Humans ; Male ; Scrotum/injuries* ; Testis/injuries*

With the development of diagnostic and screening technologies, the incidence of hepatocellular carcinoma (HCC) with extrahepatic metastasis is increasing. It is a kind of refractory disease with extremely poor prognosis. Currently, there is no standard therapy. The existing guidelines only recommend targeted therapy, systemic chemotherapy or best supportive care for HCC patients with extrahepatic metastasis, but have not mentioned surgical therapy.Several studies have shown that the majority of HCC patients with extrahepatic metastasis died of progressive intrahepatic tumor leading to hepatic failure, but not extrahepatic metastases; and primary tumor resection may have a favorable impact on the prognosis of these patients with resectable primary tumors.Furthermore, the role of resection of metastatic tumors for HCC patients with extrahepatic metastasis remains unclear so far.Majority of experts think that resection of lung metastases has survival benefit when the hepatic lesion is resected or controlled, whereas resection of lymph nodes, bone metastases, adrenal gland lesions, or brain metastases does not prolong survival, which may be recommended when the goal is to relieve symptoms or improve quality of life.Therefore, surgical treatment is important for HCC patients with extrahepatic metastasis, and surgical therapy combined with personalized systemic treatment shows survival benefit for selected patients.

Objective To investigate the application and clinical effect of uncut Roux-en-Y (uncut RY) anastomosis in laparoscopic distal radical gastrectomy of gastric cancer.Methods The retrospective crosssectional study was adopted.The clinical data of 23 patients with gastric cancer who were admitted to the Northern Jiangsu People's Hospital from December 2014 to July 2015 were collected.All the 23 patients underwent laparoscopy-assisted distal gastrectomy (LADG) and total laparoscopic distal gastrectomy (TLDG) according to the individual situations.The indexes of observation were collected,including (1) intraoperative indexes:operation time,uncut RY anastomosis time and volume of inraoperative blood loss,(2) postoperative indexes:time to anal exsufflation,time for initial water intake,time for semi-fluid diet intake,time for out-off-bed activity,duration of hospital stay,occurrence of complications and results of pathological examination,(3) results of follow-up.The follow-up was performed by outpatient examination and telephone interview up to November 2015,including postoperative discomfort after diet intake,barium meal examination of gastrointestinal tract at postoperative month 1 (anas-tomotic stenosis,recanalization and dehiscence of occlusion),detecting situations of gastric remnant and anas-tomotic stoma at postoperative month 3 by gastroscopy and occurrence of gastrointestinal obstruction.Measurement data with normal distribution were presented as x ± s.Results (1) Intraoperative situations:all the 23 patients underwent successful uncut RY anastomosis,including 18 receiving LADG and 5 receiving TLDG.The operation time,uncut RY anastomosis time and volume of intraoperative blood loss were (165.9 ± 11.6) minutes,(18.2 ± 2.2) minutes,(48 ± 6) mL in all the 23 patients and (172.0 ± 8.5) minutes,(26.6 ± 1.5) minutes,(46 ± 4) mL in 5 patients with TLDG,respectively.Two patients received hemostatic treatment using suture and hemostatic forceps due to anastomotic bleeding.(2) Postoperative situations:time to anal exsufflation,time for initial water intake,time for semi-fluid diet intake,time for out-off-bed activity,duration of hospital stay and incidence of complications in all the 23 patients were (2.2 ± 0.4) days,(2.7 ± 0.4) days,(3.5 ± 0.4) days,(2.7 ± 0.3) days,(10.6 ± 1.4) days and 8.7％ (2/23),respectively.No patient was dead in the perioperative period.Two patients complicated with incisional infection and high fever were cured by symptomatic treatment,without occurrence of anastomotic leakage,bleeding and anastomotic-related complications.All the patients received postoperative barium meal examination of upper gastrointestinal tract,with unblocked anastomotic stoma and without leakage of barium meal.Diameter of tumor and number of lymph node dissected were (3.2 ± 1.2) cm and 30 ± 4,with negative upper and lower resection margins.Numbers of patients with tumor differentiation,T stage,N stage and TNM stage were 12 and 11 in differentiated and undifferentiated tumors,1,9 and 13 in T1,T2 and T3 stages,9,11 and 3 in N0,N1and N2 stages,1,4,9,6 and 3 in Ⅰ a,Ⅰ b,Ⅱ,Ⅲ a and Ⅲ b stages,respectively.(3) All the 23 patients were followed up by outpatient examination for 3-11 months.One patient had discomfort in upper abdomen with vomiting at postoperative week 3,and no anastomotic leakage,bleeding and anastomotic-related complications were occurred in other patients.Conclusion As a modified anastomotic method,uncut RY anastomosis is safe and feasible,and it is also an ideal method of digestive tract reconstruction after laparoscopic distal radical gastrectomy.

