Successful laparoscopic cholecystectomy for acute cholecystitis with kyphoscoliosis by the devised placement of trocar ports: A case report

IntroductionKyphoscoliosis, which is a deformity of the spine caused by aging and osteoporosis, results in various surgical difficulties for laparoscopic cholecystectomy (LC) due to low-lying costal arches, such as a small abdominal working space, disturbance of the surgical view and decreased controllability of the surgical instrument.Presentation of caseWe herein report the case of a 92-year old woman with severe kyphoscoliosis who was diagnosed with Grade II acute cholecystitis. Taking her general status into consideration, emergency percutaneous transhepatic gallbladder drainage (PTGBD) was initially performed. After PTGBD, the patient’s physical status and systemic inflammation markedly improved. She then underwent interval LC. The surgical view of the upper abdomen including the gallbladder was entirely interrupted by bilateral low-lying costal arches with adhesion to the greater omentum. To access the gallbladder without interruption by the low-lying costal arch, the first umbilical port was changed to a multi-port with surgical glove and an additional port was added in the left abdomen. Consequently, LC was safely accomplished with the creation of the critical view.DiscussionA low-lying costal arch due to kyphoscoliosis can prevent surgeons from accessing the gallbladder. LC with the standard 4-port method could not be accomplished because of insufficient lifting of the low-lying costal arch. Devised placement of the ports is needed to access the gallbladder between bilateral low-lying costal arches.ConclusionA transumbilical multi-port and left abdominal port may be effective for successful LC of acute cholecystitis with kyphoscoliosis.     

Retour au travail après un accident coronarien aigu

BackgroundReturn to work (RTW) after acute coronary syndrome (ACS) is an important issue for the patient's future.AimsThe study aim was to determine whether RTW practice complies with guidelines or is delayed by failure in patient management. We analysed the factors influencing RTW beyond the 90-day period recommended by guidelines.MethodsWe conducted a survey of 216 self-employed workers admitted to the hospital for ACS using self-report questionnaires and medical examination. Factors influencing RTW, occupational and cardiac features, and recall and source of medical information were investigated.ResultsNinety-three of 216 patients did not return to work by 90 days, despite good cardiac performance in 30 cases (32 %). The mean sick leave duration was 93.3 ± 103.7 days. Advice concerning return to work was completely missing for 44 % of patients. Cardiac performance was independent of sick leave duration, but was correlated with the likelihood of RTW (P < 0.001). Patients assimilated about 70 % of the medical information they were provided, but only 53 % of work-related information. Recall of work-related information was better among patients admitted to a rehabilitation facility (65 %) compared to those who did not receive rehabilitation (P < 0.05).ConclusionCardiologists should assess the patient's cardiac performance within 2 months after ACS. Patient management should also include cardiac rehabilitation or therapeutic education toward improving information recall.     

不同剂量阿托伐他汀对急性心肌梗死患者血浆Ⅲ型前胶原肽和单核细胞趋化因子-1水平的影响

目的观察急性心肌梗死（AMI）患者分别使用不同剂量阿托伐他汀治疗后对血浆Ⅲ型前胶原肽（PⅢNP）和单核细胞趋化因子-1（MCP-1）水平的影响,探索阿托伐他汀影响AMI后心肌胶原增生的机制。方法入选204例急性心肌梗死患者,按照每天给予阿托伐他汀片的剂量将患者随机分为A1组（20 mg,每天1次,n=40）,A2组（40 mg,每天1次,n=45）、A3组（80 mg,每天1次,n=39）和阳性对照组（P组,n=40）、另入选冠状动脉造影正常的健康人30例作为对照组（C组）;用药前及用药后1、2、4周分别测定PⅢNP、MCP-1水平。结果用药2周后A1、A2和A3组PⅢNP、MCP-1水平较用药前有明显下降,其中A2组明显低于A1组（P〈0.05）,A3组明显低于A2组（P〈0.05）,A3组较A1组有显著下降（P〈0.01）;A1、A2、A3组和P组比较差异有统计学意义（P〈0.01）。服药后2周A1、A2和A3组PⅢNP和MCP-1水平之间呈显著正相关（r分别为0.25、0.59和0.62,P〈0.01）。结论阿托伐他汀能降低血脂正常急性心肌梗死患者血浆Ⅲ型前胶原肽和单核细胞趋化因子-1水平,且呈剂量依赖性。     

