Objective: To investigate clinical effect of toothless oval clamp cervical clamp in treatment for vaginal childbirth postpartum hemorrhage. Methods: Fifty cases patients with vaginal delivery with postpartum hemorrhage in our hospital were divided into the control group( 25) treated by misoprostol and oxytocin and the observation group( 25) treated by toothless oval clamp jaws for treatment of cervical on the basis of the treatment in the control group. Results: After treatment 2h postpartum bleeding( 670. 5 ± 12. 5) ml,2 ~ 24 h postpartum hemorrhage( 59. 8 ± 10. 7) ml and 1 day postpartum hemoglobin decrease( 15. 2 ± 5. 1) g / L of observation group were significantly lower than those of the control group( P 0. 01). The average amount of blood transfusion of the observation group was significantly lower than that of the control group( P 0. 01). Conclusion: While vaginal childbirth postpartum hemorrhage patients are given oxytocin and misoprostol and other conventional treatments,the application of toothless oval clamp can improve hemostasis.
Abstract Diaphragmatic hernia is a rare complication during pregnancy. Only 30 reports have been published on this subject in English between 1959 and 2009. Due to misdiagnoses and management delays, diaphragmatic hernia usually presents itself as a life‐threatening emergency. Here, we present a case report of a patient with a traumatic diaphragmatic hernia who became acutely symptomatic during pregnancy. The diaphragmatic hernia was managed successfully, and we describe the presentation, management and outcome of this case. We also present a review of all of the reported cases of diaphragmatic hernias complicating pregnancy that have been published in English during the past 50 years.
Background: Graves' disease (GD) and Hashimoto's thyroiditis (HT) were the two common types of autoimmune thyroid disease (AITD) characterized by hyperthyroidism and hypothyroidism, respectively. Approximately 20% of GD patients may result eventually in hypothyroidism in their natural course.Methods: Expression of Uterus globulin associated protein 1 (UGRP1) was assessed in the thyroid of AITD patients (293 HT and 198 GD) using IHC. The lymphocytes infiltration and serum TPOAb were analyzed. The co-expression of FAS and HLA-DR with UGRP1 was also measured in the thyroid of AITD patients by IHC. RT-qPCR was used to detect Th1/Th2 cytokines and IL-1β mRNA expression in the thyroid tissues. The mechanism of UGRP1 expression was evaluated in primary cultured thyrocytes treated with different cytokines.Findings: We found that UGRP1 was positive expressed in the thyrocytes of most HT patients and a proportion of GD patients. The pathologic features of UGRP1-positive thyrocytes resembled "Hürthle cells," and were surrounded by infiltrated lymphocytes. The positivity rate of TPOAb in UGRP1-positive GD patients was much higher than that in -negative GD patients. Moreover, UGRP1 was co-expressed with Fas and HLA-DR in the thyrocytes of AITD patients. We also found IL-1β but not Th1 or Th2 cytokines was able to upregulate the expression of UGRP1 in AITD.Interpretation: Our findings indicated that UGRP1 may be as a novel marker in thyrocytes to predict GD patients who develop hypothyroidism. Funding: This work was supported by the National Natural Science Foundation of China (Grant No. 81770786 and 81500602). Declaration of Interest: The authors have declared that no conflict of interest exists.Ethical Approval: This study was approved by the Independent Ethics Committee of Shanghai Ninth People’s Hospital affiliated to Shanghai JiaoTong University School of Medicine (NO. 2017189). All written informed consents were received from participants prior to inclusion in the study.
To summarize our experiences in the treatment of labor induction in placenta previa using uterine artery embolization. We retrospectively analyzed the clinical data of seven patients with placenta previa who underwent antepartum uterine artery embolization before vaginal delivery. After antepartum embolization, five patients with placenta previa had successful vaginal deliveries and two cases of placenta previa with accreta underwent emergency hysterectomy. Some complications were reported in this experience. The follow-up study showed that most patients resumed their normal menstruation and some of them were able to conceive. For the management of placenta previa, uterine artery embolization is a minimally invasive technique that helps to avoid cesarean section. The impact on menstruation and fertility is yet to be seen.
Objective
To summarize the application experiences and curative efficacies of single lung transplantation assisted by extracorporeal circulation with coated lung, centrifugal pump and coated pipe.
