When care goes beyond the patient.

Objective To summarize the clinical characteristics, preoperative examinations and therapeutic method of colon cancer combined with abdominal abscess. Methods The clinical data of 41 patients with colon cancer combined with abdominal abscess who were admitted to the First Hospital of Longyan between January 2008 and August 2014 were retrospectively analyzed. All the patients underwent laboratory tests and imaging examinations before operation. According to the principles of operative safety and radical resection of tumor, 41 patients underwent open operation and then received the fluid infusion, antibiotic treatment, parenteral nutrition support and symptomatic treatment after operation. Patients were followed up via telephone interview and outpatient examination till August 2014. Results All the 41 patients had different levels of obstruction and infection at admission, and concomitant diabetes mellitus were detected in 26 patients, essential hypertension in 21 patients, heart diseases in 19 patients and chronic obstructive pulmonary disease in 9 patients. The results of laboratory tests showed that there were 4 patients with hemoglobin (Hb) 90 g/L, 36 patients with albumin (Alb) <30 g/L, 18 patients with increased glycosylated hemoglobin (GHb) , 41 patients with increased serum procalcitonin and 10 patients with increased blood carcinoembryonic antigen (CEA) . Abdominal tumors and intestinal obstructions were detected in 41 patients by thoracic and abdominal enhanced CT, intraluminal tumors in 23 patients by colonoscopy because of unsuccessful placement of colonoscopy in 19 patients, the metal stent endoprosthesis was placed in 2 patients to relieve obstruction. Fifty-nine strains of bacteria were cultured from 41 copies of the pus (28 copies obtained from diagnosistic peritoneocentesis and 13 copies obtained from operation) , and most of them were escherichia coli with a percentage of 61.0% (36/59) and were sensitive to imipenem. All patients underwent open surgery including 33 patients combined wtih enterostomy. The operation time was 150-272 minutes with a median time of 221 minutes. The volume of intraoperative blood loss was 100-800 mL with a median volume of 370 mL. The tumor located at the ileocecal valve was detected in 6 patients and ascending colon in 9 patients, and then palliative or radical right hemicolectomy was performed. The tumor located at the hepatic flexure of colon was detected in 2 patients and then radical extended right hemicolectomy was performed. The tumor located at the splenic flexure was detected in 4 patients and descending colon in 7 patients, and then the radical resection and terminal ileostomy were performed. Among 13 patients with tumor located at the sigmoid colon, 12 patients received radical resection and 1 patient received palliative resection. Eleven patients were complicated with pulmonary infection, 6 patients with infection or dehiscence of incision, 5 patients with anastomotic leakage, 4 patients with ureteral injury, 4 patients with heart failure, 3 patients with paralytic intestinal obstruction, 2 patients with septicemia, 1 patient with renal failure, 1 patient with cerebral infarction and 1 patient with pulmonary embolism. Nine patients died after operation. The diameter of resected tumor was 4.5-15.0 cm with a median diameter of 9.4 cm. High-differentiated tumors were detected in 25 patients, moderate-differentiated tumors in 12 patients and low-differentiated tumors in 4 patients (signet-ring cell carcinoma in 1 patient) . There were 4 patients in the T3 stage of tumor and 37 patients in the T4 or T4b stage. The number of lymph node dissection was 23 (range, 15-35 ) with 18 positive lymph nodes. Six patients had lymph node metastasis. Twenty-eight patients were followed up for a median time of 27 months (range, 3-80 months) . During the follow-up, 16 patients died and 12 patients survived, 10 patients died of tumor recurrence and metastasis, 6 patients died of other diseases, 4 patients had tumor recurrence and metastasis and 8 patients had no recurrence and metastasis. Conclusions Patients with colon cancer combined with abdominal abscess are usually complicated with internal diseases, with a high mortality. Surgical treatment is the only curative treatment option, but an accurate preoperative evaluation is essential and the opportunity of operation should be evaluated before operation, the injury of ureteral , vascular and other surrounding important structures should be avoided during operation, meanwhile, intraoperative application of enterostomy could reduce anastomosis-related complications. After operation, routine peritoneal lavage and antibiotics according to the drug sensitive test are conducted for reducing the postoperative complications and mortality. Key words: Colonic neoplasms; Abdominal abscess; Surgical procedure, operative