Objective To compare the effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) on excess weight loss (EWL) and type 2 diabetes mellitus (T2DM),then to evaluate which one is superior to the other.Methods PubMed,Embase,Wanfang Database and HowNet database were searched for publications concerning LAGB and LSG from 2000 to 2012,with the last search on August 17,2012.EWL and T2DM improvement over 6 and 12 months were pooled and compared by meta-analysis.Odds ratios (ORs) and mean differences were calculated with 95％ confidence intervals （ CI).Results Eleven studies involving 1004 patients in total met the inclusion criteria.The mean percentage EWL for LAGB was 33.9％ after 6 months in studies and 37.8％ after 12 months; for LSG,EWL was 50.6％ after 6 months and 51.8％ after 12 months,T2DM was improved in 42 of 68 patients (61.8％) after LAGB and 66 of 80 (82.5％) after LSG.Conclusions LSG is more effective than LAGB in morbid obesity,with higher percentage EWL and greater improvement in T2DM.

Objective To compare the complications of temporary ileostomy and temporary colostomy for colorectal anastomoses,then to evaluate which one is superior to another.Methods Studies and relevant literatures comparing temporary ileostomy with temporary colostomy for defunctioning colorectal anastomoses were searched though PubMed,Embase and the Cochrane Library.The rates of complications were pooled and compared using a meta-analysis.The risk ratios were calculated with 95％ confidence intervals to evaluate the safety and efficacy of each technique.Results Five randomized controlled trials and seven non-randomized studies were included,with 1687 patients in total.The meta-analysis of the RCTs demonstrated a lower risk of stoma prolapse ( Risk ratio 0.15) in the temporary ileostomy group.Meta-analysis of the non-randomized studies showed a lower risk of stoma prolapse ( Risk ratio 0.26) and wound infection after stoma closure ( Risk ratio 0.28 ) in the temporary ileostomy group.No other statistically significant difference was observed for complications.Conclusions Each type of defunctioning stoma has its advantages and disadvantages.The authors endorse temporary ileostomy over temporary colostomy.However,there is not a strong evidence for the superiority of one temporary stoma over another for colorectal anastomoses.Large scale RCTs and high quality studies are needed.

ObjectiveTo evaluate the efficacy of self-management to improve the lower urinary tract symptoms (LUTS) and life quality in benign prostatic hyperplasia (BPH) patients.MethodsTwo hundred and twenty-two men were recruited to take αblockers for at least 3 months from March 2008 to September 2009. Participants were randomized to either attend a self-management program in addition to standard care or to standard care alone. Difference of scores of International Prostate Symptom Score (IPSS) and BPH-specific quality of life scale between the two groups was analyzed during enrollment period, the 1st week, the 3rd month and 6th month of therapy.ResultsAll participants were followed up for 6 months.The IPSS scores of the SMI group were 20.5 and 20.5 and the QOL were 50.9 and 50.8 at the 1st week.While the numbers were 19.6 and 19.3 for IPSS and 51.1 and 51.1 for QOL in the control group. There was no statistic difference in the control group.Whereas during the 3rd and 6th month assessment, the scores of IPSS and quality of life of self-management interventional group were statistically significantly lower than those of the control group.ConclusionsSelf-management intervention could reduce the LUTS symptoms and improve quality of life in BPH patients who were taking medicines.

OBJECTIVE: To study the how's for pharmacists at inpatient pharmacy to provide pharmaceutical care for improved safe and effective use of drugs. METHODS: Pharmacists at inpatient pharmacy can provide pharmaceutical care as per specific clinical needs, and start from such details as preparing the booklet of commonly-used chemotherapy drugs, offering face-to-face advises on drug use for diabetics, and helping nurses to manage the medicine cabinets. RESULTS & CONCLUSION: Pharmacists at inpatient pharmacy should provide the right pharmaceutical care that can meet actual clinical needs.

OBJECTIVE:To investigate the safety of Polyisobutylene (PIB) Gutong plaster by transdermal administration. METHODS:66 rabbits were randomly divided into a normal group,a group with intact skin and a group with damaged skin. The latter two groups were respectively re-divided into PIB group,the groups of low,medium and high-dose PIB Gutong plaster and Gutong plaster group. An acute toxicity test was conducted on the rabbits,which 14 d of continuous observation was made 24 h af-ter transdermal administration. Another 60 rabbits were divided into several groups as above except for a normal group. A single pri-mary skin irritation test was conducted on them,where skin irritation reactions were recorded 6 h after a single administration based on intra-individual left/right self comparison method. 70 guinea pigs were randomized into a negative control group (vase-line),a PIB group,a positive control group(2,4-dinitrochlorobenzene),a Gutong plaster group and the groups of low,medium and high-dose PIB Gutong plaster,which were dosed for sensitization,followed by a skin sensitization test. RESULTS:No obvi-ous toxicity symptoms could be seen after administration of PIB Gutong plaster. The rabbits’intact or damaged skin had no irrita-tion response to PIB and low and medium-dose PIB Gutong plaster. PIB Gutong plaster caused no irritation response in the rabbits’ intact skin,but slight irritation in damaged skin 1 h after administration. The allergic reaction incidence of the positive control group of guinea pigs was 100% while that of any other groups was 0. CONCLUSIONS:The PIB Gutong plaster is safe for trans-dermal administration.

