胰岛素瘤切除术围手术期血糖监测的临床意义

【摘要】 目的 探讨胰岛素瘤切除术的围术期管理。方法 回顾性分析本院5年来通过手术治疗胰岛素瘤患者的临床资料。结果 18例患者中男6例,女12例,均有典型的Whipple三联征。15例行开放性肿瘤切除术,3例行腹腔镜下肿瘤切除术。开腹手术采用硬膜外麻醉复合气管内全麻,腹腔镜手术采用单纯气管内全麻。根据术中不同的血糖管理方式将患者分为两组:持续泵注组(C组,n=10)术中静脉泵注50%葡萄糖溶液,根据血糖调节输注速度,维持血糖在3.0~6.0 mmol·L-1;非持续泵注组(NC组,n=8)未予持续泵注葡萄糖,仅在血糖低于2.8 mmol·L-1时才静脉推注50%葡萄糖50 mL。术中每隔15分钟监测一次血糖,肿瘤切除前30 min停止给糖。所有患者术中患者生命体征平稳。持续泵注葡萄糖组肿瘤切除前后血糖控制较非持续泵注稳定(P<0.05)。结论 胰岛素瘤手术时采用持续泵注葡萄糖能够稳定手术过程中血糖水平,肿瘤切除前静脉泵注50%葡萄糖可以避免肿瘤切除前后血糖急剧波动。     

Comparison of High Tibial Osteotomy and Unicompartmental Knee Arthroplasty in the Treatment of Unicompartmental Osteoarthritis : A Meta-Analysis

We conducted a systematic review of comparative clinical trials assessing the results of high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) in patients with strictly unilateral osteoarthritis of the knee. A literature search was conducted through Medline, Embase and Cochrane library. A total of 11 comparative studies were included. Pooled results showed: UKA showed significantly better results compared to HTO in terms of function results, however, no difference in specific knee score was observed; HTO got slightly better results of the range of motion; a trend towards an increased velocity was found in UKA without significant difference. Postoperative rate of revision and complications did not differ significantly between two groups. With the correct patient selection, both HTO and UKA show effective and reliable results.     

A quantitative assessment model of T‐cell immune function for predicting risks of infection and rejection during the early stage after liver transplantation

Although more and more clinical studies indicated that ImmuKnow assay could efficiently assess the immune status of recipients, it still has the challenge to predict the occurrence of clinical adverse events. This study aimed to establish a quantitative assessment model, which could more efficiently predict immune function of T lymphocytes after liver transplantation based on three indexes: CD4+ T lymphocyte count (C), CD4+/CD8+ ratio (R), and ImmuKnow adenosine triphosphate (ATP) value (A). We selected 194 recipients and measured the A, C, and R index every week, then obtained the Fisher linear discriminant functions by SPSS 16.0. Next, we divided the recipients into three groups: infection, stable, and rejection groups according to clinical status. After calculating, the discriminant function, 0.012A + 0.019C + 1.322R (simplified into T = 2A + 3C + 200R), was selected to represent the T‐cell‐mediated immune function. Based on the model, the optimal cutoff T values for infection and rejection were 1415 (sensitivity = 80%, specificity = 79.9%,AUC = 92.3%) and 1939.5 (sensitivity = 93.9%, specificity = 77.6%, AUC = 88.6%), relatively (p < 0.001). In conclusion, this model may be a more feasible way to evaluate the cellular immune function status in liver transplantation recipients.     

Indications and contraindications for double-bundle ACL reconstruction

Over recent years, double-bundle reconstruction has gained popularity after studies showed significant advantages of adding a second bundle with regard to outcomes and biomechanics; in particular, it resulted in less rotational instability than after reconstruction with a traditional single-bundle technique. As the focus shifted further towards the restoration of the native anatomy, both single-bundle and double-bundle ACL reconstruction were performed in an anatomical fashion and yielded similar results. To date, no consensus has developed as to whether double-bundle reconstruction is better than single-bundle reconstruction or vice versa. However, after surgeons started to individualise their surgical approach to the patient, it has been found that both the anatomical single- and double-bundle techniques have their own set of indications and contraindications. Reconstruction of the ligament should focus on restoration of the native functional and anatomical properties and should take the size, shape and orientation of the ACL into account. When indications and contraindications for the technique used are based on native anatomical characteristics, either a single-bundle or a double-bundle procedure can be performed according to the same double-bundle concept.     