Objective To observe the changes in visual field defect before and after treatment in patients with acute solitary occipital lobe cerebral infarction. Methods From January 2017 to May 2019, 59 patients with hemianopsia who were diagnosed as acute occipital lobe cerebral infarction in Henan Provincial People's Hospital were selected. There were 35 males (59.3%) and 24 females (40.7%); aged from 50 to 72 years, with an average age of 62.86±6.10 years. There were 23 patients of right occipital cerebral infarction and 36 patients of left occipital cerebral infarction. Lesions involved 41 patients in the striated area, 8 patients involved the occipital pole, and 23 patients involved visual radiation. All patients underwent standard medical treatment. All patients underwent visual field examination before treatment, and modified rankin scale (mRS) was used to evaluate the level of visual disability after cerebral infarction. At 1, 3, and 6 months after treatment,54 patients underwent at least one visual field examination in outpatient or inpatient follow-up visits, and 5 patients were lost to follow-up; 49 patients received repeated mRS scores. The visual field defect and mRS score of patients before and after treatment were compared and analyzed. The improvement of visual field defect in the horizontal direction exceeding 10°or the vertical direction exceeding 15°was defined as improvement, otherwise it was defined as no improvement. According to the type of visual field defect, the patients were divided into two groups: complete homonymous hemianopia and incomplete homonymous hemianopia. The cumulative visual field improvement rate of the two groups of patients was calculated. An mRS score of 0 to 2 was defined as a good prognosis, and >2 was defined as a poor prognosis. Results Before treatment, of the 59 patients, 47 were complete homonymous hemianopsia and 12 were incomplete. Of the 47 patients with complete homonymous hemianopia, 26 patients had hemianopia on the right side of both eyes, 21 patients had hemianopia on the left side of both eyes; 32 patients with macular avoidance (72.3%). Among the 12 patients of incomplete homonymous hemianopia, 10 patients of quadrant blindness included 6 patients of upper quadrant and 4 patients of lower quadrant; 2 patients of partial isotropic hemianopia on one side. Of the 54 patients reviewed after treatment, the visual field improved at the last follow-up of 25 patients (46.3%), and there was no improvement in 29 patients (53.7%). The cumulative visual field improvement rate of 47 patients with complete hemianopia hemianopia before treatment was 37.2% (16/43). The cumulative visual field improvement rate of 11 patients with incomplete isotropic hemianopia before treatment was 81.8% (9/11). There was a statistically significant difference in cumulative visual field improvement between the two groups of patients (χ2 = 7.011, P<0.05). Before treatment, 59 patients had mRS scores of 1 to 2 points in 15 patients (25.4%), and 44 patients with 2 points or more (74.6%). Of the 49 patients reviewed after treatment, 28 (57.1%) had a good prognosis and 21(42.9%) had a poor prognosis. Conclusions The visual field defect of patients with homonymous hemianopsia after acute occipital infarction may be improved after treatment. The improvement mostly occurs within 1 m after treatment, and patients with incomplete homonymous hemianopsia have more significant improvements than those with complete homonymous hemianopsia. Key words: Occipital lobe; Cerebral infarction; Visual fields; Hemianopsia

Objective The purpose of this study was to use graft bypass for giant serpentine aneurysms. Method 21 patients with giant serpentine aneurysms were treated with the use of graft bypass. Out of 14 patients with unruptured aneurysms, 4 patients presented with headache, 3 with reversible ischemic neurologic deficit( RIND), 5 patients had neck stiffness and features of lower cranial nerve palsy and out of the remaining two each had epilepsy and visual fields deficits respectively. 7 patients compromised ruptured aneurysms, inclusive of six patients with Hunt - Hess grade Ⅰ and Ⅱ1 , and one grade Ⅲ. Their suffering course ranged from 20 days to 3.5 years(mean, 7. 3 months). Cerebral angiography disclosed the M1 segment aneurysms of the middle cerebral artery in 6 patients and M2 segment in 4 patients, AI segment aneurysms of the anterior cerebral artery in 1 patients and A2 segment in 1 patient, P1 segment aneurysm of the posterior cerebral artery in 2 patients, basilar trunk in 2 patients, and the vertebral aneurysms in 5 patients. The aneurysm size in diameter from 0. 3 to 2. 5 cm(mean diameter, 1.2 cm), 13 aneurysms had length of more than 3. 0 cm and 8 patients with serpentine aneurysms had more than 5.0 cm. We used radial artery graft in 7 patients, superficial artery graft(STA) in 6 patients, occipital artery(OA) in 6 patients and greater saphenous vein ( GSV ) in remaining 2 patients. We underwent extra - intracranial bypass in 12 patients which includes external carotid artery to intracranial artery bypass in 5 cases, occipital artery to intracranial artery bypass in 4 cases and internal maxillary artery to intracranial artery bypass in 3 cases. The recipient intracranial vessel were anastomosed to the middle cerebral arteries in five patients, to the inferiopostrior cerebellar arteries in three patients, to P2 segment of the posterior cerebral arteries in three patients, and to anterioposterior cerebellar artery in one patient. The interposed grafts were performed between the arteries proximal and distal to the aneurysms in 9 patients, which includes interposition graft between M1 and M2 segment of the middle cerebral arteries(MCA) in three patients, M1 trunk of the MCA in two patients, the distal Al segment and proxmial A2 segment of the anterior cerebral arteries in two patients, and the extra - intracranial vertebral arteries in 2 patients. The aneurysms were trapped in 11 cases, the aneurysms were excised in 7 cases after isolating them, and the clip was places at the proximal end of the aneurysm in three cases with perforating arteries arising from the body of the aneurysm after performing the reverse flow bypass to the aneurysm sac securing the perforators. Results 20 patients returned to their normal life, they were free of headaches, seizure, visual acuity and visual field were improved and hemiparesis was recovered. One patient needed assist for his daily life. The postoperative angiographies demonstrated satisfactory patency of the bypass graft and elimination of the aneurysms in 19 patients though the patency of bypass graft in one patient was unidentifiable instead the patient was without neurological deficits clinically. One patient had developed postoperative hematoma in the ipsilateral sylvian fissure 2 days after the surgery. The hematoma was evacuated immediately but got neurological deficit on the contralateral lower limb with the power of grade Ⅳ. Conclusions Bypass graft should be an effective management for surgical treatment of giant serpentine aneurysms. Key words: Intracranial aneurysm; Cerebral revascularization; Vessel graft; Bypass

