Adult ; Aged ; Aged, 80 and over ; Carbon Monoxide Poisoning ; complications ; Female ; Humans ; Interleukins ; blood ; Male ; Middle Aged ; Neurotoxicity Syndromes ; blood ; etiology

Objective To investigate the etiology of and therapy for duodenal fistula caused by distal common bile duct operation. Methods An retrospective analysis of 19 cases of duodenal fistula after distal common bile duct operation was made.All cases received surgical management after the fistula was identified.Surgical procedures included abdominal abscess drainage in 2 cases, gastrostomy and jejunostomy combined with abscess drainage in 11 cases, gastrostomy and jejunostomy combined with duodenal repair?abscess drainage in 3 cases,gastrojejunostomy with pyloric exclusion combined jejunostomy in 1 case, repair of fistula with padicled intestinal seromuscular patch combined with gastrostomy and jejunostomy in 1 case, and repair of fistula with padicled intestinal seromuscular patch combined with gastrostomy and jejunostomy plus sphincteroplasty in one case. Results Among 19 cases,15 were cured. Two died of gastrointestinal bleeding, one of severe retroperitoneal infection,one of severe pancreatitis. ConclusionsEarly diagnosis is of great importance for the treatment of duodenal injury. Drainage is the mainstay for the treatment of iatrogenic duodenal fistula, while enough enteral nutrition should be given to accelerate spontaneous closure of the fistula.

Objective To study the practical value of preoperative selective intra-arterial embolization in the surgical treatment of nasopharyngeal fibroangioma. Methods Digital subtraction angiogrophy(DSA) and selective arterial embolization were carried out in 15 cases of nasopharyngeal fibroangioma. The supplying arteries originated from the maxillary and the pharyngeal ascending branches arising from external carotid artery were embolized with gelatin sponge. Results 15 cases underwent operation after selective embolization of blood supplying arteries and the amount of bleeding in operation was thus reduced greatly in 13 cases, while the blood loss during the surgery of another 2 cases was still considerable because both external carotid artery and internal carotid artery supplied the tumor with only embolization of the external carotid artery. Optimum time for the operation was taken on 2-5 days after the embolization. Conclusions Preoperative intra-arteral embolization for nasopharyngeal fibroangioma is a valuable method of choice for the clinical treatment.

Objectives:The present study was undertaken to investigate the effects of recombinant growth hormone(rhGH) on protein metabolism during intraabdominal infection.　 Methods : The study was made up of two parts: animal experiments and clinical studies. All animals were divided into three groups: normal control, sepsis control and rhGH therapy groups. All patients were divided into two groups: infection control and rhGH therapy groups. Expressions of hepatic albumin mRNA and muscle myosin heavy chain mRNA were detected.　 Results: In septic animals, rhGH accelerated nitrogen retention and recovery of body weight, improved concentrations of plasma albumin and muscle protein. Expressions of hepatic albumin mRNA and myosin heavy chain mRNA decreased significantly after infection. By using rhGH, expression of albumin mRNA and myosin heavy chain mRNA increased obviously. In clinical study, plasma concentrations of albumin, prealbumin and transferrin were higher than infectious controls after rhGH administration.　 Conclusions: rhGH improved nitrogen balance and protein synthesis of liver and muscle during sepsis .More studies were needed to determine weather rhGH was an effective metabolic intervention method during sepsis.

