妊娠期糖尿病对妊娠结局的影响

目的探讨妊娠期糖尿病对妊娠结局的影响。方法将38例妊娠期糖尿病的孕妇作为观察组,选择同期分娩的40例正常孕妇作为对照组,分析2组孕妇临床资料,比较2组患者妊娠结局、新生儿患病率以及分娩方式。结果观察组孕妇其子代体重高于对照组(P<0.05),巨大儿的发生率高于对照组(P<0.05),新生儿患病率高于对照组(P<0.05);剖宫产率观察组高于对照组(P<0.05)。结论妊娠期糖尿病能对母儿产生不良结局和严重并发症,早筛查、早诊断及早干预可以明显改善新生儿预后,降低母婴并发症。

Risk factors and prevention of biliary anastomotic complications in adult living donor liver transplantation

To evaluate risk factors of biliary anastomotic complications （BACs） and outcomes according to type of biliary reconstruction. METHODS： A total of 33 consecutive adult living donor liver transplantation （LDLT） were reviewed, 17 of which had undergone Duct-to-Duct anastomosis （D-D）. The remaining 16 patients received Roux-en-Y anastomosis （R-Y）. The perioperative factors, such as the type of graft and the number of graft bile ducts, were analyzed retrospectively. RESULTS： The overall incidence of BACs was 39.4%. The incidence of BACs was significantly higher in the patients with than without neoadjuvant chemotherapy （71.4% vs 10%, P = 0.050）. There was no significant difference in the incidence of biliary leakage in patients with D-D vs. those with R-Y. The incidence of biliary strictures following the healing of biliary leakage was significantly higher in D-D （60%） than in R-Y （0%） （P = 0.026）. However, the incidence of BACs related bacteremia was significantly higher in R-Y than in D-D （71.4% vs 0%, P = 0.008）. In D-D, use of T-tube stent remarkably reduced the incidence of 8ACs, compared with straight tube stent （0% vs 50%, P = 0.049）. CONCLUSION： Our experience showed an increase of BACs related bacteremia in the patients with R-Y. Therefore, D-D might be a preferred biliary reconstruction. However, the surgical refinement of D-D should be required because of the high incidence of biliary strictures. Use of the T-tube stent might lead to a significant reduction of BACs in D-D.

Bouveret's syndrome complicated by a distal gallstone ileus

AIM:Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret's syndrome.Endoscopic lithotomy is the first-step treatment, however,surgery is indicated in case of failure or complication during this procedure. METHODS:We report herein an 84-year-old woman presenting with features of gastric outlet obstruction due to impacted gallstone.She underwent an endoscopic retrieval which was unsuccessful and was further complicated by distal gallstone ileus.Physical examination was irrelevant. RESULTS:Endoscopy revealed multiple erosions around the cardia,a large stone in the second part of the duodenum causing complete obstruction,and wide ulceration in the duodenal wall where the stone was impacted.Several attempts of endoscopic extraction by using foreign body forceps failed and surgical intervention was mandatory.Preoperative ultrasound evidenced pneumobilia whilst computerized tomography showed a large stone,5 cm×4 cm×3 cm,logging at the proximal jejunum and another one,2.5 cm×2 cm×2 cm, in the duodenal bulb causing a closed-loop syndrome.She underwent laparotomy and the jejunal stone was removed by enterotomy.Another stone reported as located in the duodenum preoperatively was found to be present in the gallbladder by intraoperative ultrasound.Therefore, cholecystoduodenal fistula was broken down,the stone was retrieved and cholecystectomy with duodenal repair was carried out.She was discharged after an uneventful postoperative course.CONCLUSION: As the simplest and the least morbid procedure, endoscopic stone retrieval should be attempted in the treatment of patients with Bouveret's syndrome.When it fails, surgical lithotomy consisting of simple enterotomy may solve the problem. Although cholecystectomy and cholecystoduodenal fistula breakdown is unnecessary

Gastric cancer occurring in a patient with Plummer-Vinson syndrome: A case report

Plummer-Vinson syndrome (sideropenic dysphagia) is characterized by dysphagia due to an upper esophageal or hypopharyngeal web in patients with chronic iron deficiency anemia. The main cause of dysphagia is the presence of the web in the cervical esophagus,and abnormal motility of the pharynx or esophagus is also found to play a significant role in this condition.This syndrome is thought to be precancerous because squamous cell carcinoma of hypopharynx, oral cavity or esophagus takes place in 10% of those patients suffering from this malady, but it is even more unusual that Plummer-Vinson syndrome should be accompanied by gastric cancer. We have reported here a case of a43-year-old woman with Plummer-Vinson syndrome who developed stomach cancer and recovered after a radical total gastrectomy with D2 nodal dissection.

