Computer tomography-guided negative pressure drainage treatment of intrathoracic esophagojejunal anastomotic leakage: A case report.

BACKGROUND: Esophagojejunal anastomotic leakage (EJAL) is a serious and potentially crucial complication of total gastrectomy and represents the major cause of postoperative death, with a mortality rate of up to 50%. However, treatment remains challenging and controversial. We report here the case of a patient whose intrathoracic EJAL was successfully treated with computer tomography (CT)-guided negative pressure drainage treatment. CASE SUMMARY: A 69-year-old male patient complained of difficulty swallowing within the last six months. He was diagnosed with esophagogastric junction carcinoma, Siewert II, cT3N0M0 stage II. Total gastrectomy and Roux-en-Y esophagojejunostomy were performed. High fever, left chest pain and dyspnea appeared on postoperative day 5, and EJAL was confirmed by CT, gastroscopy and oral blue-dimethylene tests. Conservative treatment measures were applied immediately, including antibiotics, nasojejunal tubes, and repeated thoracic puncture and drainage under ultrasound guidance. However, without sufficient and effective drainage, the thoracic infection and systemic condition continued to deteriorate. With the cooperation of multiple departments, percutaneous CT-guided drainage (24 Fr 7 mm) in the thoracic cavity was successfully placed near the anastomotic leakage. Because of continuous negative pressure suction, the infection symptoms were effectively controlled and the general situation gradually recovered. Subsequent follow-up examination showed that the patient was in good condition. CONCLUSION: Negative pressure drainage via CT may represent an effective minimally invasive approach to treating intrathoracic EJAL.

[Evaluation of the effects of two different modes of orthognathic surgery on upper airway morphology in patients with skeletal Class â ¢ malocclusion].

PURPOSE: To establish three-dimensional models of upper airway pre- and post-orthognathic surgery in patients with skeletal Class Ⅲ malocclusion, and to compare the effects of different modes of orthognathic surgery on the cross-sectional areas and volumes of upper airway. METHODS: Twenty-eight patients with skeletal Class Ⅲ malocclusion were divided into 2 groups. Group A (12 patients) underwent bilateral sagittal split ramus osteotomy(BSSRO) for mandibular setback, named single jaw surgery group; group B (16 patients) underwent BSSRO + Le Fort I osteotomy for mandibular setback and maxillary advancement, named bimaxillary surgery group. All patients received CT scanning before (T1) and 3 months after surgery (T2). The three-dimensional models of the upper airway containing velopharynx, glossopharynx and laryngopharynx were established by using Dolphin Imaging 11.7 software. The changes of sagittal diameters, coronal diameters, cross-sectional areas and volumes of the upper airway were measured and compared between the two groups pre- and post- surgery (T1, T2) using SPSS 16.0 software package, respectively. RESULTS: In velopharynx, the values of group A were decreased after surgery, while the other values of group B were increased except the value of coronal diameter. There was a significant difference between the two groups (P<0.05). In glossopharynx and laryngopharynx, the values of group A and group B were both decreased after surgery. The reduction of the cross-sectional areas and volumes in group A were more obvious than group B (P<0.05). CONCLUSIONS: The amount of narrowing of the upper airway is smaller in patients undergoing bimaxillary surgery than in patients undergoing mandibular setback surgery.

[Study on determination and pharmacokinetics of metabolites from Folium Mori extract in rats].

OBJECTIVE: To establish a RP-HPLC method for simultaneous determination of total quercetin, kaempferol and isorhamnetin in rat plasma after oral administration of Folium Mori extract (FME). METHODS: After a single dose of FME (110 mg/kg) was taken, rat plasma samples were collected. The samples were hydrolyzed with hydrochloric acid (c=3.0 mol/L), the mixed solution was extracted with ether acetone mixture. The total quercetin, kaempferol and isorhamnetin in plasma samples were determined by HPLC, pharmacokinetic parameters were calculated by DAS 3.0 software. RESULTS: The method was linear over the concentration ranges of 0.0545-8.70, 0.0954-14.7 and 0.0545-8.55 µg/ml for quercetin, kaempferol and isorhamnetin, respectively (r=0.9979, 0.9993, 0.9981). The absolute recoveries were 85.3%-86.1%, 79.4%-86.7% and 62.8%-89.7%, respectively and the assay recoveries were all from 94.7% to 107%. The relative standard deviation (RSD) of intra-and inter-day were less than 9.5% and 9.8%, respectively. The main pharmacokinetic parameters were as follows: T(1/2z) was 92.7, 67.9 and 54.2 h; Tmax was 0.400, 0.400 and 3.87 h; AUC(0-∞) was 68.0, 67.5 and 32.8 mg/h/L; MRT(0-∞) was 128, 85.2 and 72.0 h for quercetin, kaempferol and isorhamnetin, respectively. CONCLUSION: The method established in this study is accurate, reliable and reproducible, and can be applied for determination of total quercetin, kaempferol and isorhamnetin in rat plasma after oral administration of FME; the pharmacokinetic studies showed that the distribution of drugs is rapid and elimination is very slow.

Current treatment of rectovaginal fistula in Crohn's disease.

Rectovaginal fistula (RVF) continues to be the most difficult perianal manifestation of Crohn's disease to treat. This devastating and disabling complication has a significant impact on patients' quality of life and presents unique management challenges. Current therapeutic approaches include many medical therapeutics and surgical treatments with a wide range of success rates reported. However, current evidence is lacking to support any recommendation. The choice of repair depends on various patient and disease factors and basic surgical tenets. In this article, we review the current options to consider in the treatment of Crohn's-related RVF, and try to evaluate their effects on fistulae closure and quality of life.

Identification of metabolites of Danggui Buxue Tang in rat urine by liquid chromatography coupled with electrospray ionization time-of-flight mass spectrometry.

A method coupling liquid chromatography with electrospray ionization time-of-flight mass spectrometry (LC/ESI-TOF/MS) has been developed for rapid and sensitive analysis of rat urinary metabolite profile of Danggui Buxue Tang (DBT), a well-known Chinese herbal formula. After oral administration of DBT, urine samples were collected during 0-24 h, and then pretreated by solid-phase extraction. A total of 68 compounds including 13 parent compounds and 55 metabolites were detected in the drug-containing urines compared with blank urines. The total analytical time was less than 20 min. Metabolites of DBT were identified using dynamic adjustment of the fragmentor voltage to produce structure-relevant fragment ions. By using this approach, the mass accuracy of precursor and fragment ions was typically within +/-5 ppm of the theoretical values, and enabled the identification of 43 metabolites including 27 isoflavanoid and 16 phthalide metabolites. Our results indicated that glucuronidation and sulfation were the major metabolic pathways of isoflavonoids, while glutathione conjugation, glucuronidation and sulfation were the main metabolic pathways of phthalides. No saponin-related metabolites were detected. The results of the present study provided important structural information relating to the metabolism of DBT. Furthermore, this work demonstrated the potential of the LC/ESI-TOF/MS approach for identification of metabolites from Chinese herbal medicines in urine.

[Study on applying principle component analysis to data processing on chromatographic fingerprints for Pinellia Cum Bile].

OBJECTIVE: To explore the utility of principle component analysis (PCA) on chromatographic data for quality control to Dannanxing (Pinellia Cum Bile). METHOD: Chromatographic fingerprints of sample were determined by TLC, PCA and multivariat analysis were used for data processing. RESULT: The quantitative differences among samples procesed with different biles and heating time were found with the method. CONCLUSION: PCA could be used in data processing for chromato-gramphic fingerprints of Dannanxing.