RESUMO
The interaction between probiotic bacteria and polyphenol antioxidants can potentially enhance animal health. The present study examined the effects of propyl gallate and Lactobacillus plantarum supplementation on the growth, intestinal morphology, antioxidant capacity, and immune functions of Pekin ducks. A total of 128 male Pekin ducks (7-day-old) were allocated to four treatment groups with four replicates of eight birds each. The ducks were fed the corn-soybean based diet (the control), supplemented with either propyl gallate (100 mg/kg), Lactobacillus plantarum (4 × 109 CFU/kg), or both, for 5 weeks. Dietary supplementation with propyl gallate and Lactobacillus plantarum had no significant effect on feed intake (P > 0.05), but increased average daily gain (P < 0.05). Lactobacillus plantarum also reduced the feed/gain ratio (P < 0.05). Villus height (VH) in the duodenum and ileum was increased by supplementation, while only propyl gallate supplement increased VH in the jejunum (P < 0.05). Supplementation had no effect on small intestine crypt depth (P > 0.05). Enhanced total superoxide dismutase activity was observed with supplementation (P < 0.05), but no effects were seen on catalase, malondialdehyde, total antioxidant capacity, and glutathione peroxidase values (P > 0.05). Serum immunoglobulin G was increased with Lactobacillus plantarum (P < 0.05), but not with propyl gallate (P > 0.05). No change in IgA and IgM concentrations was observed with supplementation. In conclusion, dietary supplementation with propyl gallate, Lactobacillus plantarum, or both, enhanced the villus height of the small intestines, improving the growth rate of Pekin ducks. The synergistic effects of both propyl gallate and Lactobacillus plantarum on the villus height and serum total superoxide dismutase activity surpassed the individual effects of each supplement in Pekin ducks.
Assuntos
Ração Animal , Antioxidantes , Dieta , Suplementos Nutricionais , Patos , Lactobacillus plantarum , Probióticos , Galato de Propila , Animais , Patos/crescimento & desenvolvimento , Patos/imunologia , Patos/microbiologia , Antioxidantes/metabolismo , Masculino , Suplementos Nutricionais/análise , Ração Animal/análise , Dieta/veterinária , Galato de Propila/farmacologia , Galato de Propila/administração & dosagem , Probióticos/farmacologia , Probióticos/administração & dosagem , Intestinos/efeitos dos fármacos , Intestinos/anatomia & histologiaRESUMO
Objective: To investigate the treatment method and effect of surgical resection and free flap repair of recurrent malignant tumors of maxillofacial paranasal sinus and skull base. Methods: The clinical data of 9 patients with recurrent maxillofacial paranasal sinus and skull base malignant tumors who underwent surgical resection and free flap repair in the Department of Otorhinolaryngology Head and Neck Surgery of Shandong Provincial Hospital from August 2009 to May 2019 were analyzed retrospectively, including 5 males and 4 females, aged 32-69 years. There were 4 cases of squamous cell carcinoma, 3 cases of adenoid cystic carcinoma, 1 case of myoepithelial carcinoma and 1 case of malignant fibrous histiocytoma. All patients were repaired with anterolateral femoral flap. The treatment process and postoperative effect were analyzed by descriptive statistics. Results: All patients were followed up from 16 months to 6 years. There were 6 cases of recurrence after operation, including 1 case of local recurrence and 5 cases of skull base and craniocerebral recurrence. The median tumor free survival time of recurrent patients was 35 months. Conclusion: Surgical resection and free flap repair can effectively prolong the life of patients with recurrent maxillofacial paranasal sinus and skull base malignant tumors.