Prise en charge diagnostique et thérapeutique des tumeurs épithéliales malignes de l’ovaire dans le centre ouest-africain de lutte contre le cancer de Dakar

IntroductionEpithelial ovarian cancer are the most frequent of ovarian cancer, their prognosis is very bad. The aim of this study is to describe the diagnosis, the treatment and to assess the survival rate of the patients.MethodsIt was a retrospective study realized at the Cancer Institute of Dakar from December 2000 to January 2007. We have collected 117 patients with epithelial ovarian cancer. The mean age was 49 years. Patients were comprised: 22 stage I, 32 stage II, 35 stage III and 26 stage IV. Primary surgery was performed to 34 patients and the other patients were treated with chemotherapy and surgery. The survival rate was assessed by Kaplan-Meier method and the Logrank test had allowed to compare the survival among age and optimal surgery.ResultsOptimal surgery R0 was done in 20 cases and surgical resection R2 was performed in 45 cases. Pathological exam had found 65 serous cystadenocarcinoma, 28 mucinous cystadenocarcinoma and 21 endometrioid cystadenocarcinoma, one malignant tumor of Brenner. Overall survival at five years was 13.3%. The survival among optimal surgery was 16.3 and 2.3% for suboptimal surgery. There was no significant difference of the survival among patients who were less than 40 years old (P  =  0.334).ConclusionPrognosis of epithelial ovarian cancer is worse in Senegal as like as in the world. To improve the survival of our patients, we must detect the early diagnosis of these tumors and to introduce the neoadjuvant chemotherapy before optimal surgery.     

液体超负荷与婴儿先天性心脏病术后急性肾损伤的关系

目的探讨液体超负荷与婴儿先天性心脏病术后急性肾损伤(AKI)的关系。方法对88例年龄6个月的行先天性心脏病根治术患儿进行回顾性研究。比较术后是否合并AKI患儿的治疗结局,以及术后第2天累积液体超负荷对治疗结局的影响,并分析术后AKI发生的影响因素。结果与术后无AKI患儿比较,合并AKI者年龄更小、体重更低,血肌酐、血管活性药物评分更高,术中体外循环时间和主动脉阻断时间更长,输血量更多、低心排综合征发生率更高,机械通气时间、ICU停留时间、住院时间更长,体外膜肺氧和使用率以及30 d死亡率更高,术后第2、3天的累积液体超负荷更高(P0.05)。Logistic回归分析提示液体超负荷、低心排综合征是术后发生AKI的主要影响因素。术后第2天累积液体超负荷5%的患儿低心排综合征发生率、机械通气时间、ICU停留时间和住院时间较长,死亡率较高(P0.05)。结论先天性心脏病术后液体超负荷的婴儿易发生AKI,液体超负荷可能与术后不良结局有关。     

大鼠急性肾衰竭过程中水通道蛋白-1的表达

目的 探讨水通道蛋白-1在大鼠急性肾衰竭过程中的表达.方法 将SD大鼠随机分为对照组、急性肾衰竭组.在切除右肾后,制作急性肾衰竭模型,每天腹腔注射庆大霉素100mg/Kg体重,连续7d,分别于8d、9d、10d、12d和14d 5个时间点各取6只大鼠,于相应的时间点留取血标本、肾组织,常规检查BUN和Scr;RT - PCR法检查肾组织水通道蛋白-1 mRNA的表达,观察水通道蛋白-1在急性肾衰竭中的表达；HE和PAS染色观察肾组织的病理变化.结果 (1)与对照组相比,急性肾衰竭组的Scr和BUN在8d和9d时均明显增高(p＜0.05)；(2)急性肾衰竭组肾小管受损,以8d时病理损伤最重；(3)对照组与急性肾衰竭组均表达水通道蛋白-1,与对照组相比,急性肾衰竭组水通道蛋白-1 mRNA表达明显减少；急性肾衰竭组中8d、9d、10d、12d和14d5个时间点水通道蛋白-1表达的越来越多.结论 水通道蛋白-1在急性肾衰竭组中表达明显减少.     

