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The metastasis of contralateral adrenal gland and gallbladder following radical nephrectomy is extremely uncommon in clinical practice. We presented one such case. The patient underwent laparoscopic radical right nephrectomy. Postoperative pathology revealed clear cell carcinoma of the right kidney. Five years after operation, CT revealed occupying lesions in the left adrenal gland and gallbladder. Transperitoneal laparoscopic left adrenalectomy and cholecystectomy were performed. Pathological examination showed that the left adrenal tumor and gallbladder tumor were clear cell carcinoma. The patient received targeted therapy and tumor-free survived for 10 months.
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OBJECTIVE@#To investigate the clinical efficacy of continuous irrigation combined with closed thoracic drainage for esophagojejunal anastomotic fistula (EJAF) complicated with mediastinal, thoracic and abdominal infection after total gastrectomy.@*METHODS@#Clinical data of 22 EJAF patients complicated with mediastinal, thoracic and abdominal infection after radical gastrectomy at Department of General Surgery of the 901th Hospital of PLA from June 2012 to May 2018 were retrospectively analyzed. Case inclusion criteria:(1) gastric adenocarcinoma confirmed by preoperative endoscopic pathology undergoing radical total gastrectomy without severe organ dysfunction;(2)EJAF complicated with mediastinal, thoracic and abdominal infections diagnosed by postoperative radiography, the presence of pleural effusion confirmed by CT and ultrasound. Among them, 10 cases were treated with simple thoracic closed drainage (single drainage group); 12 cases received same closed thoracic drainage, and a rubber catheter was placed next to the closed thoracic drainage tube in the same sinus. A 0.9% sodium chloride solution was applied in continuous drip irrigation with drip velocity at 50 to 100 ml/h(continuous flushing plus drainage group). Infection indicators, anastomotic fistula healing time and related clinical indicators were compared between the two groups.@*RESULTS@#In the simple drainage group, 5 cases were males, age was (61.9±10.7) years old, 4 cases received laparoscopic surgery, 6 cases received open surgery, 6 cases were EJAF grade III, 4 cases were EJAF IV. In continuous flushing and drainage group, 6 cases were males, age was (61.7±11.0) years old, 7 cases received laparoscopic surgery, 5 cases received open surgery, 6 cases were EJAF grade III, and 6 cases were EJAF grade IV. Baseline data including gender, age, underlying diseases, preoperative hematological examination indexes, surgical methods, tumor TNM stage and EJAF grade were not significantly different between the two groups (all P>0.05). When postoperative EJAF was complicated with mediastinal, thoracic and abdominal infection, biochemical parameters including white blood cell, procalcitonin, C-reactive protein were not significantly different between two groups (all P>0.05). All patients of both groups achieved clinical cure without death. Compared with the simple drainage group after closed thoracic drainage, the continuous irrigation plus drainage group had significantly shorter duration of infection parameters returning to normal levels [white blood cell count: (6.8 ± 2.0) days vs.(10.5±3.0) days, t=4.062, P<0.001; procalcitonin: (7.5±1.0) days vs. (9.2±1.9) days, t=3.236, P=0.040; C-reactive protein: (8.8±1.0) days vs. (11.2±1.5) days, t=5.177, P<0.001], meanwhile time in surgical ICU [(4.9±2.5) days vs. (9.9±6.7) days, t=2.935, P=0.006], healing time of fistula [(42.9±12.5) days vs. (101.8±53.2) days, t=4.187, P=0.001] and total postoperative hospital stay [(62.3±15.8) days vs. (119.7 ±59.4) days, t=3.634, P=0.002] were significantly shorter, and total hospitalization cost was significantly lower (median 86 000 yuan vs. 124 000 yuan, Z=2.063, P=0.040) in the continuous irrigation plus drainage group.@*CONCLUSION@#The continuous closed thoracic drainage with 0.9% sodium chloride solution can accelerate infection control and remission of EJAF patients complicated with mediastinal, thoracic and abdominal infections, and shorten the healing time of anastomotic fistula.
Subject(s)
Aged , Humans , Male , Middle Aged , Anastomosis, Surgical , Bacterial Infections , Therapeutics , Digestive System Fistula , Therapeutics , Drainage , Gastrectomy , Laparoscopy , Postoperative Complications , Therapeutics , Retrospective Studies , Therapeutic IrrigationABSTRACT
Objective To investigate the perioperative treatment of elderly patients with intestinal obstruc-tion.Methods The perioperative clinical data of 57 elderly patients with intestinal obstruction who underwent surgi-cal treatment and admitted were retrospectively analyzed.Results 24 cases (42.1%)occurred in 57 cases of com-plications with 62 times,including 9 cases of lung infection,intestinal obstruction in 3 cases,arrhythmia in 6 cases, 11 cases of wound infection,acute renal failure in 2 cases and 37 cases of hypoalbuminemia.Conclusion Underlying diseases and poor health were the characteristics of elderly patients with intestinal obstruction.A comprehensive assessment of the condition before surgery and to improve the treatment of complications can reduce the incidence of surgical complications.
