Objective The experiences of peri-operative management in senile acute abdominal patients were summarized in order to raise the successful rate.Method We analysed retrospectively 575 cases who were senile acute abdominal patients from 1990 to 2000.Results Among 575 cases,540 cases(93.9%)were cured.423 cases(73.5%) were with other chronic diseases and dysfunctions before operation.Various complications occurred in 168 cases(29.2%)and 35 cases(6.1%) died.The death causes mainly were correlated with accompanied chronic diseases.Conclusion Strengthen peri operative care,active management of other chronic diseases and adequate operation time are important significantly for senile acute abdomen to get satisfied outcome.

Objective To study the cause of misdiagnosis of pancreatic carcinoma(PC) in order to obtain the final diagnosis as early as possible,and increase the rates of early diagnosis and resection of PC.Mothods We petrospectively reviewed 102 cases of PC from 1991 to 1997,and analyzed the diagnostic accuracy of prehospitalized and admitted for PC.Results The average time from initial symptoms and jaundices to admision was 197 days and 60 days,respectively.The misdiagnostic rates of the first consult and multicosult or hospitalized in other hospitals were 100% and 85%,respectively.The most frequently misdiagnostic disease was peptic ulcer(25 cases),the rest were cholelithiasis(14 cases),hepatitis(11 cases),biliary tract ascarides(5 cases).Osteophyte proliferation(3 cases),colilis(3 cases) and others(3 cases).8 cases underwent surgery in other hospitals while 7 cases of them misdiagnosis in operation.The diagnostic rates of B-U and CT after admison were 85% and 95%,respectively.According to operative findings,60% cases had wide-ranging celiac metastasis in which 40% had hepatic metastasis simultaneously,alse 75% had local invasion and lymphatic metastasis.Only 10% and 2% patients underwent radical resection and palliative surgery respectively, while 10% patients had conservative treatment.Conclusion We demonstrated that there are high misdiagnositic rate,low radical rate and delaying final diagnosis for PC.It is urgent to increase its initial diagnostic rate and apply for CT in early stage would be the best device.

Objective To study the effect of inosine monophosphate dehydrogenase inhibitor (IMPDHI) on chemotaxis, migration and endocytosis of human peripheral myeloid dendritic cells (MDCs). Methods Freshly isolated peripheral blood mononuclear cells(PBMC)collected from healthy volunteers (N=15) and the study group were treated with IMPDHI. CC chemokine receptors on MDCs were analyzed by flow cytometry. The study group, control group and different chemokines were added via trans-well approach for different chemokines, stained by Lin-1/CD11c/HLA-DR and counted by flow cytometry. The migration index was calculated as a percentage of MDC migrated in response to the tested chemokine. After isolation of blood dendritic cell antigen-1+ (BDCA-1+ ), mannose receptor-mediated endocytosis was measured as the cellular uptake of FITC-dextran by the flow cytometry. Results (1) Compared to the control group, the expression of CCR1 in the study group was up-regulated significantly(17.02±3.23～30.63±9.13, P＜0.05) and the expressions of CCR3(10.26±2.25～5.81±0.97 P＜0.05) and CCR7 (9.56± 1.84～5.18±0.60 P＜0.05)were downregulated significantly. MDCs in the study group showed enhanced migratory response to inflammatory chemokine CCL2, CCL3, CCL4, CCL7 and CXCL12 (P＜0.05). (2)The endocytosis capacity in the study group was significantly higher than that in control group (P ＜0.05). Conclusion IMPDHI enhances the endocytotic capacity of MDCs and impairs the migratory response of peripheral MDCs to lymphocytic tissue by up-regulating the expression of chemokine receptor in MDCs and enhancing migratory response to inflammatory chemokines.

Objective To evaluate the efficacy and safety of the damage-controlling surgery for the elderly patients with obstructive biliary diseases. Methods 278 elderly patients with obstructive biliary diseases were divided into the damage-controlling surgery group and definite surgery group.The obstructive biliary diseases were divided into the benign obstructive group and the malignant obstructive group. The complication rate and mortality between the 2 groups were analyzed and compared. Results One hundred and eighteen elderly patients were treated by damage-contolling surgery, its complication rate was 9.32 % and the mortality was 0 %. One hundred and sixty elderly patients,were treated by definite surgery, its complication rate was 24.38%, the mortality was 6.88%. There were significant differences in complication rate and mortality between the damage-controlling surgery group and the definite surgery group (all P＜0.01). The complication rate of the benign obstructive diseases group treated by damage-controlling surgery was 17.3%, the mortality was 0%. The complication rate of the benign obstructive diseases group treated by definite surgery was 16.3%, the mortality was 4.34%. There was no significant difference in the complication rate and mortality between the 2 groups (all P＞0.05). The complication rate and mortality of the malignant obstructive biliary diseases group treated by damage-controlling surgery were 4.45% and 0% respectively, and were 35.29% and 10.29% by definite surgery, there were significant differences in the complication rate and mortality between the 2 groups (P＜0.01 and P＜0.05). Conclusions Damage-controlling surgery may decrease the complication rate and mortality of the elderly patients with obstructive biliary diseases, and improve the operation safety of the elderly patients.

