Objective To observe the interaction between the extreme stress and mild traumatic brain injury in the patients surviving Wenchuan earthquake.Methods Forty survivors in Wenchuan earthquake were selected for the psychological status survey 2-30 days after the disaster,among them 20 survivors were suffering from mild traumatic brain injury,and the remainders were in normal physical conditions.The Symptom Checklist-90(SCL-90),which consisted of 90 items with 5 grades for each item(0-4 grade,grade zero as none and grade 4 as severe),including 9 symptom factors,was adopted to perform the evaluation for all the subjects in both groups,and the subscales were compared.Results Five subscales of SCL-90,including somatization,depression,anxiety,hostility and fear,which averaged 2.12?0.50,1.83?0.60,1.99?0.40,1.80?0.70 and 2.20?0.8,respectively,were significantly increased in mild traumatic brain injury group than that in control group(P0.05).Conclusions Mild traumatic brain injury occurred among survivors of severe earthquakes is strongly associated with psychological problems.A higher incidence of psychological disorder in survivors of earthquake with mild traumatic brain injury indicates that one must be cautious when attributing a health problem to mild traumatic brain injury,since the post-traumatic stress disorder and depression may be the primary problem.The high-risk population with psychological obstacle consists of the survivors with mild traumatic brain injury,and the interactions of both psychological stress and traumatic brain injury may lead to more complex clinical symptoms,so psychotherapy should be emphasized in the treatment of patients with mild traumatic brain injury.

Hernia, Hiatal ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Omentum ; Tomography, X-Ray Computed

OBJECTIVETo explore living anatomy of pancreas and peripancreatic spaces,as well as their implications on laparoscopic gastrectomy with D(2) lymphadenectomy for distal gastric cancer.

METHODSLiving observation was carried out in 132 patients diagnosed as distal gastric cancer and undergoing laparoscopic gastrectomy with D(2) lymphadenectomy.

RESULTSSpaces between greater omentum and transverse mesocolon continued to pre-pancreatic and retro-pancreatic spaces at inferior margin of pancreas. The pre-pancreatic and retro-pancreatic spaces continued each other at inferior and superior margin of pancreas and extended in all directions. Left gastroepiploic vessels were located in pre-pancreatic spaces at superior margin of pancreatic tail. In retro-pancreatic space at inferior margin of pancreatic neck, superior mesenteric veins were located. In retro-pancreatic spaces or in gastric mesenteries inferior to gastric antrum, right gastroepiploic vessels were located. In spaces between gastric antrum and pancreatic heads, gastroduodenal arteries were located and traced to locate common hepatic arteries. In retro-pancreatic spaces at superior margin of pancreatic body, common hepatic arteries, left gastric arteries,celiac arteries and splenic arteries were located. Hepatopancreatic folds and gastropancreatic folds were landmarks respective to locate common hepatic arteries and left gastric arteries. The aforementioned vessels and spaces in their vagina vasorum continued each other and united as a whole.

CONCLUSIONSLaparoscopic gastrectomy with D(2) lymphadenectomy for distal gastric cancer is carried out in macroscopic surgical planes of pre-pancreatic space and retro-pancreatic space, as well as their extensions in all directions, and in microscopic surgical planes of spaces in vagina vasorum of perigastric vessels which continue each other, under the guidance of central landmarks of pancreas and concrete landmarks of vessel trunks and their furcations.

Adult ; Aged ; Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Lymph Node Excision ; methods ; Male ; Middle Aged ; Neoplasm Staging ; Pancreas ; anatomy & histology ; Stomach ; anatomy & histology ; Stomach Neoplasms ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo explore the regional anatomy of the rectum including the perirectal fasciae and spaces.

METHODSTwenty-one cadavers (15 males and 6 females) were embalmed and their vessels were visualized by injection with color dye. From the cadavers, 30 hemipelvis and 6 three-quarter pelvis were harvested. The perirectal fasciae and spaces and the pelvic autonomic nerves were dissected and examined.

