PURPOSE: Ostomy takedown is often considered a simple procedure without intention; however, it is associated with significant morbidity. This study is designed to evaluate factors predicting postoperative complications in the ostomy takedown in view of metabolism and nutrition. METHODS: A retrospective, institutional review-board-approved study was performed to identify all patients undergoing takedown of an ostomy from 2004 to 2010. RESULTS: Of all patients (150), 48 patients (32%; male, 31; female, 17) had complications. Takedown of an end-type ostomy showed a high complication rate; complications occurred in 55.9% of end-type ostomies and 15.7% of loop ostomies (P < 0.001). Severe adhesion was also related to a high rate of overall complication (41.3%) (P = 0.024). In preoperative work-up, ostomy type was not significantly associated with malnutrition status. However, postoperatively severe malnutrition level (albumin <2.8 mg/dL) was statistically significant in increasing the risk of complications (72.7%, P = 0.015). In particular, a significant postoperative decrease in albumin (>1.3 mg/dL) was associated with postoperative complications, particularly surgical site infection (SSI). Marked weight loss such as body mass index downgrading may be associated with the development of complications. CONCLUSION: A temporary ostomy may not essentially result in severe malnutrition. However, a postoperative significant decrease in the albumin concentration is an independent risk factor for the development of SSI and complications.
Albumins ; Body Mass Index ; Female ; Humans ; Male ; Malnutrition ; Nutrition Assessment ; Ostomy ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Weight Loss

PURPOSE: Treatment for malignant colonic obstruction consists of a multiple-staged emergency operation. In recent years, some authors have reported low morbidity and mortality rates using self-expandable metallic stents. This study is designed to evaluate the usefulness of self-expandable metallic stents in patients with malignant colonic obstruction. METHODS: The records of 38 patients who had undergone surgery for malignant colonic obstruction at our institution between January 2004 and August 2006 were reviewed retrospectively. Seventeen patients were treated with elective surgery after stent insertion, bowel decompression, and bowel preparation (stent group), and 21 patients were treated with emergency surgery without stent insertion (control group). RESULTS: There were no significant differences in age, sex, tumor node metastasis (TNM) stage, or cancer position between the two groups (elective operation after stent insertion vs. emergency operation). Of the 17 patients who underwent elective operation after stent insertion, primary anastomosis was possible in 15 (88.2 vs. 57.1% in the control group), with a lower need for a colostomy (11.8 vs. 42.9% in the control group, P=0.036). Also, the number of patients with severe complications (17.6 vs. 47.6% in the control group, P=0.048) and the hospital stay (10.82 vs. 13.43 days in the control group, P=0.032) were significantly lower in the study group. CONCLUSION: Placement of a self-expandable metallic stent for malignant colonic obstruction is a safe and effective procedure. It can reduce the colostomy, mortality, and morbidity rates and the hospital fee for treatment.
Colon ; Colostomy ; Decompression ; Emergencies ; Fees and Charges ; Humans ; Length of Stay ; Neoplasm Metastasis ; Retrospective Studies ; Stents

Although rare, traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration present substantial diagnostic and management challenges for surgeons. Between February 2004 and February 2006, six patients were treated for traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration at the Department of Surgery, Chonnam National University Hospital. All six patients underwent a diverting colostomy, primary repair, and presacral a drainage, but only three cases underwentva a sphincteroplasty. Three patients who underwent a sphincteroplasty had normal findings on anorectal manometry. Traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration have a high morbidity rate and a great influence on the quality of life. Thus, such injuries require aggressive management, and treatment modalities should be tailored to the individual case.
Anal Canal ; Colostomy ; Drainage ; Humans ; Lacerations ; Manometry ; Muscles ; Quality of Life ; Rectum

OBJECTIVETo discuss and analyze the feasibility and strategy for perform the newborn gene screening in the process of newborn hearing screening in order to supply the defects or limitation in the hearing screening.