Objective To evaluate the effects of carbohydrate-electrolyte solution(CES)on serum glucose,pancreas islet function,and safety in elderly patients after abdominal operation.Methods In this prospective,double-blinded,randomized,and controlled study,40 elderly patients who met the defined criteria were enrolled.Subjects in CES group were intravenously administered with 1 000 ml CES for consecutive three days beginning from the 1st and 2nd post-operative day,while subjects in the control group were administered with 10% glucose of the same volume under the same arrangement.The changes of serum glucose,insulin and insulin C-peptide,as well as lactic acid and uric acid and uric acid were determined before and after injection.Adverse events were recorded.Results All patients completed the study.The increase rate of serum glucose was significantly lower on the 2nd and 3rd day after injection in CES group than in control group(P=0.008,P:0.001).Blood insulin and insulin C-peptide levels showed increasing trends in both two groups,but were not significantly different between two groups(P=0.612,P=0.213).In the CES group,6 patients experienced systemic inflammatory response syndrome and 4 patients had infective complications after surgeries ;on the contrary,these two numerals were 8 and 6 in the control group(P=0.639,P=0.606).No increase in serum lactic acid or uric acid was detected.Conclusion Appropriate application of CES has minimal effect on the blood gluocse and pancreas islet function in elderly patients after abdominal surgery and may be helpful to improve clinical outcomes.

Objective To study the effect of inosine monophosphate dehydrogenase inhibitor (IMPDHI) on maturation, migration, endocytosis and allostimulatory properties of human peripheral myeloid dendritic cell (MDC). Methods PBMC from healthy donors were isolated. MDC were cocultured with PBMC and exposed to mycophenolic acid (MPA) for 48 h. The expression of co-stimulatory and adhesion molecules as well as chemokine receptors on MDC was analyzed by flow cytometry. In separate experiments,MDC were cultured with or without MPA, and their endocytosis function was estimated by means of FITC dextran uptake. MDC migration experiments were performed in Transwell chambers. Inflammatory chemo kines were added to the lower chambers and MDC numbers were analyzed by flow cytometry. MPA treated (48 h) BDCA-1 + DC served as stimulator cells in MLR. Allogenic healthy CD4 T responder cells were labeled with fluorescent dye CFSE and measured by flow cytometry. Results Maturation: compared to the control group, the expression of CD40, CD62L, HLA-DR, CD54, CD80, CD83 and CD86 on MDC in study group were significantly down-regulated ( P ＜ 0.05 ). Chemokine receptor and migration: compared to control group, the expression of CCR1 on MDC in study group was up-regulated significantly (17.02 ±3.23 vs 30.63 ± 9.13, P ＜ 0.05 ), the expression of CCR3 ( 10.26 ± 2.25 vs 5.81 ± 0.97, P ＜ 0.05 ) and CCR7(9.56 ± 1.84 vs 5.18 ±0.60, P ＜0. 05) on MDC were down-regulated significantly in the study group.MDC in study group showed enchanced migratory response to inflammatory chemokine CCL2, CCL3, CCL4,CCL7, CXCL12 (P＜0.05). Endocytotic capacity: the capacity of endocytosis in study group was signifi cantly higher than that in control group( P ＜ 0.05 ). Llostimulatory capacity: MPA-treated MDC exhibited a markedly reduced ability to stimulate allogenic CD4+ T cell proliferation. Conclusion Treatment of MDC with MPA exhibited an immature phenotype, a propensity to migrate in response to inflammatory chemokines, increased endocytotic capacity and impaired allogenic ability of MDC.