The treatment of relapsing primary nephrotic syndrome in children

Objective: To explore better therapy and reduce the rate of re-relapse of primary nephritic syndrome in children who had been treated with corticosteroids but relapsed. Methods: Eighty relapsers were enrolled from Jan. 1994 to Apr. 2000, who were randomly divided into two groups. The treatment group (n=39) had been treated with tripterysium glucosides for three months,with the control group (n=41) members were treated with cyclophosphmide (CTX) by intermission intravenous pulse, with total dose of CTX not being more than 150 mg/kg. Prednisone, meanwhile, was given to both groups. The total treatment period of prednisone was prolonged by 12-18 months. Results: After following up for 3-7 years, the re-relapse rates of both groups were observed. The re-relapse rate of the treatment group was 28.2% to 29.3% in the CTX-controlled group. The re-relapse rates between two groups were almost similar, and with no observed significant difference (P>0.05). The side effect of tripterysium glucosides was less than that of CTX. Conclusion: For the treatment of relapsing nephritic syndrome in children, the combination of tripterysium glucosides and prolonged corticosteroid therapy is as effective as the regimen of CTX plus prolonged use of prednisone.

Pancreatic fistula after pancreatectomy:Evolving definitions,preventive strategies and modern management

Pancreatic resection is the treatment of choice for pancreatic malignancy and certain benign pancreatic disorders. However, pancreatic resection is technically a demanding procedure and whereas mortality after a pancreaticoduodenectomy is currently < 3%-5% in experienced high-volume centers, post-operative morbidity is considerable, about 30%-50%. At present, the single most significant cause of morbidity and mortality after pancreatectomy is the development of pancreatic leakage and fistula (PF). The occurrence of a PF increases the length of hospital stay and the cost of treatment, requires additional investigations and procedures, and can result in life-threatening complications. There is no universally accepted definition of PF that would allow standardized reporting and proper comparison of outcomes between different centers. However, early recognition of a PF and prompt institution of appropriate treatment is critical to the prevention of potentially devastating consequences. The present article, reviews the evolution of post resection pancreatic fistula as a concept, and discusses evolving definitions, the current preventive strategies and the management of this problem.

TGF-β signaling in vascular biology and dysfunction

Transforming growth factor （TGF）-β family members are multifunctional cytokines that elicit their effects on cells, including endothelial and mural cells, via specific type I and type II serine/threonine kinase receptors and intracellular Smad transcription factors. Knock-out mouse models for TGF-β family signaling pathway components have revealed their critical importance in proper yolk sac angiogenesis. Genetic studies in humans have linked mutations in these signaling components to specific cardiovascular syndromes such as hereditary hemorrhagic telangiectasia, primary pulmonary hypertension and Marfan syndrome. In this review, we present recent advances in our under- standing of the role of TGF-β receptor signaling in vascular biology and disease, and discuss how this may be applied for therapy.

Clinical significance of hepatic derangement in severe acute respiratory syndrome

AIM:Elevation of alanine aminotransferase (ALT) level is commonly seen among patients suffering from severe acute respiratory syndrome (SARS). We report the progression and clinical significance of liver derangement in a large cohort of SARS patient. METHODS: Serial assay of serum ALT was followed in patients who fulfilled the WHO criteria of SARS. Those with elevated ALT were compared with those with normal liver functions for clinical outcome. Serology for hepatitis B virus (HBV) infection was checked. Adverse outcomes were defined as oxygen desaturation, need of intensive care unit (ICU) and mechanical ventilation and death. RESULTS: Two hundred and ninety-four patients were included in this study. Seventy (24%) patients had elevated serum ALT on admission and 204 (69%) patients had elevated ALT during the subsequent course of illness. Using peak ALT >5xULN as a cut-off and after adjusting for potential confounding factors, the odds ratio of peak ALT >5x ULN for oxygen desaturation was 3.24 (95%CI 1.23-8.59, P= 0.018), ICU care was 3.70 (95%CI 1.38-9.89, P= 0.009), mechanical ventilation was 6.64 (95%CI 2.22-19.81, P = 0.001) and death was 7.34 (95%CI 2.28-24.89, P= 0.001). Ninety-three percent of the survived patients had ALT levels normalized or were on the improving trend during follow-up. Chronic hepatitis B was not associated with worse clinical outcomes. CONCLUSION: Reactive hepatitis is a common complication of SARS-coronavirus infection. Those patients with severe hepatitis had worse clinical outcome.