Objective To investigate the surgical management of huge pelvic tumor.Methods The clinical data of 56 patients with huge pelvic tumor who were admitted to the Cancer Hospital of Henan Province from February 2005 to January 2012 were retrospectively analyzed.Tumor resectability was assessed via enhanced computed tomography or three-dimensional reconstruction,and the tumors were freed and resected by combination of muliiple surgical approaches.All the patients were followed up via telephone or re-examination at the out-patient department to learn the recurrence and metastasis of tumor.The survival rate was calculated using the life table.Results Fifty patients received preoperative computed tomography examination,and the imaging data of 6 patients were three-dimensionally reconstructed.Preoperative evaluation showed that 49 patients needed combined multivisceral resection,5 needed tumor resection,and the tumors of 2 patients were unresectable.Fourteen patients were diagnosed preoperatively,and 8 patients were diagnosed by intraoperative rapid frozen section examination,and the rest 34 patients were diagnosed by postoperative pathological examination.The surgical approaches including anterior median sacral approach combined with transperineal coccyx anterior approach (21 patients),anterior median sacral approach (11 patients),obturator approach (8 patients),retropubic approach (8 patients) and obturator approach combined with transperineal approach of coccyx (8 patients).Tumor and rectum resection was carried out on 18 patients,tumor and partial bladder resection on 12 patients,tumor,uterus and ovariectomization on 12 patients,tumor,part of the small intestine and colorectal resection on 10 patients,tumor and total pelvic exenteration on 4 patients.In all the 56 patients,53 achieved R0 resection,2 cases reached naked eye clean,1 case had residual tumor.The mean operation time was 100 minutes.Fifty patients recovered uneventfully.Six patients had postoperative complications,including 3 patients with intestinal obstruction (2 patients were cured by conservative treatment,and 1 patient was cured by surgery),2 patients with pelvic infection and 1 patient with colostomy hernia,and they were cured by drainage and nutritional support.One patient died of postoperative myocardial infarction.The results of postoperative pathologic study showed that 25 patients were with adenocarcinoma,16 with sarcoma and 15 with gastrointestinal stromal tumor.Forty-seven patients were followup to December 2012,and the 5-year survival rate was 26.7％ for patients with adenocarcinoma,18.9％ for patients with sarcoma,and 52.6％ for patients with gastrointestinal stromal tumor.Conclusion Preoperative assessment of resectability of huge pelvic tumor can reduce unnecessary laparotomy and improve the safety of operation. Key words: Huge pelvic tumor; Imaging examination; Resectability evaluation; Surgical approach

Objective To investigate the improvement of symptoms of the patients after treatment in patients with Rome Ⅳ or non-Rome Ⅳ irritable bowel syndrome (IBS), and to explore the influence of IBS diagnosed by different criteria on the patients. Methods From June 2nd to 8th in 2016, at Outpatients Department of Gastroenterology, Union Hospital Affiliated to Tongji Medical College, Huazhong Uiversity of Science and Technology in Wuhan, 1 500 outpatients aged over 18 years old and with intestinal symptom were selected for questionnaire. After treatment for six months, IBS patients, non-IBS patients, patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS were followed up by phone calls. After treatment, the improvement of symptoms of the patients was evaluated by irritable bowel syndrome symptom severity scale (IBS-SSS). The degree of influence of IBS diagnosed with different criteria on patients was evaluated by the patient′s daily work whether to choose colonoscopy examination, whether to choose medication, and the efficacy of medicine. Student′s t test, Mann-Whitney U test and chi-square test were performed for statistical analysis. Results A total of 352 patients with intestinal symptoms were followed-up, including 175 patients with IBS (84 patients with Rome Ⅳ IBS and 91 patients with non-Rome Ⅳ IBS) and 177 non-IBS patients, and 142 patients responded. There were no statistically significant differences in response rate between non-IBS patients and IBS patients (37.3%, 66/177 vs. 43.4%, 76/175), and between patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS (40.5%, 34/84 vs. 46.2%, 42/91) (χ2=1.379 and 0.573, P=0.240 and 0.449). Compared with the non-IBS patients, the degree of satisfaction of medicine was lower in IBS patients (71.4%, 30/42 vs. 47.5%, 19/40). Compared with non-Rome Ⅳ IBS patients, Rome type Ⅳ IBS patients were more likely to receive colonoscopy (35.7%, 15/42 vs. 58.8%, 20/34), and the differences were statistically significant (χ2=4.878 and 4.039, P=0.027 and 0.044). After six months of treatment, symptoms improved in both Rome Ⅳ IBS patients and non-Rome Ⅳ IBS patients (both P<0.05), however, the symptoms improved more significantly in Rome Ⅳ IBS patients and the total score of IBS-SSS was lower than that of non-Rome Ⅳ IBS patients (-130, -185 to 60 vs. -70, -100 to 28), and the difference was statistically significant (Z=-3.065, P=0.002). The difference was mainly showed the symptom of abdominal pain, and the IBS-SSS abdominal pain score of Rome Ⅳ IBS patients was lower than that of non-Rome Ⅳ IBS patients (-80, -100 to -40 vs. 0, -40 to 0), and the difference was statistically significant (Z=-4.631, P<0.01). Conclusions IBS symptoms influence a lot on the satisfaction degree of treatment in outpatients. Even with similar good therapeutic effects, the Rome Ⅳ IBS symptoms have a more severe impact on patients than non-Rome Ⅳ IBS symptoms. Key words: Irritable bowel syndrome; Diagnosis; Rome type Ⅳ; Treatment response

