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Poor oncologic outcomes of hepatocellular carcinoma patients with intra-abdominal infection after hepatectomy

World Journal of Gastroenterology 2015年第18期21卷 5598-5606页

作者： Dan-Yun Ruan Ze-Xiao Lin Yang Li Nan Jiang Xing Li Dong-Hao Wu Tian-Tian Wang Jie Chen Qu Lin Xiang-Yuan Wu Department of Medical Oncology The Third Affiliated Hospital of Sun Yat-sen University Guangzhou 510630 Guangdong Province China Department of Liver Surgery the Third Affiliated Hospital of Sun Yat-sen University Guangzhou 510630 Guangdong Province China

AIM: To evaluate the impact of postoperative infectious complications on hepatocellular carcinoma following curative hepatectomy.METHODS:We performed a retrospective analysis of200 hepatocellular carcinoma patients who underwent hepatectomy at our institution between September2003 and June 2011.The patients’demographics,clinicopathological characteristics and postoperative infectious complications were analyzed.The ClavienDindo classification was adopted to assess the severity of complications.The dynamic change in the neutrophilto-lymphocyte ratio,defined as the absolute neutrophil count divided by the absolute lymphocyte count,after surgery was also investigated.The observation endpoints for this study were recurrence-free survival and overall survival of the patients.Statistical analysis of the survival curves was performed using the KaplanMeier method and the log-rank test.The prognosticvalue of each variable for predicting prognosis was assessed via multivariate Cox proportional hazards regression analysis.The cutoff score for each variable was selected based on receiver operating characteristic curve analysis.All statistical tests were two-sided,and significance was set at Pintra-abdominal infection group exhibited a worse prognosis than the non-intra-abdominal infection group(Pintra-abdominal infection was observed in the patients with hepatic cirrhosis(P=0.028),concomitant splenectomy(P=0.007)or vascular invasion(P=0.026).The patients who had an elevated postoperative neutrophil-to-lymphocyte ratio change(>1.643)clearly exhibited poorer recurrence-free survival than those who did not(P=0.

关键词： Hepatocellular carcinoma Postoperative intra-abdominal infection Neutrophil-to-lymphocyte ratio change Hepatectomy Prognosis

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Effect of intra-abdominal volume increment on kidneys in minipigs with intra-abdominal hypertension after hemorrhagic shock and resuscitation

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Journal of Medical Colleges of PLA(China) 2014年第1期29卷 37-43页

作者： Zheng-Gang Wang Hao Tan Lian-Yang Zhang Dao-Cheng Liu Hua-Liang Xiao Wen-Hua Du State Key Laboratory of Trauma Burns and Combined Injury Trauma Center Institute of Surgery Research Daping Hospital Third Military Medical University

Background: To investigate the effect of intra-abdominal volume increment(IAVI) on intra-abdominal hypertension(IAH) in the kidneys.Methods: Eight minipigs were successfully established as IAH models and were randomly divided into two groups: the IAVI group and the sham-operated group. The intravesical pressure, inferior vena cava pressure and urine volume were measured before shock, 2 h after IAH, and 22 h after surgery, respectively. The following indices were measured: serum creatinine, urea nitrogen, renal cortical thickness, ratio of abdominal anteroposterior diameter/transverse diameter, renal thickness, diameter of the renal sinus and the wet/dry ratio of renal tissues.Results: The intravesical pressure(IVP) of the 8 minipig IAH models was calculated to be 21.16±4.63 mmHg. There was a significant increase in the abdominal anteroposterior diameter/transverse diameter ratio. The minipigs in the IAVI group survived during the observational period, whereas 2 minipigs died at 18 h and 20 h in the sham-operated group. Twenty-two hours after surgery, the animals in the IAVI group displayed increased urinary volume(UV) and decreased Cr and Ur and remarkable decreases of VP and IVCP. After IAH, the renal cortical thickness and the renal thickness increased significantly. The renal wet/dry ratio in the sham-operated group was higher than that in the IAVI group.Conclusion: IAVI helps to control renal dysfunction after IAH, which may be related to lowering the intra-abdominal pressure, thus alleviating renal edema and blood stasis.

关键词： intra-abdominal volume increment intra-abdominal h

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Mild to moderate intra-abdominal hypertension: Does it matter?