Objective To investigate the safety and feasibility of the reversed π-shaped esophagojejunal anastomosis in laparoscope-assisted total gastrectomy (LATG) for gastric cancer (GC).Methods The retrospective corss-sectional study was conducted.The clinicopathological data of 18 GC patients who were admitted to the Subei People's Hospital of Jiangsu Province between January 2015 and October 2016 were collected.All the 18 GC patients underwent LATG,surgical procedures included free stomach and lymph node dissection firstly,side-to-side jejunal anastomosis secondly and laparoscopic gastrointestinal reconstruction using reversed π-shaped anastomosis finally.Observation indicators:(1) surgical situations:side-to-side jejunal anastomosis method,conversion to open surgery,operation time,reversed π-shaped anastomosis time,volume of intraoperative blood loss and number of lymph node dissected;(2) postoperative situations:time for initial out-of-bed activity,time to initial anal exsufflation,time for postoperative water intake,time of drainage tube removal,postoperative complications and duration of hospital stay;(3) postoperative pathological examination;(4) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect diet intake,anastomosis patency,gastrointestinal obstruction and patients' survival up to March 2017.Measurement data with normal distribution were represented as (x)±s.Results (1) Surgical situations:18 patients underwent successful LATG and reversed π-shaped esophagojejunal anastomosis,without conversion to open surgery and perioperative death.Five patients used in vitro hand-sewn side-to-side esophagojejunal anastomosis through small incision of specimens sampling,and 13 completed all surgery under laparoscopy.Operation time,reversed π-shaped anastomosis time,volume of intraoperative blood loss and number of lymph node dissected of 18 patients were (187±12)minutes,(37±5) minutes,(735±18)mL and 29±2,respectively.(2) Postoperative situations:time for initial out-of-bed activity,time to initial anal exsufflation,time for postoperative water intake and time of drainage tube removal in 18 patients were (1.6±0.5) days,(2.3±0.4) days,(2.5±0.5) days and (7.5± 1.5) days,respectively.One patient complicated with esophagojejunal anastomosis fistula at postoperative day 3 was cured by drainage and symptomatic treatment and then discharged from hospital.Eighteen patients received regularly angiography using oral water-soluble contrast medium after recovering fluid diet intake,showing anastomosis patency and no contrast medium leakage,and then discharged from hospital.Duration of hospital stay of 18 patients was (12± 11) days.(3) Postoperative pathological examination:of 18 patients,15 were diagnosed with adenocarcinoma and 3 with signet-ring cell carcinoma.T2,T3 and T4 of T staging were respectively detected in 3,3 and 12 patients.N0,N1,N2 and N3 of N staging were respectively detected in 8,3,2 and 5 patients.Stage Ⅰ,Ⅱ and Ⅲ of TNM stage were detected in 3,5 and 10 patients,respectively.(4) Follow-up and survival situations:17 of 18 patients were followed up for 6-25 months,with a median time of 12 months.During the follow-up,2 patients were complicated with sour regurgitation and vomiting after eating at month 6 and 12 postoperatively and received gastrointestinal contrast examination,showing anastomotic stenosis,and then were cured by endoscopic dilation and discharged form hospital.Other patients had good diet and survival,without anastomotic complications.Conclusion The reversed π-shaped esophagojejunal anastomosis in LATG for GC is safe and feasible,with good short-term outcomes.

OBJECTIVETo investigate the treatment of postoperative chyle leak after surgery for digestive malignancies.

METHODSFrom December 2008 to February 2012, in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University, clinical data of 19 patients with chyle leak after digestive system cancer surgery were retrospective analyzed.

RESULTSNineteen cases of chyle leak were all identified between the second and the fourth postoperative day and were all initially managed with conservative treatment including early fasting, parenteral nutrition(PN), 24-hour continuous infusion of somatostatin, and low pressure suction drainage. Eight patients were treated successfully for 6 to 10 days with a significant reduction of the daily drainage volume. Ten patients had enteral nutrition(EN) and their drain tubes were repeatedly washed with 30 ml of compound meglumine diatrizoate injection every day until the drainage volume decreased to 200 ml/day. The time to resolution of chyle leak in these ten patients ranged from 12 to 24 days. One patient had no significant decrease in fluid drainage and developed abdominal distension after one week of conservative treatment. Surgical closure of chyle leak was performed on the 11th postoperative day, abdominal cavity drainage tube was removed on the 4th postoperative day. The patient was discharged home in good condition.

CONCLUSIONMost postoperative chyle leak after surgery for digestive malignancies can be successfully managed with conservative treatment. Somatostatin and the drainage are the main therapeutic approaches. When chyle leak is not resolved with conservative treatment, surgical treatment should be considered to prevent serious complications.

Adult ; Aged ; Anastomotic Leak ; therapy ; Chyle ; Digestive System Neoplasms ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Retrospective Studies