Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast followth...Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast followthrough and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients.展开更多
Periodontal disease is a high prevalent disease.In the United States 47.2% of adults ≥ 30 years old have been diagnosed with some type of periodontitis.Longitudinal studies have demonstrated a two-way relationship be...Periodontal disease is a high prevalent disease.In the United States 47.2% of adults ≥ 30 years old have been diagnosed with some type of periodontitis.Longitudinal studies have demonstrated a two-way relationship between diabetes and periodontitis,with more severe periodontal tissue destruction in diabetic patients and poorer glycemic control in diabetic subjects with periodontal disease.Periodontal treatment can be successful in diabetic patients.Short term effects of periodontal treatment are similar in diabetic patients and healthy population but,more recurrence of periodontal disease can be expected in no well controlled diabetic individuals.However,effects of periodontitis and its treatment on diabetes metabolic control are not clearly defined and results of the studies remain controversial.展开更多
目的：探讨应用回肠代输尿管术治疗医源性长段输尿管损伤的疗效。方法：总结自2010年8月至2014年9月期间接受回肠代输尿管术的9例医源性长段输尿管损伤患者的临床资料,其中男性3例,女性6例,中位年龄40岁。中位输尿管损伤长度为20 cm,范...目的：探讨应用回肠代输尿管术治疗医源性长段输尿管损伤的疗效。方法：总结自2010年8月至2014年9月期间接受回肠代输尿管术的9例医源性长段输尿管损伤患者的临床资料,其中男性3例,女性6例,中位年龄40岁。中位输尿管损伤长度为20 cm,范围13~25 cm。常见医源性输尿管损伤原因为泌尿外科手术6例,妇产科手术2例,普外科手术1例。9例患者均行回肠代输尿管术,术后留置输尿管内双J管1~2个月。对所有入组患者进行门诊及电话随访,了解其并发症及术后肾功能情况,采用Clavien并发症分级系统对术后并发症进行分级。结果：9例手术均顺利完成,手术时间为203~394 min,平均（278.1±68.8）min,估计出血量为10~1 000 m L（中位数200 m L）,平均住院时间为（16.8±7.5）d。4例（44.4%）患者发生术后并发症,均为ClavienⅠ~Ⅱ级轻微并发症,其中不全肠梗阻3例（33.3%）,近端吻合口漏1例（11.1%）。中位随访时间11个月,8例（88.9%）患者术后肌酐水平较术前相比有所改善或稳定。随访过程中3例（33.3%）患者出现轻度肾积水,但无明显症状亦不需特殊处理;1例（11.1%）患者发生短期泌尿系感染,需口服抗生素治疗;未发现代谢性并发症发生。结论：回肠代输尿管术是一种可选择的尿路重建方式,尤其对难治性医源性长段输尿管损伤的治疗效果满意,其远期临床疗效仍需进一步观察。展开更多
Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the ...Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently em-ployed. However, at the moment, none of these tech-niques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medi-cal therapy and those causing disabling symptoms. Ut-most attention should be paid to correcting the balance between eradication of the fistula and the preservationof fecal continence.展开更多
AIM: To evaluate the effects of varying ischemic durations on cirrhotic liver and to determine the safe upper limit of repeated intermittent hepatic inflow occlusion. METHODS: Hepatic ischemia in cirrhotic rats was in...AIM: To evaluate the effects of varying ischemic durations on cirrhotic liver and to determine the safe upper limit of repeated intermittent hepatic inflow occlusion. METHODS: Hepatic ischemia in cirrhotic rats was induced by clamping the common pedicle of left and median lobes after non-ischemic lobes resection. The cirrhotic rats were divided into six groups according to the duration and form of vascular clamping: sham occlusion (SO), intermittent occlusion for 10 (IO-10), 15(IO-15), 20(IO-20) and 30(IO-30) minutes with 5 minutes of reflow and continuous occlusion for 60 minutes (CO-60). All animals received a total duration of 60 minutes of hepatic inflow occlusion. Liver viability was investigated in relation of hepatic adenylate energy charge (EC). Triphenyltetrazollum chloride (TTC) reduction activities were assayed to qualitatively evaluate the degree of irreversible hepatocellular injury. The biochemical and morphological changes were also assessed and a 7-day mortality was observed. RESULTS: At 60 minutes after reperfusion following a total of 60 minutes of hepatic inflow occlusion, EC values in IO-10 (0.749 +/- 0.012) and IO-15 (0.699 +/- 0.002) groups were rapidly restored to that in SO group (0.748 +/- 0.016), TTC reduction activities remained in high levels (0.144 +/- 0.002 mg/mg protein, 0.139 +/- 0.003 mg/mg protein and 0.121 +/- 0.003 mg/mg protein in SO, IO-10 and IO-15 groups, respectively). But in IO-20 and IO-30 groups, EC levels were partly restored (0.457 +/- 0.023 and 0.534 +/- 0.027) accompanying with a significantly decreased TTC reduction activities (0.070 +/- 0.005 mg/mg protein and 0.061 +/- 0.003 mg/mg protein). No recovery in EC values (0.228 +/- 0.004) and a progressive decrease in TTC reduction activities (0.033 +/- 0.002 mg/mg protein) were shown in CO-60 group. Although not significantly different, the activities of the serum aspartate aminotransferase (AST) on the third postoperative day (POD(3)) and POD(7) and of the serum alanine aminotransferase (ALT) on POD(3) in CO-60 group展开更多
