Curative effect of laparoscopic surgery on acute gastric perforation

Objective:To investigate the postoperative inflammatory reaction, stress reaction and immune response of laparoscopic surgery and laparotomy for acute gastric perforation. Methods: Forty-four patients with acute gastric perforation receiving emergency surgery in our hospital from May 2012 to December 2015 were selected and retrospectively analyzed. Among these patients, there were 19 patients treated with laparoscopic surgery (LS group) and 25 patients treated with laparotomy (laparotomy group). At the first day after surgery, their serums were collected and the indexes of inflammatory reaction and stress reaction were detected. Mononuclear cells and red blood cells in peripheral blood were collected and detected for the immune function indexes. Results: At day 1 after surgery, the contents of serum interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-10, cortisol, norepinephrine, epinephrine, renin and angiotensin-II of patients in the LS group were all significantly lower than those of the laparotomy group;fluorescence intensities of CD3, CD4, CD16 and CD56 of mononuclear cells in peripheral blood were all obviously higher than those of the laparotomy group;and the numbers of red blood cell C3bR and immune complex resette and the fluorescence intensities of complement receptor type 3, CD58 and CD59 were obviously higher than those of the laparotomy group. Conclusions: Emergency laparoscopic surgery used to treat acute gastric perforation shows slight postoperative inflammatory reaction and stress reaction and presents weak nonspecific immune response, specific immune response and erythrocyte immune response, which makes less trauma than laparotomy.

Abnormality in coronary slow flow phenomenon detected by nailfold microcirculation microanalysis

To the Editor:The coronary slow flow phenomenon(CSFP)was first reported by Tambe et al in 1972.[1]Specifically,patients suffering from chest pain but without significant coronary artery lesion,displayed slow coronary blood flow during coronary angiography examination,which could lead to myocardial ischemia,acute myocardial infarction,and acute coronary syndrome.The development of CSFP has been reported to be around 7%in patients with suspected coronary heart disease.[2]The common clinical symptoms during CSFP include slow opacification of distal parts of normal epicardial coronary arteries in the absence of ventricular dysfunction,connective tissue disorder,valvular heart diseases,and coronary spasm or ectasia.Nowadays,the identification of the CSFP is achieved through coronary angiography by thrombolysis in myocardial infarction(TIMI)flow grade.The corrected TIMI frame count(CTFC)is a very common,simple,and repeatable method used for the quantification of the coronary flow.[3]