ObjectiveTo investigate the prevalence of nutritional risk and malnutrition among hospitalized elderly abdominal surgical patients with malignant tumors.MethodsTotally 269 elderly patents ( ≥ 65 years) with malignant tumor who were hospitalized in our department of abdominal surgery from December 2009 to November 2010 were consecutively enrolled.Nutritional Risk Screening 2002 ( NRS 2002 ) was performed on the next morning after admission.Body mass index (BMI) lower than 18.5 kg/m2 was considered as malnutrition.Results The NRS 2002 was completed in all the 269 enrolled patients.The overall prevalence of malnutrition was 30.1％ (81/269) ; more specifically,37.5％ (21/56) among geriatric patients ( ≥80 years) and 17.6％ (43/245) among the other age groups (P =0.001 ).The overall rate of nutrition risk was 38.3％ (103/269) ; more specifically,57.1％ (32/56) among the geriatric patients and 29.3％ (72/245) among the other age groups (P ＜0.001 ).The rate of nutrition risk in patients with pancreas cancer was 58.3％,which was higher than other elderly patients; on the contrary,and the rate of nutrition risk in the patients with colorectal cancer was relatively lower.ConclusionThe rates of nutrition risk and malnutrition in hospitalized elderly abdominal surgical patients ( ≥ 65years) with malignant tumor are relatively higher than other age groups,especially among the geriatric patients.

ObjectiveTo explore the clinical outcome of the combined nutrition support for colorectal cancer patients.MethodsTwo research arms were obtained using a cohort sampling method.Ann A ( the study group): from 2009 to 2010,30 colorectal cancer patients were enrolled.They received nutritional risk screening (NRS) 2002 after admission.Nutritional risk was defined as NRS 2002 score ≥3 three days before operation.Patients with nutritional risk received enteral nutrition (EN) for bowel preparation without laxative drug and enema.After operation,they received EN combined with parenteral nutrition (PN) supports provided.Arm B (control group): 30 cases with historically confirmed colorectal cancer were enrolled from 2007 to 2008.They received routine bowel preparation (diet control,laxative drug,and enema) and PN supports after operation.Nutritional parameters,the rate of infectious complications,the rate of systemic inflammatory response syndrome,and the duration of hospital stay were analyzed.ResultsThere were no significant difference in body weight and plasma albumin between these two arms ( P ＞ 0.05 ). The incidence of systemic inflammatory response syndrome (13.3 ％ ),infectious complications (10.0％ ),and the duration of hospital stay [ (12.3 ± 6.5 ) d ] in arm A were significantly lowerthan those in arm B [33％,30％,and (15.0 ±7.2) d,respectively] (P =0.038,P =0.042,P =0.045).Conclusion For the colorectal cancer patients,nutritional risk screening on admission,bowel preparation with eneral nutrition before operation,and combined nutritional support after operation can improve the clinical outcome.

ObjectiveTo study the feasibility and technique in liver transplantation (LT) in an adult with situs inversus (SI) and reviewed the medical literature on this subject.MethodsA 45-year-old male with complete SI,suffered from progressive hepatic failure secondary to hepatolithiasis,obstructive jaundice,portal hypertension and liver cirrhosis.He underwent liver transplantation in July 2004.His anatomy was studied by preoperative CT scan and three-dimensional liver reconstruction imaging and angiography.LT was performed using the modified piggyback technique.The donor right liver was rotated 45 degree to the left,making the donor left liver pointing to the left paracolic sulcus and the donor right liver was in the recipient hepatic fossa.The donor suprahepatic vena cava was anastomosed end-to-side to the recipient vena cava,and the infrahepatic vena cava was closed by oversewing.ResultThe patient recovered uneventfully.His liver function was stable during a follow-up of 75 months.ConclusionLT in patients with SI is safe and feasible.Exact determination of the anatomy,comprehensive preoperative planning,and good technique in liver transplantation play important roles in LT for patients with SI.

Objective To explore the effect of age on clinical postoperative outcomes of elderly patients with colorectal cancer undergoing surgical treatment. Methods The clinical data of 1249 patients from January 1999 to December 2007 were analyzed retrospectively, and patients were divided into two groups according to age; the study group (≥75 years, n=312) and the control group (<75 years, n=937). Results (1) The average age was significantly higher in study group than in control group (t=33.09,P<0.05), and the rates of malnutrition risk, co-morbidity, tumor in right colon and local Iymphonodus metastasis were significantly higher in study group than in control group (x2=47.33, 130.75, 21.24 and 45.33, P<0.05). ( 2 ) The rates of preoperative surgical complications, bowel obstruction and emergency operation were significantly higher in study group than in control group (x2 =26.81, 34.14 and 10.72, P<0.05) . The rate of resection was significantly lower in study group than in control group (x2 =9.732, P<0.05). (3) The overall incidences of postoperative complications, general complications and mortality of perioperative period were significantly higher in study group than in control group (x2= 19.38, 20.75 and 10.11,P<0.05). (4) The two-year survival and five-year survival were significantly lower in study group than in control group (x2=11.91 and 27.17, P<0.05), but there were no significant differences in the cancer-specific two-year survival and five-year survival between the both groups. Conclusions Preoperative complications and co-morbidities, local tumor metastasis and postoperative nonsurgical complications adversely affect the postoperative outcomes for elderly patients with colorectal cancer.