Simultaneous laparoscopic multi-organ resection combined with colorectal cancer:Comparison with non-combined surgery

AIM: To access the short-term outcomes of simultaneous laparoscopic surgery combined with resection for synchronous lesions in patients with colorectal cancer. METHODS: Between March 1996 and April 2010 prospectively collected data were reviewed from 93 consecutive patients who had colorectal cancer and underwent simultaneous multiple organ resection (combined group) and 1090 patients who underwent conventional laparoscopic right hemicolectomy or laparoscopic low/ anterior resection for colorectal cancer (non-combined group). In the combined group, there were nine gastric resections, three nephrectomies, nine adrenalectomies, 56 cholecystectomies, and 21 gynecologic resections. In addition, f ive patients underwent simultaneous laparoscopic resection for three organs. The patient demographics, intra-operative outcomes, surgical morbidity, and short-term outcomes were compared between thetwo groups (the combined and non-combined groups). RESULTS: There were no signifi cant differences in the clinicopathological variables between the two groups. The operating time was signifi cantly longer in the combined group than in the non-combined group, regardless of tumor location (laparoscopic right hemicolectomy and laparoscopic low/anterior resection groups; P = 0.048 and P < 0.001, respectively). The other intraoperative outcomes, such as the complications and open conversion rate, were similar in both groups. The rate of post-operative morbidity in the combined group was similar to the non-combined group (combined vs non-combined, 15.1% vs 13.5%, P = 0.667). Oncological safety for the colon and synchronous lesions were obtained in the combined group. CONCLUSION: Simultaneous laparoscopic multiple organ resection combined with colorectal cancer is a safe and feasible option in selected patients.

A case of primary isolated non-Hodgkin’s lymphoma of the esophagus in an immunocompetent patient

Primary non-Hodgkin’s lymphoma of the esophagus is a rare disease.A case of primary isolated nonHodgkin’s lymphoma of the esophagus in a 77-yearold man without acquired immunodeficiency syndrome is presented.We describe the clinical features and the imaging findings(barium swallow,endoscopic ultrasonography and CT)of a biopsy proven B-cell lymphoma with diffuse transmural involvement of the esophagus wall,which was discovered incidentally.We also briefly review the literature.

A rare complication of a common disease: Bouveret syndrome, a case report

This is a case report of an 85-year old patient who presented with abdominal pain, nausea and vomiting associated with altered liver function test. The plain X-rays and CT scan showed pneumobilia with an ectopic gallstone.The patient was diagnosed with Bouveret syndrome and managed surgically. The report is followed by a discussion about Bouveret syndrome.

Is the severity of obstructive sleep apnea or the magnitude of respiratory effort associated with gastroesophageal reflux?

In a recent issue ot World Journal of Gastroenterology, Demeter et al., reported that in patients having both gastro-esophageal reflux disease （GERD） and obstructive sleep apnea （OSA）, there was a positive correlation between endoscopic findings of GERD and the number of apneas and hypopneas per hour, namely apnea hypopnea index. They proposed that the severity of OSA and GERD are parallel to each other. The study of Demeter and colleagues is very important, not only for assessing reflux-induced esophageal damage in OSA,

Research progress of traditional Chinese medicine nursing techniques for the management of postoperative complications in mixed hemorrhoids

Mixed hemorrhoids,especially ring-shaped mixed hemorrhoid,is still a headache for anorectal surgeons due to its post-operative complications.In recent years,clinicians have been studying and exploring to avoid and alleviate these complications.In the Chinese medicine industry,the application of traditional Chinese medicine nursing technology has good and unique effect in prevent local pain,perianal edema,promote wound healing,relieve urinary retention,improve constipation,relieve anxiety,and so on.This article summarized the evidences of investigated the role of traditional Chinese medicine nursing technique in preventing and treating mixed hemorrhoid so that practitioners can make decision based on the best available evidences.

Churg-Strauss syndrome complicated by colon erosion, acalculous cholecystitis and liver abscesses

We report on a case of Churg-Strauss syndrome (CSS)with colon erosion, cholecystitis and liver abscesses. A 21-year-old woman with a history of bronchial asthma for 3 years was admitted with a complaint of abdominal pain. Laboratory findings included remarkable leukocytosis and eosinophilia, and a colonoscopy revealed erosion from the rectum to the ileocecal region. In addition, a colonic biopsy specimen showed necrotizing vasculitis and marked eosinophilic infiltration. On the basis of the clinical features and histopathological findings, she was diagnosed with CSS and subsequently treated with oral prednisolone,after which the eosinophilia and abdominal pain disappeared. However, on the 15th d in hospital she developed cholecystitis and liver abscesses. She was therefore treated with antibiotics and as a result went into clinical remission.