Methods
Retrospective analysis was conducted for clinical data of 6 adult patients with respiratory insufficiency undergoing single lung transplantation. The changes of hemodynamics and oxygenation before and after adjuvant treatment were observed, the effects of adjuvant evaluated and the experiences of application summarized.
Results
The hemodynamic parameters post-assistance significantly improved as compared with that pre-assistance and pulmonary arterial pressure dropped from (56±15) to (45±13) mmHg with statistically significant differences. Arterial blood gas parameters significantly improved. PO2 spiked from (47±12) to (68±9) mmHg and PCO2 declined from (65±14) to (55±12)mmHg. And there were statistically significant differences. All patients were discharged successfully.
Conclusions
The simple extracorporeal membrane oxygenation system of coated lung, centrifugal pump and coated pipe during routine extracorporeal circulation may guarantee the operative safety of single lung transplantation and provide a new therapeutic option.
Key words:
Single lung transplantation; Extracorporeal membrane oxygenation; Hemodynamics; Blood gas analysis
e16029 Background: In the Union for International Cancer Control /American Joint Committee on Cancer TNM classification system, the prognosis of rectal cancer patients with adjuvant treatment are based on pre-radiotherapy clinical TNM stage. However, the value of this classification system is still debated. Here, we find that neoadjuvant pathologic TNM stage may be better than clinical TNM stage in patients with rectal cancer. Furthermore, we propose a novel risk stratification which may be more accurate in the assessment of prognosis of these patients. Methods: Between 2010 and 2015, 316 patients with rectal cancer who underwent neoadjuvant chemoradiotherapy followed by radical surgery were included for analysis. The clinicopathological factors for developing recurrences that affected prognosis were analyzed. Results: Our findings showed that the pathological complete response group had significantly better overall survival and recurrence-free survival than did the non-pCR group. Clinical N stage was not only an independent factor for developing recurrences but was also a significant prognostic factor in the pCR group, just as neoadjuvant pathologic TNM stage in the non-pCR group. Based on the independent prognostic factors, pCR patients were stratified into two recurrence risk categories: pCR with cN0 stage or pCR with cN+ stage. Non-pCR patients were stratified into three recurrence risk categories: non-pCR with ypTNM I stage, ypTNM II stage or ypTNM III stage, which might offer greater potential for the prognosis of patients with rectal cancer. Conclusions: Neoadjuvant pathologic TNM stage, rather than pre-radiotherapy clinical TNM stage, was an independent factor for developing recurrences in the non-pCR group. Furthermore, a novel risk stratification, which may be more accurate in the assessment of prognosis of rectal cancer patients, was proposed.
Abstract Background The American Society of Colon and Rectal Surgeons is suggesting laparoscopic surgeries for colorectal cancer. Conventional perioperative procedures like long preoperative fasting and bowel procedures are not useful and harmful to patients undergoing surgeries for colorectal cancer. The objectives of the study were to compare surgery outcomes, hospital stays, and survival of patients who received fast-track (laparoscopy/open) surgical procedure followed by chemotherapy against those who received conventional (laparoscopy/open) surgical procedure followed by chemotherapy for colorectal cancer. Methods The study analyzes the outcomes of a total of 542 colorectal cancer (preoperative biopsies stage II or III) patients submitted to surgery and adjuvant chemotherapy. The study cohort is retrospectively subdivided in 4 groups submitted to open or laparoscopic resection with or without fast-track protocol appliance and two different chemotherapy regimens. Patients who ended up being TNM stage I have not received the adjuvant chemotherapy. Results The fast-track surgical procedure had shorter total hospital stays and postoperative hospital stays than the conventional surgical procedures. Flatus resumption time, the time until first defecation, and intraoperative blood loss were shorter for the fast-track surgical procedures than the conventional surgical procedures. Those surgery outcomes were also shorter for the fast-track laparoscopy than the open fast-track. Resumption of a fluid diet and ambulation onset time were shorter for the fast-track surgical procedures than the conventional surgical procedures. The surgical checkpoints that were compliance by patient of fast-track surgeries were significantly fewer than those of the conventional surgeries. Clinically significant difference for QLQ-C30/CR38 score after chemotherapy was reported between patients who received open conventional surgeries and those patients who received fast-track laparoscopy (59.63 ± 2.26 score/patient vs. 71.67 ± 5.19 score/patient). There were no significant differences for the number of patients with any grade adverse effects ( p = 0.431) or with grade 3–4 adverse effects ( p = 0.858), and the disease-free and overall survival among cohorts. Conclusions The fast-track surgical procedure is effective and safe even in a multidisciplinary scenario as colorectal cancer treatment in which surgery is only a part of management. Level of evidence: III Technical efficacy stage: 4.