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World Journal of Critical Care Medicine 2016年第1期5卷 96-102页

作者： Liivi Maddison Joel Starkopf Annika Reintam Blaser Joel Starkopf Annika Reintam Blaser Department of Anaesthesiology and Intensive Care University of Tartu Department of Anaesthesiology and Intensive Care Tartu University Hospital Department of Anaesthesiology Intensive Care Emergency and Pain Medicine Lucerne Cantonal Hospital

This review summarizes the epidemiology, pathophysiological consequences and impact on outcome of mild to moderate(Grade Ⅰ to Ⅱ) intra-abdominal hypertension(IAH), points out possible pitfalls in available treatment recommendations and focuses on tasks for future research in the field. IAH occurs in about 40% of ICU patients. Whereas the prevalence of abdominal compartment syndrome seems to be decreasing, the prevalence of IAH does not. More than half of IAH patients present with IAH grade Ⅰ and approximately a quarter with IAH grade Ⅱ. However, most of the studies have addressed IAH as a yes-or-no variable, with little or no attention to different severity grades. Even mild IAH can have a negative impact on tissue perfusion and microcirculation and be associated with an increased length of stay and duration of mechanical ventilation. However, the impact of IAH and its different grades on mortality is controversial. The influence of intra-abdominal pressure(IAP) on outcome most likely depends on patient and disease characteristics and the concomitant macro- and microcirculation. Therefore, management might differ significantly. Today, clear triggers for interventions in different patient groups with mild to moderate IAH are not defined. Further studies are needed to clarify the clinical importance of mild to moderate IAH identifying clear triggers for interventions to lower the IAP.

关键词： intra-abdominal pressure intra-abdominal hypertension Pathophysiology Epidemiology Severity Treatment

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Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair

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World Journal of Critical Care Medicine 2013年第2期2卷 9-16页

作者： Konstantin M Gaidukov Elena N Raibuzhis Ayyaz Hussain Alexey Y Teterin Alexey A Smetkin Vsevolod V Kuzkov Manu LNG Malbrain Mikhail Y Kirov Department of Anesthesiology and Intensive Care Medicine Northern State Medical University Department of Anesthesiology and Intensive Care Medicine City Hospital #1 of Arkhangelsk Department of General Surgery City Hospital #1 of Arkhangelsk Intensive Care Unit and High Care Burn Unit Ziekenhuis Netwerk Antwerpen ZNA Campus Stuivenberg

AIM: To determine the influence of intra-abdominal pressure(IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period. METHODS: Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study.IAP monitoring was performed via both a balloontipped nasogastric probe [intragastric pressure(IGP), Ci MON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure(IBP), Uno Meter Abdo-Pressure Kit, Uno Medical, Denmark] on five consecutive stages:(1) after tracheal intubation(AI);(2) after ventral hernia repair;(3) at the end of surgery;(4) during spontaneous breathing trial through the endotracheal tube; and(5) at 1 h after tracheal extubation. The patients were in the complete supine position during all study stages.RESULTS: The IAP(measured via both techniques) increased on average by 12% during surgery compared to AI(P intraoperatively by 15%-20%(P < 0.025). At all stages, we observed a significant correlation between IGP and IBP(r = 0.65-0.81, P < 0.01) with a mean bias varying from-0.19 mm Hg(2SD 7.25 mm Hg) to-1.06 mm Hg(2SD 8.04 mm Hg) depending on the study stage. Taking all paired measurements together(n = 133), the median IGP was 8.0(5.5-11.0) mm Hg and the median IBP was 8.8(5.8-13.1) mm Hg. The overall r2 value( n = 30) was 0.76(P < 0.0001). Bland and Altman analysis showed an overall bias for the mean values per patient of 0.6 mm Hg(2SD 4.2 mm Hg) with percentage error of 45.6%. Looking at changes in IAP between the different study stages, we found an excellent concordance coefficient

关键词： intra-abdominal pressure Gastric pressure Bladder pressure intra-abdominal hypertension Hernia Oxygenation Respiratory function

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Endoscopic ultrasound-guided drainage of postoperative intra-abdominal abscesses

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World Journal of Gastroenterology 2015年第11期21卷 3402-3408页

作者： Koichiro Mandai Koji Uno Kenjiro Yasuda Department of Gastroenterology Kyoto Second Red Cross Hospital

