Purpose:Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury.CT has been applied for several decades to evaluate blunt pelvic trauma patients.However,...Purpose:Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury.CT has been applied for several decades to evaluate blunt pelvic trauma patients.However,it has a certain rate of inaccurate diagnosis of abdominal hollow viscus injury(HVI),especially in the early stage after injury.The delayed diagnosis of HVI could result in a high morbidity and mortality.The bowel injury prediction score(BIPS)applied 3 clinical variables to determine whether an early surgical intervention for blunt HVI was necessary.We recently found another clinical variable(iliac ecchymosis,IE)which appeared at the early stage of injury,could be predicted for HVI.The main objective of this study was to explore the novel combination of IE and BIPS to enhance the early diagnosis rate of HVI,and thus reduce complications and mortalities.Methods:We conducted a retrospective analysis from January 2008 to December 2018 and recorded blunt pelvic trauma patients in our hospital.The inclusion criteria were patients who were verified with pelvic fractures using abdomen and pelvis CT scan in the emergency department before any surgical intervention.The exclusion criteria were abdominal CT insufficiency before operation,abdominal surgery before CT scan,and CT mesenteric injury grade being 5.The MBIPS was defined as BIPS plus IE,which was calculated according to 4 variables:white blood cell counts of 17.0 or greater,abdominal tenderness,CT scan grade for mesenteric injury of 4 or higher,and the location of IE.Each clinical variable counted 1 score,totally 4 scores.The location and severity of IE was also noted.Results:In total,635 cases were hospitalized and 62 patients were enrolled in this study.Of these included patients,77.4%(40 males and 8 females)were operated by exploratory laparotomy and 22.6%(8 males and 6 females)were treated conservatively.In the 48 patients underwent surgical intervention,46 were confirmed with HVI(45 with IE and 1 without IE).In 46 patients confirmed without HVI,only 3 patients had IE and the rest had no IE.The sensitivity and specificity of IE in predicting HVI was calculated as 97.8%(45/46)and 81.3%(13/16),respectively.The median MBIPS score for surgery group was 2,while 0 for the conservative treatment group.The incidence of HVI in patients with MBIPS score≥2 was significantly higher than that in patients with MBIPS score less than≤2(OR=17.3,p<0.001).Conclusion:IE can be recognized as an indirect sign of HVI because of the high sensitivity and specificity,which is a valuable sign for HVI in blunt pelvic trauma patients.MBIPS can be used to predict HVI in blunt pelvic trauma patients.When the MBIPS score is≥2,HVI is strongly suggested.展开更多
AIM： To explore the regularity of multi-meridians controlling a same viscus （MMCSV）. METHODS： The rabbit gastric ulcer model was established by ethanol intragastric instillation. Fifty-six rabbits were randomly di...AIM： To explore the regularity of multi-meridians controlling a same viscus （MMCSV）. METHODS： The rabbit gastric ulcer model was established by ethanol intragastric instillation. Fifty-six rabbits were randomly divided into normal group, model group （MG）, model plus acupuncture at Foot Yangming Meridian group （YMG）, model plus acupuncture at Foot Taiyin Meridian group （TYG）, model plus acupuncture at Foot Shaoyang Meridian group （SYG）, model plus acupuncture at Foot Jueyin Meridian group （JYG）, model plus acupuncture at Foot Taiyang Meridian group （TYMG）, with eight rabbits in each group. Gastric mucosal nitric oxide （NO） and nitric oxide synthase （NOS） were assayed by the nitric acid reductase method, and prostaglandin E2 （PGE2） and epidermal growth factor （EGF） were measured by radioimmunoassay. The comprehensive effects were analyzed by weighing method. RESULTS： Compared to MG, SYG, JYG and TYMG, the rabbits gastric mucosal injury index （GMII） reduced very significantly in YMG （P〈0.01）. Compared to MG, the GMII also reduced significantly in TYG （P〈0.05）. NO, NOS, PGE2 and EGF increased very significantly in YMG （P〈0.01）. The EGF in YMG also increased significantly than that in TYG compared to those in MG, SYG, JYG and TYMG （P〈0.05）. The PGE2 and EGF also increased very significantly in TYG than those in MG, JYG and TYMG （P〈0.01）. While compared to SYG, the NOS increased significantly in TYG （P〈0.05）. NOS was the highest in YMG （P〈0.01）, and was higher in TYG than in MG （P〈0.01）. CONCLUSION： MMCSV is common. The Foot Yangming Meridian is most closely related to the stomach, followed by Foot Taiyin Meridian, Foot Shaoyang Meridian and Foot Jueyin Meridian. Foot Taiyang Meridian has no correlation with the stomach.展开更多