Assuntos
Carcinoma de Células Escamosas , Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Base do Crânio/cirurgiaRESUMO
Objective:To discuss the changes and rules of nighttime blood pressure in obstructive sleep apnea(OSA) patients without hypertension.Method:Eighty-nine non-hypertensive patients whose office blood pressure was lower than 130/85 mmHg and diagnose with OSA by PSG in sleep monitoring room were choose as the research group.Forty non-hypertensive and polyp of vocal cord or vocal nodules patients whose office blood pressure was lower than 130/85 mmHg and diagnose with non-OSA by PSG were choose as matched group.All the patients were in treatment in our hospital from December 2017 to June 2018. All the patients got PSG,and the same time got the ambulatory blood pressure monitoring based on pulse transit time all night.Compared the mean value of systolic blood pressure,the mean value of diastolic blood pressure.Higher than 12 mmHg blood pressure rise index,the mean rise in blood pressure. The highest increase in blood pressure, maximum systolic pressure between the study group and the marched group all night.Result:The difference of all the test index between the study group and the marched group was significant(P<0.05).In OSA patients.The difference of all the test index between the severe OSA group and the mild OSA group or the moderate OSA group was significant(P<0.05).In severe OSA group.The difference between the fluctuation of blood pressure caused by respiratory events and spontaneous blood pressure fluctuation was significant(P=0.004).The difference of the mean value of diastolic blood pressure(P=0.032) blood pressure rise index(P=0.037) the mean rise in blood pressure(P=0.045) between age 55 or older patients and under 55years old patients.Conclusion:Ambulatory blood pressure monitoring synchronizatied in PSG contribute to the early diagnosis and prevention of hypertension in OSA patients.
Assuntos
Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Apneia Obstrutiva do Sono/diagnóstico , Correlação de Dados , Humanos , HipertensãoRESUMO
Axillary branching is controlled by a very complex mechanism involving various endogenous and environmental factors. Previous studies have shown that Tb1/BRC1 is the point of integration in the network of molecular mechanisms regulating axillary branching in plants. In this study, we cloned the Tb1/BRC1 ortholog, NtBRC1, from Nicotiana tabacum and functionally analyzed its role in the control of axillary branching in tobacco. Overexpression of NtBRC1 resulted in significant retardation of axillary branching, and downregulation of this gene resulted in significant acceleration of axillary branching after decapitation. This indicates a negative role for this gene in the regulation of axillary branching. In-line with previous reports, NtBRC1 was found to be expressed predominantly in axillary buds. Additionally, as expected, expression was decreased 8 h following decapitation, which further confirms its role in the suppression of axillary branching. Furthermore, the expression of NtBRC1 was significantly downregulated by cytokinin, but was not affected by GR24, a synthetic strigolactone. Based on the data collected in the present study, we demonstrate that NtBRC1 negatively regulates axillary branching in tobacco after decapitation and functions downstream of the cytokinin signaling pathway inside axillary buds.
Assuntos
Nicotiana/fisiologia , Proteínas de Plantas/genética , Fatores de Transcrição/genética , Clonagem Molecular , Citocininas/farmacologia , Regulação da Expressão Gênica de Plantas/efeitos dos fármacos , Lactonas/farmacologia , Nicotiana/genéticaRESUMO
A serine/threonine protein kinase gene (NrSTK) was cloned from Nicotiana repanda based on the sequence of a previously isolated resistance gene analog (RGA). Expression of RGA was induced by challenge with the pathogen black shank. The NrSTK gene was predicted to encode a protein kinase that contained an ATP binding site at residues 41-69 and a serine/threonine protein kinase activation sequence spanning the region 161-173. Overexpression of NrSTK in the susceptible tobacco variety Honghuadajinyuan significantly enhanced resistance to black shank, indicating that NrSTK plays a role in incompatibility reactions between tobacco and the pathogen. Characterization of NrSTK will help elucidate the molecular mechanisms involved in black shank resistance in N. repanda.
