Acute Mediastinitis – Outcomes and Prognostic Factors of Surgical Therapy (A Single-Center Experience)

Purpose: The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors’ worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy.Methods: During the period 2006–2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment.Results: The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times.Conclusion: Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.     

潘立群教授以升阳举陷法治疗食管癌术后腹泻经验

潘立群教授以升阳举陷法治疗食管癌术后腹泻并发症,认为其病因病机多为手术所伤,脾胃虚弱,中气下陷;患病日久,命门火衰,脾肾阳虚;虚实夹杂之证亦常见,以脾胃虚弱为本,外感六淫、饮食情志所伤为标.脾虚气陷、脾失健运是致病关键,治疗以升阳举陷为立法之本,以升陷汤为基础方随证加减,从而升发脾阳,使脾胃升降协调,脾运得复,腹泻即止...     

两种剂量生长抑素对肝硬化门脉高压的治疗对比研究

目的　观察小剂量生长抑素 (SS)对门脉高压患者肝血流动力学影响及其对食管静脉曲张破裂出血治疗效果。方法　 (1) 37例门脉高压患者分两次给予常规剂量SS(2 5 0 μg静注 ,后 2 5 0 μg/h静滴 1h)和小剂量SS(12 5 μg静注 ,后 12 5 μg/h静滴 1h) ,在给药前后分别测定门脉主干和脾静脉内径、血流速度及血流量。 (2 ) 72例食管静脉曲张破裂出血患者分小剂量组 37例 (SS 12 5 μg静注 ,后 12 5 μg/h静滴 72h)和常规剂量组 35例 (SS 2 5 0 μg静注 ,后 2 5 0μg/h静滴 72h)。 结果　 (1)小剂量SS能明显减少门脉和脾静脉血流量 ,与常规剂量相比无明显差异 (P >0 .0 5 )。(2 )两组在止血率、再出血率、手术率和病死率等方面无明显差异 (P均 >0 .0 5 )。结论　小剂量SS可明显减少门脉和脾静脉血流量 ,降低门脉压力 ,可有效治疗食管静脉曲张破裂出血。     

浊漳河水及改水对林州市居民年龄别食管癌发病率的影响

目的探讨浊漳河水及改水对林州市居民食管癌性别、年龄别发病率的影响。方法对林州市居民食管癌性别、年龄别发病率时间变化与浊漳河水(红旗渠水)水量变化关系进行相关分析。结果1959年—2003年间,林州市食管癌发病率、死亡率随浊漳河水、红旗渠水的水量时多、时少而上升和下降。1959年—1963年红旗渠通水前食管癌的性别、年龄别发病率相对偏低。红旗渠通水6年后,即1969年—1970年食管癌发病率、死亡率达到历史高峰期,随后,当红旗渠水量减少和恢复时,食管癌发病率、死亡率随之显著下降和显著上升。1995年全县85%的居民改用地下水后,食管癌发病率、死亡率稳定在较低水平。结论林州市居民食管癌发病率时间变化与浊漳河水量变化相一致、并有时间先后关系,先浊漳河水量变化,5-10年发病率随之变化。预防措施应加强"氮循环"病因学说的宣传教育,要特别预防浊漳河水源的工农业污染,净化红旗渠水后再灌溉土地,同时加强饮用水管理和检测,改水、改厕、改善环境卫生、保护水源是预防食管癌的关键措施。     

钠尿肽受体A在食管鳞状细胞癌中的表达及对食管癌细胞迁移和侵袭能力的影响

目的 探讨钠尿肽受体A(NPRA)在食管鳞状细胞癌中的表达及其对食管癌细胞迁移和侵袭的影响.方法 采用免疫组织化学染色法检测119例食管鳞状细胞癌组织和91例癌旁组织中NPRA的表达情况,并分析食管鳞状细胞癌组织中NPRA表达情况与患者临床特征及预后的关系.采用蛋白质印迹法(Westernblot)检测食管癌细胞株Ec...     

Absolute lymphocyte count and C-reactive protein-albumin ratio can predict prognosis and adverse events in patients with recurrent esophageal cancer treated with nivolumab therapy

Predicting the prognosis and adverse events (AEs) of nivolumab therapy for recurrent esophageal cancer is very important. The present study investigated whether a simple blood biochemical examination could be used to predict prognosis and AEs following nivolumab treatment for relapse of esophageal cancer. A total of 41 patients who received nivolumab treatment for recurrent esophageal cancer after esophagectomy were analyzed. The absolute lymphocyte count (ALC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR) and C-reactive protein-albumin ratio (CAR) were assessed at the time of nivolumab induction as indices that can be calculated by blood biochemical examinations alone. Median values were 1,015 for ALC, 3.401 for NLR, 242.6 for PLR, 0.458 for MLR and 0.119 for CAR, and patients were divided into two groups according to values. A high ALC, low NLR, low PLR, low MLR and low CAR were associated with a better response to nivolumab. In addition, patients with the aforementioned indices, with the exception of low PLR, or better response were more likely to develop AEs in univariate analysis. In multivariate analysis, a high ALC [odds ratio (OR): 4.857, P=0.043] and low CAR (OR: 9.099, P=0.004) were identified as independent risk factors for AEs. Survival analysis revealed that overall survival and progression-free survival (PFS) rates after nivolumab treatment differed significantly between the high and low groups of ALC, NLR, PLR, MLR and CAR. The multivariate analysis identified a low ALC [hazard ratio (HR): 3.710, P=0.003] and high CAR (HR: 2.953, P=0.007) as independent poor prognostic factors of PFS. In conclusion, ALC and CAR have potential as biomarkers for outcomes of recurrent esophageal cancer following nivolumab treatment.     