RESULTSThree tissue layers were dissected from the inside to the periphery including the proper rectal fascia enveloping the mesorectum, the presacral fascia, and the piriformis fascia fused with the sacral periosteum. The mesorectum comprised 2 parts with the classical posterolateral fat covered by the proper rectal fascia posteriorly and the anterior fat covered by the posterior layer of Denonvilliers fascia anteriorly. Extending anteriorly to the anterior layer of Denonvilliers fascia, the presacral fascia bisected the space between the mesorectum and the piriformis fascia into the retrorectal space and the presacral space. The retrorectal space extended cranially to the left retrocolic space, anterior to the space between the 2 layers of Denonvilliers fascia(prerectal space).

CONCLUSIONSFrom the inside to the periphery, the proper rectal fascia, the presacral fascia, and the muscular fascia are distributed in an annular pattern around the mesorectum. The presacral fascia divides the perirectal space into 2 annular parts, the central retrorectal space and the peripheral presacral space. The retrorectal space is the ideal surgical plane for total mesorectal excision.

Adult ; Aged ; Cadaver ; Fascia ; anatomy & histology ; Female ; Humans ; Male ; Mesocolon ; anatomy & histology ; surgery ; Middle Aged ; Pelvis ; anatomy & histology ; Rectum ; anatomy & histology

OBJECTIVETo evaluate the feasibility, safety, radicality and short-term outcome of laparoscopic total mesorectal excision(TME) in comparison with open procedure for the middle-lower rectal cancer.

METHODSFrom November 2005 to October 2008, 93 patients with middle-lower rectal cancer received laparoscopic total mesorectal excision (LTME group), while 105 patients underwent conventional open TME (OTME group). The operative procedures, clinicopathological data and short-term outcome were collected and compared between the 2 groups.

RESULTS(1) Comparison of surgical procedures. The demographic data of LTME and OTME groups were comparable (P >0.05). Four (4.3%) patients were converted to open procedure in LTME group. The anal sphincter preserved procedure accounted for 82.8% in LTME group and 81.9% in OTME group. The difference was not significant (P >0.05). (2) Comparison of perioperative surgical data. The mean operating time was (164.6+/-35.6) min in LTME group, significantly longer than that in OTME group (141.9+/-29.4) min (P <0.001). The operative blood losses were (51.4+/-20.2) ml and (180.0+/-64.7) ml in LTME and OTME group respectively, the difference was significant (P <0.001). The analgesia requirement, time for bowel movement retrieval, time to liquid food intake, time to resuming early activity and hospital stay in LTME group were significant lower or shorter than those in OTME group (P <0.001). There was no operative death in both groups. (3) Comparison of operative complications. The overall morbidity rate was 11.8% in LTME group, and 12.4% in OTME group, the difference was not significant (P >0.05). The major complications were equivalent between two groups. (4) Comparison of specimen. No significant differences were observed between two groups in terms of specimen length, lymph node harvest and negative distal margin. (5) Follow-up results. The mean follow-up time was 19 months. The recurrent rate and overall survival rate were 4.4% and 97.8% in LTME group, with no significant difference compared to those in OTME group (7.3% and 97.9%, P >0.05).

CONCLUSIONSLaparoscopic TME for middle-low rectal cancer is safe and feasible, and can potentially offer all the benefits of a minimally invasive approach and achieve satisfactory oncological outcome,which may lead to a better future of the TME technique.

Adult ; Aged ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Laparoscopy ; Laparotomy ; Male ; Mesentery ; surgery ; Middle Aged ; Rectal Neoplasms ; surgery ; Rectum ; surgery

OBJECTIVETo compare the recurrence between laparoscopic resection and conventional open resection for colorectal cancer with meta-analysis.

METHODSEligible articles were identified by searches of MEDLINE, EMBASE and the Cochrane database between January 1991 and January 2007 using the terms (laparoscopy, surgery, minimal invasive, colon, intestine, large, colectomy, colonic neoplasms, rectal neoplasms and randomized controlled trial). Prospective randomized clinical trials were eligible if they included patients with colorectal cancer treated by laparoscopic surgery versus open surgery followed-up by recurrence. Data were extracted from these trials by three independent reviewers.