Assuntos
Resistência à Doença/genética , Nicotiana/genética , Doenças das Plantas/genética , Proteínas Serina-Treonina Quinases/genética , Sequência de Aminoácidos , Sequência de Bases , Clonagem Molecular , DNA Complementar , Dados de Sequência Molecular , Filogenia , Plantas Geneticamente Modificadas , Alinhamento de Sequência , Análise de Sequência de DNARESUMO
BACKGROUND: Growth arrest and DNA damage-inducible gene 153 (GADD153), an apoptosis regulated gene, increased during endoplasmic reticulum stress. However, the expression of GADD153 in cardiomyocytes under mechanical stress is little known. We aimed to investigate the regulation mechanism of GADD153 expression and apoptosis induced by mechanical stress in cardiomyocytes. MATERIALS AND METHODS: Aorta-caval shunt was performed in adult Sprague-Dawley rats to induce volume overload. Rat neonatal cardiomyocytes grown on a flexible membrane base were stretched by vacuum to 20% of maximum elongation, at 60 cycles min(-1). RESULTS: The increased ventricular dimension measured using echocardiography in the shunt group (n = 8) was reversed to normal by treatment with chaperon 4-phenylbutyric acid (PBA) (n = 8) at 500 mg kg(-1) day(-1) orally for 3 days. GADD153 protein and mRNA were up-regulated in the shunt group when compared with sham group (n = 8). Treatment with PBA reversed the protein of GADD153 to the baseline values. The TUNEL assay showed that PBA reduced the apoptosis induced by volume overload. Cyclic stretch significantly increased GADD153 protein and mRNA expression after 14 h of stretch. Addition of c-jun N-terminal kinase (JNK) inhibitor SP600125, JNK small interfering RNA and tumour necrosis factor-alpha (TNF-alpha) antibody 30 min before stretch, reduced the induction of GADD153 protein. Stretch increased, while GADD153-Mut plasmid, SP600125 and TNF-alpha antibody abolished the GADD153 promoter activity induced by stretch. GADD153 mediated apoptosis induced by stretch was reversed by GADD153 siRNA, GADD153-Mut plasmid and PBA. CONCLUSIONS: Mechanical stress enhanced apoptosis and GADD153 expression in cardiomyocytes. Treatment with PBA reversed both GADD153 expression and apoptosis induced by mechanical stress in cardiomyocytes.
Assuntos
Miócitos Cardíacos/metabolismo , Estresse Mecânico , Fator de Transcrição CHOP/genética , Animais , Derivação Arteriovenosa Cirúrgica , Western Blotting , Volume Cardíaco , Células Cultivadas , Regiões Promotoras Genéticas , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos , Ratos Sprague-Dawley , Transdução de Sinais , Fator de Transcrição CHOP/metabolismo , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo , Regulação para CimaRESUMO
BACKGROUND: Gene and stem cell therapies hold promise for the treatment of ischaemic cardiovascular disease. However, combined stem cell and angiogenic growth factor gene therapy for acute ischaemic myocardium has not been previously reported. This study hypothesized that combined stem cell and gene therapy would not only augment new vessels formation but also improve myocardial function in acute ischaemic myocardium. METHODS: Human angiopoietin-1 (Ang1) cDNA and VEGF(165) cDNA were ligated into AAV vector. The purified CD34(+) cells were obtained from human umbilical cord blood samples. Cord blood CD34(+) cells were transduced with AAV vector encoding either the human Ang1 (AAV-Ang1) or VEGF(165) (AAV-VEGF) cDNA alone, or both (AAV-Ang1 plus VEGF). Immediately after ligation of the left anterior descending coronary artery in male SCID mice, culture-expanded CD34(+) cells transduced with AAV-Ang1, AAV-VEGF or AAV-Ang1 plus VEGF were injected intramyocardially at the left anterior free wall. RESULTS: Western blot showed that Ang1 and VEGF protein expressions were enhanced in the CD34(+)cells transduced with AAV-Ang1 and AAV-VEGF, respectively. Infarct size significantly decreased and capillary density significantly increased after treatment with CD34(+)/AAV-Ang1 plus VEGF when compared with treatment by CD34(+) only. Combined therapy with CD34(+) and AAV-Ang1, CD34(+) and AAV-VEGF, CD34(+) and AAV-Ang1 plus VEGF, all showed significantly higher cardiac performance in echocardiography than the therapy with CD34(+) alone 4 weeks after myocardial infarction. CONCLUSIONS: Combined therapy with human umbilical cord blood CD34(+) cells and both Ang1 and VEGF genes reduced infarct size, attenuated the progression of cardiac dysfunction and increased capillary density in acute myocardial infarction in mice.
Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical/métodos , Terapia Genética/métodos , Infarto do Miocárdio/terapia , Angiopoietina-1/análise , Animais , Antígenos CD34/metabolismo , Modelos Animais de Doenças , Coração/fisiopatologia , Humanos , Masculino , Camundongos , Camundongos SCID , Infarto do Miocárdio/fisiopatologia , Miocárdio/metabolismo , Neovascularização Patológica/fisiopatologia , RNA Mensageiro/análise , Transfecção , Fator A de Crescimento do Endotélio Vascular/análiseRESUMO
OBJECTIVE: Total lymphoid irradiation (TLI) has been used to treat rheumatoid arthritis (RA) since the 1970s. This study reviews long-term (15-20-year) mortality outcomes of patients treated with TLI for RA at Stanford University Medical Center and compares these outcomes with those in patients treated with disease-modifying antirheumatic drugs (DMARDs). METHODS: Fifty-three patients with RA were treated with full-dose TLI at Stanford University Medical Center. All had failed previous therapy with gold salts and penicillamine. One hundred six control patients were selected from the Arthritis, Rheumatism, and Aging Medical Information Systems database and were matched with the patients for age, sex, disease duration, and mean Health Assessment Questionnaire (HAQ) score. Survival was analyzed using Kaplan-Meier methods and Cox proportional hazards regression. RESULTS: No significant difference in age and sex was found between TLI-treated patients and controls. TLI-treated patients had more education (mean 13.4 years versus 11.8 years; P = 0.016) and received more DMARDs prior to TLI (mean 2.1 versus 1.3; P = 0.0001). TLI-treated patients had lower mean HAQ scores at the time of TLI (2.0 versus 2.4; P = 0.0002). TLI had no significant overall effect on survival in treated patients compared with controls (P = 0.62). The survival curves appeared to cross over at approximately 11 years of followup, with better early survival in the TLI group and better late survival in the control group. There was a total of 25 deaths in the TLI group. There were 45 deaths in the control group, with causes of death available for 20 patients. There were 3 patients with lymphoma and 2 with myelodysplastic syndrome in the TLI group, and none in the control group. The most common cause of death in both groups was infection. CONCLUSION: TLI had no significant effect on overall survival, with trends toward higher early mortality in controls and trends toward higher late mortality in TLI-treated patients. Overall, there was no difference in mortality, but it appears that there may have been more lymphoproliferative malignancies in the TLI cohort. We would recommend that TLI be used cautiously for patients with refractory RA in whom the benefits outweigh the risks.
Assuntos
Artrite Reumatoide/mortalidade , Artrite Reumatoide/radioterapia , Irradiação Linfática , Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise de SobrevidaRESUMO
BACKGROUND AND PURPOSE: Mechanical forces have profound effects on vascular smooth muscle cells (VSMCs). The mechanism by which mechanical stimuli regulate vascular endothelial growth factor (VEGF) expression and regulation has yet to be elucidated. We investigated the effect of cyclical mechanical stretching on regulation of the VEGF gene in VSMCs. MATERIALS AND METHODS: Cultured rat VSMCs grown on a flexible membrane base were stretched by applying a vacuum at 60 cycles/minute. VEGF concentration in the cultured media was determined by enzyme-linked immunoassay. VEGF gene expression was determined by Western blot and Northern blot. The location of VEGF in the VSMC was studied immunohistochemically. Chimeric constructs of the VEGF promoter were deleted and the promoter activity was determined by luciferase activity. RESULTS: VEGF concentration increased by 21 to 32% as early as 10 minutes after stretching and remained at this level for up to 12 hours. The concentration of VEGF reached a maximum of 2.8-fold over that in control cells by 2 hours after stretching and declined slightly thereafter. The amount of VEGF mRNA in stretched cells increased as early as 1 hour after stretching, reached a maximum of 3.2-fold over the amount in control cells by 2 hours, and remained at this level for up to 6 hours after stretching. Immunohistochemical study confirmed increased VEGF expression in VSMCs after stretching. Stretched cells transfected with a Sac-Nhe fragment showed only 46% of the luciferase activity of unstretched control cells. However, stretched cells transfected with chimeric plasmids containing a Spe-Nhe fragment showed 2.8-fold luciferase activity over that in control cells. CONCLUSIONS: Cyclical mechanical stretching upregulates expression of the VEGF gene in VSMCs at the transcription level. The VEGF 5'-flanking region contains a negative stretch-response element located in the 0.4-kb Sac-Pst fragment and a positive stretch-response element located in the 0.6-kb Spe-Sac fragment.