BACKGROUND: Intra-abdominal free fluid is commonly caused by injuries of solid or hollow organs in patients suffering from blunt abdominal trauma (BAT). However, it presents a diagnostic dilemma for surgeons when free...BACKGROUND: Intra-abdominal free fluid is commonly caused by injuries of solid or hollow organs in patients suffering from blunt abdominal trauma (BAT). However, it presents a diagnostic dilemma for surgeons when free fluid is unexplained, especially in stable BAT patients. This study was to analyze the incidence of such unexplained free fluid in BAT patients and its diagnostic value in abdominal organ injury. METHODS: Altogether 597 patients with BAT who had been treated at our trauma center over a 10-year period were reviewed. Stable patients with free fluid but without free air or definite organ injury on abdominal computed tomography were studied. Clinical management and operative findings were analyzed. RESULTS: Thirty-four (5.70%) of the 597 patients met the inclusion criteria: 24 (4.02%) underwent therapeutic exploratory laparotomy: bowel injuries were found in 13, hepatic rupture in 3, colon rupture in 3, duodenal rupture in 2, spleen rupture in 1, pancreas rupture in 1, and gallbladder perforation in 1. In 2 patients, laparotomy was nontherapeutic. Those with moderate or large amounts of free fluid were more likely to suffer from a hollow viscus injury and have a therapeutic procedure. The mean time of hospital stay for the delayed laparotomy group was longer than that for the emergency group (19 5.12 vs. 12 2.24 days; t=2.73, P<0.01). CONCLUSIONS: There was a positive correlation between the amount of unexplained free fluid and the determination of intra-abdominal organ injury. The proportion of BAT patients who required surgical intervention was high, particularly those with a moderate or large amount of free fluid, and most of them suffered from a hollow organ injury. Emergency laparotomy is recommended for these patients.展开更多
BACKGROUND Thyroid storm is an uncommon condition manifesting in severe thyrotoxicosis with a high mortality rate.The concurrence of peptic ulcer disease and hyperthyroidism is rare due to concurrent activation of bot...BACKGROUND Thyroid storm is an uncommon condition manifesting in severe thyrotoxicosis with a high mortality rate.The concurrence of peptic ulcer disease and hyperthyroidism is rare due to concurrent activation of both the sympathetic and parasympathetic pathways.We present a case of perforated giant gastric ulcer with concurrent thyroid storm who underwent damage control surgery with emergency patch repair with falciform ligament and recovered well.CASE SUMMARY A 53-year-old male chronic smoker,with no previous medical history,presented with severe generalized abdominal pain and vomiting for one day duration.Further history revealed weight loss,diarrhea,and anxiety over the past three months.On clinical examination,patient was febrile with temperature of 38.6 Degrees Celsius and tachycardic at 130-140 beats per minute,his blood pressure was low at 90/50mmHg.His abdomen was tender with generalized peritonism.In view of his clinical history,a thyroid screen was ordered which showed raised thyroxine(T4)levels of 90.3 pmol/L and low thyroxine stimulating hormone(TSH)levels of 0.005μU/mL.Chest X-ray showed no sub-diaphragmatic free air,but contrasted CT scan revealed pneumoperitoneum with large amount of intraabdominal free fluid.The working diagnosis was perforated peptic ulcer complicated by thyroid storm.An urgent endocrinologist consult was made,and patient was started on beta blocker and intravenous steroids pre-operatively.The patient underwent emergency laparotomy with washout and patch repair of the perforated gastric ulcer.Patient was monitored post-operatively in intensive care unit and required IV hydrocortisone and Lugol’s iodine.Histology of the ulcer edges showed no malignancy.On post-operative day seven,T4 decreased to 20.4 pmol/L,TSH was 0.005 mLU/L.His thyroid function test subsequently normalized 3 mo post-operatively with T418.1 pmol/L,TSH 1.91 mLU/L.Patient’s recovery was otherwise uneventful.Thyroid receptor antibody subsequently was positive,and patient was managed for Grave’s disease by the endocrinologist.CONCLUSION This case highlights the rare but life-threatening clinical emergency of peptic ulcer perforation complicated by thyroid storm.Multidisciplinary perioperative management is crucial to optimize patient for surgery and damage control principles should be taken for an acute surgical patient with concurrent endocrine crisis.展开更多