RESULTSTen trials with recurrence information of 2474 patients were involved. In the combined results, no significant difference in the OR for overall recurrence between the laparoscopic surgery and open surgery group was found (OR 0.95, 95%CI 0.76 to 1.19, P=0.64). Stratified by recurrence type, the combined results of the individual reports showed no significant differences for local recurrence (OR 0.79, 95%CI 0.50 to 1.25,P=0.32), distant metastasis (OR 0.89, 95%CI 0.62 to 1.28, P=0.54) and port-site or wound-site recurrence (OR 1.04,95%CI 0.21 to 5.27,P=0.96) between the two surgical techniques.

CONCLUSIONThe recurrence rates for patients with colorectal cancer treated by laparoscopic surgery do not differ significantly from those by open surgery. Longer follow up studies will further define outcomes comparing the two techniques in the treatment of colorectal cancer.

Colectomy ; Colorectal Neoplasms ; pathology ; surgery ; Humans ; Laparoscopy ; Neoplasm Recurrence, Local ; Randomized Controlled Trials as Topic ; Treatment Outcome

OBJECTIVETo develop a clinical database system of gastric cancer surgery integrated with data mining function for better management of clinical data and better performance of both retrospective and prospective studies.

METHODSCore fields for clinical data were determined based on the JGCA(13th and 14th edition) and UICC gastric cancer staging system. Microsoft Visual Basic and VistaDB were used for programming. The database structure was designed according to data mining theory and clinical workflow.

RESULTSAfter one year of development and refinement, data of over 600 patients from our hospital were retrospectively entered, and function tests were satisfactory. This system was accepted as the database platform for the Chinese Laparoscopic Gastrointestinal Surgery Study Group (CLASS) and was successfully used in the first stage of the Multicenter Retrospective Study of the Feasibility of Laparoscopy for Gastric Cancer among 30 hospitals from both Mainland China and Hong Kong. The data mining function met the requirements, which could carry out complex search with visualized presentation. Descriptive analyses could be performed with the analysis function. Efficient communication among institutions could be executed by data import and export with excellent compatibility and without errors.

CONCLUSIONThe system has established a clinical database of approximately 4000 fields with data mining function. This system can be widely applied for the clinical research for gastric cancer.

Data Mining ; Databases, Factual ; Humans ; Software Design ; Stomach Neoplasms ; surgery

OBJECTIVETo analyze the learning curve for an experienced laparoscopic colorectal surgeon in performing to laparoscopic D2 gastrectomy for gastric cancer.

METHODSFrom July 2004 to July 2009, 70 patients undergoing laparoscopic D2 gastrectomy performed by a single surgical team were retrospectively evaluated. The patients were divided into groups A to G (n=10) based on the surgery date, and the operation time, estimated blood loss (EBL), conversion to open surgery, number of lymph nodes harvested, complications, and recovery indicators were compared.

RESULTSNo statistical differences were found among the groups in age, gender, gastrectomy approach, EBL, number of lymph nodes harvested, time to flatus, or postoperative hospital stay (P>0.05). No significant differences were found in the operation time between groups A and B (P=0.999) or among the other 5 groups (P>0.05), but the operation time in groups A (300.00-/+104.59 min) and B (261.00-/+40.50 min) were significantly longer than that in the other 5 groups (C: 191.30-/+23.11 min, D: 188.60-/+31.38 min, E: 181.10-/+20.18 min, F: 167.50-/+32.81 min, and G: 161.30-/+29.03 min). Compared with that in group A, the time to liquid diet decreased significantly in the remaining 6 groups (P<0.05). Conversion to open surgery occurred in two cases (2.86%, both in group B), 2 patients in group B and another 2 in group C developed intraoperative complications, and one in group C had postoperative complication, with the total incidence of complication of 7.14% in this series.

CONCLUSIONA well-trained laparoscopic colorectal surgeon, by following the standard surgical procedures, are likely to overcome the learning curve smoothly after performing approximately 20 cases of laparoscopic D2 gastrectomy for gastric cancer.

