人工晶体植入术后炎性并发症与TNF-α和IL-8的关系

目的 :探讨血浆和房水肿瘤坏死因子 - α( TNF- α)、白细胞介素 - 8( IL- 8)与人工晶状体植入术后炎性并发症的关系。方法 :采用放射免疫法对 40例晶状体囊外摘除后房型人工晶状体植入术后 3种不同级别炎性并发症家兔进行血浆和房水 TNF-α和 IL- 8测定。结果 :40只家兔在血浆和房水内 TNF-α和 IL- 8术后较术前均升高 ,且与术后炎性并发症呈正相关。结论 :血浆和房水 TNF-α和 IL- 8水平在晶状体囊外摘除后房型人工晶状体植入后升高 ,且升高水平与炎性并发症呈正相关 ,TNF- α和 IL- 8可作为监测术后恢复情况。

喉和咽肿瘤手术后炎性并发症的预防与治疗

近年来，随着喉癌和咽癌的手术切除和修复技巧的改进，新的仪器和设备的使用，抗生素的广泛应用，使喉、咽肿瘤手术后炎性并发症的发生率降低，其种类、发生原因和处理方式等亦有改变，了解并发症的发生原因并给予及时的治疗，可预防或早期治愈并发症，以减少对患者康复的影响。

抗菌药物对下颌阻生第三磨牙拔除术后炎性并发症影响的研究进展

随着社会经济水平不断发展,人们的饮食习惯逐渐发生改变,饮食结构也有所变化,颌骨负担逐渐减少,骨量随之减少,但是牙体体积仍然不便,导致牙齿萌出位置不足,出现第三磨牙阻生。第三磨牙阻生是导致患者出现冠周炎等牙科疾病的主要原因之一,也是引起第二磨牙损害的原因,因此当出现第三磨牙阻生后需要及时对其进行拔除。由于阻生下颌第三磨牙的解剖结构存在一定特殊性,与邻牙关系密切,因此在治疗上有一定难度,拔除术后如果没有做好口腔管理工作,也会增加术后炎性并发症发生风险,为此需要加强预防与治疗。本文旨在综述对下颌阻生第三磨牙拔除术后应用抗菌药物对炎性并发症的影响研究。

抗菌药物对下颌阻生第三磨牙拔除术后炎性并发症影响的研究进展

下颌第三磨牙阻生发生率很高，常引起冠周炎、邻牙远中龋、牙间骨吸收，少数可引起颌骨周围软组织间隙感染、颌骨骨髓炎、颌骨囊肿等并发症。下颌阻生第三磨牙拔除术后如何规范应用抗菌药物具有重要临床意义，但围手术期抗菌药物的选择和剂量并无明确的应用指南，国内外文献报道不一。不合理应用抗菌药物可能导致感染病菌的高度耐药而难以控制感染；另一方面加大了患者就医和整个社会的经济负担。现对下颌阻生第三磨牙拔除术围手术期应用抗菌药物能否预防术后炎性并发症的相关文献综述，以期对临床应用提供参考。一、下颌阻生第三磨牙术后炎性并发症下颌阻生第三磨牙术后炎性并发症是在下颌阻生第三磨牙拔除术后由于各种原因引起的伤口及周围组织出现的炎性病理现象，包括干槽症、术后伤口部位感染、前颊部感染和咽峡前间隙感染等。

膨体聚四氟乙烯补片颞部填充术后皮肤炎性并发症一例

病例患者女，45岁，因双侧颞部凹陷，影响外观，于2006年10月在外院行双侧颞部膨体聚四氟乙稀（expandedp01ytetrafluoroe—thylene，ePTFE）补片材料填充术，经颞部发际内切口置入。术后1个月颞部填充部位出现皮肤红斑且逐渐加重，局部烧灼样感，伴有瘙痒，常自行服用阿司咪唑（息斯敏）及局部应用皮炎平软膏后症状好转，但仍反复发作，不能治愈。

术后早期炎性肠梗阻的护理观察与处理

目的:探讨如何早期发现与正确处理术后炎性肠梗阻。方法:通过普外科21例各种腹部术后并发早期炎性肠梗阻的病例观察,应用禁食、持续胃肠减压及配合双侧肾囊封闭及足浴联合按摩等护理措施。结果:21例病例均治愈出院,未造成多次手术、肠瘘、短肠综合征等并发症,平均住院19.8 d。结论:对腹部术后肠蠕动功能恢复或部分恢复并进食后出现肠梗阻症状的患者,应首先考虑炎性肠梗阻并选择积极的保守治疗。

