Forensic Analysis of 43 Medical Disputes Caused by Death after Cardiac Surgery / 法医学杂志

Objective To explore the causes and characteristics of medical disputes caused by death after cardiac surgery and to analyze the pathological changes after cardiac surgery and the key points of forensic anatomy, thus to provide pathological evidence for clinical diagnosis and treatment of cardiac surgery and judicial appraisal as well as reference for the prevention of medical disputes in such cases. Methods Forensic pathological cases of medical disputes caused by death after cardiac surgery which were accepted by the Center for Medicolegal Expertise of Sun Yat-Sen University from 2013 to 2018 were analyzed retrospectively from aspects such as causes of death, pathological diagnosis, surgery condition, medical misconduct, and so on. Results The causes of death after cardiac surgery of 43 patients were abnormal operation, low cardiac output syndrome, postoperative infection, postoperative thrombosis, and other diseases. Among the 43 cases, there were 18 cases without medical fault while 25 cases had medical fault. Conclusion The medical disputes caused by death after cardiac surgery are closely related to the operative technique and postoperative complications. The causes of medical faults include defects in diagnosis and treatment technique, as well as unfulfillment of duty of care.

Diagnosis and treatment of autoimmune pancreatitis and the value of surgery / 中国实用外科杂志

OBJECTIVE: To summarize the experience of diagnosis and treatment of autoimmune pancreatitis(AIP)and to investigate the value of surgery in the management of AIP.METHODS: The clinical data of 17 patients with AIP who were admitted to Fujian Medical University Union Hospital between January 2013 and June 2017 were analyzed retrospectively. Observed indexes included clinical manifestations,blood test results,imaging findings,diagnosis and treatment and follow-up status. RESULTS:(1)Clinical manifestations:of the 17 patients,7 demonstrated obstructive jaundice,8 had upper abdominal pain,1 had recurrent diarrhea and 1 was found a pancreatic tumor by health checkup. Extrapancreatic organ involvement was detected in 11 of the 17 patients.(2)Blood test results:13 patients underwent serum IgG4 detection and increased expression of IgG4 was found in 13 patients.Increased expression of serum CA199 was detected in 4 patients. Elevated level of serum amylase was found in 3 patients.(3)Imaging findings:all the 17 patients underwent enhanced computed tomography(CT)scan of pancreas.Diffused enlargement of pancreas was observed in 12 patients and localized pancreatic enlargement was observed in 5 patients.(4)Diagnosis and treatment:All of the 17 patients were diagnosed as type 1 AIP. Three of the 17 patients underwent operation due to suspicion of pancreatic cancer and were diagnosed as AIP based on postoperative pathological examinations, including 2 pancreaticoduodenctomy and 1 distal pancreatectomy with splenectomy.Fourteen patients received initial steroid treatment. After steroid treatment,11 patients achieved remission, 1 underwent distal pancreatectomy with splenectomy due to continuous elevation of serum CA199,1 underwent pancreaticoduodenctomy because of a continuous enlarged pancreatic pseudocyst in the head of pancreas with obstructive jaundice,and 1 underwent cystjejunostomy due to a pancreatic pseudocyst in the body of pancreas with abdominal pain.(5)Follow-up status:All of the 17 patients were followed up for an average time of 29 months(range,12-66 months). Three patients who initially underwent pancreatectomy achieved remission after operation and no recurrence was observed. Of the 14 patients who received initial steroid treatment,11 got remission and the other three patients received maintenance steroid treatment for 3 months after operation and no recurrence was observed. CONCLUSION: The diagnosis of AIP should be based on the clinical manifestations,blood test results,imaging findings and pathological examinations. Steroid is the most critical therapy for AIP,but surgery is still important for the management of AIP,especially for localized AIP which is difficultly distinguished from pancreatic cancer and AIP with pancreatic pseudocyst which is refractory to steroid treatment.

Feasibility of lymphadenectomy with skeletonization in extended right hemicolectomy by hand-assisted laparoscopic surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of lymphadenectomy with skeletonization in extended right hemicolectomy by hand-assisted laparoscopic surgery (HALS).</p><p><b>METHODS</b>From November 2001 to September 2004, 30 cases with right hemicolonic cancer were divided into two groups, and received laparoscopic or open extended right hemicolectomy plus lymphadenectomy with skeletonization. Clinical data of two groups were compared.</p><p><b>RESULTS</b>The mean operative time were (214.0 +/- 16.5) min and (245.0 +/- 24.6) min (t=2.248, P< 0.05), the mean volumes of intraoperative bleeding (78.4 +/- 24.3) ml and (203.3 +/- 48.5) ml (t=4.927, P< 0.05), the mean time of anal aerofluxus (53.4 +/- 6.7) h and (67.3 +/- 9.7) h (t=2.530, P< 0.05), the mean postoperative hospital stay (11.5 +/- 1.11) d and (17.9 +/- 3.98) d (t=3.413, P< 0.05) respectively in laparoscopic and open operation groups. The mean numbers of N1, N2 and N3 lymph nodes cleared in laparoscopic group were (15.3 +/- 2.6), (5.6 +/- 1.6) and (4.3 +/- 2.2) respectively,while (16.2 +/- 3.3), (5.9 +/- 2.2) and (6.1 +/- 1.5) respectively in open operation group (all P > 0.05). The complication rates were 20.0% (3/15) and 33.3% (5/15) respectively in laparoscopic and open operation groups (chi(2)=0.0227, P > 0.05).</p><p><b>CONCLUSION</b>Extended right hemicolectomy plus lymphadenectomy with skeletonization can be perfectly performed by HALS.</p>