Incidence Of Gastrointestinal Complications Research Articles

Results of open prosthetics of abdominal aortic aneurysms using laparotomic and retroperitoneal approaches

The OBJECTIVE was to evaluate the results of surgical treatment of abdominal aortic aneurysm using laparotomic and retroperitoneal approaches.METHODS AND MATERIALS. The study included 206 patients operated on at the Department of Vascular Surgery of the Novgorod Regional Clinical Hospital from 2010 to 2018. All patients were divided into 2 groups. The first – 112 people, whose surgical intervention was performed through laparotomic approach. The second – 94 patients, approach to the aorta was made by the retroperitoneal technique according to Rob. comparison of non-specific life-threatening complications included the development of myocardial infarction and acute cardiovascular failure, acute respiratory distress syndrome and respiratory failure, the development of ischemic colitis and small bowel obstruction, which required repeated interventions. The development of acute renal injury was characterized as an increase in creatinine by 50 % from baseline or a decrease in glomerular filtration rate (GFR) by more than 25 %. This group of complications also included ischemic stroke, sepsis, and multiple organ failure. Wound complications included insolvency of postoperative wounds of retroperitoneal and laparotomic approaches, cases of eventration.RESULTS. When analyzing the incidence of nonspecific complications, it was found that in group I their frequency was 41 (46.6 %) clinical cases, and in group II – 26 (27.6 %) (p=0.173*). In group I, the incidence of cardiovascular complications significantly exceeded those in group II – 17 (15.2 %) vs 6 (6.4 %) (p*=0.046). The incidence of gastrointestinal complications was also significantly higher in group I – 9 (8 %) vs 1 (1.06 %) (p*=0.021). The frequency of deaths in groups I and II did not differ significantly in 7 (6.25 %) and 5 (5.3 %) cases (p*=0.77).CONCLUSION. As our study showed, retroperitoneal approach is a worthy alternative to laparotomy, mainly in case of repeated interventions, as well as in the presence of signs of visceral obesity of the patient. At the same time, laparotomic approach is associated with a higher risk of developing cardiovascular and gastrointestinal complications in the treatment of abdominal aortic aneurysms.

Individualized nutritional intervention improves the nutritional status of liver cancer patients after transcatheter arterial chemoembolization.

Introduction: to explore the effect of individualized nutritional intervention on the nutritional status of patients with liver cancer after transcatheter arterial chemoembolization (TACE). Methods: 56 patients who underwent TACE in our hospital from March 2022 to March 2023 were selected as the study subjects. The patients were randomly divided into a control group (28 cases) and an intervention group (28 cases). The control group received routine dietary intervention, while the intervention group received individualized nutritional intervention. We analyzed the body mass index (BMI), nutritional risk screening 2002 (NRS 2002), nutritional status, liver function status, and incidence of complications in two groups of patients before TACE, 3 days after TACE, and 1 month after TACE. Results: on the third day after TACE, the nutritional related indicators of both groups of patients showed a significantly decrease compared to those before TACE (p < 0.05), while the majority of liver function indicators significantly increased (p < 0.05). Compared with those at 3 days after TACE, the nutritional status of the intervention group patients significantly improved (p < 0.05) and liver function indicators significantly decreased (p < 0.05) 1 month after TACE. One month after TACE, all nutritional indicators in the intervention group were significantly higher than those in the control group (p < 0.05), and AST was significantly lower than that in the control group (p < 0.05). The incidence of gastrointestinal complications and electrolyte disorders in the intervention group were significantly lower than that in the control group (p < 0.05). Conclusion Individualized nutritional intervention can effectively improve nutritional status, improve liver function, and reduce the incidence of postoperative complications in liver cancer patients after TACE. It was worth promoting.

Comparison of Two Different Threshold Values for the Measurement of Gastric Residual Volume on Enteral Nutrition Support in the Neurocritically Ill Patients.

