Objective To analyze the outcome of patients with Blunt Abdominal Injury (BAI) in the Deyang People’s Hospital after the Wenchuan Earthquake, in order to provide evidence for future improvement in emergency response after earthquakes and in the treatment of BAI patients. Methods Data on the BAI patients within 1 week after the earthquake were collected from the Information Department of the Hospital. Microsoft EXCEL was used for data input. Results A total of 23 BAI inpatients were treated, of whom 15 were from Mianzhu City and sent to hospital within 12 hours of the earthquake. This was 1.9% of the total inpatients. The BAI inpatients suffered severe and complex injuries, and 5 of them died (mortality rate: 22%). Linenectomy was conducted for patients with spleen injuries and two inpatients developed incision infection due to lack of antibiotics during the perioperative period. Conclusions It is important to establish an emergency response mechanism for medical rescue for patients with the viscera injury, including BAI, after an earthquake. This would help to guarantee rational allocation of the rescue workers, triage of the wounded, optimization of operation, as well as a reduction in mortality from BAI.
Objective To explore the prevention and treatment of injury to brangches of the middle hepatic vein in laparoecopic cholecystectomy. Methods The clinical data of 27 hemorrhage cases of injury to brangches of the middle hepatic vein in laparoscopic cholecystectomy from January 2008 to January 2010 were analyzed retrospectively. Results All 27 hemorrhage cases were successfully stopped bleeding under laparoscopy by the way of packing hemostasis （n=17）, clamping hemostasis （n=6）, and suturing hemostasis （n=4）. In the 3 hemostasis methods, the operating time and amout of bleeding in the cases with packing hemostasis was the shortest and the least, respectively, which was （90.26±12.46） min and （240.32±80.15）ml, respectively, but the differences of the 3 methods were not statistical significance （P＞0.05）. Conclusions During laparoscopic cholecystectomy, gallbladder bed should be seperated in the correct plane to avoid injury to brangches of the middle hepatic vein. The most important to ensure surgery safety is applying the right surgical hemostasis method to stop bleeding quickly, and the open surgery will be the first choice in the right time when the difficult hemostasis occurs under laparoscopy.
Objective To study the effect and intrinsic mechanism of acute suppurative peritonitis associated ascitic fluid (ASPAAF) on experimental liver injury of rats. Methods Thirty-two male or female Sprague-Dawley (SD) rats were randomly divided into two groups: ASPAAF group (n=16) and control group (n=16), in which 8 ml ASPAAF or normal saline (NS) were injected into the peritoneal cavity, respectively. The rats were killed at each time intervals after peritoneal cavity injection (6 h and 12 h) respectively in two groups and specimens were made to detect the levels of serum TNF-α, endotoxin and liver function (AST, ALT and STB). The level of TNF-α in liver tissues was measured. The pathological change of liver was observed by microscope. Results The levels of TNF-α, endotoxin, ALT, AST and STB in serum and the levels of TNF-α in liver tissues at different time points were markedly higher in ASPAAF group compared with those in control group (P＜0.05), and these indexes increased with increasing time in ASPAAF group (P＜0.05). In ASPAAF group, hepatic tissue appeared hydrops, even spotty necrosis and the changes at 6 h and 12 h were not obvious different. No abnormal pathological change of hepatic tissue was found in control group. Conclusion ASPAAF can induce the injury of the liver in rats, which may involved in TNF-α and endotoxin.