AIM: To summarize the clinical characteristics of Crohn's disease(CD) patients who underwent surgery in China.METHODS: We searched four main Chinese electronic databases: CBM, VIP, CNKI, and Wanfang(from January19...AIM: To summarize the clinical characteristics of Crohn's disease(CD) patients who underwent surgery in China.METHODS: We searched four main Chinese electronic databases: CBM, VIP, CNKI, and Wanfang(from January1990 to October 2013). Then, we selected and carefully read 97 studies and extracted the surgical data for CD. We found that 1858 patients with CD underwent surgery between 1961 and 2012. The patients were stratified into two groups according to the year of surgery: 1961-2000 and 2000-2012. The clinical characteristics of these CD cases were compared between the two groups.RESULTS: The mean age at the time of surgery was 38.13 years. The most common locations of disease were the small intestine(40.84%), the colon(33.60%) and the ileocolon(23.09%). The primary indications for surgery were intestinal obstruction or stricture(23.84%), failure of drug therapy(14.80%), acute abdominal disease(13.46%), abdominal mass(10.93%), intestinal fistulae(9.90%), intestinal perforation(8.45%), perianal disease(6.73%), gastrointestinal bleeding(4.79%), and abdominal abscess(4.04%). The rate of diagnosis of CD before surgery was low(34.78%), and the misdiagnosis rate was 20.49%. The predominant surgical procedure for CD was bowel resection(69.54%). The rate of surgical complications was 20.34%, and the primary complications of surgery were infection(39.44%) and intestinal fistulae(26.09%). The relapse rate after surgery was 27.71%. For the periods of 1961-2000 and 2000-2013, the rates of both misdiagnosis before surgery and surgery related-death decreased(34.90% vs 12.10%, P < 0.001, and 23.53% vs 5.26%, P < 0.001, respectively). CONCLUSION: The rates of surgical complications and misdiagnosis were higher, whereas the rate of CDassociated tumor and the relapse rate were lower in China than in West countries.展开更多
文摘Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast followthrough and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients.
文摘Periodontal disease is a high prevalent disease.In the United States 47.2% of adults ≥ 30 years old have been diagnosed with some type of periodontitis.Longitudinal studies have demonstrated a two-way relationship between diabetes and periodontitis,with more severe periodontal tissue destruction in diabetic patients and poorer glycemic control in diabetic subjects with periodontal disease.Periodontal treatment can be successful in diabetic patients.Short term effects of periodontal treatment are similar in diabetic patients and healthy population but,more recurrence of periodontal disease can be expected in no well controlled diabetic individuals.However,effects of periodontitis and its treatment on diabetes metabolic control are not clearly defined and results of the studies remain controversial.
文摘目的：探讨应用回肠代输尿管术治疗医源性长段输尿管损伤的疗效。方法：总结自2010年8月至2014年9月期间接受回肠代输尿管术的9例医源性长段输尿管损伤患者的临床资料,其中男性3例,女性6例,中位年龄40岁。中位输尿管损伤长度为20 cm,范围13~25 cm。常见医源性输尿管损伤原因为泌尿外科手术6例,妇产科手术2例,普外科手术1例。9例患者均行回肠代输尿管术,术后留置输尿管内双J管1~2个月。对所有入组患者进行门诊及电话随访,了解其并发症及术后肾功能情况,采用Clavien并发症分级系统对术后并发症进行分级。结果：9例手术均顺利完成,手术时间为203~394 min,平均（278.1±68.8）min,估计出血量为10~1 000 m L（中位数200 m L）,平均住院时间为（16.8±7.5）d。4例（44.4%）患者发生术后并发症,均为ClavienⅠ~Ⅱ级轻微并发症,其中不全肠梗阻3例（33.3%）,近端吻合口漏1例（11.1%）。中位随访时间11个月,8例（88.9%）患者术后肌酐水平较术前相比有所改善或稳定。随访过程中3例（33.3%）患者出现轻度肾积水,但无明显症状亦不需特殊处理;1例（11.1%）患者发生短期泌尿系感染,需口服抗生素治疗;未发现代谢性并发症发生。结论：回肠代输尿管术是一种可选择的尿路重建方式,尤其对难治性医源性长段输尿管损伤的治疗效果满意,其远期临床疗效仍需进一步观察。
文摘Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently em-ployed. However, at the moment, none of these tech-niques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medi-cal therapy and those causing disabling symptoms. Ut-most attention should be paid to correcting the balance between eradication of the fistula and the preservationof fecal continence.