炎症性肠病伴骨关节病变患者中HLA-B27表达情况分析

目的:研究HLA-B27在炎症性肠病(IBD)伴骨关节病变患者中的表达情况及两者间的相关性。方法:采用微量淋巴细胞毒试验(CDC)检测92例炎症性肠病患者(溃疡性结肠炎69例,克罗恩病23例,伴骨关节病变者18例)及55例健康对照者血清中HLA-B27的表达。结果:IBD患者HLA-B27的阳性率为22.83%,与正常对照组(3.64%)相比有统计学差异(P<0.01)。IBD伴骨关节病变及IBD不伴骨关节病变患者HLA-B27的阳性率分别为55.56%和17.58%,两者相比有统计学差异(P<0.01),HLA-B27与炎症性肠病伴骨关节病变具有显著相关性(OR=5.87)。结论:HLA-B27阳性有助于炎症性肠病的诊断,并与骨关节病变的发生率密切相关,利于预测病情。

Study progress on mechanism of severe acute pancreatitis complicated with hepatic injury

Study on the action mechanism of inflammatory mediators generated by the severe acute pancreatitis （SAP） in multiple organ injury is a hotspot in the surgical field. In clinical practice, the main complicated organ dysfunctions are shock, respiratory failure, renal failure, encephalopathy, with the rate of hepatic diseases being closely next to them. The hepatic injury caused by SAP cannot only aggravate the state of pancreatitis, but also develop into hepatic failure and cause patient death, lts complicated pathogenic mechanism is an obstacle in clinical treatment. Among many pathogenic factors, the changes of vasoactive substances, participation of inflammatory mediators as well as OFR （oxygen free radical）, endotoxin, etc. may play important roles in its progression.

Hemoconcentration is a poor predictor of severity in acute pancreatitis

AIM： To determine whether the hematocrit （Hct） at admission or at 24 h after admission was associated with severe acute pancreatitis （AP）, organ failure （OF）, and pancreatic necrosis. METHODS： A total of 336 consecutive patients with a first AP episode were studied. Etiology, Hct values at admission and at 24 h, development of severe AP according to Atlanta＇s criteria, pancreatic necrosis, OF and mortality were recorded. Hemoconcentration was defined as Hct level 〉44% for males and 〉40% for females. The t-test and ;x^2 test were used to assess the association of hemoconcentration to the severity, necrosis and OF. Diagnostic accuracy was also determined. RESULTS： Biliary disease was the most frequent etiology （n = 148）. Mean Hct levels at admission were 41±6% for females and 46±7% for males （P〈0.01）. Seventyeight （23%） patients had severe AP, and OF developed in 45 （13%） patients. According to contrast-enhanced computed tomography scan, 36% （54/150） patients showed pancreatic necrosis. Hct levels were elevated in 58% （55/96） and 61% （33/54） patients with interstitial and necrotizing pancreatitis, respectively. Neither Hct levels at admission nor hemoconcentration at 24 h were associated with the severity, necrosis or OF. Sensitivity, specificity and positive predictive values for both determinations were very low; and negative predictive values were between 61% and 86%, being the highest value for OF. CONCLUSION： Hct is not a useful marker to predict a worse outcome in acute pancreatitis. In spite of the high negative predictive value of hemoconcentration, the prognosis gain is limited due to an already high incidence of mild disease.

Proteasome inhibitor ameliorates severe acute pancreatitis and associated lung injury of rats

AIM: To observe the effect of proteasome inhibitor MG-132 on severe acute pancreatitis (SAP) and associated lung injury of rats. METHODS: Male adult SD rats were randomly divided into SAP group, sham-operation group, and MG-132 treatment group. A model of SAP was established by injection of 5% sodium taurocholate into the biliary- pancreatic duct of rats. The MG-132 group was pretreated with 10 mg/kg MG-132 intraperitoneally (ip) 30 min before the induction of pancreatitis. The changes in serum amylase, myeloperoxidase (MPO) activity of pancreatic and pulmonary tissue were measured. The TNF-α level in pancreatic cytosolic fractions was assayed with an enzyme-linked immunosorbent assay (ELISA) kit. Meanwhile, the pathological changes in both pancreatic and pulmonary tissues were also observed. RESULTS: MG-132 significantly decreased serum amylase, pancreatic weight/body ratio, pancreatic TNF-α level, pancreatic and pulmonary MPO activity (P < 0.05). Histopathological examinations revealed that pancreatic and pulmonary samples from rats pretreated with MG-132 demonstrated milder edema, cellular damage, and inflammatory activity (P < 0.05). CONCLUSION: The proteasome inhibitor MG-132 shows a protective effect on severe acute pancreatitis and associated lung injury of rats.