Objective: To investigate the efficacy of surgical treatment for cutaneous malignant melanoma. Methods: Retrospective analysis of clinical records, surgical procedures and the prognosis was performed in 93 patients who were diagnosed of cutaneous malignant melanoma and underwent surgical treatment between October 2007 and December 2011. According to American Joint Committee on Cancer (AJCC) staging system, one patient was in stage ⅠA, two patients were in stage ⅠB, eight patients were in stage ⅡA, nine patients were in stage ⅡB, twenty patients were in stage ⅡC, eighteen patients were in stage ⅢA, seventeen patients were in stage ⅢB, sixteen patients were in stage ⅢC, and two patients were in stage Ⅳ. The surgical procedures include extensive skin resection for 26 patients, extensive skin resection plus construction with skin graft or local flap for 7 patients, finger (toe) amputation for 8 patients, ilioinguinal lymph node dissection for 32 patients, axillary lymph node dissection for 3 patients, extensive skin resection plus one-stage ilioinguinal lymph node dissection for 15 patients, and extensive skin resection plus one-stage axillary lymph node dissection for 2 patients. Fifty-three patients received adjuvant chemotherapy and seventy-eight patients received interferon or interleukin treatment. Of 93 patients, 77 patients were followed-up, with an average follow-up period of 20 months (range: 2-50 months). Results: All of three stage Ⅰ patients survived; of 28 stage Ⅱ patients, 8, 2 and 6 patients had linguinal lymph node, bone or skin metastasis 12, 18 and 36 months after surgical treatment, respectively; of 44 stage Ⅲ patients, 11 patients died of lung metastasis, and 5 patients died of liver metastasis during the follow-up; of 2 stage Ⅳ patients, 1 patients died of lung metastasis 12 months after surgical treatment, and 1 patient died of liver metastasis 11 months after surgical treatment. Of the 77 patients who were followed-up, 43 patients survived with neither local recurrence nor progressive disease. Conclusion: Early diagnosis and surgical treatment of cutaneous malignant melanoma can achieve desirable disease control, and the standardized regional lymph node dissection is important in the control of tumor progression, as well as the adjuvant therapy is benefit for the survival. DOI:10.3781/j.issn.1000-7431.2012.09.013