METHODSFour hundreds and sixty newborn babies from December 2006 to April 2007 accepted the simultaneous hearing and gene screening. Otoacoustic emission (OAE) was used for the first step hearing screening and OAE combined with auto auditory brainstem response (AABR) detection for the second step screening. Newborn genetic disease screening cards were used for collecting the blood spot from the umbilical cord within the moment of newborn. The cards could be directly performed the polymerase chain reaction (PCR) for screening the mitochondrial 12SrRNA 1555G and GJB2 as well as SLC26A4 genes mutations. The restriction enzyme Alw26I was used to recognize the point mutation of 12SrRNA A1555G. The samples with the possible 12SrRNA A1555G mutation were then sequenced to verify. The PCR products from the GJB2 coding region and SLC26A4 IVS7-2A > G hot spot region were sequenced directly. The software of DNAStar was used to analysis the sequence.

RESULTSThe first step of hearing screening of 460 newborn babies showed " refer" on the left ear of nine babies and on the right ear of three babies. Seven showed "refer" on bilateral with the the total of babies 19. After 42 days, they accepted the second step for hearing screening. 16 of the 19 were showed "pass" with OAE and AABR. One baby showed "pass" on the left ear, "refer" on the right ear with the OAE detection but bilateral "pass" with AABR. Two babies failed to accept the re-examination. The newborn gene screening showed five of the 460 babies had the positive response on the A1555G restriction enzyme assay. Of the five babies, one was proved to be the 12SrRNA A1555G mutation and three were the C1556T mutations and one sequence was normal. For the SLC26A4 gene screening, five were the heterozygote of IVS7-2A > G mutation were found and one was carrier the polymorphism of IVS7-18T > G and another was IVS6-62_63insGT heterozygote carrier. For the GJB2 gene screening, eight were 235delC heterozygote carriers, four were G109A heterozygote carriers. All the gene screening found 23 newborn babies of the 460 harbored the changes in the three genes. Of those, one was the 12SrRNA A1555G. pathogenic mutation and 13 were pathogenic heterozygote carriers, nine were the polymorphisms. It was worth to pay more attentions that A1555G mutation was found in the baby whose hearing screening was "pass" in the hearing screening as well as the 13 heterozygote carrier for GJB2 and SLC26A4 gene.

CONCLUSIONSIt might be one of the powerful strategy for adding the concept of newborn gene screening into the hearing screening for the purpose of early diagnosis and discovery the prelingual or late-onset or the high risk as well as the pathogenic carriers. On the basis of the research progress, it was necessary to develop the national newborn gene screening into the process of newborn hearing screening.

Connexins ; Evoked Potentials, Auditory, Brain Stem ; Female ; Hearing Disorders ; diagnosis ; genetics ; prevention & control ; Hearing Tests ; Humans ; Infant, Newborn ; Male ; Neonatal Screening ; Point Mutation

Baicalein (BAI) is an effective bactericide. The antibacterial activity and mechanism experiments were carried out by determining conductivity and content of macromolecules of membrane penetrability, the oxidative respiratory metabolism and protein synthesis changes and the inhibition of DNA topoisomerase activities. Electrical conductivity and the number of large molecules of BAI increased 2.48% and 1.8%, respectively, than that of the control. However, the membrane integrity did not destroyed by BAI directly. With BAI treatment, inhibition rates of activities for SDH and MDH were 56.2% and 57.4%, respectively, demonstrating that BAI could inhibit cell respiratory. After treated with BAI for 20 h, the total soluble content of proteins decreased by 42.83%. Moreover, the activities of DNA topoisomerase I and II were inhibited completely by 0.2 mmol x L(-1) BAI. These results indicated that BAI had obvious antibacterial activity on Staphylococcus aureus. The mechanism is that it could affect bacterial membrane penetrability, inhibit protein synthesis and influence SDH, MDH and DNA topoisomerase I and II activities to exert its antibacterial functions.
Anti-Bacterial Agents ; isolation & purification ; pharmacology ; Bacterial Proteins ; metabolism ; Cell Membrane Permeability ; drug effects ; DNA Topoisomerases, Type I ; metabolism ; DNA Topoisomerases, Type II ; metabolism ; Flavanones ; isolation & purification ; pharmacology ; Malate Dehydrogenase ; metabolism ; Plant Roots ; chemistry ; Plants, Medicinal ; chemistry ; Scutellaria baicalensis ; chemistry ; Solubility ; Staphylococcus aureus ; cytology ; drug effects ; metabolism ; Succinate Dehydrogenase ; metabolism