Pancreatic pseudocyst

Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Initial diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound with fine needle aspiration has become the preferred test to help distinguish pseudocyst from other cystic lesions of the pancreas. Most pseudocysts resolve spontaneously with supportive care. The size of the pseudocyst and the length of time the cyst has been present are poor predictors for the potential of pseudocyst resolution or complications, but in general, larger cysts are more likely to be symptomatic or cause complications. The main two indications for some type of invasive drainage procedure are persistent patient symptoms or the presence of complications (infection, gastric outlet or biliary obstruction, bleeding). Three different strategies for pancreatic pseudocysts drainage are available: endoscopic (transpapillary or transmural) drainage, percutaneous catheter drainage, or open surgery. To date, no prospective controlled studies have compared directly these approaches. As a result, the management varies based on local expertise, but in general, endoscopic drainage is becoming the preferred approach because it is less invasive than surgery, avoids the need for external drain, and has a high long-term success rate. A tailored therapeutic approach taking into consideration patient preferences and involving multidisciplinary team of therapeutic endoscopist, interventional radiologist and pancreatic surgeon should be considered in all cases.

Difficulty with diagnosis of malignant pancreatic neoplasms coexisting with chronic pancreatitis

Chronic pancreatitis is a relatively common disease. We encountered two different cases of belatedly demonstrated pancreatic carcinoma featuring underlying chronic pancreatitis. The first case was one that was highly suspected as that of a malignancy based upon imaging study, but unfortunately, it could not be confirmed by intra-operative cytology at that time. Following this, the surgeon elected to perform only conservative bypass surgery for obstructive biliary complication. Peritoneal carcinomatosis was later noted and the patient finally died. The second case, a malignant mucinous neoplasm,was falsely diagnosed as a pseudocyst, based upon the lesion's sonographic appearance and associated elevated serum amylase levels. After suffering repeated hemoptysis,the patient was found to exhibit lung metastasis and peritoneal seeding. We reviewed some of the literature,including those studies discussing chronic pancreatitis predisposing to a malignant change. These two case analyses illustrate clearly that the diagnosis for such conditions, which is simply based upon imagery or pathological considerations may end up being one of a mistaken malignancy. Some of our suggestions for the treatment of such malignancies as revealed herein include,total pancreatomy for univocal mass lesion, and needle aspiration of lesion-contained tissue for amylase, CA199and CEA levels for a suspicious cystic pancreatic mass.

Are acute exacerbations of chronic inflammatory appendicitis triggered by coprostasis and/or coproliths?

AIM: To examine the role of coprostasis and coproliths in recurrent appendicitis. METHODS: We evaluated four hundred and twenty seven consecutive pathology reports of all appende- ctomy specimens from January 2003 to December 2004. Findings were categorised as showing acute appen- dicitis, acute recurrent appendicitis, subacute recurrent appendicitis, chronic appendicitis, or appendices without inflammation. All patients had presented with acute right lower quadrant pain. In 94 instances, there was a history of recurrent similar episodes in the past. RESULTS: Of the 427 histology reports, 294 were inter- preted as showing acute appendicitis, 56 acute recurrent appendicitis, 34 subacute recurrent appen-dicitis, 28 chronic appendicitis, and 15 non-inflamed appendices. Coprostasis was observed in 58 patients (13.58%) and the presence of coprolith in 6 (1.4%). Coprostasis, and age, were among the predictors in the final model. CONCLUSION: Coprostasis but not coproliths seems to be a contributing factor to acute exacerbations of chronic inflammatory appendicitis.