Objective To explore the role and intrinsic mechanism of the injury of intestines induceded by pancreatitis associated ascitic fluid (PAAF) and acute suppurative peritonitis associated ascitic fluid (ASPAAF) in rats. Methods Forty-eight Sprague-Dawley (SD) rats, male or female, were randomly divided into three groups averagely. The control group: 8 ml of normal saline (NS) was injected into the peritoneal cavity; the PAAF group: 8 ml of PAAF was injected into the peritoneal cavity; and the ASPAAF group: 8 ml of ASPAAF was injected into the peritoneal cavity. After peritoneal cavity injection, the rats were put to death in batches at 6 h and 12 h, eight rats per-batch. Levels of TNF-α and endotoxin in serum were measured. The activity of ATP enzyme and level of TNF-α in the intestinal tissues were measured. The pathological changes of intestines were observed by microscope.Results The levels of TNF-α, endotoxin and the degree of injury of the intestines were markedly elevated and the activity of ATP enzyme of the intestinal tissues was decreased in the PAAF group and ASPAAF group compared with those in the control group (P＜0.05). The levels of TNF-α, endotoxin and the degree of injury of the intestines were markedly elevated and the activity of ATP enzyme of the intestinal tissues was decreased in the ASPAAF group compared with those in the PAAF group (P＜0.05). Conclusion PAAF and ASPAAF can induce the injury of intestines, but the injury of intestines induced by ASPAAF is more serious.
ObjectiveTo investigate the etiologic feature and prognosis of adult patients with severe community-acquired pneumonia (SCAP). MethodsAccording to the guideline on the diagnosis and treatment of community-acquired pneumonia in 2006, 105 patients with SCAP were included in the study. The proportion of pathogens (including multiple resistant bacteria) and mortality rate were recorded. Appropriate statistical methods were selected and all data were analyzed by using SPSS Version 18.0 computerized program. ResultsThe predominant pathogen with SCAP was Pseudomonas aeruginosa, followed by Klebsiella pneumoniae, Staphylococcus aureus, and Legionella pneumophila. In death cases, Klebsiella pneumoniae was the most common pathogen, followed by Staphylococcus aureus. It was showed in the drug sensitivity test that most pathogens were drug-sensitive strains. The patients with tumor had higher risks to get infected with Gram-negative bacillus. ConclusionsThe etiology of patients with SCAP in our emergency department is given priority to Gram-negative bacillus and sensitive strains, of which Pseudomonas aeruginosa and Klebsiella pneumoniae are predominant. As for the Gram-positive cocci, Staphylococcus aureus is the most common pathogen. Legionella pneumophila is the most common pathogen in atypical pathogens, which only account for a small proportion of the aetiology of SCAP. Patients with Klebsiella pneumoniae and Staphylococcus aureus infections are associated with poor prognosis.
Objective To find a simple, practical and cheap way in suturation to prevent incision complications after celoscope surgery. Methods Using the elastic snell needle to stitch small incision under laparoscopy. Chosed 3 120 cases using the elastic snell needle to stitch stratified suturation as research group, and 3 120 cases by using trditional arc shaped needle in celoscope surgery as control group. The incident rate of incisional hernia and incision bleeding among groups were compared. Results In research group, the incident rate of incision bleeding was 0.16%, among which was 0.15% in epigastrium group, 0.18% in hypogastrium group, while in control group, the incident rate of incision bleeding was 0.68%, among which was 0.64% in epigastrium group, 0.70% in hypogastrium group. The incident rate of incision bleeding was obviously decreased (P＜0.05), and the incident rate of incision bleeding in hypogastrium group was obviously decreased as well (P＜0.05), compared research group and control group. In research group, the incident rate of incisional hernia was 0.07%, among which was 0 in epigastrium group, 0.12% in hypogastrium group, 0.15% in gerontism group, while in control group, the incident rate of incisional hernia was 0.44%, among which was 0.24% in epigastrium group, 0.59% in hypogastrium group, 0.99% in gerontism group, and the incident rate of incisional hernia after surgery was obviously decreased (P＜0.05), the incident rate of incisional hernia after surgery in hypogastrium group was obviously decreased as well (P＜0.05), comparing research group and control group. Conclusions Using the elastic snell needle to stitch small incision under laparoscopy, the peritoneal layer and muscular layer can be apposition sutured in the case without prolonging incision and costing more, hidden hernia and abdominal wall defects located at the incision can be found, ligation and stitched, thereby the incident rate of incisional hernia and incisional bleeding after celoscope surgery are significantly reduced.