文摘Purpose:Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury.CT has been applied for several decades to evaluate blunt pelvic trauma patients.However,it has a certain rate of inaccurate diagnosis of abdominal hollow viscus injury(HVI),especially in the early stage after injury.The delayed diagnosis of HVI could result in a high morbidity and mortality.The bowel injury prediction score(BIPS)applied 3 clinical variables to determine whether an early surgical intervention for blunt HVI was necessary.We recently found another clinical variable(iliac ecchymosis,IE)which appeared at the early stage of injury,could be predicted for HVI.The main objective of this study was to explore the novel combination of IE and BIPS to enhance the early diagnosis rate of HVI,and thus reduce complications and mortalities.Methods:We conducted a retrospective analysis from January 2008 to December 2018 and recorded blunt pelvic trauma patients in our hospital.The inclusion criteria were patients who were verified with pelvic fractures using abdomen and pelvis CT scan in the emergency department before any surgical intervention.The exclusion criteria were abdominal CT insufficiency before operation,abdominal surgery before CT scan,and CT mesenteric injury grade being 5.The MBIPS was defined as BIPS plus IE,which was calculated according to 4 variables:white blood cell counts of 17.0 or greater,abdominal tenderness,CT scan grade for mesenteric injury of 4 or higher,and the location of IE.Each clinical variable counted 1 score,totally 4 scores.The location and severity of IE was also noted.Results:In total,635 cases were hospitalized and 62 patients were enrolled in this study.Of these included patients,77.4%(40 males and 8 females)were operated by exploratory laparotomy and 22.6%(8 males and 6 females)were treated conservatively.In the 48 patients underwent surgical intervention,46 were confirmed with HVI(45 with IE and 1 without IE).In 46 patients confirmed without HVI,only 3 patients had IE and the rest had no IE.The sensitivity and specificity of IE in predicting HVI was calculated as 97.8%(45/46)and 81.3%(13/16),respectively.The median MBIPS score for surgery group was 2,while 0 for the conservative treatment group.The incidence of HVI in patients with MBIPS score≥2 was significantly higher than that in patients with MBIPS score less than≤2(OR=17.3,p<0.001).Conclusion:IE can be recognized as an indirect sign of HVI because of the high sensitivity and specificity,which is a valuable sign for HVI in blunt pelvic trauma patients.MBIPS can be used to predict HVI in blunt pelvic trauma patients.When the MBIPS score is≥2,HVI is strongly suggested.
基金Supported by the National Natural Science Foundation of China,NO. 90209023
文摘AIM： To explore the regularity of multi-meridians controlling a same viscus （MMCSV）. METHODS： The rabbit gastric ulcer model was established by ethanol intragastric instillation. Fifty-six rabbits were randomly divided into normal group, model group （MG）, model plus acupuncture at Foot Yangming Meridian group （YMG）, model plus acupuncture at Foot Taiyin Meridian group （TYG）, model plus acupuncture at Foot Shaoyang Meridian group （SYG）, model plus acupuncture at Foot Jueyin Meridian group （JYG）, model plus acupuncture at Foot Taiyang Meridian group （TYMG）, with eight rabbits in each group. Gastric mucosal nitric oxide （NO） and nitric oxide synthase （NOS） were assayed by the nitric acid reductase method, and prostaglandin E2 （PGE2） and epidermal growth factor （EGF） were measured by radioimmunoassay. The comprehensive effects were analyzed by weighing method. RESULTS： Compared to MG, SYG, JYG and TYMG, the rabbits gastric mucosal injury index （GMII） reduced very significantly in YMG （P〈0.01）. Compared to MG, the GMII also reduced significantly in TYG （P〈0.05）. NO, NOS, PGE2 and EGF increased very significantly in YMG （P〈0.01）. The EGF in YMG also increased significantly than that in TYG compared to those in MG, SYG, JYG and TYMG （P〈0.05）. The PGE2 and EGF also increased very significantly in TYG than those in MG, JYG and TYMG （P〈0.01）. While compared to SYG, the NOS increased significantly in TYG （P〈0.05）. NOS was the highest in YMG （P〈0.01）, and was higher in TYG than in MG （P〈0.01）. CONCLUSION： MMCSV is common. The Foot Yangming Meridian is most closely related to the stomach, followed by Foot Taiyin Meridian, Foot Shaoyang Meridian and Foot Jueyin Meridian. Foot Taiyang Meridian has no correlation with the stomach.
