-
Gentry Munksgaard posted an update 1 month, 2 weeks ago
Understanding the anatomy of subperitoneal space would increase the capabilities to detect pathways of spread and localizing features of infections, malignancies, and traumas.At present, radiotherapy as an auxiliary treatment for rectal cancer is widely used in clinic. Although radiotherapy has significant effect on reducing tumor stage, improving anus preservation rate and less tumor recurrence, radiotherapy will damage the anal function and seriously affect the quality of life of patients. Anal sphincter plays an important role in anal function. There are three main damage effects of radiotherapy on anal sphincter first, the increased deposition of collagen in internal anal sphincter (IAS); second, the destroyed ultrastructure of external anal sphincter (EAS); third, degenerative lesions of the perianal nerve. This article reviews these three points, in order to provide a certain theoretical basis for how to reduce the incidence of anal dysfunction caused by radiotherapy.Objective To understand the treatment status and effects on colorectal cancer (CRC) patients in China during the COVID-19 pandemic, and provide evidence for decision-making for health-care workers. Methods The method of cross-sectional study was applied. A questionnaire survey of CRC patients in China was carried out. Their basic and treatment information during the COVID-19 were collected and associated effects on treatment, nursing, state of psychology and needs of social support were analyzed. Results Of the 1147 participants in the study, 635 (55.4%) were male and 512 (44.6%) were female with mean age of (52.8±12.8) years. The treatment or follow up of 896 (78.1%) CRC patients were affected during the COVID-19 outbreak. A total of 253 patients (22.1%) had their treatment regiments changed, of whom 141 (12.3%) had their chemotherapy regiments postponed or changed, and 83 patients (7.2%) had their surgical treatment affected. Among the above 83 patients, 39 patients (3.4%) underwent emergency surgery. A total of 277 patients (24.1%) had their out-of-hospital care needs affected, mainly due to maintenance of PICC (49.5%, 137/277). CRC patients had poorer sleep quality and increased levels of insomnia than before (P less then 0.001), and were more distressed, anxious, depressed, and angry than they were before. Sodium Pyruvate compound library chemical They presented the more requirements of help (P less then 0.001). In addition, 376 patients (32.8%) had received telemedicine services, but only 36.4% (137/376) of them were satisfied. Conclusions The COVID-19 epidemic has effect on the integrated treatment of CRC patients include diagnosis, treatment, examination and prognosis. While protecting CRC patients from being infected with SARS-CoV-2, health-care workers should also actively help them to receive timely and correct treatment and pay attention to their nursing, nutritional, psychological and social support needs in the COVID-19 epidemic.Objective To explore the safety and feasibility of indocyanine green (ICG) injection through accessory incision in laparoscopic right hemicolectomy. Methods A descriptive case series study was carried out. Clinicopathological data of 29 patients with colon cancer undergoing right hemicolectomy at Department of General Surgery, Guangdong Provincial People’s Hospital were retrospectively analyzed. All the patients received ICG injection through accessory incision at the beginning of operation. Results Among 29 patients, 13 were male and 16 were female with a mean age of (60.8±7.7) years and mean body mass index of (24.3±2.8) kg/m(2); 3 were stage I, 19 were stage II, 7 were stage III. Pericolic, intermediate and main lymph nodes could be detected under near infrared fluorescence imaging (NIRFI) in all the cases. No.6 lymph nodes were observed in 3 cases, while no lymph nodes around superior mesenteric vein (SMV) were found. The average number of fluorescent lymph node was 14.2±6.1. The average developing time of fluorescence was (36.2±3.7) minutes. The average number of harvested lymph nodes was 22.4±8.2. There was no extravasation of imaging agent during the operation, and there were no intraoperative complications such as allergies, massive abdominal bleeding, peripheral organ damage, etc. Operative time was (113.1±10.7) minutes, blood loss during operation was (22.4±3.9) ml, ambulatory time was (1.2±0.4) days, time to the first flatus was (1.7±0.7) days, time to the first fluid diet was (0.7±0.4) days, and postoperative hospital stay was (5.8±1.5) days. No operation-associated complications such as anastomotic bleeding, anastomotic leakage, peritoneal bleeding, peritoneal infection, incision infection occurred after operation. Conclusion ICG injection through accessory incision in laparoscopic right hemicolectomy is safe and feasible.Objective To analyze clinical characteristics of recurrent appendicitis. Methods A retrospective cohort study was carried out. Clinical data of patients who underwent appendectomy due to acute appendicitis confirmed by pathology in the Affiliated Hospital of Qingdao University from January 2011 to December 2015 were analyzed retrospectively. Exclusion criteria (1) age of less than 18 years;(2) chronic appendicitis; (3) periappendiceal abscess; (4) appendiceal mucocele or mucinous neoplasms; (5) appendiceal neuroendocrine tumors or cancers; (6) appendicitis during pregnancy; (7) concurrent AIDS, hematological disease, autoimmune disease, inflammatory bowel disease or advanced cancer; (8) other simultaneous surgery. A total of 373 patients were enrolled the study. These patients were divided into the recurrent group (133 cases) and the first episode group (240 cases) according to the previous history of antibiotic therapy for acute appendicitis. The prevalence of recurrent appendicitis was calculated, and the cof length of removed appendix ≥7 cm was higher as compared with the first episode group [44.4% (59/133) vs. 32.9% (79/240), χ(2)=4.808, P=0.028], while the ratio of complicated appendicitis was significantly lower [8.3% (11/133) vs. 22.9% (55/240), χ(2)=10.823, P=0.001]. CT images were available in 129 patients, intraluminal appendicoliths was found in 19 of 50 patients (38%) in the recurrent group, while in 16 of 79 patients (20.3%) in the first episode group, and there was statistically significant difference between the two groups (χ(2)=4.880, P=0.027). Conclusions Clinical characteristics of recurrent acute appendicitis include age less than 50 years, concurrent diabetes, short onset time, less abdominal tension or rebound pain, low modified Alvarado score, low WBC count, high percentage of lymphocyte, appendix length longer than 7 cm, non-complicated appendicitis and intraluminal appendicoliths.