Objective To evaluate the plasma amino acid level alteration and determine amino acid loss in patients with abdominal inflammation and acute renal failure during continuous veno-venous hemofiltration (CVVH). Methods Ten patients with abdominal infection and acute renal failure were admitted to the Nanjing General Hospital of Nanjing Military Command of PLA from September 2008 to September 2009. CVVH was performed with AV600S polysulfone hemofilter for 24 hours. Samples of plasma amino acid were obtained before,at 12 and 24 hours after the beginning of CVVH. High pressure liquid chromatography was used to detect amino acid concentrations in plasma and replacement fluid. All data were analyzed using t test or Wilcoxon rank sum test. Results Of the ten patients, three died of septic shock and three died of multi-organ dysfunction syndrome.The level of plasma amino acids decreased significantly after CVVH, and the levels of histidine, isoleucine, cysteine and glutamine decreased from (22.1 ±10.3), (20.0 ±7.6), (10.3±4.7), (122.3 ±72.2)μmol/L to (5.6 ±3.4), ( 6.4 ± 2.5 ), ( 2.9 ± 2.4 ), (42.5 ± 33.6) μ mol/L. The total plasma amino acid levels significantly reduced by 52% at 12 hours after the beginning of CVVH and by 59% at 24 hours after the beginning of CVVH.The mean amino acid loss was (9631± 1089)mg/d. The mean losses of essential and non-essential amino acids were ( 5072 ± 618 ) mg/d and ( 3747 ± 654 ) mg/d, respectively, with a significant difference ( t = 4. 52,P ＜0.05 ). There was a positive correlation between individual amino acid loss and the plasma concentrations of respective amino acids at 12 hours after the beginning of CVVH ( r = 0. 68, P ＜ 0.05 ). Conclusions Plasma amino acid would be cleared through hemofilter during CVVH in patients with abdominal inflammation and acuterenal failure. As a result, it is necessary to take account of the ultrafiltrate amino acid loss when setting nutritional schedule, especially increasing the non-essential amino acid content of total parenteral nutrition.

ObjectiveTo evaluate gallbladder conserving gallstone removal and polyps resection using combination laparoscopy,hard gallbladder endoscopy and soft choledochoscopy.MethodsClinical data of 122 patients with cholecystolithiasis or polyps undergoing removal of calculus (polyps) and preservation of gallbladder were analyzed retrospectively.ResultsGallstones in 56 patients and polyps in 24 cases was removed or resected successfully by laparoscopy and hard gallbladder endoscopy; In the remaining 34 cases stones were completely removed by combination soft choledochoscopy; 8 cases were converted to laparoscopic cholecystectomy.Romoved stone was single in 25 cases and multiple in 65 cases,with the number ranging from 1to 52,the diameter of stone ranged from 0.2 cm to 3.2 cm.In the 24 gallbladder polyps,7 cases were single,17 cases were multiple,the diameter of polyp ranged from 0.8cm to 1.2 cm.The operation time was 40-125 (78) min. The mean hospitalization was 4 days. No intraoperative and postoperative complications occurred.All patients were followed up for 1year.Gallstones recurred in 3 cases,and the recurrence rate was 3.06％. ConclusionsLaparoscopy combined with hard gallbladder endoscopy and soft choledochoscopy for removing calculi (polyp) and conserving gallbladder is safe and feasible.

ObjectiveTo detect the Alu expression in the stool of patients with pancreatic cancer and investigate its value in the diagnosis of pancreatic cancer.MethodsStool samples were obtained from patients with pancreatic cancer (PC) ( n =41 ),chronic pancreatitis (CP) ( n =27 ) and healthy subjects ( n =23 ),the DNA was extracted from the stool and the expression of Alu repetitive sequences was subjected to quantitative analysis by the real-time PCR.ResultsThe expressions of Alu repetitive sequences in PC,CP,and healthy subjects were (5.17 ± 0.99 ),( 3.79 ± 0.94),(0.28 ± 0.35 ) rig/g,and the difference among the three groups was statistically significant (P ＜0.05).The AUC of PC was 74.8％ with the 95％ CI 0.661 ～0.835,and the sensitivity,specificity was 75.6％ and 67.1％,respectively.ConclusionsAlu repetitive sequences are highly expressed in the stool of patients with pancreatic cancer,and it is of value in the diagnosis of pancreatic cancer.