Clinical Competence ; Gastrectomy ; education ; Humans ; Laparoscopy ; education ; Lymph Node Excision ; Lymphatic Metastasis ; Retrospective Studies ; Stomach Neoplasms ; surgery

BACKGROUNDMirizzi syndrome is often difficult to diagnose before surgery, and is often accompanied by extensive adhesions in the cystohepatic (Calot's) triangle and the difficulty of separating tissue can lead to bile duct injury and other intraoperative and postoperative complications. The aim of this study is to investigate minimally invasive means of treating different types of Mirizzi syndrome.

METHODSFifty-four patients diagnosed with Mirizzi syndrome were enrolled between July 2004 and May 2012. The diagnosis was further refined according to the Csendes classification. Twenty-seven patients were treated with a combination of endoscopic retrograde cholangiopancreatography (ERCP), laparoscopy, and choledochoscopy (tripartite approach group); type I in 16 cases, type II five cases, and type III in six cases. Twenty-seven patients were treated with laparotomy (routine approach group); type I in 19 cases, type II in six cases, and type III in two cases. The operation time, blood loss during operation, initiation of intake time of food, postoperative complications, and hospital stays were compared between two groups.

RESULTSAll patients were successfully cured in surgical operation. The operation time was (49.7 ± 27.5) minutes, blood loss during operation was (21.1 ± 15.9) ml, initiation of intake time of food was (6.3 ± 2.7) hours, postoperative complications were with two cases (7%, 2/27), and hospital stay was (6.7 ± 1.8) days in the tripartite approach group. In the routine approach group, the operation time was (85.1 ± 20.3) minutes, blood loss during operation was (150.3 ± 20.5) ml, initiation of intake time of food was (36.6 ± 10.3) hours, postoperative complications were with three cases (11%, 3/27), and hospital stay was (10.9 ± 3.4) days. Except for postoperative complications, there were significant differences in the operation time, blood loss during operation, initiation of intake time of food, and hospital stays between two groups (P < 0.05).

CONCLUSIONSERCP combined with laparoscopy and choledochoscopy is a safe and effective means of treating Mirizzi syndrome. The approach is minimally invasive and patients recover quickly requiring only brief hospitalization.

Adult ; Aged ; Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde ; methods ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Mirizzi Syndrome ; diagnostic imaging ; surgery

BACKGROUNDManagements of optic neuritis (ON) included high-dose corticosteroids or combined with systemic immunomodulatory agents. It was important to make a correct diagnosis of ON before initiation of treatment. The purpose of the study was to report and analyze the clinical features of retinal diseases in patients who were misdiagnosed as having retrobulbar ON.

METHODSRetrospective review of 26 patients (38 eyes) initially diagnosed with retrobulbar ON but were ultimately diagnosed with retinal or macular diseases. Data obtained from fundus examination, fluorescence fundus angiography (FFA), automated static perimetry, full-field electroretinogram (ffERG), multifocal electroretinogram (mfERG), and optical coherence tomography (OCT) were evaluated.

RESULTSThirty-eight eyes of 26 patients were found to have misdiagnosis of retrobulbar ON, based on normal or slight abnormal fundus findings and abnormal visual evoked potentials (VEP). The mean age of the patients was 34 years and the correct diagnosis of the patients included acute zonal occult outer retinopathy (AZOOR, 15 eyes, 14 patients), occult macular dystrophy (OMD, 8 eyes, 4 patients), cone or cone-rod dystrophy (10 eyes, 5 patients), acute macular neuroretinopathy (AMNR, 3 eyes, 2 patients), and cancer-associated retinopathy (CAR, 2 eyes, 1 patient).

CONCLUSIONWhen attempting to diagnose retrobulbar ON in clinical practice, it is crucial to carry out necessary examinations of the retinal function and morphology to decrease misdiagnosis.

Adult ; Aged ; Electroretinography ; Female ; Humans ; Male ; Middle Aged ; Optic Neuritis ; diagnosis ; Retinal Diseases ; diagnosis ; Retrospective Studies ; Tomography, Optical Coherence