Mini-nutrition assessment, malnutrition, and postoperative complications in elderly Chinese patients with lung cancer.

PURPOSE: To assist healthcare professionals in using the mini nutrition assessment (MNA) and its short-form (MNASF) for early identification of malnourished elderly lung cancer patients, conducting preoperative nutritional support, and improving patients' postoperative prognosis, quality of life, and survival. METHODS: The MNA with revised cut-off points to better suit the Chinese population was conducted on 103 elderly lung cancer Chinese patients aged 60 or above in the Tianjin Cancer Hospital prior to their scheduled surgery. Patient demographic data, anthropometric parameters, biochemical markers, and postoperative complications were collected and analysed. RESULTS: Of the 103 patients studied 12.6% (13/103) were malnourished, 31.1% (32/103) were at risk of malnutrition, and 56.3% (58/103) had adequate nutrition; the average MNA score was 23.6±3.7. Significant positive correlations were found between total MNA score and body mass index (BMI), mid-arm circumference (MAC), calf circumference (CC), and hemoglobin (Hb) (p<0.05), as well as between total MNA-SF score and BMI, MAC, CC, and total MNA score. Significant negative correlations occurred between total MNA-SF score and age (p<0.05). Among postoperative complications, cardiovascular diseases had the highest morbidity rate (23%), followed by respiratory diseases (22%), and cardiovascular and respiratory diseases combined (19%). No significant relationship between nutritional status with types of morbidity (p=0.235) and postoperative complications (p=0.362) was found. CONCLUSION: The MNA scale is an effective tool to preoperatively evaluate the nutritional status of elderly Chinese patients with lung cancer. These patients have poor nutritional status. Further investigations are needed to re-examine the correlation between the MNA results and postoperative complications.

Preliminary analysis of factors influencing organ donation rates in China.

In recent years, the People's Republic of China has experienced advancements in organ transplant surgical techniques, growing transplant waiting lists, and stagnant organ donation rates. All of these factors have pressured China to find ways to increase brain-dead cadaveric donation rates to narrow the gap between organ supply and demand. The objective of this work was to review the factors influencing brain-dead cadaveric donation rates in China including legislation, brain-death criteria, and clinical practice as well as cultural and public attitudes toward brain death and organ donation, for comparisons with other countries.

Acute abdominal pain and urgency to defecate in the young and the old: a useful symptom-complex?

In the belief that "pattern recognition" is an important first step of the diagnostic process, we report our observation of an uncommon and heretofore poorly documented symptom-complex in 10 patients, and suggest that the constellation of abdominal pain and urgency to defecate in the acutely ill surgical patient should raise the diagnostic possibility of intra-abdominal bleeding. In our experience, this is statistically likely to be associated with a ruptured abdominal aortic aneurysm in the old and a ruptured ectopic pregnancy in the young.

Traumatic pseudoaneurysm of the hepatic artery after percutaneous liver biopsy and laparoscopic cholecystectomy in a patient with biliary cirrhosis: a case report.

Hemobilia is a rare but recognizable complication of percutaneous transhepatic diagnostic or therapeutic procedures. The diagnosis is sometimes difficult because of the time lag between the procedure and the first symptoms, which can be intermittent. A 35-year-old woman had hemobilia after percutaneous Trucut biopsy of the liver followed by laparoscopic cholecystectomy. The diagnosis of hemobilia was made on clinical grounds, and a pseudoaneurysm of the right hepatic artery was detected on selective angiography. The patient was successfully treated with arterial embolization during angiography.

Pseudoaneurysm secondary to pancreatitis presenting as GI bleeding.

Pseudoaneurysm formation is a rare but potentially dev approximately astating complication of pancreatitis. It can be diag approximately nosed by using various imaging modalities including computer tomography, ultrasound, and angiography and should be entertained in any patient with a history of pancreatitis. We present the imaging findings in three patients with pseudoaneurysm formation secondary to pancreatitis who initially presented with gastrointestinal bleeding.

A simple method for endoscopic placement of a nasoduodenal feeding tube.