Objective To investigate the epidemiological characteristics, clinical features, diagnosis, treatment and prognosis of benign tumor of the bile ducts. Methods The retrospective cross-sectional multicenter study was conducted. The clinical data of 136 patients with benign tumor of the bile ducts who were admitted to the eight hospitals between January 2007 and December 2016 were collected, including 70 in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, 19 in the First Affiliated Hospital of Zhengzhou University, 15 in the First Affiliated Hospital of Xi′an Jiaotong University, 11 in the First Affiliated Hospital of Dalian Medical University, 7 in the Affiliated Hospital of North Sichuan Medical College, 6 in the Southwest Hospital of the Third Military Medical University, 4 in the Cancer Center of Sun Yat-Sen University and 4 in the Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. All the patients received laboratory and imaging examinations, and then underwent corresponding surgery when treatment planning was respectively determined by comprehensive hospitals according to clinical features and results of examinations. Surgical procedures were performed based on the results of intraoperative frozen section in rapid pathological diagnosis. Observation indicators: (1) epidemiological characteristics; (2) clinical features; (3) results of laboratory and imaging examinations; (4) treatment situations; (5) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the survival of patients up to March 2017. Measurement data with normal distribution were represented as ±s . Results (1) Epidemiological characteristics: Of 136 patients, the male to female ratio was 1.78∶1. The incidence of whole bile duct tumors was from high to low, including 52 patients with duodenal papilla adenoma, 32 with extrahepatic bile duct adenoma, 24 with intrahepatic biliary cystadenoma, 11 with intrahepatic papillary adenoma, 9 with intrahepatic bile duct epithelial tumor, 7 with epithelial tumor of duodenal papilla and 1 with neuroendocrine tumor of duodenal papilla. Among 136 patients, adenomas (including cystadenoma) was detected in 108 patients, papillomas in 11 patients, intraepithelial neoplasias in 16 patients, neuroendocrine tumor in 1 patient; intrahepatic bile duct benign tumors in 44 patients and extrahepatic bile duct (including duodenal papilla) benign tumors in 92 patients. (2) Clinical features: of 44 patients with intrahepatic bile duct benign tumors, 29 had abdominal pain, fever and abdominal masses, 4 had jaundice, 11 had no obvious clinical symptoms and were diagnosed by physical examination. Among 92 patients with extrahepatic bile duct benign tumors, 76 developed obstructive jaundice, 68 were accompanied by abdominal pain or colicky pain, 8 were combined with pancreatitis and 2 developed hemobilia, some patients were combined with multiple clinical symptoms. (3) Results of laboratory and imaging examinations: 82 patients received CA19-9 test, results of 22 patients were abnormal, with a level of (148±126)U/mL. Ninety-seven patients received carcinoembryonic antigen (CEA) test, with a level of test of (2.7±2.0)μg/L, and a level of CEA in 1 patient was slight abnormal, with a level of 11.2 μg/L. One hundred and thirty-six patients underwent preoperative ultrasound examinations, showing unqualified hepatic and bile duct space occupying lesions and bile duct dilatation. Ninety-five patients underwent preoperative computed tomography (CT), 80 underwent preoperative magnetic resonance imaging (MRI) or magnetic resonanced cholangio-pancreatography (MRCP), and 13 underwent preoperative endoscopic ultrasonography (EUS). Twenty-nine patients were considered for intrahepatic bile duct benign tumors; 76 were diagnosed with obstructive jaundice, with uncertain benign or malignant tumors; other patients had bile duct space occupying, considering bile duct tumor (including cancer). Twelve patients with bile duct obstruction underwent ERCP, showing obstruction site and morphology. (4) Treatment situations: among 136 patients, 65 underwent pancreaticoduodenectomy, 17 underwent right hemihepatectomy+ cholecystectomy, 16 underwent cholecystectomy+ hepatic left lateral lobectomy, 11 underwent left hemihepatectomy+ cholecystectomy, 11 underwent duodenal papillary local excision+ papilla reconstruction, 11 underwent Roux-en-Y choledochojejunos-tomy anastomosis, 4 underwent cholecystectomy+ extrahepatic bile duct local excision+ end-to-end bile duct anastomosis and 1 underwent endoscopic mucosal resection of duodenal papillary adenoma. Of 136 patients with postoperative complications, 25 were complicated with pancreatic leakage, 11 with bile leakage, 2 with postoperative hemorrhage and 1 with hepatic failure. Two patients with pancreatic leakage died of massive hemorrhage caused by abdominal infection, 1 died of hepatic failure and other patients were discharged from hospital after symptomatic treatment. (5) Follow-up situations: 47 of 136 patients were followed up for 3-123 months, with a follow-up rate of 34.6%. During follow-up, 2 patients undergoing duodenal papillary local excision + papilla reconstruction had canceration, and other patients had good survival. Conclusions There is a low clinical incidence of benign tumor of the bile ducts, which is more common in male than in female, and in adenomas (including cystadenoma) and papillomas. The preoperative imaging examinations or ERCP biopsy pathological examination can increase an accuracy of preoperative diagnosis. Benign tumors with high canceration rates need positive surgical treatment. Key words: Bile ducts, benign neoplasms; Diagnosis; Surgical procedures, operative; Multicenter; Retrospective study

Introduction : Home parenteral nutrition (HPN) represents a kind of therapy for intestinal failure. The system of HPN for adult patients was established in Slovenia by the Clinical Nutrition Unit of the Institute of Oncology, Ljubljana in 2008. The aim of the article is to analyse Slovenian data on HPN in cancer patients in the four-year period from 2008 to 2012. Patients and Methods : In the time period from 2008 to 2012, 53 cancer patients were included in the HPN system in Slovenia–19 males and 34 females. Results : The average age of the patients at enrollment into the HPN system was 53 years. This represents 74.6 % of all patients on HPN who were registered in our unit in this period. Forty-four patients had advanced cancer and 9 patients had no recurrence of cancer during the observation period. In patients with advanced cancer, tumors of the gastrointestinal tract (15 patients stomach and esophagus, 11 patients colon and rectum) and gynecological cancers (10 patients) were represented most frequently.. Gastrointestinal obstruction (74 %) was the major indication for long-term parenteral nutrition in cancer patients. Thirty-seven patients died during the observation period. Median survival time of patients with advanced cancer was 8 months (95 % CI, 3.61 to 12.39 months). Twenty-seven patients received HPN during anti-cancer therapy (chemotherapy, radiotherapy, surgery). Medians for survival time of patients receiving an anticancer therapy and patients without any therapy were 11 months (95 % CI, 3.72 to 18.28 months) and 2 months (95 % CI, 1.26 to 2.74 months), respectively. The survival of patients with anticancer therapy was significantly longer (p < 0.001). The majority of patients (90 %) had HPN each day, 7 times per week. Twenty-eight patients (52 %) had venous access complications . The most common cause of complication was infection in 16 patients (30 %), which did not shorten the survival time of patients with advanced cancer. The number of VAP complications was time-independent and did not affect the survival of the observed patients. The significance value was 0.44 (95 % CI, 0.153–2.275). Conclusion : The results of the retrospective study represent the first Slovenian data on the survival time of cancer patients on HPN treatment for intestinal failure. The results are comparable to the results from European surveys, which are a direct indicator that inclusion criteria for HPN in cancer patients used in Slovenia are good. Introduction of HPN as a therapeutic option also offers a possibility to continue with anticancer therapy and improve the survival rate of patients with advanced cancer. They are also an indirect sign that the quality of HPN service is good and serves as a platform for further development of HPN in cancer patients in Slovenia, and at the same time for other patients who would need a replacement therapy in the form of HPN owing to intestinal failure.