The stratification of severity of acute radiation proctopathy after radiotherapy for cervical carcinoma using diffusion-weighted MRI

ObjectiveTo determine whether diffusion-weighted imaging (DWI) can be used for quantitatively evaluating severity of acute radiation proctopathy after radiotherapy for cervical carcinoma.Materials and methodsOne hundred and twenty-four patients with cervical carcinoma underwent MR examination including DWI before and after radiotherapy. Acute radiation proctopathy was classified into three groups (grade 0, grade I–II and grade III–IV) according to Toxicity Criteria of the Radiation Therapy Oncology Group (RTOG). The pretreatment ADC (ADC_pre), ADC after treatment (ADC_post) and ADC change (ΔADC) were compared among three groups. In addition, acute radiation proctopathy was classified into good-prognosis group and poor-prognosis group. ADC_pre, ADC_post and ΔADC were compared between two groups. For DWI parameter that had significant difference, discriminatory capability of the parameter was determined using receiver operating characteristics (ROC) analysis.ResultsADC_post and ΔADC were higher in grade I–II group than in grade 0 group (p < 0.05), yielding a sensitivity of 79.3% and specificity of 69.4% for ADC_post, and 85.1%, 72.3% for ΔADC for discrimination between two groups. ADC_post and ΔADC were higher in grade III–IV group than in grade I–II group (p < 0.05), yielding a sensitivity of 80.3% and specificity of 72.5% for ADC_post, and 84.1%, 74.5% for ΔADC for discrimination between two groups. ADC_post and ΔADC were higher in poor-prognosis group than in good-prognosis group (p < 0.05), yielding a sensitivity of 79.5% and specificity of 73.4% for ADC_post, and 87.2%, 78.3% for ΔADC for discrimination between two groups.ConclusionDiffusion-weighted MRI can be used for quantitative stratification of severity of acute radiation proctopathy, which serves as an important basis for appropriate timely adjustment of radiotherapy for cervical carcinoma in order to maximally reduce the radiation injury of rectum.     

Paediatric orthopaedic infections

Bone and joint infections in children are uncommon, but potentially devastating. The use of effective antibiotic chemotherapy has minimized associated mortality, but prompt recognition and treatment is necessary to preserve normal growth and function of the affected bone or joint. Diagnostic challenges include inability of patients to report symptoms, non-specificity of clinical signs and low sensitivity of diagnostic tests while treatment challenges include choosing appropriate empiric antibiotics, accounting for patient and epidemiological risk factors, and ensuring adequate compliance with long antibiotic courses in children. Successful management requires regular review of clinical progress and assessment for development of complications requiring surgical intervention. This article will cover the commonest infections seen clinically. Septic arthritis and osteomyelitis are discussed separately though concurrent infection can occur, particularly in children under 2 years of age, and recognition of this can alter the duration of treatment required.     

N-acetylcysteine protects against star fruit-induced acute kidney injury

Background: Star fruit (SF) is a popular fruit, commonly cultivated in many tropical countries, that contains large amount of oxalate. Acute oxalate nephropathy and direct renal tubular damage through release of free radicals are the main mechanisms involved in SF-induced acute kidney injury (AKI). The aim of this study was to evaluate the protective effect of N-acetylcysteine (NAC) on SF-induced nephrotoxicity due to its potent antioxidant effect.

Materials and methods: Male Wistar rats received SF juice (4?mL/100?g body weight) by gavage after a 12?h fasting and water deprivation. Fasting and water deprivation continued for 6?h thereafter to warrant juice absorption. Thereafter, animals were allocated to three experimental groups: SF (n?=?6): received tap water; SF?+?NAC (n?=?6): received NAC (4.8?g/L) in drinking water for 48?h after gavage; and Sham (n?=?6): no interventions. After 48?h, inulin clearance studies were performed to determine glomerular filtration rate. In a second series of experiment, rats were housed in metabolic cages for additional assessments.

Results: SF rats showed markedly reduced inulin clearance associated with hyperoxaluria, renal tubular damage, increased oxidative stress and inflammation. NAC treatment ameliorated all these alterations. Under polarized light microscopy, SF rats exhibited intense calcium oxalate birefringence crystals deposition, dilation of renal tubules and tubular epithelial degeneration, which were attenuate by NAC therapy.

Conclusions: Our data show that therapeutic NAC attenuates renal dysfunction in a model of acute oxalate nephropathy following SF ingestion by reducing oxidative stress, oxaluria, and inflammation. This might represent a novel indication of NAC for the treatment of SF-induced AKI.