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To investigate the diagnosis and surgical treatment of inraspinal tumors. The clinical data of 246 patients with inraspinal tumors who had undergone operations in the Affiliated Hospital of Qingdao University Medical Col ege between January 2010 and January 2013 were retrospectively analyzed. The treatment and prognosis of inraspinal tumors were reviewed. 262 operations were performed, with posterior bilateral laminectomy approach in 202 cases, semi-laminectomy approach in 28 cases, laminoplasty approach in 10 cases, and lateral resection of extra-vertebral canal dumbbel shaped tumors in 22 cases. The short-term remission rate of the nerve root pain reached 95.0%(133/140), and the improvement rates of the sensory disability, motor disturbance, and sphincter dysfunction were 85.6%(125/146), 86.7%( 136/157), and 84.6(11/13) respectively. The ASIA nervous function scores and grades at the last fol ow-up were significantly superior to those before and 3 months after the operation in 236 patients. Intraspinal tumors are mostly benign. The clinical appearance of them should be watched closely, and thorough physical check-up should be performed. MRI is the examination of choice at early diagnosis. The key to improve the treatment effects is to perform operations as soon as possible.
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BACKGROUND:Restoration of neurological functions after the damaged peripheral nerve is reconstructed is a hot topic in existing research. Within a short term fol owing peripheral nerve injury, nerve and muscle begin to develop irreversible degeneration. Restoration of the damaged nerve requires delayed degeneration and basic microenvironment. OBJECTIVE:To investigate the protective effect of cardiotrophin-1 on PC12 cells and Schwann cells. METHODS:Schwann cells and PC12 cells were obtained and cultured in complete medium, serum-free medium and 50 ℃ medium, respectively. cells in cardiotrophin-1 group were treated with exogenous cardiotrophin-1 solvent, while those in the control group were treated with equivalent Dulbecco’s modified Eagle’s medium, for 24 hours. The survival rate for PC12 cells and Schwann cells was determined using cellCounting Kit-8 colorimetric method. The lactate dehydrogenase activity in supernatant was detected by lactate dehydrogenase kit, and the malondialdehyde content and superoxide dismutase activity were measured by thiobarbituricaicd and xanthine oxidese method respectively. RESULTS AND CONCLUSION:The survival rate of PC12 cells and Schwann cells in cardiotrophin-1 group was obviously increased, lactate dehydrogenase releasing and malondialdehyde content were obviously decreased, superoxide dismutase activity was dramatical y improved compared with control group. Exogenous cardiotrophin-1 reduces the injury caused by ischemia and heat stress stimulation for PC12 cells and Schwann cells. The mechanism of protection may be related to the expression of anti-apoptosis protein activated by the combination of cardiotrophin-1 and its receptors.
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Objective To discuss the diagnosis and treatment of spontaneous perforation of the large intestine.Methods The clinical data of 9 cases with spontaneous perforation of the large intestine admitted into our hospital since 1994 were analyzed retrospectively.Results All the 9 cases were over 60 years of age,had no specific clinical manifestations,and were misdiagnosed preoperatively.Among them,4 cases had a(longstanding) history of hypertension and arteriosclerosis,and 6 cases had habitual constipation.There was 1 case with perforation of transverse colon,1 case of descending colon,3 cases of sigmoid colon,and 4 cases of upper rectum.Four cases underwent exteriorization after a simple closure of the perforation,while in the other 5 cases closure of the perforation was followed by a loop colostomy.The postoperative complications included cardiac arrhythmia(1 case),lung infection(2 cases),and infection of incisional wound(1 case).All cases recovered smoothly and were discharged.Conclusions Spontaneous perforation of the large intestine usually presents in old patients,and frequeatly occurs in the rectum and sigmoid colon.It is usually misdiagnosed preoperatively,and surgical intervention should be performed as soon as possible.The operation should be simple.It is crucial to intensify management after operation.
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Objective To establish the fingerprint of Gentiana straminea from Qinghai Province by HPLC. Methods By orthogonal design and related methods based on information theories and chemometrics to optimize the proper HPLC conditions so that the fingerprint spectra of ten groups of different samples have been formed. Results The experimental results are the fact that the common fingerprint peaks, precision, and repeatability in the fingerprint totally meet the relative regulations required in Technical Requirements of the Fingerprint Research in Injection of Chinese Materia Medica (Tentatine Standard). Conclusion The chromatographic fingerprint can be used to identify and evaluate the quality of G. straminea.