基金This Work was supported by the grant from the Science and Technology Committee of Zhejiang Province,No.971103132
文摘AIM: To evaluate the effects of varying ischemic durations on cirrhotic liver and to determine the safe upper limit of repeated intermittent hepatic inflow occlusion. METHODS: Hepatic ischemia in cirrhotic rats was induced by clamping the common pedicle of left and median lobes after non-ischemic lobes resection. The cirrhotic rats were divided into six groups according to the duration and form of vascular clamping: sham occlusion (SO), intermittent occlusion for 10 (IO-10), 15(IO-15), 20(IO-20) and 30(IO-30) minutes with 5 minutes of reflow and continuous occlusion for 60 minutes (CO-60). All animals received a total duration of 60 minutes of hepatic inflow occlusion. Liver viability was investigated in relation of hepatic adenylate energy charge (EC). Triphenyltetrazollum chloride (TTC) reduction activities were assayed to qualitatively evaluate the degree of irreversible hepatocellular injury. The biochemical and morphological changes were also assessed and a 7-day mortality was observed. RESULTS: At 60 minutes after reperfusion following a total of 60 minutes of hepatic inflow occlusion, EC values in IO-10 (0.749 +/- 0.012) and IO-15 (0.699 +/- 0.002) groups were rapidly restored to that in SO group (0.748 +/- 0.016), TTC reduction activities remained in high levels (0.144 +/- 0.002 mg/mg protein, 0.139 +/- 0.003 mg/mg protein and 0.121 +/- 0.003 mg/mg protein in SO, IO-10 and IO-15 groups, respectively). But in IO-20 and IO-30 groups, EC levels were partly restored (0.457 +/- 0.023 and 0.534 +/- 0.027) accompanying with a significantly decreased TTC reduction activities (0.070 +/- 0.005 mg/mg protein and 0.061 +/- 0.003 mg/mg protein). No recovery in EC values (0.228 +/- 0.004) and a progressive decrease in TTC reduction activities (0.033 +/- 0.002 mg/mg protein) were shown in CO-60 group. Although not significantly different, the activities of the serum aspartate aminotransferase (AST) on the third postoperative day (POD(3)) and POD(7) and of the serum alanine aminotransferase (ALT) on POD(3) in CO-60 group
基金Supported by Key Technologies Research and Development Program of China,No.2012BAI06B03National Natural Science Foundation of China,No.81270447
文摘AIM: To summarize the clinical characteristics of Crohn's disease(CD) patients who underwent surgery in China.METHODS: We searched four main Chinese electronic databases: CBM, VIP, CNKI, and Wanfang(from January1990 to October 2013). Then, we selected and carefully read 97 studies and extracted the surgical data for CD. We found that 1858 patients with CD underwent surgery between 1961 and 2012. The patients were stratified into two groups according to the year of surgery: 1961-2000 and 2000-2012. The clinical characteristics of these CD cases were compared between the two groups.RESULTS: The mean age at the time of surgery was 38.13 years. The most common locations of disease were the small intestine(40.84%), the colon(33.60%) and the ileocolon(23.09%). The primary indications for surgery were intestinal obstruction or stricture(23.84%), failure of drug therapy(14.80%), acute abdominal disease(13.46%), abdominal mass(10.93%), intestinal fistulae(9.90%), intestinal perforation(8.45%), perianal disease(6.73%), gastrointestinal bleeding(4.79%), and abdominal abscess(4.04%). The rate of diagnosis of CD before surgery was low(34.78%), and the misdiagnosis rate was 20.49%. The predominant surgical procedure for CD was bowel resection(69.54%). The rate of surgical complications was 20.34%, and the primary complications of surgery were infection(39.44%) and intestinal fistulae(26.09%). The relapse rate after surgery was 27.71%. For the periods of 1961-2000 and 2000-2013, the rates of both misdiagnosis before surgery and surgery related-death decreased(34.90% vs 12.10%, P < 0.001, and 23.53% vs 5.26%, P < 0.001, respectively). CONCLUSION: The rates of surgical complications and misdiagnosis were higher, whereas the rate of CDassociated tumor and the relapse rate were lower in China than in West countries.
