OBJECTIVETo explore the significance of application of Dannang Recipe No. 2 (DNR2), a Chinese herbal preparation, in the perioperative period of laparoscopic cholecystectomy (LC).

METHODSThree hundred and sixty patients with LC were randomly assigned to two groups, 180 in each group. The treatment group was treated with DNR2 in the perioperative period, one dose of the recipe composed of aucklandia root 10 g, red peony root 15 g, giant knotweed rhizome 10 g, scutellaria root 10 g, honeysuckle flower 15 g, forsythia fruit 10 g, rhubarb 9 g, immature bitter orange 10 g, magnolia bark 10 g, peach kernel 10 g, red sage root 20 g and licorice root 4 g, which was boiled with water and taken one dose per day, starting from the previous night of operation. The control group was treated by antibiotic with Ceftizoxime sodium 2.0 g or Levofloxacin 200 mg via intravenous dripping once 0.5 h before operation preventively and 1-3 days after operation according to patients' condition. The indexes, including recovery time of borborygmus, gas elimination and defecation, post-operation body temperature, days needing fluid transfusion, hospitalization time, incidence of infectious complication, as well as the white blood cell counting (WBC) and serum C-reactive protein (CRP) before and after operation, were analyzed and compared between groups.

RESULTSThe recovery time of borborygmus, gas elimination and defecation were shorter in the treatment group as compared with that in the control group (10.42 +/- 4.38 h vs. 17.11 +/- 6.25 h, 15.60 +/- 5.03 h vs. 32.74 +/- 9.43 h and 38.81 +/- 9.87 h vs. 56.09 +/- 11.00 h, respectively) and all the other indexes were better in the treatment group than those in the control group, showing significant difference (P < 0.01 or P < 0.05), except the incidence of postoperative infectious complication, it was similar in the two groups.

CONCLUSIONApplication of DNR2 in perioperative stage of laparoscopic cholecystectomy can effectively promote the recovery of postoperative gastrointestinal motility and suppress the occurrence of acute inflammation.

Adult ; Aged ; Aged, 80 and over ; Cholecystectomy, Laparoscopic ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Gallbladder Diseases ; complications ; surgery ; Humans ; Male ; Middle Aged ; Pain, Postoperative ; drug therapy ; Perioperative Care ; Young Adult

OBJECTIVETo study the concordance rate of external pathology consultation referred by hospitals of various scales and to evaluate the value of such practice.

METHODSA total of 12 206 external pathology consultation cases referred by outside institutions were encountered during a 5-year period. The final pathologic diagnoses in 3289 cases were compared with the original interpretations. Each case was reviewed by at least two experienced pathologists. Immunohistochemical study was carried in selected examples. The pathologic findings were categorized as follows: (1) no diagnostic discrepancy, (2) minor diagnostic discrepancy and (3) major diagnostic discrepancy.

RESULTSAmongst the 12 206 cases studied, 7198 cases (59.0%) were sampled from the digestive tract, hematolymphoid system, soft tissue or breast. Seven thousand eight hundred and sixty-five cases (64.4%) were referred by small and medium-sized hospitals, while only 948 cases (7.8%) were referred by large hospitals (ranked IIIA). The diagnoses in 1842 cases (15.1%) were confirmed upon examination of the original paraffin sections, while the diagnoses in 2569 cases (21.1%) were made with cutting of additional sections from the paraffin blocks. On the other hand, the diagnoses in 7795 cases (63.8%) were arrived with the application of ancillary studies, including histochemistry and immunohistochemistry. Amongst the 3289 cases reviewed, diagnostic agreement was noted in 582 cases (17.7%), while major diagnostic discrepancy was observed in 113 cases (3.4%), including a change in diagnosis from "benign" to "malignant" in 31 cases (0.9%) and from "malignant" to "benign" in 38 cases (1.1%). The pathologic classification of the original diagnoses was modified in 44 cases (1.3%).

CONCLUSIONSExternal pathology consultation is useful for patient management in small and medium-sized hospitals, especially in resolving difficult and controversial pathologic diagnoses. Application of ancillary techniques, including immunohistochemistry, further helps to clear up the potential diagnostic dilemma.

Academic Medical Centers ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Diagnostic Errors ; Female ; Hospitals, Community ; Hospitals, General ; Humans ; Male ; Middle Aged ; Neoplasms ; pathology ; Pathology, Surgical ; Referral and Consultation ; Retrospective Studies ; Young Adult