Assuntos
Fatores de Crescimento Endotelial/biossíntese , Linfocinas/biossíntese , Músculo Liso Vascular/metabolismo , Animais , Western Blotting , Células Cultivadas , Fatores de Crescimento Endotelial/genética , Ensaio de Imunoadsorção Enzimática , Expressão Gênica , Imuno-Histoquímica , Luciferases/genética , Luciferases/metabolismo , Linfocinas/genética , Masculino , Músculo Liso Vascular/fisiologia , Plasmídeos , RNA Mensageiro/análise , Ratos , Ratos Sprague-Dawley , Estresse Mecânico , Transfecção , Regulação para Cima , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio Vascular , beta-Galactosidase/genética , beta-Galactosidase/metabolismoRESUMO
BACKGROUND AND PURPOSE: Norepinephrine (NE) is elevated in heart failure and can induce apoptosis in adult cardiac myocytes. However, it is not known whether NE can induce apoptosis in neonatal cardiac myocytes. This study examined the ability of NE to stimulate apoptosis in rat neonatal cardiac myocytes in vitro. METHODS: Neonatal rat cardiac myocytes were exposed to NE alone, NE + propranolol, or NE + prazosin for 24 hours. Apoptosis was assayed by DNA laddering with agarose gel electrophoresis and immunofluorescent terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining. Reverse transcription polymerase chain reaction was used to evaluate the expression of Mcl-1. Creatine kinase activity in the cultured medium was used as a measure of the toxicity of NE on myocytes. RESULTS: NE increased DNA laddering on agarose gel electrophoresis and increased the number of apoptotic cells in a dose-dependent manner. No increase in apoptosis was found in response to NE doses between 1 and 50 mumol/L. NE at concentrations of 100 to 400 mumol/L increased apoptosis from 10% to 31% of cells. The ability of NE to stimulate apoptosis in rat neonatal cardiac myocytes was completely blocked by propranolol, but not prazosin. NE treatment at high concentrations sharply reduced the level of Mcl-1 mRNA, coincident with the increase in the number of apoptotic cells. Creatine kinase activity in the cultured medium was similar among the controls and NE-treated myocytes. CONCLUSIONS: Our results showed that NE at high concentrations stimulated apoptosis in rat neonatal cardiac myocytes in vitro. Apoptosis induced by NE was associated with down-regulation of Mcl-1. However, NE at the same concentration was not toxic to rat neonatal cardiac myocytes.