Although endoscopic ultrasound(EUS)-guided drainage has become the standard procedure for pancreatic pseudocysts in recent years and is generally regarded as a safe and effective method,there have been few reports of EUS-guided drainage of postoperative intra-abdominal abscesses.Here we report our experience with 4 cases of postoperative intraabdominal abscesses for which EUS-guided drainage was performed between May 2011 and May 2014.Distal pancreatectomy had been performed in 3 cases,whereas low anterior resection for rectal cancer was performed in the remaining case.All patients underwent transgastric naso-cystic drainage,which resulted in clinical improvement without complications,even when performed within 4 wk after surgery.On average,the naso-cystic drain was removed 10 d after placement,with no abscess recurrence.Based on these findings,we believe that EUS-guided drainage of postoperative intraabdominal abscesses is a safe and effective method,although further large-scale investigations are required to confirm our findings.

关键词： Postoperative intra-abdominal abscess Endoscopic u

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intra-abdominal Cystic Lymphangioma: Report of 21 Cases

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Journal of Cancer Therapy 2015年第7期6卷 572-578页

作者： Mohamed Ben Mabrouk Malek Barka Waad Farhat Fathia Harrabi Mohamed Azzaza Nefis Abdennaceur Amine Schaidar Abdelkader Mizouni Jaafar Mazhoud Ali Ben Ali Department of Digestive Surgery Sahloul Hospital Sousse Tunisia

Studying in a retrospective review of 21 cases, diagnostic, therapeutic and evolutionary aspects of intra-abdominal cystic lymphangioma (CL). Methods: Between 1992 and 2014, 21 patients were operated at our institution for a CL. Clinical presentation, location, surgical management and outcome were studied. Results: There were 14 women and 7 men. All CL were diagnosed by abdominal ultrasound and/or abdominal CT scan. The most common site was the retroperitoneum (24%) followed by equally by the mesentery, the mesocolon and abdominal wall. Surgical treatment consisted of a complete resection of cyst in 20 patients. This resection required a splenectomy in one case for a splenic location and digestive resection in 2 cases. Two cases of recurrence of CL were revealed. The first case was a result of partial resection, but the second case occurred in a patient who underwent a total cystectomy. These patients were asymptomatic, so we decided to monitor them. Conclusion: CL in adult is a rare disease. The preoperative diagnostic has benefited from the contribution of imaging mainly ultrasound and CT scan, treatment consisted of surgical complete excision to prevent recurrences.

关键词： Cystic Lymphangioma intra-abdominal Diagnosis Surgical Treatment Evolution

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Gossypiboma Presenting as an Atypical intra-abdominal Cyst: A Case Report

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Health 2014年第18期6卷 2499-2504页

作者： Dilip Dan P. Ramraj Viren Solomon Olivier Leron Malini Ramnarine Kavita Deonarine Vijay Naraynsingh Nigel Bascombe Department of Surgery University of the West Indies St. Augustine Trinidad and Tobago

Gossypibomas are generally retained surgical sponges, and are usually a rare occurrence. They are diagnostic dilemmas with an incidence ranging from 1 in 8000 to 1 in 18,000 surgeries. However the incidence of this problem is on the rise and the clinician needs to have a high index of suspicion to make an accurate diagnosis. We reported the case of a 50-year-old male patient who presented with a 6-month history of vague epigastric discomfort, early satiety and nausea. Further investigation revealed an intra-abdominal cyst that proved to be secondary to a retained laparotomy sponge and was treated laparoscopically. This is usually an unanticipated surgical misadventure which is often preventable, with significant associated stigma for the surgical professional involved. Unfortunately it leads to extensive and often unnecessary surgical intervention. The condition can be managed conservatively or surgically. Our case report demonstrates the use of laparoscopy for the successful management of intra-abdominal gossypibomas and represents the first reported case of laparoscopic management of a gossypiboma in the Caribbean setting. It also demonstrates both the acute and delayed presentations of gossypibomas in the same patient.