NPWT combined with porcine ADM dressing can effectively remove wound bacteria, reduce wound exudation, and promote wound healing in repairing deep partial-thickness burn wounds and full-thickness burn wounds. Its clinical effect is better than NPWT or porcine ADM dressing alone, and this method may be suitable for patients with non-surgical treatment.

Phase II Study Assessing Safety and Preliminary Efficacy of High Dose Intravenous Ascorbic Acid in Patients with TET2 Mutant Clonal Cytopenias of Undetermined Significance

Commentary--goodbye M(C)ID! Hello MID, where do you come from?

Objective To investigate the diagnosis and treatment of ectopic opening of the common bile duct in the duodenal bulb. Methods The clinical data of 3 patients who were admitted to the Binzhou People's Hospital and 9 patients who were admitted to the Tianjin People's Hospital from January 2006 to December 2013 with ectopic opening of the common bile duct in the duodenal bulb were retrospectively analyzed. Seven patients had choledocholithiasis and 5 had stenosis at the end of common bile duct. The medical histories and clinical features in patients were analyzed and routine blood test and serum liver function test were done. All the patients received the endoscopic retrograde cholangiopancreatography (ERCP) examination and were cured. All the patients were followed up via outpatient examination and telephone interview up to August 2014. Results Six patients had histories of cholangitis recurrence and 2 had histories of duodenal ulcer recurrence. All the patients had pain in the right hypochondriac region of the abdomen. Seven patients had fever, chills, skin yellowing sclera and tenderness in the right hypochondriac region of the abdomen. The levels of alkaline phosphatase (ALP) and glutamyl-transpeptidase (GGT) in 11 patients, the levels of TBil and DBil in 8 patients and the count of WBC in 7 patients were increased. (1) The results of ERCP showed as follows: there was no papillar opening at the second and third segment of duodenum. The crack-like opening located at the duodenal post-bulb with rough and erosive mucosal surfaces and intermittent outflow of bile. Duodenal ulcer was detected in 5 patients and duodenal bulb metamorphosis in 3 patients. All the 12 patients received successfully intubations. (2) The results of retrograde cholangiography showed as follows: the end of common bile duct of 12 patients was taper and sickle-shaped. Intra-and extrahepatic bile duct dilation was detected in 10 patients, choledocholithiasis in 7 patients and clear findings for the pancreatic duct in 5 patients. Among the 12 patients, 8 received balloon dilation (5 with stenosis at the end of common bile duct , 3 with choledocholithiasis) , 3 received laparoscopic common bile duct exploration (LCBDE) combined with cholangioenterostomy due to diameter of stone more than 1. 5 cm and ectopic opening stenosis of the common bile duct in the duodenal bulb. One patient was treated by percutaneous transhepatic cholangiography (PTC) lithotomy of common bile duct after unsuccessful ERCP without bleeding and pancreatitis-related complications. The symptoms of cholangitis in 3 patients were alleviated after balloon dilation, 2 patients had recurrence of cholangitis and were cured by Roux-en-Y cholangioenterostomy. The mean open surgery time and mean duration of postoperative hospital stay in 5 patients were 85 minutes (range, 60-150 minutes) and 10 days (range, 8-14 days) , respectively. All the 12 patients were followed up with a median time of 38 months (range, 8-90 months) . During the follow-up, 10 patients survived well without recurrence of cholangitis and cholelithiasis. Two patients had recurrence of cholangitis at postoperative month 2 and month 14, including 1 patient with the recurrence of common bile duct sand-like stones, and they were readmitted to hospital and treated by Roux-en-Y cholangioenterostomy without recurrence by follow-up. Conclusions The clinical symptoms of ectopic opening of the common bile duct in the duodenal bulb included recurrence of cholangitis, duodenal ulcer history, pain in the right hypochondriac region of the abdomen, skin yellowing sclera, abnormal liver function, crack-like openings in the duodenal bulb by ERCP examination with outflow of bile, cholangiography-guided taper and sickle-shaped end of common bile duct. The treatment should be aimed at the concomitant diseases. Key words: Common bile duct ectopic opening; Duodenal bulb; Diagnosis; Therapy