Objective To investigate the surgical strategies for management of unstable fractures of intertrochanteric lateral wall.Methods From July 2012 to June 2014,50 patients with unstable fractures of intertrochanteric lateral wall received osteosynthesis with proximal femoral nail anti-rotation.They were 37 men and 13 women,with an average age of 65.6 years (range,from 42 to 87 years).According to our morphology classification,25 patients belonged to type Ⅰ (comminuted fracture of lateral wall),4 to type Ⅱ (split fracture of lateral wall with loss of medial support),21 to type Ⅲ (comminuted fracture of lateral wall and subtrochanteric part with loss of medial support).The fractures were managed differently according to our classification.Type Ⅰ were treated by intramedullary fixation with compression screws to reconstruct the lateral wall,type Ⅱ by intramedullary fixation after reconstruction of the lateral wall lby cables,and type Ⅲ by intramedullary fixation after optimal reduction of the coronal plane and neck-shaft angle because the lateral wall could not be reconstructed.Results The 50 patients obtained an average follow-up of 17 months (range,from 5 to 24 months).No deep infection or wound dehiscence happened.Deep vein thrombosis occurred in 2 patients.No nonunion,cutout of the sliding screw,or coxa vara occurred.The operation time,blood loss,time of weight loading after operation and time of union increased with our increased classification.One patient died from a heart disease 5 months after operation.Functional outcome of the other 49 patient was assessed by Harris hip score one year after operation.Forty patients were excellent,6 good and 3 fair,giving an excellent to good rate of 93.9％.Conclusion Unstable fractures of intertrochanteric lateral wall should be treated using different surgical strategies based on the morphology classification system.

Objective To evaluate diagnostic value of diffusion tensor imaging(DTI)in ringlike- enhanced lesions.Methods Nine abscesses,12 glioblastomas,10 metastases confirmed clinically or pathologically underwent conventional MRI and DTI.Average diffusion coefficient(ADC)value,fractional anisotropy(FA)value and maps were calculated in the central portion and peripheral edema of the lesions. Results On DTI,the abscesses displayed as hyperintense signal with hypointense or isointense signal of edema;but glioblastomas and metastases all showed as hypointense signal with isointense or hypointense signal of edema.On ADC map,the abscesses showed as hypointense signal,the mean ADC value was (0.66?0.07)x10~(-3)mm~2/s,The mean ADC value were(2.50?0.11)x10~(-3)mm~2/s and(2.37?0.52)x10~(-3)mm~2/s for the glioblastomas and metastases,respectively,all demonstrated as hyperintense signal with slightly hyperintense signal of edema.The difference between abscess and necrotic tumors was statistically significant(F=108.80,P

Objective To investigate the diagnostic value of the K-ras mutations in FNA samples for early detection of pancreatic cancer. Methods FNA samples of 27 patients with pancreatic cancers, 9 patients with other malignant tumors and 14 patients with non malignant pancreatic mass (NMPM) were collected. DNA was extracted, and K-ras gene was amplified through PNA-mediated PGR clamping, the products were sequenced to determine the mutation type. Results The positive rate of K-ras mutations in pancreatic cancers,other malignant tumors and NMPM were 88.9%, 44.4%, 35.7%. There was significant difference in K-ras gene mutations in FNA samples between pancreatic cancer and other malignant tumors ( P = 0. 013 ) and NMPM ( P = 0. 001 ). The sensitivity, specificity, positive predictive value, negative predictive value,accuracy of K-ras mutations in FNA samples of pancreatic cancers were 88.9%, 55.6%, 85.7%, 62.5%,80.6% when compared with other malignant tumors, and the difference between the two groups was significant (P =0. 013) ;Those were 88.9%, 64.3%, 82.8%, 75.0%, 80. 5% when compared with NMPM, and the difference between the two groups was significant ( P = 0. 001 ). When cytology of FNA samples and K-ras mutations was combined, the positive rate of pancreatic cancer was up to 96.3%. Conclusions The detection of K-ras mutations in EUS-FNA samples helped improve the positive diagnostic rate of pancreatic cancer.