ABSTRACT
Acute suppurative cholecystitis is a complex acute abdomen in general surgery, which usually occurs in middle-aged and elderly people. With the improvement of living standards and the aging of the population, the incidence of the disease is increasing year by year. Elderly patients have certain clinical particularities, and they are often combined with other underlying diseases such as cardiovascular and cerebrovascular diseases. Therefore, specific programs should be implemented for different situations during patient treatment, and a more complete risk assessment should be carried out. The preferred treatment for acute suppurative cholecystitis is surgery, but for patients with poor general conditions or intolerable surgery, percutaneous transhepatic gallbladder drainage may be a good alternative. This article reviews the clinical characteristics, diagnosis and treatment of acute suppurative cholecystitis in the elderly.
ABSTRACT
Intrahepatic cholangiocarcinoma(ICC) is a malignant tumor that originates in the epithelium of the proximal proximal to the second-degree bile ducts and has a high degree of malignancy. The causes of ICC are widely geographically diverse. Pathogenesis of ICC involves multiple molecular alterations at the level of genome, epigenome and stromal environment resulting in several deregulated signal transduction pathways. There are three types of pathological classification: mass-forming, periductal infiltrating, and intraductal growth. The mixed type of mass-forming + periductal infiltrating has the highest degree of malignancy. Early diagnosis of ICC is not easy, and tumor biomarkers such as CA19-9, CEA and so on, have some reference values, and multiple imaging examinations are needed to confirm each other. The effect of surgery mainly depends on the characteristics of the tumor, the vascular invasion of the tumor, the resection margin of the tumor and lymphatic metastasis. Lymph node dissection is controversial. If local lymphatic metastasis is identified, standardized lymph node dissection can improve ICC prognosis. Some ICC patients benefit from laparoscopic staging. In experienced centers, minimally invasive treatment can provide oncological outcomes similar to open resection for specific ICC patients. Liver transplantation is feasible in early ICC patients, but further clinical validation is needed.
ABSTRACT
Objective:To study the methods of protecting recurrent laryngeal nerve(RLN) in endoscopic thyroidectomy through the upper part of sternum.Methods:The clinilical data of 46 cases underwent endoscopic thyroidectomy through the upper part of sternum was analyzed.RLN was revealed when we performed nodulectomy or partial thyroidectomy.But during subtotal and near-total thyroidectomy the RLN was always revealed.Results:Forty-five of forty-six cases were compeleted successfully with endoscopic thyroidectomy.One case was converted to open thyroidectomy because of thyroid carcinoma.No intraoperative or postoperative hemorrhage,RLN injuried and deadlimb occurred.Conclusion:In order to reduce the injury of RLN,we should select the fitting cases strictly,master the opportunity and methods of revealed RLN.
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Objective: To explore the clinical features and prognosis of breast cancers with different stages in young women. Methods: A retrospective study was made in 61 cases of young patients with breast cancer (≤35 years as young group) and 74 cases of breast cancer patients of control group (36-69 years), who were with stageⅠto Ⅲ disease underwent surgical treatment. Results: The significant differences were observed in pTNM staging and differentiation between two groups. There were no differences between the two groups in stage Ⅰand Ⅱ patients. Significant differences were found between the two groups in stage Ⅲ patients. Conclusion: Breast cancer was with strong invasion in young patients. Early diagnosis and treatment of young women with breast cancer were important to improve the survival rate.
ABSTRACT
Objective:In this study we evaluated the diagnostic value of plasma D-dimer level as an early indicator in acute mesenteric ischemia in rats.Methods:Forty-eight mature male Wistar rats were divided equally into experimental group (EG) and control group (CG),The superior mesenteric artery was ligated In EG,and while a simple laparotomy was performed in CG.Blood samples were taken for laboratory test in both groups at 1h、6h、12h respectively.Results:The longer the duration of mesenteric ischemia,the higher were the serum D-dimer levels in the study groups,and statistical significance was obtained between these two groups (P=0.0375).Otherwise,significant difference was not found in other laboratory parameters between them.Conclusions:Serum D-dimer dynamic measurements may be a important valuable screening parameter in the early diagnosis of mesenteric ischemia.