated rectal prolapse.</p><p><b>METHODS</b>Clinical and follow-up data of 9 patients with acute incarcerated rectal prolapse undergone Altemeier procedure were retrospectively analyzed.</p><p><b>RESULTS</b>The mean operation time was 1.7 (range 1.0-1.5) hours. The mean total blood loss during surgery was 109 (50-200) ml. The mean time to the first bowel movements was 2.8(1-6) days after surgery. The hospital stay was 5.3(3-10) days. There were no postoperative complications such as anastomotic leakage, intra-abdominal infection, or urogenital dysfunction. One patient developed thrombosis in the mesorectum and one patient had symptoms of anal discomfort. After a mean follow-up of 3.5(5 months-6.5 years) years, no patient had recurrent prolapse. Six months after operation, anal function was Kirwan grade I( in 8 cases and grade II( in 1 case. All the patients were satisfied with the result.</p><p><b>CONCLUSION</b>Altemeier procedure can result in good postoperative anal function when treating incarcerated rectal prolapse, which should be the first choice in emergency treatment.</p>

Combination of trans-anal intersphincteric resection and trans-abdominal total mesorectal excision for anus-retained ultra-low rectal tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To study the combination of trans-anal intersphincteric resection and transabdominal total mesorectal excision for anus-retained ultra-low rectal tumors.</p><p><b>METHODS</b>Clinical data of 34 ultra-low rectal tumor patients without external anal sphincter involved, who underwent the combination surgery, were retrospectively analyzed.</p><p><b>RESULTS</b>The distance from the distal incisal margin of the rectum to the inferior margin of the tumor ranged from 1.8 cm to 3.0 cm on an average of 2.1 cm. For pathological types, there were 23 cases of adenocarcinoma (9 well differentiated and 14 moderately differentiated), 1 papillary carcinoma, 2 rectal stromal tumor, 5 rectal villous adenoma with neoplasia and 3 giant villous adenoma. For pathological stages, there were 18 cases at stage pTNM I, 5 at IIA, 1 at IIB, 4 at IIIA, 1 at III and for T grading, there were 15 cases at stage T1, 5 at T2, 8 at T3, 1 at T4. In these 34 patients, there were 3 cases with postoperative anastomotic stenosis, 2 with postoperative anastomotic rupture, 2 with rectovaginal fistula and no operative death. Because of the dysfunction of bowel control, bowel frequency varied from 3 to 12 in the early stage after operation, but with the recovery of anus function, bowel frequency decreased and ranged form 1 to 5 times a day and the time of formed bowel control could be more than 5 min in 6-12 months after operation. However, patients underwent total resection of internal anal sphincter still suffered from incontinence of loose stool after 1 year. After operation, anastomotic recurrence was found in 1 case in 5 months, liver metastasis in 1 case in 10 months and 28 months respectively, cardiac sudden death in 1 case in 26 months.</p><p><b>CONCLUSION</b>The combination of trans-anal ISR and trans-abdominal TME for anus-retained ultra low rectal tumor is not only coincident with radical tumor principle but also retains the function of anus, on the premise of the strict indication.</p>