OBJECTIVETo explore the relationship between abdominal fat volume and obstructive sleep apnea hypopnea syndrome in obesity people.

METHODSFrom July 2009 to July 2010, 50 patients with BMI > 25 were prospectively selected for study from the patients who complained of snoring in the Respiratory department. The patients were divided into OSAHS group and non-OSAHS group according to the result of sleep apnea monitoring. All the patients also received full abdominal CT and the whole abdominal fat volume was measured by 3-D CT reconstruction system. SPSS 13.0 was used for statistical analysis.

RESULTSThe whole abdominal fat volume in the two groups was analyzed by T- test, which was significantly different between the two groups (P < 0.01). It showed that there was a statistical relationship between OSAHS and abdominal fat in obesity people.

CONCLUSIONIn obesity people, OSAHS has a close relationship with abdominal fat volume. The abdominal fat volume is markedly higher in OSAHS patients than that in non-OSAHS people.

Abdominal Fat ; diagnostic imaging ; Adult ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Obesity ; diagnostic imaging ; Prospective Studies ; Radiography ; Sleep Apnea, Obstructive ; epidemiology

OBJECTIVETo evaluate the feasibility of the fibreoptic intubating laryngeal mask airway (LMA) CTrach (CTrach) in anticipated difficult airway caused by face and neck scar contracture.

METHODSTotally 33 patients undergoing selective face and neck scar plastic surgery and requiring general anesthesia were enrolled in our study. After anesthesia induction, the CTrach was inserted and the viewer was attached, which allowed fibreoptic visualization of the larynx before and during passage of the tracheal tube through the vocal cords. The duration and the success rates of CTrach insertion, tracheal intubation, and CTrach removal were recorded. The view of glottis on viewer and the adjusting maneuvers for improving the laryngeal view were recorded. Noninvasive blood pressures and heart rates were recorded before and after anesthesia induction and at CTrach insertion, tracheal intubation, and CTrach removal.

RESULTSThe CTrach was successfully inserted in all patients, among whom 4 patients succeeded at the second attempt. The full view of glottis were shown in 10 patients, while partial view and no view of glottis were shown in 8 and 15 patients, respectively. The good view of glottis was achieved by adjusting manoeuvres. Tracheal intubation via the CTrach was successful in 27 patients at the first attempt and in 6 patients at the second attempt. Hemodynamic changes during the performance with the CTrach were minimal.

CONCLUSIONSThe CTrach can be easily inserted, with clear view and high success rate of tracheal intubation. Therefore, it is an effective way to resolve difficulty intubation caused by face and neck scar contracture.

Adolescent ; Adult ; Cicatrix ; complications ; surgery ; Contracture ; etiology ; surgery ; Face ; Female ; Fiber Optic Technology ; methods ; Humans ; Intubation, Intratracheal ; instrumentation ; methods ; Laryngeal Masks ; Male ; Middle Aged ; Neck ; Young Adult

OBJECTIVETo observe the clinical effectiveness of inductions and tracheal intubating conditions with 3% sevoflurane and different doses of remifentanil without muscle relaxant in children.