Clinical characteristics of fulminant hepatitis in pregnancy

AIM： To investigate the clinical characteristics of fulminant hepatitis in pregnancy. METHODS： We compared and analyzed the etiology, clinical characteristics, and laboratory examinations of 25 cases of fulminant hepatitis in pregnancy and 30 cases of fulminant hepatitis not in pregnancy. RESULTS： HBV infection and chronic fulminant hepatitis were most common both in the pregnant and in the non-pregnant groups. Jaundice, digestive tract symptoms, increase of bilirubin and thrombinogen activity were the main manifestations. The incidence of hepatic encephalopathy （HE） and hepato-renal syndrome （HRS） was significantly different between the two groups. The incidence of preterm labor, dead fetus and neonatal asphyxia was high. CONCLUSION： Fulminant hepatitis is likely to occur in late pregnancy wibh more severe complications, which significantly influences maternity, perinatal fetus, and newborn.

Acute necrotizing pancreatitis complicated with pancreatic pseudoaneurysm of the superior mesenteric artery: A case report

Acute necrotizing pancreatitis complicated with pancreatic pseudoaneurysm is a rare emergency associated with high mortality that demands immediate treatment to save the patient’s life. We treated a 64-year-old man who presented with a bleeding pseudoaneurysm of the superior mesenteric artery caused by acute pancreatitis, using interventional embolizing therapy. In the present report we show that interventional treatment is an effective therapeutic modality for patients with acute necrotizing pancreatitis complicated with intra-abdominal bleeding.

Common carotid arterial thrombosis associated with ulcerative colitis

A 26-year-old woman with ulcerative colitis was transferred to our hospital with left hemiparesis due to cerebral infarction. Cervical ultrasonography and magnetic resonance imaging angiography revealed thrombosis at the right common carotid artery and the right internal carotid artery. Antithrombotic and anticoagulant therapies were commenced. After about 2 wk of the treatment, the frequency of her diarrhea increased. She underwent emergency subtotal colectomy, but 10 d later an abundant hemorrhage from the remnant rectum occurred, so the remnant rectum was resected and an ileal pouch anal anastomosis was performed. Antithrombotic and anticoagulant therapies were continued, but neither her neurological status nor magnetic resonance imaging angiography findings showed subsequent changes. She was discharged 3 mon after operation. This is a rare case of common carotid arterial thrombosis occurring as a complication of ulcerative colitis, in which antithrombotic and anticoagulant therapies are considered to provoke a deterioration of the patient’s bowel disease.

Porphyria cutanea tarda as a complication of therapy for chronic hepatitis C

There is a strong association between porphyria cutanea tarda (PCT) and chronic viral hepatitis C. Therapy for chronic viral hepatitis C may improve PCT. However, there are only a few reports of the de novo development of PCT during therapy for chronic viral hepatitis C. We describe the development of PCT in a 56-year-old patient with chronic viral hepatitis C after 12 wk of peginterferon/ribavirin therapy. In addition, the patient was homozygous for the H63D hereditary hemochromatosis gene (HFE ) mutation. The association of PCT with chronic viral hepatitis C and the possible role of hepatic iron overload and ribavirin-induced hemolytic anemia in the development of PCT during therapy for chronic viral hepatitis C are discussed.

Liver biopsy in a district general hospital:Changes over two decades

AIM： To study liver biopsy practice over two decades in a district general hospital in the United Kingdom.METHODS： We identified all patients who had at least one liver biopsy between 1986 and 2006 from the databases of the radiology and gastroenterology departments. Subjects with incomplete clinical data were excluded from the study.RESULTS： A total of 103 liver biopsies were performed. Clinical data was available for 88 patients, with 95 biopsies. Between 1986 and 1996, 18 （95%） out of the 19 liver biopsies performed were blind and 6 （33%） were for primary biliary cirrhosis. Between 1996 and 2006, 14 （18%） out of 76 biopsies were blind; and the indications were abnormal liver tests （33%）, hepatitis C （12%） and targeted-biopsies （11%）. Liver biopsies were unhelpful in 5 （50） subjects. Pain was the most common complication of liver biopsy （5%）. No biopsy-related mortality was reported. There was a trend towards more technical failures and complications with the blind biopsy technique.CONCLUSION： Liver biopsies performed in small district hospitals are safe and useful for diagnostic and staging purposes. Abnormal liver tests, non-alcoholic fatty liver disease and targeted biopsies are increasingly common indications. Ultrasound-guided liver biopsies are now the preferred method and are associated with fewer complications.