Assuntos
Apoptose/efeitos dos fármacos , Coração/efeitos dos fármacos , Norepinefrina/farmacologia , Proteínas Proto-Oncogênicas c-bcl-2 , Animais , Animais Recém-Nascidos , Creatina Quinase/metabolismo , Fragmentação do DNA , Relação Dose-Resposta a Droga , Proteína de Sequência 1 de Leucemia de Células Mieloides , Miocárdio/citologia , Proteínas de Neoplasias/genética , Ratos , Ratos WistarRESUMO
OBJECTIVE: To assess the risk factors that influence mortality from perforated peptic ulcer. DESIGN: Retrospective study. SETTING: General hospital, Taiwan. SUBJECTS: 179 patients who had their perforated peptic ulcers operated on and who had minimum follow-up of one year. MAIN OUTCOME MEASURES: Mortality. RESULTS: The overall mortality was 15% (26/179). Of the 26 patients who died, the cause of death was uncontrolled systemic infection in 21 (81%), hypovolaemic shock in 2, and fatal arrhythmia and heart failure in 1 each. 15 of the patients who died of sepsis did not have fulminant abdominal sepsis. Most deaths occurred early after operation, (range 1-96 days). Old age, preoperative shock, and type of operation seemed to be related to these deaths on univariate analysis, but multivariate analysis showed that coexisting medical illness, delayed treatment, and low albumin concentration were independent risk factors for mortality. CONCLUSIONS: To improve the result of treatment of perforated peptic ulcer, the diagnosis and treatment should not be delayed, the associated medical illnesses should be treated, and nutritional support should be given.
Assuntos
Úlcera Péptica Perfurada/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To examine the variation of alcohol extraction rates of Ganoderma lucidum spores with different rates of wall-wrack, and analyze the antitumor components of alcohol extract by chromatography. METHOD: The G. lucidum spores were soaked and extracted with absolute alcohol. The alcohol extract was chromatographed on a silica gel column and HPLC in proper order, and the antitumor activity of every eluted fraction was represented by its cytotoxicity towards Hela cells. RESULT: Extraction rates 5%, 25% and 33% corresponded to wall-wrack rates 0%, 60%-80% and 99% respectively. The alcohol extract from spores with the highest wall-wrack rate was chromatographed on a silica gel column, eluting successfully with CHCl3, EtOAc and CH3OH in order. The CHCl3 fraction had not any antitumor activity, while this activity of CH3OH fraction was 34 times greater than that of EtOAc fraction. HPLC analysis found out that two mixtures(II1 and II3) possess significant antitumor activity in vitro. CONCLUSION: The weight of alcohol extract from spores with wall-wrack was far greater than that of spores without. The antitumor components of G. lucidum spores could be analyzed with methanol-water on a reverse HPLC.
Assuntos
Antineoplásicos Fitogênicos/isolamento & purificação , Medicamentos de Ervas Chinesas/isolamento & purificação , Reishi/química , Antineoplásicos Fitogênicos/farmacologia , Cromatografia Líquida de Alta Pressão/métodos , Medicamentos de Ervas Chinesas/farmacologia , Células HeLa/efeitos dos fármacos , Humanos , Esporos/químicaRESUMO
BACKGROUND: We conducted a retrospective review of all early-stage breast cancer patients treated at the Veterans General Hospital-Kaohsiung to determine overall and disease-free survival rates, and to evaluate prognostic factors for these outcomes. METHODS: During the period of October, 1990, to December, 1997, 332 patients with early-stage breast cancer were treated at our institution. Cox's multivariate regression analysis was used to select prognostic factors significant for overall survival and disease-free survival. RESULTS: The survival rate for breast cancer patients was 88.35% at five years. Prognostic factors predicting breast cancer mortality included poorly differentiated histologic grade, four or more lymph nodes positive for metastasis and negative progesterone-receptor status. For disease recurrence, prognostic factors included positive nodes, aneuploidy and poorly differentiated histologic grading. CONCLUSIONS: We conclude that a combination of lymph node status, DNA ploidy, histologic grading and progesterone-receptor status help to evaluate the possible outcomes for patients with breast cancer and to plan for optimal therapy.