Resistin expression correlates with steatohepatitis in morbidly obese patients

Background

Morbidly obese patients are at risk for nonalcoholic steatohepatitis (NASH) even in the absence of risk factors for liver disease. Unfortunately, NASH is usually not clinically evident, and a definitive, noninvasive test for NASH does not exist. Resistin, a cytokine originating from adipose tissue, is involved in insulin resistance and also initiates proinflammatory signaling from hepatic stellate cells. This study explores the relationship between resistin expression and liver pathology in bariatric surgery patients.

Methods

Blood samples from 30 patients undergoing bariatric surgery were collected. Total RNA was extracted and cDNA was synthesized. Quantitative RT-PCR was used to quantify relative gene expression using 18s rRNA gene as an internal control. Wedge liver biopsies from these patients were sectioned and stained. Based on a previously published scoring method, biopsies were assigned an overall NASH severity score and subscores for steatosis, inflammation, and fibrosis. Results were analyzed by using Student’s t test.

Results

Resistin mRNA levels ranged from 0.5 to 9.7. A group of five patients with very high resistin expression (>4) was identified. These patients had a significantly higher average NASH score compared with the rest of the group (7.9 vs. 4.48, p = 0.019). Steatosis and inflammation scores were significantly higher in the high-resistin group (p < 0.05 for both comparisons). There also was a trend toward higher fibrosis score in this group, which approached statistical significance (p = 0.051).

Conclusions

In morbidly obese patients, high resistin expression in serum is associated with hepatic steatosis, inflammation, and fibrosis. The development of elevated resistin expression may represent a link between obesity and the onset of steatohepatitis.     

Repair of hand defects by transfer of free tissue flaps from toes

Introduction

There are very few reports on the use of a free composite flap from the toe to repair small tissue defects in the hand. Here, we describe our experience using a free composite flap from the great toe and second toe.

Method

Fifteen patients sought surgical treatment for tissue defects of the hand at our medical institution from July 2008 to December 2010. These defects included: dorsal defect of the distal thumb, dorsal-radialis defect of the proximal thumb, degloving injury of distal index finger, pulp defect of the middle finger and these were repaired with toe side pulp flaps. In five subjects, treatment of the metatarsophalangeal joint (MPJ) or proximal interphalangeal joint (PIPJ) involved a combined extensor tendon defect with a composite flap with MPJs and PIPJs and the extensor tendon of the second toe. All flaps were transferred as free flaps.

Results

All flaps survived. At 34.8 months of follow-up, the average subjective satisfaction score was 8. Eleven patients (73.3 %) experienced cold intolerance, and one patient (6.7 %) dysesthesia. The Semmes–Weinstein Sensitivity Score was 3.48–4.71 at the flap and 0–4.21 at the donor site. The mean two-point discrimination was 7.13 mm. Grip strength was 10 % less than in the unaffected hand. Mobility loss in the MPJ and PIPJ was <10°. No patients had complications at the donor sites.

Conclusion

Based on the unique characteristics of the free flap from toes, we consider them to be good options for reconstruction of small tissue defects in the hand according to various sizes, shapes, and sites.     

Nodal Skip Metastasis is not a Predictor of Survival in Thoracic Esophageal Squamous Cell Carcinoma

Background

The presence of nodal skip metastasis (NSM) has been found to be of clinical importance in non-small cell lung cancer, but the study of this phenomenon in esophageal carcinoma is relatively rare. The purpose of this study was to identify risk factors influencing NSM and to assess its prognostic value in thoracic esophageal squamous cell carcinoma (ESCC).

Methods

A total of 207 patients with thoracic ESCC who underwent three-field lymphadenectomy and who had lymph node metastasis were reviewed. Associations of NSM occurrence with the clinicopathological characteristics of patients and primary tumors were evaluated using logistic regression analysis. The influence of NSM on the overall survival (OS) was assessed by log-rank tests and Cox regression analysis.

Results

NSM were present in 58 (26 %) patients. No factor was significantly associated with the incidence of NSM except for the location of primary tumor. There were no NSMs in the 29 patients from our study with upper thoracic ESCC, and the rates of tumors occurrence in the middle and lower third of the esophagus were 38.9 and 14.9 %, respectively. The median OS was 30 months, and no significant difference in OS was found between the patients with or without NSM (p = 0.767). Only N status was found to be the independent risk factor for OS by Cox multivariate analysis.

Conclusions

NSM is common in thoracic ESCC, especially in patients with tumors located in the middle and lower third of the esophagus. However, the presence of NSM did not predict prognosis.