BackgroundAlthough recommendations on gastric residual volume (GRV) have been applied to the clinical practice of patients who are intubated, evidence-based data about the GRV of patients who are neurocritically ill are still lacking. We conducted this study to investigate the safety of increased GRV in patients who are neurocritically ill on enteral nutrition (EN) support.MethodsPatients who are neurocritically ill feeding through intragastric enteral tubes were recruited consecutively between July 2018 and June 2021. Patients were divided into a control group (GRV 100 ml) and a study group (GRV 200 ml). Demographic data, admission diagnosis, and severity scores were collected from the patient medical records. The frequency of diet volume ratio (diet received/diet prescribed), the incidence of gastrointestinal complications, and outcome variables were evaluated.ResultsThere were 344 patients enrolled, of whom 197 had mechanical ventilation support. High GRV events in the control group were more frequent than those in the study group (38.1 vs. 22.8%, p = 0.002). The total gastrointestinal complication rate did not differ significantly between the two groups (study group: 61.1%, 102/167 vs. control group: 67.9%, 114/168). In the study group, two patients had aspiration (1.2 vs. 0%, p = 0.245). The study group showed a superior diet volume ratio, but the difference was not significant. The outcomes of the study group were slightly better than those of the control group; however, no significant differences were observed between the two groups concerning the length of stay in the neurointensive care unit (19.5 days vs. 25.3 days) and mortality (10.8 vs. 14.9%) at discharge.ConclusionOur results suggest that 200 ml may be a safe normal limit for GRV in patients who are neurocritically ill.

Effect of Dexmedetomidine-Assisted Intravenous Anesthesia on Gastrointestinal Motility in Colon Cancer Patients After Open Colectomy.

BackgroundTo explore the effect of dexmedetomidine (Dex)-assisted intravenous anesthesia on gastrointestinal motility in patients with colon cancer (CC) after open colectomy.MethodsA total of 102 patients with CC, undergoing open colectomy in our hospital from January 2018 to January 2020, were selected and randomly divided into an observation group (n = 51) and a control group (n = 51). The patients in the control group received a routine combination of intravenous and inhalation anesthesia (CIIA), while those in the observation group received a Dex-assisted CIIA. The systolic blood pressure (SBP), the diastolic blood pressure (DBP), heart rate (HR), and the mean arterial pressure (MAP) were compared at different time points between the two groups. In addition, the intraoperative general conditions, the dosage of anesthetics, and the recovery of gastrointestinal functions were also compared between the two groups. Moreover, before operation and at 24 h after operation, the levels of serum gastrin (GAS) and plasma motilin (MTL) were detected by radioimmunoassay, and the level of plasma cholecystokinin (CCK) was detected by an enzyme-linked immunosorbent assay. The incidence of gastrointestinal complications was recorded in both groups.ResultsAt T1-T3, the HR, SBP, DBP, and MAP levels were lower in both groups than those at T0. In addition, they were also lower in the observation group than those in the control group, showing significant differences (p < 0.05). The dosage of propofol and remifentanil in the observation group was lower than that in the control group, and there was a significant difference (p < 0.05). In the observation group, the postoperative first exhaust time, first defecation time, first ambulation time, and first feeding time were all earlier than those in the control group with significant differences (p < 0.05). After the operation, the observation group had higher levels of GAS and MTL but a lower level of CCK than the control group, and the differences were significant (p < 0.05). The incidence rate of gastrointestinal complications in the observation group (7.04%) was lower than that in the control group (19.61%), and there was a significant difference (χ2 = 4.346, p < 0.05).ConclusionsDex-assisted intravenous anesthesia can facilitate the recovery of gastrointestinal motility, can regulate the levels of gastrointestinal hormones, and can stabilize the levels of hemodynamic indexes in patients with CC after open colectomy.

