Effects of laparoscopic Hartmann reversal on short-term operative outcomes among vietnamese patients / Resultados da reversão precoce da cirurgia de Hartmann em pacientes vietnamitas

Abstract Background The reestablishment of continuity after Hartmann operation is considered a major surgical procedure with high morbidity and mortality. The optimal interval time between the Hartman procedure and reversal is controversial. Our study aimed to evaluate the effectiveness of laparoscopic Hartmann reversal and to determine the optimal timing of operation. Methods All patients who underwent laparoscopic Hartmann reversal from 2008 to 2019 (11 years) at the University Medical Center (UMC) in Ho Chi Minh City were recruited and divided into 2 groups according to the interval time (≤ 4 or > 4 months). The short-term operative outcomes of these groups were compared. Results There were 66 patients who underwent laparoscopic Hartmann reversal (mean age: 63.2 years old); ~ 77% of them had colorectal cancer, and 17% had complicated diverticular disease. Themortality rate, anastomotic leakage rate, and overall complication rate were 0%, 1.5%, and 13.2%, respectively. Early operation was performed in 36 patients, and late reversal in 28 patients. There was no difference in mortality, anastomotic leakage, operative complications, and hospital stay between the two groups. Conclusion Laparoscopic Hartmann reversal was effective with acceptable morbidity and mortality at the UMC. There was no observed impact of the interval time between the Hartmann procedure and laparoscopic Hartmann reversal on the short-term operative outcomes.

Resumo Introdução O reestabelecimento da continuidade após a cirurgia de Hartmann é considerado um procedimento cirúrgico de grande porte com altas morbidade e mortalidade. O tempo ideal de intervalo entre a cirurgia de Hartmann e a reversão é controverso. Nosso estudo teve como objetivo avaliar a eficácia da reversão da cirurgia de Hartmann e determinar o momento ideal para a cirurgia. Métodos Todos os pacientes submetidos à reversão laparoscópica da cirurgia de Hartmann entre 2008 e 2019 (11 anos) no Centro Médico Universitário (UMC, na sigla em inglês) na cidade de Ho Chi Minh foram recrutados e divididos em 2 grupos de acordo como tempo de intervalo (≤ 4 or > 4 meses). Os resultados pós-operatórios de curto prazo destes grupos foram comparados. Resultados Um total de 66 pacientes foram submetidos à reversão laparoscópica da cirurgia de Hartmann (mediana de idade: 63.2 anos); ~ 77 deles tinha câncer colorretal, e 17% tinham doença diverticular complicada. As taxas de mortalidade, de vazamento, e de complicações em geral foram de 0%, 1,5%, e 13,2%, respectivamente. Cirurgia precoce foi realizada em 36 pacientes, e reversão tardia foi realizada em 28 pacientes. Não houve diferença em mortalidade, vazamento anastomótico, complicações operatórias e duração da internação entre os dois grupos. Conclusão A reversão laparoscópica da cirurgia de Hartmann foi eficaz, com morbidade e mortalidade aceitáveis no UMC. Não foi observado qualquer impacto no tempo de intervalo entre a cirurgia de Hartmann e a reversão laparoscópica nos resultados pós-operatórios de curto prazo.

Interval of ≤2 weeks between 12-core prostate biopsy and laparoscopic radical prostatectomy does not affect perioperative parameters or surgical outcomes / 中华男科学杂志

<p><b>Objective</b>To determine whether a short interval (≤2 weeks) between 12-core prostate biopsy and laparoscopic radical prostatectomy (LRP) affects perioperative parameters and the outcome of surgery.</p><p><b>METHODS</b>This retrospective study included 102 cases of prostate cancer treated by LRP after 12-core prostate biopsy from January 2012 to December 2016. Based on the interval between prostate biopsy and LRP, we divided the patients into three groups: ≤2 wk (n = 35), >2－6 wk (n = 21), and >6 wk (n = 46). The patients averaged 69.87 (59－84) years in age, 24.99 (15.62－33.14) kg/m2 in the body mass index (BMI), 24.41 (0.41－111.78) μg/L in the baseline PSA level, 56.05 (15.97－216.52) ml in the prostate volume, and 7.51 (6－9) in the Gleason score. We analyzed the clinical data, perioperative parameters and outcomes of surgery, and compared them among the three groups of patients.</p><p><b>RESULTS</b>Operations were completed successfully in all the 102 cases without transferring to open surgery. There were no statistically significant differences among the three groups of patients in age, BMI, baseline PSA level, prostate volume, Gleason score, or T stage, nor in the operation time, estimated intraoperative blood loss, blood transfusion rate, intestinal injury, positive incision margin rate, or urinary continence rate at 3 months after surgery.</p><p><b>CONCLUSIONS</b>Laparoscopic radical prostatectomy at ≤2 weeks after 12-core prostate biopsy is safe and effective in the treatment of prostate cancer and does not affect the perioperative parameters and outcomes of surgery.</p>

Research on the Application of Quality Control Circles to Improve the Turnover of the Surgery and the Satisfaction of Medical Staff / 中国医学伦理学