The key to short-term enteral feeding in patients with gastroparesis is to deliver the nutrition beyond the pylorus. Endoscopic assisted methods allow the precise placement of the feeding tube to the small bowel. However, the main difficulty in association with these procedures is feeding-tube migration into the stomach during the withdrawal of the endoscope. We have developed an endoscopic method with a high success rate which prevents this problem. A reusable angiocatheter guidewire was threaded through the feeding tube, passing beyond the distal opening prior to the withdrawal of the scope. Counterpressure was applied to the feeding tube during the withdrawal of the endoscope. We have successfully placed feeding tubes in 22 out of 23 patients with no complications.

Intra-arterial fibrinolytic treatment for mesenteric arterial embolus: a case report.

The diagnosis of mesenteric ischemia is based on acute clinical awareness of the condition and confirmed by angiography or laparotomy. The standard treatment is abdominal exploration with resection of the gangrenous segment of the bowel or embolectomy of the superior mesentery artery, or both. Alternative treatment such as intra-arterial thrombolysis may be considered in selected patients. A 66-year-old man with a history of atrial fibrillation presented with abdominal pain. Angiography documented an embolus in both the ileocolic artery and a branch of the right renal artery. The patient was treated with selective intra-arterial infusion of streptokinase. The abdominal pain resolved. Repeat angiography showed lysis of both emboli.

Gastrointestinal perforation or vascular injury? A diagnostic dilemma for computed tomography in blunt abdominal trauma.

The authors describe an unconscious 20-year-old woman with Crohn's disease who was examined after a motor vehicle accident. During dynamic computed tomography after intravenous and oral administration of contrast material, contrast agent was observed in the peritoneal cavity. The source of the free contrast material was active bleeding, but it was initially mistaken for extravasation from the bowel. Exploratory laparotomy revealed transection of the superior mesenteric vein.

Perforated colonic carcinoma mimicking perforated peptic ulcer: an argument for full exploration of the stomach and duodenum.

Perforated peptic ulcer is one of the commonest types of hollow-viscus perforation. Because many of these ulcers are found at laparotomy to be sealed off, some authors believe it is unnecessary to dissect the surrounding tissue from the presumed site of perforation. A patient with a long history of peptic ulcer disease experienced the sudden onset of signs and symptoms of perforated peptic ulcer. On exploration, the omentum appeared to be densely adherent to the pylorus and duodenum. However, no perforation was found when the omentum was dissected free from the stomach and duodenum. Further exploration revealed a walled-off, perforated carcinoma of the transverse colon adjacent to the mesenteric border. As a result of this experience, the authors emphasize that when the findings at operation do not fit the clinical presentation in a patient with a presumed perforated peptic ulcer, a thorough exploration of the abdominal viscera is mandatory to identify the pathologic process.

Pulmonary metastases from adrenal cortical carcinoma: results of resection.

Adrenal cortical carcinoma is uncommon. There is little controversy concerning treatment of the primary tumor. However, data concerning the treatment of pulmonary metastases are sparse. In order to assess the results of therapy, we reviewed our 14-year experience. Records of 24 patients admitted to our institution from 1973 to 1991 with the diagnosis of adrenal cortical carcinoma and pulmonary metastases were reviewed. Ten patients underwent pulmonary resection, 12 received chemotherapy, and 2 no therapy. In the pulmonary resection group, treatment consisted of wedge resection in 8 patients and lobectomy in 2. For the 10 patients undergoing resection of their pulmonary metastases, the 5-year survival was 71% (median not reached at 5 years). This was significantly longer than those not resected, with no one alive at 3 years (median survival 11 months). Our data suggest that those patients who are able to have their pulmonary metastases resected survive significantly longer than those who do not.

Actions of GIP.

Two structurally similar peptides were isolated from a preparation of GIP using an HPLC system. The major peptide corresponds to GIP1-42 and the minor has the sequence GIP3-42. GIP1-42 has both insulinotropic and somatostatinotropic activities, whereas GIP3-42 has only insignificant activity. GIP was also shown to potentiate insulin release initiated by D-glyceraldehyde, L-leucine/L-glutamine and 2-keto-isocaproic acid. No potentiation was observed with 2-ketocaproate. The 4 substrates studied are all metabolized but via different mechanisms.