Geriatric cardiology and the Great Wall International Congress of Cardiology 2015

The burgeoning geriatric population worldwide has resulted in an unprecedented challenge to the cardiology community. Cardiovascular disease is the major cause of morbidity and mortality in the elderly population, but its recognition and management are characteristically confounded by substantial comorbidities, polypharmacy, and other complexities of care, not encountered in younger cardiac patients.

Application of enhanced recovery after surgery program for posterior lumbar decompression and fusion

Objective: To establish and optimize an enhanced recovery after surgery (ERAS) program, for the classic posterior lumbar decompression and fusion (PLDF).Methods: 1.An ERAS for PLDF procedure during the perioperative period had been designed. 2.A total of 155 patients (73 in the ERAS group and 82 in the traditional health care group) were analyzed, and their clinical outcomes were compared. The evaluation indexes included physiological function, postoperative visual analogue scale (VAS), pain score, postoperative complications. Results: ERAS significantly promoted early food-taking (7.93±2.15h vs 24.54 ± 5.72h, P < 0.00), early catheter removal (36.31 ± 8.42h vs 71.48 ± 13.75h, P < 0.00), early defecation (3.80 ± 1.3 days vs 5.3±1.41 days, P < 0.00);reduced the incidence of urinary tract infection (2.7% vs 9.7% P = 0.01) and shorter hospital stay (3.80 ± 1.04 days vs 7.29±1.62 days, P < 0.00), while no difference between the two groups in vomiting, lung infection, wound bleeding and infection. Conclusion: ERAS for PLDF can facilitate the recovery of physiological function, reduce postoperative pain, reduce operative complications and morbidity after surgery and contribute to a shorter hospital stay. Further research is needed to optimize the process.

Z-plasty for uterus-to-abdominal-wall fistula

Objective:Uterus-to-abdominal-wall fistula is a very rare complication after uterine-incision delivery over the last decades.It can even lead to death.Mainly,the fistula occurs when big tension and critical infection exist within the incision of uterus and abdominal wall.Methods:The authors described the clinical presentation,pathology of uterus-to-abdominal-wall fistula,and reported their experience in 6 cases who underwent Z-plasty operation for this rare complication from January 1998 to January 2008.Results:All flaps survived completely and all the wounds in abdominal walls healed very well.The six cases were followed up for 1 to 5 years,and no fistula recurrence occurred.Conclusion:Z-plasty technique is a very simple and efficient approach to repair uterus to abdominal fistula after uterine-incision delivery.

Enterolithiasis-associated ileus in Crohn's disease

Stasis of the flow of the intestinal contents,ingested material and unfavorable composition of the chylus can lead to the formation of enteroliths inside the bowel.Enterolithiasis represents a rare disorder of the gastrointestinal tract that can be associated with intermittent abdominal pain or more serious complications such as bleeding or obstruction.Enterolithiasis in Crohn' s disease represents an extremely rare condition and usually occurs only in patients with a long symptomatic history of Crohn's disease.We report an unusual case of enterolithiasis-related intestinal obstruction in a young male patient with Crohn's disease(A2L3B1 Montreal Classification for Crohn's disease 2005) undergoing emergency laparotomy and ileocoecal resection.In addition,we present an overview of the relevant characteristics of enterolithiasis on the basis of the corresponding literature.

Helicobacter pylori Bab A in adaptation for gastric colonization

Helicobacter pylori(H. pylori) as a causative agent of gastric complications, is well adapted for the colonization of gastric mucosa. Although the infectious process depends on several factors, the adhesion to the gastric mucosa is the first and important step. Among several outer membrane proteins, Bab A is one of the significant protein involving in many inflammatory processes in addition to its role in the attachment for the persistent colonization. We performed a Pub Med search using the key words: "bab A ", "pylori", "gastric complications", "homologous recombination", "slipped strand mispairing"; a total of 249 articles were displayed. Of these we mainly focused on articles with the full text in English and published between 2005 and 2016. H. pylori Bab A is involved in binding with receptors; however, its synthesis is regulated by phase variation. In this review we confirm that H. pylori bab A can be modulated at the molecular and functional levels to adapt to the stress within the gastro-intestinal tract.