Ivermectin administration is associated with lower gastrointestinal complications and greater ventilator-free days in ventilated patients with COVID-19: A propensity score analysis

IntroductionCOVID-19 patients have been reported to have digestive symptoms with poor outcome. Ivermectin, an antiparasitic drug, has been used in COVID-19 patients. The objective of this study was to evaluate whether ivermectin has effects on gastrointestinal complications and ventilator-free days in ventilated patients with COVID-19. MethodsCOVID-19 patients who were mechanically ventilated in the ICU were included in this study. The ventilated patients who received ivermectin within 3 days after admission were assigned to the Ivermectin group, and the others were assigned to the Control group. Patients in the Ivermectin group received ivermectin 200 μg/kg via nasal tube. The incidence of gastrointestinal complications and ventilator-free days within 4 weeks from admission were evaluated as clinical outcomes using a propensity score with the inverse probability weighting method. ResultsWe included 88 patients in this study, of whom 39 patients were classified into the Ivermectin group, and 49 patients were classified into the Control group. The hazard ratio for gastrointestinal complications in the Ivermectin group as compared with the Control group was 0.221 (95% confidence interval [CI], 0.057 to 0.855; p = 0.029) in a Cox proportional-hazard regression model. The odds ratio for ventilator-free days as compared with the Control group was 1.920 (95% CI, 1.076 to 3.425; p = 0.027) in a proportional odds logistic regression model. ConclusionsIvermectin improved gastrointestinal complications and the number of ventilator-free days in severe COVID-19 patients undergoing mechanical ventilation. Prevention of gastrointestinal symptoms by SARS-Cov-2 might be associated with COVID-19 outcome.

Opioid-free anesthesia for patients with joint hypermobility syndrome undergoing craneo-cervical fixation: a case-series study focused on anti-hyperalgesic approach

BackgroundPatients with Ehlers-Danlos Syndrome/Hypermobility Type (EDS-HT/JHS) and Craneo-Cervical Instability frequently suffer from severe widespread pain which is difficult to control. Chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization may explain this painful condition. The aim of this study was to determine if opioid-free anesthesia plus the postoperative administration of lidocaine, ketamine and dexmedetomidine can reduce postoperative pain and the need of methadone rescues in comparison with opioid-based management in these patients undergoing Craneo-Cervical Fixation (CCF). The secondary aim was to assess the needs of opioids at hospital-discharge, incidence of gastrointestinal complications and the requirement of anxiolytic.MethodsA retrospective, consecutive case series study was designed. 42 patients with EDS-HT/JHS undergoing CCF were enrolled in two groups: an OFA-plus Group that received opioid-free anesthesia with propofol, lidocaine, ketamine and dexmedetomidine, and OP Group, opioid-based anesthesia-analgesia. The main variables: Preoperative Visual Analogue Score (VAS), postoperative VAS on the 1st, 2nd, 4th and 6th days, sufentanil or morphine requirements, need for methadone rescue, and VAS at hospital-discharge. Data was presented by mean ± SD, percentage, median or interquartile range. Chi-squared or Fisher’s test. 95% C.I and P values < 0.05.ResultsNineteen patients in OFA-plus, and 23 patients in OP group. VAS was lower in OFA-plus on the postoperative days evaluated (p < 0.001).VAS at hospital-discharge was lower in OFA-plus: 4.96 (4.54–5.37) vs. OP 6.39 (6.07–6.71) (p < 0.001). Methadone requirement was lower in the OFA-plus (p < 0.001). 78% of patients in OFA-plus didn’t need methadone rescue. 95% in OP group needed methadone rescues at high doses(> 15 mg/day). No differences regarding equivalent doses of sufentanil or morphine consumption on the 2nd, 4th, and 6th postoperative days were found. OFA-plus decreased ileus, nausea and vomiting (p < 0.001). 60.9% in OFA-plus group decreased opioid requirements at hospital-discharge compared with preoperative values. A 77% reduction of anxiolytics requirements was shown.ConclusionOFA-plus management for patients undergoing CCF with EDS-HT/JHS shows significant reduction in postoperative pain and at hospital-discharge compared with opioid-based anesthesia. OFA-plus management decreases the total doses of methadone rescues, reduces anxiolytic requirements and gastrointestinal side-effects, except for constipation. OFA-plus management is a feasible option to improve postoperative pain control, reducing the opioids’ use and their postoperative side-effects in patients undergoing CCF with EDS-HT/JHS.