升降汤加减治疗食管癌术后胃肠功能紊乱的疗效观察

目的 探讨对食管癌术后胃肠功能紊乱患者采用升降汤进行治疗的效果及对生活质量的影响。方法 选取2015年1月—2019年1月在我院进行食管癌手术的患者,遴选术后出现胃肠功能紊乱及符合纳入标准的患者60例作为本研究对象,根据随机原则分为对照组（30例,采用西药治疗）与观察组（30例,采用西药联合升降汤加减治疗）,比较两组患者的治疗效果及生活质量。结果 经过不同方案的治疗后,与对照组比较,观察组患者总有效率与生活质量更高,差异有统计学意义（P <0.05）;与对照组比较,观察组患者临床症状评分与并发症发生率的更低,差异有统计学意义（P <0.05）。观察组患者经治疗后肠鸣音恢复时间、首次排便时间及首次排气时间较对照组更短,差异有统计学意义（P <0.05）。结论 食管癌术后胃肠功能紊乱患者采用升降汤加减进行治疗后,能有效改善患者的临床症状,提高生活质量,且治疗后的并发症率较低,可在临床上进行推广使用。     

Isolated sigmoid varicose vein rupture and hemorrhage: A case report

Rationale:Ectopic varices are the collateral circulation of portal vein located anywhere in the gastrointestinal tract other than the esophageal and gastric regions. Rupture of these varices often results in life-threatening hemorrhage. Management guidelines for ectopic variceal bleeds are not yet standardized because cases are rare and treatment approaches described in the literature vary considerably.Patient concerns:A 53-year-old woman with a 20-year history of chronic hepatitis C cirrhosis came to our hospital for treatment due to intermittent black stools for 4 days. After admission, the patient developed hemorrhagic shock, with hemodynamic instability.Diagnosis:Postoperative histological examination confirmed the diagnosis of sigmoid varicose veins.Intervention:Emergency colonoscopy showed that a varicose vein mass in the sigmoid colon wall 30 cm from the anus was ruptured and bleeding. Percutaneous transhepatic inferior mesenteric venography revealed the presence of a varicose mass of sigmoid colon veins. After embolization of the sigmoid varicose veins with spring coils, angiography showed that the hemorheology of the distal varicose vein mass was slow but not completely blocked. Three days after embolization, the patient had hematochezia again. Splenectomy and sigmoid colon resection were performed immediately.Outcomes:Follow-up computed tomography showed no residual varices were observed after sigmoid colon resection.Lessons:Ectopic varices, which are rare sequelae of portal hypertension, need to be taken seriously because bleeding from these varices can be catastrophic. We report a case of isolated sigmoid variceal rupture and hemorrhage due to portal hypertension in cirrhosis. The patient experienced failure of endoscopic hemostasis and sigmoid colon venous coil embolization. She was eventually successfully brought to hemostasis by surgery.     

Can the patient pinpoint where the ingested fish bone is impacted?: A single-center,retrospective study

Among the plethora of foreign body impactions, fish bones are common examples that patients may struggle to properly disclose in clinical situations. This study investigated whether patients could pinpoint where the ingested fish bone was lodged. In addition, we investigated the differences between fish bone and other foreign bodies, the usefulness of computed tomography (CT), and the related risk factors for hospitalization. The cases of patients who underwent an endoscopic removal of fish bone between April 2008 and April 2020 were retrospectively reviewed. The clinical outcomes, X-ray scan, CT, and complications of each patient were investigated. A total of 96 patients were included in this study. The mean size of the impacted fish bone was 23.78 mm, and most were found in the upper esophagus (n = 38). There was a weak correlation between pain location and the actual lesion location (r = 0.419, P < .001). Compared to those of other foreign bodies, the location of impacted fish bones was different (P < .001), the X-ray detection rate of fish bones was lower (P < .001), and the complication incidence was higher (P = .030). CT (95.89%) showed higher sensitivity than X-ray scanning (11.24%) (P < .001). Foreign body size (P = .004) and door-to-endoscopy time (P = .029) were related to admission. Patients only managed to point out the approximate location of the ingested fish bone. CT detected fish bones well, but scans should include at least the entire esophagus instead of solely the area where pain is felt. Fish bone impaction has different clinical characteristics from other foreign bodies. Endoscopic removal without delay can reduce the admission rates.