METHODSTotally 120 peadiatric patients (aged 4-10 years, American Society of Anesthesiologists grade I for inhalational induction) were randomly allocated into group I (remifentanil 1 microg/kg), group II (remifentanil 2 microg/kg), group III (remifentanil 3 microg/kg), and control group (vecuronium bromide 0.1 mg/kg). After inhalational induction with 3% sevoflurane and 60% nitrous oxide in 40% oxygen for 2 minutes, remifentanil 1 microg/kg, 2 microg/ kg, and 3 microg/kg were intravenously injected over 1 minute into patients in group I , group II, and group III, respectively. After remifentanil administration and manual ventilation for 1 minute, the trachea was intubated. In the control group, 2 minutes after intravenous administration of vecuronium bromide 0.1 mg/kg, tracheal intubation was attempted. Agitation, intubating satisfactoriness, and the circulation changes after tracheal intubation and anesthesia induction were observed.

RESULTSIn these four groups, agitation occurred in 37.5% of patients during sevoflurane induction. Satisfactory intubation rate was 70.0% in group I, 86.7% in group II, 90.0% in group III, and 93.3% in the control group. Compared with the control group, the impact of tracheal intubation on the circulatory system was smaller in group I , II , and III.

CONCLUSIONSInduction with 3% sevoflurane combined with remifentanil can be smoothly performed, followed by the successful tracheal intubation. The intubating conditions are more satisfactory with 3% sevoflurane combined with remifentanil 2 microg/kg or 3 microg/kg.

Anesthesia, Inhalation ; Anesthetics, Inhalation ; administration & dosage ; Child ; Child, Preschool ; Dose-Response Relationship, Drug ; Female ; Humans ; Intubation, Intratracheal ; adverse effects ; Male ; Methyl Ethers ; administration & dosage ; Piperidines ; administration & dosage

OBJECTIVETo evaluate the influence of different salt iodine concentration on urinary iodine excrition among the target population and to determine the appropriate level of salt iodization to the local people.

METHODSIn the 31-day random control trial, 1099 subjects from 399 families were randomly distributed into four groups and were supplied with iodized-salt with different iodine concentration of (6 +/- 2)mg/kg, (15 +/- 2)mg/kg, (24 +/- 2)mg/kg and (34 +/- 2)mg/kg, respectively. The original family salt was retrieved, whose iodine content was determined in those subjects' families with single-blind method. Baseline survey was conducted including salt and urinary iodine of the subjects. From the 27th day after the intervention, the urinary samples of the subjects were continuously collected for 5 days and urinary iodine was tesed respectively. Meanwhile, daily meal investigation was conducted to evaluate the influences originated from food.

RESULTSThe median of local water iodine content was 3.05 microg/L and the average salt iodine concentration was (36.4 +/- 5.4)mg/kg while 98.8% of the household consumed sufficient iodized-salt. The medians of baseline urinary iodine of the subjects were 293.6 microg/L in city, and 508.8 microg/L in the countryside. The urinary iodine medians of four groups in the day of 28th after intervention were 97.2 microg/L, 198.6 microg/L, 249.4 microg/L, and 330.7 microg/L respectively in the city group, while they were 100.5 microg/L, 193.0 microg/L, 246.3 microg/L and 308.3 microg/L seperately in the countryside group. There was no statistically significant differences among the medians of urine iodine in the 27th, 28th, 29th, 30th and 31st day after intervention (P > 0.05).

CONCLUSIONSThe target areas were with iodine deficiency which possessed high coverage of qualified iodized-salt at household level. The average urinary iodine level of the subjects was slightly higher than the standard level, according to the baseline survey. The intervetion trail showed that the salt iodine concentration of 15-24 mg/kg was sufficient to the local people.

Adolescent ; Adult ; Child ; Child, Preschool ; Dose-Response Relationship, Drug ; Female ; Housing ; Humans ; Iodine ; deficiency ; pharmacology ; urine ; Male ; Pregnancy ; Sodium Chloride, Dietary ; pharmacology ; Time Factors

Adult ; Cerebral Infarction ; etiology ; prevention & control ; Female ; Humans ; Immunosuppressive Agents ; adverse effects ; Intracranial Hemorrhages ; etiology ; prevention & control ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Tacrolimus ; adverse effects