Laparoscopic duodenum-preserving subtotal pancreatic head resection: a clinical analysis of eight patients / 中华肝胆外科杂志

Objective@#To summarize the clinical experience of laparoscopic duodenum-preserving subtotal pancreatic head resection (LDPPHR).@*Methods@#The clinical data of 8 patients with LDPPHR performed at the Second Hospital of Hebei Medical University from November 2016 to February 2019 were analyzed retrospectively.@*Results@#All the eight patients underwent LDPPHR successfully. The operation time was 207.0~540.0 minutes. The estimated blood loss was 50.0~200.0 ml. The postoperative hospital stay was 10.0~27.0 days. One patient developed pancreatic fistula of grade B, and one patient developed biliary fistula. Pathologic results showed pancreatic solid pseudopaillary neoplasm in 3 patients, intraductal papillary mucinous neoplasms in 1 patient, mucinous cystadenoma in 1 patient, serous cystadenoma in 1 patient, neuroendocrine neoplasm in 1 patient, and pancreatic true cyst in 1 patient.@*Conclusion@#LDPPHR is a safe and effective surgical method for treatment of pancreatic head inflammatory mass, pancreatic head benign or low-grade malignant tumors.

Plastrón apendicular y manejo clínico actual: una decisión a reconsiderar: a propósito de un caso / Appendicular mass and current clinic management: a decision to reconsiderate: about a case

Introducción: La apendicitis es uno de los principales motivos de consulta e intervención quirúrgica en los servicios de urgencias. Debe tratarse oportunamente dado que puede evolucionar hacia una perforación apendicular y con ello a una peritonitis o un plastrón apendicular, en aproximadamente un 10%, e incrementando las morbilidades, como tiempo de reposo o estadía hospitalaria. Actualmente no existe consenso acerca del tratamiento del plastrón apendicular, por ello, el objetivo del presente trabajo es respaldar y promover la alternativa quirúrgica diferida, versus el manejo médico, como el tratamiento más idóneo del plastrón apendicular. Presentación del caso: Se derivó al Hospital Base Valdivia a una escolar, de 8 años y 11 meses de edad, por dolor en hemiabdomen inferior de 3 semanas de evolución acompañado de sensación febril no cuantificada, vómito y diarrea; se diagnosticó un plastrón apendicular, optándose por el manejo médico; evolucionó favorablemente, dándole el alta. En controles posteriores se planificó una apendicectomía, llevándose a cabo con éxito meses después. La biopsia del apéndice extraído evidenció un carcinoma de apéndice cecal, por lo que se inició el estudio de extensión de neoplasia sin encontrar hallazgos patológicos. Discusión: Actualmente el manejo del plastrón apendicular depende del médico tratante y su criterio. Existen ventajas y desventajas entre la elección de un tratamiento médico o quirúrgico, sea inmediato o diferido; dentro de las ventajas del último destacan la prevención de apendicitis recurrentes y detección temprana del carcinoma apendicular, como en el caso presentado, permitiendo de esta forma un mejor pronóstico para el paciente y evitando el uso de terapias más agresivas.

Introduction: Appendicitis is one of the main reasons for consultation and surgery in the emergency department. It must be treated promptly because it can evolve into a ruptured appendix and thus to peritonitis or an appendiceal plastron, by approximately 10%, and increasing the morbidity, as downtime or hospital stay. There is currently no consensus on the treatment of appendicular plastron, therefore, the objective of this work is to support and promote alternative deferred surgical versus medical management, as the most suitable treatment of appendiceal plastron. Case presentation: A girl of 8 years 11 months old consult for pain in lower abdomen of three weeks of evolution, accompanied by feverish feeling, unquantified, vomiting and diarrhea; Is diagnosed a plastron appendiceal opting for medical management, evolving favorably and giving the discharge. In subsequent controls was planned appendectomy, taking place successfully months later. Biopsy of removed appendix showed a appendix cancer, reason why an extension study of neoplasia was initiated without pathological findings. Discussion: Currently the management of appendicular plastron is dependent on the treating physician and judgment. There are advantages and disadvantages of choosing a medical or surgical treatment, immediate or delayed, inside the advantages of the latter include the prevention of recurrent appendicitis and early detection of appendiceal carcinoma, as in the case presented, thus allowing better prognosis for the patient and avoiding the use of more aggressive therapies.