Assuntos
Neoplasias da Mama/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Neoplasias da Mama/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Receptores de Progesterona/análise , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
BACKGROUND: Laparoscopic herniorrhaphy (LH) shares the same repair principle as open preperitoneal prosthetic herniorrhaphy (PPH). Theoretically, the recurrence rate of LH for recurrent inguinal hernia will match the low recurrence rate of PPH (1.2-3%). METHODS: One-hundred forty-five cases of recurrent inguinal hernia were retrospectively studied between 1990 and 1994. Forty-two cases receiving LH were compared to 103 cases receiving PPH. RESULTS: There were no differences in operative time, hospital stay, morbidity rate, satisfaction scale and recurrence rate between the LH group and the PPH group. The LH group showed significantly less postoperative pain and 2 times shorter convalescence (p<0.01). Unsuspected asymptomatic contralateral hernia was found in 4.8% of patients receiving LH. 11.9% of patients had bilateral hernia repairing at the same time in the LH group. CONCLUSIONS: LH is suitable for recurrent inguinal hernia, but further investigation of this technique is required before its wide application.
Assuntos
Hérnia Inguinal/cirurgia , Laparoscopia , Telas Cirúrgicas , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Estudos RetrospectivosRESUMO
BACKGROUND: Operating for bleeding gastric ulcer remains controversial. Gastric resection bears a higher surgical risk while limited operation may result in more postoperative hemorrhage. There has been little discussion of effective risk assessment of patients. The aim of this study is to define surgical risk by using the APACHE II scoring system, and to determine optimal management. STUDY DESIGN: Records from October 1990 to December 1996 were retrospectively reviewed for patients (n=101) with bleeding gastric ulcer who had undergone emergency operation after failed endoscopic therapy. Mortality rates were examined according to different APACHE II scores, and the surgical risk was defined. From January 1997 to December 1997, 35 consecutive patients were enrolled for prospective study. Partial gastric resection (PGR) was performed for patients with huge ulcers (>2 cm) and for low-risk patients with ulcers at the antrum or angularis, while limited operation (oversewing or excision of bleeding ulcer) was reserved for others. The results were compared with the retrospective study. RESULTS: In the retrospective study, the mortality rates for the group with a score < 15 and > or = 15 were 5% (3 of 63) and 58% (22 of 38), respectively (p < 0.05). In the group with a score < 15, PGR was performed on 27 patients, and one died. For those patients with a score > or = 15, PGR carried a lower mortality than limited operation, although this was not statistically significant (47% vs 65%). Limited operation resulted in an overall rate of 22% postoperative hemorrhage and 12% reoperation rate, in which all patients with a score > or = 15 died. In the prospective study, the mortality rates in those scoring <15 and > or = 15 were 6% and 50%, respectively. This is not significantly different than the retrospective study. However, the rate of postoperative hemorrhage was diminished (5%). CONCLUSIONS: APACHE II score is a useful tool for assessing risk in patients with bleeding gastric ulcer. The mortality is minimal in those with a score <15, and PGR can be performed with low risk. Although high-risk patients have dreadful outcomes, limited operation cannot improve them if postoperative hemorrhage occurs. Decision making in emergency operation for such patients should be based on the ulcer conditions and the patient's hemodynamic status.
Assuntos
APACHE , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/cirurgia , Úlcera Gástrica/diagnóstico , Úlcera Gástrica/cirurgia , Doença Aguda , Adulto , Idoso , Tomada de Decisões , Emergências , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Gastroscopia , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Úlcera Gástrica/complicações , Úlcera Gástrica/mortalidadeRESUMO
Treatment is always abandoned in those HCC with jaundice, because it is usually attributed to the underlying liver cirrhosis and extensive tumor. In this series, 7 cases (0.8%) of HCC with jaundice were caused by bile duct invasion and tumor thrombi (BTT). 57% of cases showed Charcot's triad. 57% of BTT were small HCC, significantly higher than the 1.7% of total cases (p<0.05). The growth pattern of BTT was all spreading type, significantly higher than the 42% of total operation cases (p<0.05). The DNA ploidy of BTT was all aneuploid. 57% of BTT had AFP level higher than 400 IU/ml, but it was 27% in total cases. The prognosis is poor in those treated with palliative tube drainage. Aggressive hepatic resection was proved to be safe and achieved the best results in our limited experience. Choledochotomy to remove tumor thrombi is contraindicated because it easily causes tumor seeding. It is advocated to search BTT for resection from the group of HCC with jaundice.