Objective:To discuss the implementation and experience of the quality control circle ( QCC) activi-ty in shortening the interval time of consecutive operation and speeding up the turnover of operating table. Method:We formed a QCC team and explored the influential factors of the interval time of consecutive operation using quali-ty control technique. We found out the real reason, put forward corresponding countermeasures, and organized the implementation. Results: Before the implementation of QCC, the average interval time of consecutive operation was 24. 6 minutes, whereas it decreased to 16. 2 minutes after the implementation of QCC with the progress rate of 64. 87%. Through the QCC activities, the problem-solving ability, responsibility, communication and coordina-tion ability, motivation, confidence, team cohesion, and the use of quality control technique of the QCC members has improved significantly. Conclusion:Through the quality management tools of QCC, the interval time of con-secutive operation has greatly shorten, the turnover of operation table has improved, and doctors′ and operating room nurses′satisfaction has improved significantly.

Influencing Factors in Determination of Anticoagulant Activity of Whitmania Pigra Whitman by Thrombin Titration / 中国药师

Objective: To analyze the influencing factors in thrombin titration for the determination of anticoagulant activity of Whitmania Pigra Whitman. Methods: The white porcelain plates were used as the titration carriers instead of tubes in the titration ( called white porcelain method for short) . The effect of different carriers, interval time of titration and thrombin concentration on the results of anticoagulant activity test was studied. Results:Under the same conditions, the anticoagulant activity was more accurate and stable using white porcelain method. Using white porcelain method with 20 u·ml-1 or 10 u·ml-1 as the thrombin concentration and titrating 5μl each time, once every minute, the thrombin consumption volume was linear with the sample concentration within the range of 0. 125-0. 333 g·ml-1(r20 =0. 961 and r10 =0. 992), and the anticoagulant activity respectively was (33. 08 ± 2. 64) and (31. 24 ±1.32) u·g-1(RSD20 =8.0% and RSD10 =4.2%). As for a certain sample concentration (0.333 g·ml-1), the theoretical error of determination was not more than 10% and 5%. Conclusion:The improved white porcelain method is more suitable for determining anticoagulant activity of Whitmania Pigra Whitman with more stable results and accurate end point states than tube method. Under the conditions of 10 u·ml-1 thrombin concentration, titrating 5μl each time, once every minute, the linearity, accuracy and precision are all promising.

A study of pericardial fluid enzymes activities after death and their correlation with post-mortem interval.

The estimation of time since death at the time of autopsy has been and remains to be one of the challenges to the Forensic Pathologist. .A prospective study was undertaken in SMS Hospital, Jaipur on activity of Pericardial Fluid enzymes after death in deceased. A total of 50 study cases were randomly selected after screening. The pericardial fluid was examined biochemically for enzyme activity of Amylase, Creatine Kinase (CK), Gamma-glutamyl Transferase (GGT) and Lactate Dehydrogenase (LDH) enzymes by photoelectric colorimetry method. The enzyme activity levels so obtained were charted and statistically studied and graphical records obtained against known post-mortem interval. The data thus obtained was analysed with a view to ascertain whether such assays could be of any help to estimate time since death routinely. In this study we observed a positive correlation of all the four enzymes with the time elapsed after death of which rise in CK was found to be statistically significant.

Influence of frequency of ventilator pipe replacement on bacterial colonization in patients with abdominal infection / 中国实用护理杂志

Objective To discuss the frequency of ventilator pipe replacement in ICU ward for reducing the frequency of VAP occurrence caused by bacterial colonization in ventilator-line. Methods 30 patients hospitalized to ICU ward from Janurary,2008 to June, 2009 who had mechanical-ventilation above 48h were randomly divided into group A, B and C with 30 patients in each group, then bacteria culture and strain analysis were employed for the pipeline sample of ventilator inspiratory side at the time point to be use and used mechanical ventilation for 1 day, 3 days and 7 days. Results There was no bacteria grew after ventilator-line sterilization, and positive ratio of bacterial culture in 1d, 3d and 7d were 46.66%,53.33% and 100.00%, respectively. Conclusions The frequency of ventilator pipe replacement should be shortened in patients with abdominal infection, to replace every 3 days is suitable in ICU where infectious patients gathered.

Relationship between DNA of Rat Kidney and Post by Comet Assay / 中山大学学报(医学科学版)

[Objective] To study the correlation between kidney cell DNA degradation and postmortem interval within the span of 6-48 hour after the subject rats′ death.[Methods] To select 18 healthy mature female SD rats and equally divide them into 6 groups.To execute the rats with cervical spine articulation and put the rats under the incubator temperature of 25.1℃ (the average temperature of the 5 previous Decembers in Guangzhou prefecture).Sample kidney tissue from the rat separately 0 hour,6 hours,12 hours,24 hours,36 hours,48 hours,and 60 hours after the rats′ execution to prepare monoplast suspension,which is committed to comet assay.The comet images were captured by fluorescence CCD.Kinetic Comet 4.0 software was used to analyze images.Relevant data were collected by kinetic Comet 4.0 software and were subjected to Kruskal-Wallis test.[Results] Within the postmortem interval of 6-48 h,the number of SD rat kidney cell DNA fragments increased as the postmortem interval lengthens.So did the comet tail length.The Oliver tail moment and tail DNA of comet also showed sign of increase in positive proportion to the postmortem interval (their values corresponding to 60-hour-postmortem-interval were not obtainable.Kruskal-Wallis test indicated:the discrepancies of TL among the 6 groups were all significant (P ＜ 0.01).The difference of TM between 6 h group and 12 h group was not significant (P ＞ 0.05).The difference of TM between 24 h and 36 h was significant (P ＜ 0.05).The difference of TDNA among 6 h,12 h,and 36 h groups were not significant (P ＞ 0.05).The difference of TDNA between 36 h and 48 h was significant (P ＜ 0.05).[Conclusion] Degradation of nuclear DNA of the rat kidney cells increases as the postmortem interval lengthens and comet assay may provide important empirical evidence for determining the postmortem interval.