基金supported by grants from the National Natural Science Foundation of China(No.30801188)the Natural Science Foundation of Zhejiang Province,China(No.Y2090443 and No.Y2090460)
文摘BACKGROUND: Intra-abdominal free fluid is commonly caused by injuries of solid or hollow organs in patients suffering from blunt abdominal trauma (BAT). However, it presents a diagnostic dilemma for surgeons when free fluid is unexplained, especially in stable BAT patients. This study was to analyze the incidence of such unexplained free fluid in BAT patients and its diagnostic value in abdominal organ injury. METHODS: Altogether 597 patients with BAT who had been treated at our trauma center over a 10-year period were reviewed. Stable patients with free fluid but without free air or definite organ injury on abdominal computed tomography were studied. Clinical management and operative findings were analyzed. RESULTS: Thirty-four (5.70%) of the 597 patients met the inclusion criteria: 24 (4.02%) underwent therapeutic exploratory laparotomy: bowel injuries were found in 13, hepatic rupture in 3, colon rupture in 3, duodenal rupture in 2, spleen rupture in 1, pancreas rupture in 1, and gallbladder perforation in 1. In 2 patients, laparotomy was nontherapeutic. Those with moderate or large amounts of free fluid were more likely to suffer from a hollow viscus injury and have a therapeutic procedure. The mean time of hospital stay for the delayed laparotomy group was longer than that for the emergency group (19 5.12 vs. 12 2.24 days; t=2.73, P<0.01). CONCLUSIONS: There was a positive correlation between the amount of unexplained free fluid and the determination of intra-abdominal organ injury. The proportion of BAT patients who required surgical intervention was high, particularly those with a moderate or large amount of free fluid, and most of them suffered from a hollow organ injury. Emergency laparotomy is recommended for these patients.
文摘BACKGROUND Thyroid storm is an uncommon condition manifesting in severe thyrotoxicosis with a high mortality rate.The concurrence of peptic ulcer disease and hyperthyroidism is rare due to concurrent activation of both the sympathetic and parasympathetic pathways.We present a case of perforated giant gastric ulcer with concurrent thyroid storm who underwent damage control surgery with emergency patch repair with falciform ligament and recovered well.CASE SUMMARY A 53-year-old male chronic smoker,with no previous medical history,presented with severe generalized abdominal pain and vomiting for one day duration.Further history revealed weight loss,diarrhea,and anxiety over the past three months.On clinical examination,patient was febrile with temperature of 38.6 Degrees Celsius and tachycardic at 130-140 beats per minute,his blood pressure was low at 90/50mmHg.His abdomen was tender with generalized peritonism.In view of his clinical history,a thyroid screen was ordered which showed raised thyroxine(T4)levels of 90.3 pmol/L and low thyroxine stimulating hormone(TSH)levels of 0.005μU/mL.Chest X-ray showed no sub-diaphragmatic free air,but contrasted CT scan revealed pneumoperitoneum with large amount of intraabdominal free fluid.The working diagnosis was perforated peptic ulcer complicated by thyroid storm.An urgent endocrinologist consult was made,and patient was started on beta blocker and intravenous steroids pre-operatively.The patient underwent emergency laparotomy with washout and patch repair of the perforated gastric ulcer.Patient was monitored post-operatively in intensive care unit and required IV hydrocortisone and Lugol’s iodine.Histology of the ulcer edges showed no malignancy.On post-operative day seven,T4 decreased to 20.4 pmol/L,TSH was 0.005 mLU/L.His thyroid function test subsequently normalized 3 mo post-operatively with T418.1 pmol/L,TSH 1.91 mLU/L.Patient’s recovery was otherwise uneventful.Thyroid receptor antibody subsequently was positive,and patient was managed for Grave’s disease by the endocrinologist.CONCLUSION This case highlights the rare but life-threatening clinical emergency of peptic ulcer perforation complicated by thyroid storm.Multidisciplinary perioperative management is crucial to optimize patient for surgery and damage control principles should be taken for an acute surgical patient with concurrent endocrine crisis.