关键词： Gossypiboma intra-abdominal Cyst Laparoscopic

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CHANGES OF PLASMA AMINO ACID IN TPN SUPPORTED PATIENTS WITH intra-abdominal INFECTION

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医学研究生学报 1989年第1期2卷 1-8页

作者：黎介寿李爱华顾寿年刘放南 Department of abdominal Surgery Jinling HospitalNanjingChina

The changes of plasma aminogram were observed prospectively on 95 cases of enteric fistula associated with intra-abdominal infection under the supplement of TPN(total parenteral nutrition) with a conventional balanced nutritional amino acid solution Anfumine 14s (8.5% Tianjin, China). Plasma levels of amino acid and albumin were determined on the day of initiation of TPN and weekly through the Course of nutritional support and the day of termination of TPN or 2-5 days within death. Initial plasma aminograms obtained on the day before the TPN support were of characterics of aminogram of both sepsis and starvation. The initial total amount of plasma free amino acid was lower than normal and gradually elevated to normal range after two weeks TPN supplement in survivors. While in nonsurvivors, the total free amino acid was increased rapidly and reached the peak value at preterminal stage, significantly higher than the normal range. The level of phenylalanine was constantly high through the course of investigation, either in survivors or nonsurvivors. Proline also elevated proportional to the severity of infection, but to a lesser degree In contrast, the plasma ratio of BCAA/AAA (branched-chain amino acids /aromatic amino acids) was lower than normal and the level of arginine was decreased proportional to the severity of infectionAuthors considered that (1) the amino acid solution specific for starved septic patients should contain lower content of phenylalnine and higher amount of BCAA and arginine as compared with the conventional nutritional amino acid solution; (2) constant elevation of plasma phenylalanine and proline associated with progressive decrease of arginine is one of the meaningful predictive criteria for prognosis of septic patients; (3) inappropriate administration of exogeneous amino acids in metabolic decompensated septic patients might do more harm rather than benefit.

关键词： Amnio acid pattern intra-abdominal infection TPN

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Complete Remission by Primary Chemotherapy of Advanced Non-Seminomatous Germ Cell Tumor in an intra-abdominal Testis

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Open Journal of Urology 2014年第8期4卷 105-108页

作者： Pierre Sarkis Hampig Raphael Kourie Joseph Gharios Joseph Kattan Saint-Joseph Hospital Raymond and Aida Najjar Medical Center Saint-Joseph University Beirut Lebanon

Ectopic testis predisposes to a high risk of germ cell tumor development. Treatment of advanced testicular germ cell tumor developing in an uncorrected abdominal testis is based on primary chemotherapy followed by removal of the testis along with residual masses. However, persistence of viable tumor particularly in the testis is always noted since testis penetration of chemotherapeutic agents is reduced. We report a case of complete pathological remission of a patient with advanced non-seminomatous germ cell tumor in intra-abdominal testis by primary chemotherapy alone, with a review of the literature.

关键词： Germ Cell Tumors intra-abdominal Testis Non-Seminomatous Germ Cell Tumors

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Multimodal treatments of right gastroepiploic arterial leiomyosarcoma with hepatic metastasis:A case report and review of the literature

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World Journal of Clinical Cases 2018年第8期6卷 219-223页

作者： Hyung-Il Seo Dong-Il Kim Youngsoo Chung Chang In Choi Minjoo Kim Sungpil Yun Suk Kim Do Youn Park Department of Surgery Biomedical Research InstitutePusan National University Hospital Department of Surgery Pusan National University Yangsan Hospital Department of Surgery On Hospital Department of Radiology Biomedical Research Institute Pusan National University Hospital Department of Pathology Biomedical Research Institute Pusan National University Hospital

Leiomyosarcoma of an artery is very rare, and cases with hepatic metastasis are even rarer. We describe a case of a 70-year-old man who after follow up due to rectal cancer, presented with an intra-abdominal hypervascular mass and a hepatic mass. After surgical resection, it was diagnosed as a leiomyosarcoma of the right gastroepiploic artery with hepatic metastasis. Multiple metastases had recurred at the liver. He has survived more than 53 mo through multimodal treatments(three surgical resections, radiofrequency ablation, transarterial chemoembolization, chemotherapies, and targeted therapy). Multimodal treatments, including active surgical resection, may behelpful in the treatment of aggressive diseases such as arterial leiomyosarcoma with metastasis.

关键词： Multimodal treatments intra-abdominal arterial leiomyosarcoma Hepatic metastasis Arterial leiomyosarcoma Surgical resection

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