Objective
To investigate the efficacy of fascia iliaca compartment block combined with general anesthesia for total hip arthroplasty.
Methods
Fifty patients underwent total hip arthroplasty were divided into trial group or control group by random digits table method with 25 cases each. Preoperatively, both groups were given fascia iliaca compartment block with the trial group receiving 60 ml 0.25% ropivacaine and the control group receiving 60 ml 0.9% sodium chloride. Both groups received general anesthesia. The consumption of general anesthetics and intraoperative hemodynamic variation in the 2 groups were recorded. The recovery time, extubation time, observer's assessment of alertness/sedation score (modified OAA/S) at 15 and 30 min postoperative and visual analog score (VAS) at postoperative instantly were compared between the 2 groups.
Results
The consumptions of propofol and remifentanil during maintenance of anesthesia in trial group were significantly lower than those in control group, and there were statistical differences: (250±40) mg vs. (420±85) mg and (300±50) μg vs. (600±150) μg, P<0.01. The recovery time and extubation time in trial group were significantly shorter than those in control group, and there were statistical differences: (7.2±4.5) min vs. (16.2±7.1) min and (8.0±2.8) min vs. (20.0±8.3) min, P<0.01. The modified OAA/S at 15 and 30 min postoperative in trial group were significantly higher than those in control group, and there were statistical differences: (4.3±0.3) scores vs. (3.0±1.2) scores and(4.6±0.2) scores vs. (3.9±0.8) scores, P<0.01. The VAS at postoperative instantly in trial group was significantly lower than that in control group, there was statistical difference: (1.6±0.9) scores vs. (4.5±0.8) scores, P<0.01. The degree of satisfaction in trial group was better than that in control group, and there was statistical difference (P<0.05).
Conclusion
Compared with general anesthesia alone for total hip arthroplasty, the fascia iliaca compartment combined with general anesthesia has better hemodynamic stability, marked reduction of consumption of general anesthetics, rapid recovery and good postoperative analgesia.
Key words:
Anesthesia, general; Arthroplasty, replacement, hip; Fascia iliaca compartment
Background: The aim of this study was to assess the association between the severity of hematuria (microscopic or gross) and the tumor stage and grade in a population of histopathologically confirmed upper tract urothelial carcinoma (UTUC) patients. Patients and methods: We conducted a multicenter, observational study of patients who were newly diagnosed with UTUC between January 2011 and December 2016. Demographic information, pathology, and the status of hematuria were retrospectively reviewed. The association between the severity of hematuria and the tumor stage and grade was evaluated using logistic regression. Results: The UTUC patients presented with gross hematuria (GH, 76.7%), microscopic hematuria (MH, 11.1%), and no hematuria (12.2%) at the time of diagnosis. The pathological stages at diagnosis for those with MH were Ta in 5.1%, T1 in 47.5%, and ≥T2 in 47.5%. The stages at diagnosis for those with GH were Ta in 1.7%, T1 in 35.5%, and ≥T2 in 62.7%. On univariate and multivariate logistic regression analyses, after adjusting for clinical factors such as age, gender, and smoking history, GH was an independent risk factor for muscle-invasive UTUC (≥T2 disease) at diagnosis (OR 1.89, 95% CI 1.073–3.329; P =0.027). High-grade tumor was found in 47.8% of patients with GH and 39.0% of those with MH. The severity of hematuria was not associated with tumor grade. Conclusion: We are the first to report evidence that microscopic hematuria at presentation accurately predicts lower pathological stage in patients with newly diagnosed UTUC. Earlier detection of disease, before the development of GH, may influence the treatment decision and survival. The type of hematuria at the time of diagnosis does not impact the tumor grade. Keywords: upper tract urothelial carcinoma, gross hematuria, microscopic hematuria, stage
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