Objective To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic patients with cirrhotic portal hypertension. Methods The retrospective and descriptive study was conducted. The clinicopathological data of 425 patients with cirrhotic portal hypertension who were admitted to Northern Jiangsu People′s Hospital Affiliated to Yangzhou University were collected. There were 289 males and 136 females, aged (53±11)years, with a range from 21 to 79 years. All the patients were allocated into 3 periods according to the operation time, including 100 patients of early period from February 2012 to March 2014, 156 patients of mature technology period from April 2014 to August 2016, and 169 patients of technology innovation period from september 2016 to December 2018. The patients of early period and mature technology period underwent laparoscopic splenectomy combined with pericardial devascularization, and the patients of technology innovation period underwent vagus nerve-preserving laparoscopic splenectomy combined with pericardial devascularization. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Patients were followed up by outpatient examination to detect the upper digestive rebleeding, gastric retention, and diarrhea up to March 2019. Sequential therapy of endoscopic variceal ligation (EVL) was slectively performed on patients based on results of gastroscopy. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using ANOVA, and paired comparison was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was anlyzed using the Kruskal-Wallis rank sum test, and paired comparison was analyzed using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test and Fisher exact probability. Results (1) Surgical situations: the operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion, cases with conversion to open surgery, and cases with emergency operation for bleeding were (187±46)minutes, 150 mL (range, 50-1 300 mL), 2, 2 , 1 for patients of early period, (164±22)minutes, 50 mL (range, 30-100 mL), 1, 1, 1 for patients of mature technology period, and (150±18)minutes, 50 mL (range, 10-300 mL), 0 , 0 , 0 for patients of technology innovation period, respectively. There were significant differences in the operation time and volume of intraoperative blood loss between the three groups (F=55.482, χ2=94.620, P 0.05). (2) Postoperative situations: 425 patients had oral aspirin enteric-coated tablets for prevention of thrombus, with no perioperative death. Duration of postoperative hospital stay, cases with portal vein thrombosis at postoperative 7 days, cases with pancreatic fistula, cases with pulmonary infection, and cases with abdominal infection were (11.0±2.9)days, 46, 2, 1, 0 for patients of early period, (9.9±1.7)days, 81, 3, 0, 0 for patients of mature technology period, and (8.8±1.3)days, 83, 2, 1, 1 for patients of technology innovation period, respectively. There was a significant difference in the duration of postoperative hospital stay between the three groups (F=39.836, P 0.05) and no significant difference in the cases with pancreatic fistula, cases with pulmonary infection, or cases with abdominal infection between the three groups (P>0.05). Patients with portal vein thrombosis at postoperative 7 days had oral aspirin enteric-coated tablets or warfarin for treatment. Patients with pancreatic fistula, pulmonary infection, and abdominal infection were cured and discharged after conservative treatment. (3) Follow-up: all the 425 patients were followed up for 1-72 months, with a median follow-up of 36 months. Of the 425 patients, 261 underwent postoperative sequential therapy of EVL, including 133 patients of mature technology period and 128 patients of technology innovation period. The incidence rate of upper digestive rebleeding was 3.83%(10/261) of the 261 patients undergoing postoperative sequential therapy of EVL and 17.68%(29/164) of 164 patients without postoperative sequential therapy of EVL, showing a significant difference between them (χ2=23.185, P<0.05). The incidence rates of gastric retention and diarrhea were 96.24%(128/133) and 61.65%(82/133) for 133 patients undergoing sequential therapy of EVL in mature technology period, and 1.56%(2/128) and 3.91%(5/128) for 128 patients undergoing sequential therapy of EVL in technology innovation period, showing significant differences between them (χ2=233.876, 97.883, P<0.05). Conclusions It is safe and feasible of laparoscopic splenectomy combined with pericardial devascularization for patients with cirrhotic portal hypertension, and intraoperative vagus nerve-preserving can reduce volume of intraoperative blood loss and incidence of postoperative complications. Key words: Liver cirrhosis; Portal hypertension; Splenectomy; Pericardial devascularization; Vagus nerve; Laparoscopy