Effect of different fraction interval on tumor control in C57BL mice implanted with Lewis lung cancer / 中华放射肿瘤学杂志

Objective To study the effect of different fraction interval with same total radiation dose on tumor growth delay and survival in C57BL mice implanted with lewis lung cancer,and to determine whether prolonged fraction interval will decrease the tumor response to radiation. Methods Forty-eight mice were implanted with lewis lung cancer in the back legs.When the diameter of transplanted tumor reached 0.8 to 1 cm,the mice were randomized into 6 groups:normal control group,single fraction of 18 Gy group,18 Gy in 2 fractions of 9 Gy at 30 min interval group,18 Gy in 7 fractions of 2.57 Gy at 5 min inter val group,18 Gy in 2 fractions of 9 Gy at 60 min interval group and 18 Gy in 7 fractions of 2.57 Gy at 10 rain interval group.The maximal and minimal diameters of the tumor were measured and record every other day to study the tumor growth tendency,the tumor growth delay and the mice survival time. Results The tumor growth delay of groups at prolonged fraction interval was shorter than the group with single fraction of 18 Gy (P < 0.05).The tumor growth delay of groups at fraction interval of 30 rain was longer than that of groups at interval of 60 rain (P < 0.05).There was no significant difference of the tumor growth delay be tween the groups with same delivery time (P >0.05).The mice survival time of the groups with prolonged fraction interval was shortened when omparing to the group with single fraction of 18 Gy.While the difference was not significant between the groups at fraction interval of 30 min and 60 min. Conclusions The pro longed fraction interval but same total radiation dose shortens the tumor growth delay and survival time in the mice implanted with Lewis lung cancer.The longer fraction interval impairs the tumor control more signifi candy.However the difference of the effect on mice survival time is not significant between the groups at fraction interval of 30 min and 60 min.

Outcome of breast-conservative therapy for early-stage breast cancer: a retrospective analysis / 中华放射肿瘤学杂志

Objective To analyze the results of survival and local regional control of early-stage breast cancer patients treated with breast-conserving surgery and whole breast radiation therapy, and to explore the factors influencing local control. Methods From October 1995 to September 2005,335 patients with early-stage breast cancer were treated with breast conservative therapy, including 25 with post-operative radiotherapy alone( group A), 194 with sequential chemo-radiotherapy( group B) ,80 with concurrent chemoradiotherapy( group C), and 36 with chemo-radio-chemotherapy (group D). Axillary dissection was performed in 312 patients and sentinel node biopsy in 2. Adjuvant chemotherapy was given to 310 patients. Radiation of 50 Gy in 25 fractions was delivered to the whole breast in 256 patients,and to the breast and regional nodes in 79. Another 10 Gy in 5 fractions was boosted to the tumor bed. The proportion of patients with surgery-radiation interval of less than 4 weeks,4-8 weeks,8-20 weeks and over 20 weeks was 16.4%, 23.6% ,37.3% and 22.7% ,respectively. Concurrent chemo-radiation and" sandwich" modality were delivered in 80 and 36 patients,respectively. Results The median follow-up was 48(25.3-146.7) months. The 5-year local-regional control and ipsilateral breast control rates were 94.5% and 95.6%, respectively. The 5-year disease-free survival,metastasis-free survival and overall survival rates were 88.6% ,93.2% and 98.8% ,respectively. Lymph-vascular invasion and neural invasion were significant factors influencing local control in univariate analysis. No significant differences were found in local control rates among different surgery-radiation intervals or different sequencing of radiotherapy and chemotherapy. Multivariate analysis showed that lymph-vascular invasion and reexcision for positive or unknown margin were independent prognostic factors influencing local control. In group A + B, C and D, the frequency of grade Ⅲ skin toxicity was4.5%.80.0%.and 77.0%,respectively(χ2=226.00,P=0.000).Conclusiom Breast conservative therapy for early-stage breast eancer results in good local-regional control and overall survival.Lymph-vascular invasion and reexcision are independent prognostic factors for local control.Surgery-radiation interval and sequencing of radiotherapy and chemotherapy have no impact on local contr01.Grade Ⅲ skin toxicity of the concurTent radio.chemotherapy and the chemo.radio.chemotherapy group is significantly higher than that of the sequential chemotherapy-radiotherapy plus radiotherapy alone group.