Clinical application of intersphincteric resection in the anal-preserving operation for ultra-low rectal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of intersphincter resection (ISR) combined with total mesorectal excision (TME) and colon-anal anastomosis in the treatment for ultra-low rectal carcinoma.</p><p><b>METHODS</b>To review and analyze retrospectively the data of 34 patients with ultra-low rectal carcinoma (without external anal sphincter involvement) who received treatment of ISR, TME and colon-anal anastomosis.</p><p><b>RESULTS</b>Partial resection of internal sphincter was performed in the patients with a distal edge of the tumor greater than or equal to 2 cm from the dentate line. Subtotal removal of the rectum was performed between 1 cm and 2 cm. Total resection was performed in less than 1 cm or involvement of dentate line. Reconstruction of digestive tract was done by manual colon-anal anastomosis. The average distance from distal excised margin to the tumor was 2.3 (1.8 - 3.2) cm among 34 patients. The pathological types were as follows: 28 cases of adenocarcinoma (11 were well differentiated, 17 moderately differentiated), 1 case of papillary carcinoma and 5 cases of villous adenoma with malignant change. The postoperative pathological stages were: Dukes stage A in 28 cases, stage B in 1 and stage C in 5 cases. The pTNM staging was 28 cases in phase I, 1 in phase IIa, 4 in phase IIIa and 1 in phase IIIb. The T stages of the patients were as following: 16 Tl, 17 T2 and 1 T3. Postoperative anastomotic stenosis occurred in 3 cases, anastomotic dehiscence in 2 cases and rectovaginal fistula in 2 cases. The ability of controlling feces of patients decreased significantly in the early postoperative period, and restored gradually at 6 to 12 months after operation. Anastomotic recurrence occurred in 1 case at 5 months after operation and liver metastasis in 1 case at 40 months.</p><p><b>CONCLUSION</b>With strictly grasping indications, radical resection can be attained and anal sphincter preserved by ISR combined with TME and colon-anal anastomosis. It is an effective sphincter-preserving operation.</p>

Auditory evoked potentials recorded in monkeys with hallucinatory-like behaviors induced by bromocriptine / 神经科学通报·英文版

Objective Bromocriptine and other dopamine D2 receptor agonists can affect a range of behaviors in nonhuman primates, particularly those behaviors associated with motor and mental function, such as suppressant behaviors and hallucinatory-like behaviors in monkeys. Besides bromocriptine, the dysfunction of the rapid eye movement sleep (REM) mechanism may also contribute to hallucinations. Dissociation of wakefulness, REM, and non-REM (NREM) can cause a series of psychotic symptoms. Methods We simultaneously recorded auditory evoked potentials (AEP) from five cerebral regions in monkeys during normal and psychotomimetic states to investigate and compare state-dependent changes in AEP. Results Phase reversal of peak-to-baseline amplitude of 250 ms component (PBA250) in dorsolateral prefrontal cortex was common characteristic of hallucinatory-like and REM, and that hallucinatory-like and REM shared the equivalent modulatory orderliness of the PBA250 in dorsolateral prefrontal cortex. This result suggests that hallucinatory-like and REM share an equivalent electrophysiological modulatory in dorsolateral prefrontal cortex. Conclusion These results reveal that emergence of the N250 in dorsolateral prefrontal cortex is an exclusive marker that may help to discern whether hallucinatory-like behaviors is exhibited, which suggests that dorsolateral prefrontal cortex may be the most pivotal region for exhibition of hallucinatory-like behaviors.

Specific neural basis of Chinese idioms processing:an event-related functional MRI study / 中华放射学杂志

Objective To address the neural basis of Chinese idioms processing with different kinds of stimuli using an event-related fMRI design.Methods Sixteen native Chinese speakers were asked to perform a semantic decision task during fMRI scanning.Three kinds of stimuli were used: Real idioms (Real-idiom condition);Literally plausible phrases (Pseudo-idiom condition,the last character of a real idiom was replaced by a character with similar meaning);Literally implausible strings (Non-idiom condition,the last character of a real idiom was replaced by a character with unrelated meaning).Reaction time and correct rate were recorded at the same time.Results The error rate was 2.6%,5.2% and 0.9% (F = 3.51,P0.05 )for real idioms,pseudo-idioms and wrong idioms, respectively.Similar neural network was activated in all of the three conditions.However,the right hippocampus was only activated in the real idiom condition,and significant activations were found in anterior portion of left inferior frontal gyrus (BA47)in real-and pseudo-idiom conditions,but not in non-idiom condition.Conclusion The right hippocampus plays a specific role in the particular wording of the Chinese idioms.And the left anterior inferior frontal gyms (BA47)may be engaged in the semantic processing of Chinese idioms.The results support the notion that there were specific neural bases for Chinese idioms processing.