Objective To investigate the diagnosis and treatment of splenic space occupying lesions associated with comorbidity.Methods The clinical data of 5 patients from Jiangyin People' s Hospital and 9 patients from Wuxi People's Hospital from January 2002 to June 2012 were retrospectively analyzed.All the patients suffered from splenic space occupying lesions associated with comorbidity.Splenectomy or multi-visceral resection were selected according to the results of preoperative B sonography and computed tomography examination.Chemotherapy regimes were selected based on postoperative pathological examination.All the patients were followed up till June 2013.Results The symptoms of patients with splenic space occupying lesions were non-specific.The first symptoms of 4 patients were discomfort or distending pain of left upper abdomen,and the other 10patients had no symptoms.The coincidence rate of preoperative diagnosis was 10/14,and the coincidence rate of preoperative diagnosis for patients with malignant tumors was 2/5.Fourteen patients received preoperative B ultra-sonography,and 9 were definitively diagnosed.Nine patients received computed tomography,and 7 were definitively diagnosed.Of the 14 patients,right ovarian cancer,bilateral ovarian cancer and sigmoid colon cancer were correlated with solitary splenic metastasis,and the main lesions of the other 11 patients were not correlated with splenic space occupying lesions.The main lesions of patients with left colon carcinoma,type 2 diabetes and vascular tumor of the spleen,patients with renal carcinoma and splenic sclerosing hemangioma,and patients with hypertension,cholecystolithiasis and splenic lymphangioma were diagnosed simultaneously with the splenic space occupying lesions,and the main lesions of theother 11 patients were diagnosed separately with the splenic space occupying lesions.Ten patients underwent simple splenectomy and 4 patients received multi-visceral resection.Chemotherapy regimens were selected according to the type of main lesions for 5 patients who were diagnosed by pathological examinations.All the patients were recovered smoothly with no occurrence of severe infections.Two patients with splenic sarcoma had tumor metastasis at postoperative 6 months and 1 year,respectively.One patient with right ovarian cancer and solitary splenic metastasis had transverse colonic metastasis at postoperative 3 years.One patient with bilateral ovarian cancer and solitary splenic metastasis had peritoneal metastasis at postoperative 2 years.One patient with sigmoid colon cancer and solitary splenic metastasis died of peritoneal tumor recurrence at postoperative 4 years.One patient with left colon carcinoma,type 2diabetes and vascular tumor of the spleen survived for 6 years and was still sound and well.The other 9 patients with benign disease survived within the period of follow-up.Conclusions The definitive diagnosis for patients with splenic space occupying disease associated with comorbidity depends on the preoperative imaging examination and postoperative pathological examination.Surgical treatment is safe when operative contraindications are excluded.The prognosis of patients is determined by the progress of main lesions and the character of splenic space occupying lesions. Key words: Splenic space occupying lesions; Diagnosis ; Treatment

Objective To understand the clinical features of drug-induced kidney injury (DIKI) in inpatients. Methods The medical records data of inpatients diagnosed as DIKI from January 31, 2010 to January 31, 2017 were retrospectively analyzed. The main analytic indicators included general conditions of patients, degree of renal damage, outcomes, and suspected drugs causing acute kidney injury (AKI), and so on. Results A total of 20 patients were entered into this study, including 16 males (80.0%) at age 8 to 80 years and the average age of (44±20) years, 4 females (20.0%) at age 27 to 71 years and the average age of (49±22) years. Eleven patients (55.0%) were ≤44 years old (young people), 4 patients (20.0%) were 45-59 years old (middle-aged people), 5 patients (25.0%) were ≥60 years old (old people). The kinds of diseases were 2 to 6 in each patient in the 20 patients. Of them, 3 patients (15.0%) had 2 kinds of diseases at the same time, 7 patients (35.0%) had 3 kinds of diseases, 5 patients (25.0%) had 4 kinds of diseases, 4 patients (20.0%) had 5 kinds of diseases, 1 patient (5.0%) had 6 kinds of diseases. The serum creatinine (Scr) and blood urea nitrogen (BUN) values in the 20 patients were 56.0-132.5(89.1±22.1)μmol/L and 2.9-8.5(4.9±1.6)mmol/L before medication, respectively and significantly increased to 128.0-506.0 (241.8±112.8) μmol/L and 4.3-28.0 (13.0±5.9) mmol/L after medication, respectively. After treatments with hemodialysis or renal protective drugs, the Scr and BUN values were significantly reduced to 52.0-439.0(174.8±97.5) μmol/L and 1.0-27.6(9.3±7.1)mmol/L, respectively. The differences of Scr and BUN levels between before medication and after medication, before treatment and after treatment were statistically significant (all P<0.05). All DIKI during hospita-lization were AKI. Six patients (30.0%) were in AKI stage 1, 10 patients (50.0%) in AKI stage 2, and 4 patients (20.0%) in AKI stage 3 (acute renal failure). By the time of discharge, 5 patients were cured, in 12 patients the condition was improved, 1 patient had no change, in 1 patient the condition was deteriorated, and 1 patient died. The effective rate of treatments was 85.0%. A total of 29 kinds of drugs were used in combination in the 20 inpatients, and 6-24(14±5) kinds of drugs were used in each patient. Five categories and 12 drugs were found to induce kidney injury in this study, involving antibacterial drugs(15 patients), chemotherapeutic drugs (2 patients), antiviral drugs (2 patients), immunosupp-ressants (3 patients), and anti-gout drugs(1 patient). Kidney damage was clearly documented in the instructions of all above-mentioned drugs. The time from medication to onset of DIKI was 1-56 days and the median time was 9 days. Conclusions Antibacterial drugs, especially antifungal drugs such as amphotericin B, were the main drugs causing kidney injury in hospital. The DIKI was AKI during hospitalization, and the treatment effect for AKI was good. Key words: Acute kidney injury; Drug-related side effects and adverse reactions; Inpatients