Bouveret's syndrome, defined as gastric outlet obstruction due to a large gallstone, is still one of the most dramatic biliary gallstone complications. Although new radiological and endoscopic techniques have made...Bouveret's syndrome, defined as gastric outlet obstruction due to a large gallstone, is still one of the most dramatic biliary gallstone complications. Although new radiological and endoscopic techniques have made pre-surgical diagnosis possible in most cases and the death rate has dropped dramatically, "one-stage surgery" (biliary surgery carried out at the same time as the removal of the gut obstruction) should be still considered as the gold standard for the treatment of gallstone ileus.In this case, partial gastric outlet obstruction resulted in an atypical and insidious clinical presentation that allowed us to perform the conventional one-stage laparatomic procedure that completely solved the problem, thus avoiding any further complications.展开更多
Objective: To study the composition of microecosystem in ostiomeatal complex (OMC) of adults and the changes via functional endoscopic sinus surgery. Methods: 220 adults with chronic sinusitis(20 as control) were clas...Objective: To study the composition of microecosystem in ostiomeatal complex (OMC) of adults and the changes via functional endoscopic sinus surgery. Methods: 220 adults with chronic sinusitis(20 as control) were classified into pre- and post-operative groups, and categorised according to its type of sinusitis. Swab specimens were taken from three different sites of ostiomeatal complex in each individual, and cultivations and identifications of aerobes, anaerobes and fungi were performed simultaneously. The microecosystem was analysed. Results: Cultured aerobes belonged to 30 species from 13 genera, anaerobes species, and fungi 3 major species, most of which have none or less virulence. The difference of mi-croecological status between type Ⅰ and Ⅱ was not significant (P > 0.05). Aerobic culture rates between preoperative group and control group had significance(P < 0.01);culture rate descended in postoperative group while the difference was not significant compared to preoperative group (P > 0. 05); difference of rate of same aerobic culture from three sites (RSAC) , which reflects the microecological integrity of OMC, between preoperative and control group was significant (P < 0.01), while was not between postoperative group and control one(P > 0. 05). Taking fungi into account, differences among all groups had no significance(P>0.05); anaerobes were rare in all groups. Conclusion: Being a microecosystem under normal condition, ostiomeatal complex is relatively clean and exists as a whole space. Chronic inflammations separate different parts of which from each other with multimicrobial existence.FESS reverses separation of the microecosystem and rebuild it as a whole again, thus promote the recovery.展开更多
文摘Bouveret's syndrome, defined as gastric outlet obstruction due to a large gallstone, is still one of the most dramatic biliary gallstone complications. Although new radiological and endoscopic techniques have made pre-surgical diagnosis possible in most cases and the death rate has dropped dramatically, "one-stage surgery" (biliary surgery carried out at the same time as the removal of the gut obstruction) should be still considered as the gold standard for the treatment of gallstone ileus.In this case, partial gastric outlet obstruction resulted in an atypical and insidious clinical presentation that allowed us to perform the conventional one-stage laparatomic procedure that completely solved the problem, thus avoiding any further complications.
文摘Objective: To study the composition of microecosystem in ostiomeatal complex (OMC) of adults and the changes via functional endoscopic sinus surgery. Methods: 220 adults with chronic sinusitis(20 as control) were classified into pre- and post-operative groups, and categorised according to its type of sinusitis. Swab specimens were taken from three different sites of ostiomeatal complex in each individual, and cultivations and identifications of aerobes, anaerobes and fungi were performed simultaneously. The microecosystem was analysed. Results: Cultured aerobes belonged to 30 species from 13 genera, anaerobes species, and fungi 3 major species, most of which have none or less virulence. The difference of mi-croecological status between type Ⅰ and Ⅱ was not significant (P > 0.05). Aerobic culture rates between preoperative group and control group had significance(P < 0.01);culture rate descended in postoperative group while the difference was not significant compared to preoperative group (P > 0. 05); difference of rate of same aerobic culture from three sites (RSAC) , which reflects the microecological integrity of OMC, between preoperative and control group was significant (P < 0.01), while was not between postoperative group and control one(P > 0. 05). Taking fungi into account, differences among all groups had no significance(P>0.05); anaerobes were rare in all groups. Conclusion: Being a microecosystem under normal condition, ostiomeatal complex is relatively clean and exists as a whole space. Chronic inflammations separate different parts of which from each other with multimicrobial existence.FESS reverses separation of the microecosystem and rebuild it as a whole again, thus promote the recovery.