A Clinical Research on Intervention in Appendix Inflammatory Mass by Heavenly Cool-inducing Technique Adopted Distant and Neighboring Point Selection / 中国中医药信息杂志

Objective To study the clinical efficacy and the difference of intervention in appendix inflammatory mass by heavenly cool-inducing technique adopted distant and neighboring point selection. Methods Eighty patients of the appendix inflammatory mass with toxic heat syndrome were randomly divided into control group, distant point selection group, neighboring point selection group, and combined group, 20 cases in each group. The control group adopted the conventional western medicine treatment. On the basis of control group, the rest 3 acupuncture groups adopted the heavenly cool-inducing technique for 14 d. The distant point selection group chose Hegu point and Lanwei point;the neighboring point selection group chose Ashi point and Tianshu point (right);the combined group put them together. The longest diameter and three-dimensional volume of inflammatory mass were determined before and after treatment. The serum levels of white blood cells, C-reactive protein were determined at the same time, and then the clinical effective was estimated. Results The longest diameter, three-dimensional volume of inflammatory mass, the serum levels of white blood cells, and C-reactive protein of patients in 4 groups were reduced after treatment. The above indicators in patients of 3 acupuncture groups were lower than the ones in control group, the indicators in combined group were the lowest (P0.05). The invalid number of cases in 3 acupuncture groups were fewer than the one in control group, and the indicators in combined group were fewest (P0.05). Conclusion There is obvious therapeutic efficacy of heavenly cool-inducing technique to appendix inflammatory mass, while the combination of distant and neighboring point selection is better than the single methods.

The diagnosis and management of inflammatory abdominal mass after appendectomy / 中国普通外科杂志

Objective To investigate the diagnosi s and management of inflammatory abdominal mass after appendectomy. Methods Clinical data of 42 patients wit h inflammatory abdominal mass developing after appendectomy from 1972 to 2004 we re retrospectively analyzed. Results There were two kinds of mass: on abdominal wall (26 cases) and that within the abdominal cavity (16 cases). Diagnosis was established on clinical fi ndings and the barium enema examination. Correct preoperative diagnosis was achi eved in 30 cases, with 12 cases (28.6%) misdiagnosed. Laparotomy was performed in 29 cases. Postoperative pathology revealed inflammatory mass. All the 42 case s recovered from the illness. Conclusions Post-appendectomy abdominal mass is infrequent complication. T he clinical course is most often self-limited. However, laparotomy is indicated in patients when conservative therapy fails or there is a fear of malignancy or tuberculosis.

The spiral CT differential diagnosis of pulmonary inflammatory mass and peripheral lung carcinoma / 重庆医科大学学报

Objective:To investigate the CT manifestations of pulmonary inflammatory mass and peripheral lung carcinoma,and to improve the differentiation of the diseases.Methods:The CT manifestations of 26 cases of pulmonary inflammatory masses and 38 cases of peripheral lung carcinomas were retrospectively analyzed.All cases were proved by pathological or clinical appearances.The masses were divided into typical and atypical masses according to morphology.Studying the CT signs of lesions and combining them with the results of morphological classification improve diagnosis of the morphological classification.Results:According to the morphological classification of masses,the diagnostic sensitivity,specificity and accuracy of inflammatory mass were 65.4%,73.7% and 70.3% respectively.The improved sensitivity,specificity and accuracy were 80.8%,86.8% and 82.8% respectively.Conclusion:Combining the results of morphological classification of masses with the CT signs of lesions have important value in the differentiation of pulmonary inflammatory mass and peripheral lung carcinoma.