Gastrointestinal complications are associated with a poor outcome in non-critically ill pneumonia patients

BackgroundDevelopment of gastrointestinal (GI) complications is adversely associated with prognosis in the critically ill. However, little is known about their impact on the outcome of non-critically ill patients. In this study, we aimed to investigate the incidence of GI complications and their influence on prognosis of hospitalized pneumonia patients.MethodsAdult patients admitted with a diagnosis of pneumonia from 2012 to 2014 were included. Medical records were reviewed to obtain patients’ demographics, physical signs, comorbidities, laboratory results, clinical events, and the Confusion, Urea, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score was calculated to assess the severity of pneumonia. GI complications, including bowel distension, diarrhea, GI bleeding and ileus, were evaluated during the first 3 days of hospitalization and their association with patient outcomes, such as hospital mortality and length of stay, was analyzed.ResultsA total of 1001 patients were enrolled, with a mean age of 73.7 years and 598 (59%) male. Among them, 114 (11%) patients experienced at least one GI complication and diarrhea (5.2%) was the most common. The hospital mortality was 14% and was independently associated with an increase in the CURB-65 score (odds ratio [OR] 1.952 per point increase; 95% confidence interval [CI] 1.516–2.514), comorbid malignancy (OR 1.943; 95% CI 1.209–3.123), development of septic shock (OR 25.896; 95% CI 8.970–74.765), and the presence of any GI complication (OR 1.753; 95% CI 1.003–3.065).ConclusionsCompared to a critical care setting, GI complications are not commonly observed in a non-critical care setting; however, they still have a negative impact on prognosis of pneumonia patients, including higher mortality and prolonged length of hospital stay.

Gastrointestinal complications following on-pump cardiac surgery-A propensity matched analysis.

BackgroundGastrointestinal complications following on-pump cardiac surgery are orphan but serious risk factors for postoperative morbidity and mortality. We aimed to assess incidence, perioperative risk factors, treatment modalities and outcomes.Material and methodsA university medical center audit comprised 4883 consecutive patients (median age 69 [interquartile range IQR 60–76] years, 33% female, median logistic EuroScore 5 [IQR 3–11]) undergoing all types of cardiac surgery including surgery on the thoracic aorta; patients undergoing repair of congenital heart disease, implantation of assist devices or cardiac transplantation were excluded. Coronary artery disease was the leading indication for on-pump cardiac surgery (60%), patients undergoing cardiac surgery under urgency or emergency setting were included in analysis. We identified a total of 142 patients with gastrointestinal complications. To identify intra- and postoperative predictors for gastrointestinal complications, we applied a 1:1 propensity score matching procedure based on a logistic regression model.ResultsOverall, 30-day mortality for the entire cohort was 5.4%; the incidence of gastrointestinal complications was 2.9% and median time to complication 8 days (IQR 4–12). Acute pancreatitis (n = 41), paralytic ileus (n = 14) and acute cholecystitis (n = 18) were the leading pathologies. Mesenteric ischemia and gastrointestinal bleeding accounted for 16 vs. 18 cases, respectively. While 72 patients (51%) could be managed conservatively, 27 patients required endoscopic/radiological (19%) or surgical intervention (43/142 patients, 30%); overall 30-day mortality was 12.1% (p<0.001). Propensity score matching identified prolonged skin-to-skin times (p = 0.026; Odds Ratio OR 1.003, 95% Confidence Interval CI 1.000–1.007) and extended on-pump periods (p = 0.010; OR 1.006, 95%CI 1.001–1.011) as significant perioperative risk factors.CommentProlonged skin-to-skin times and extended on-pump periods are important perioperative risk factors regardless of preoperative risk factors.

One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program

ObjectiveOur enhanced recovery after cardiac surgery (ERAS Cardiac) program is an evidence-based interdisciplinary process, which has not previously been systematically applied to cardiac surgery in the United States. MethodsThe Knowledge-to-Action Framework synthesized evidence-based enhanced recovery interventions and implementation of a designated ERAS Cardiac program. Standardized processes included (1) preoperative patient education, (2) carbohydrate loading 2 hours before general anesthesia, (3) multimodal opioid-sparing analgesia, (4) goal-directed perioperative insulin infusion, and (5) a rigorous bowel regimen. All cardiac anesthesiologists and surgeons agreed to follow the standardized pathway for adult cardiac surgery cases. The 1-year outcomes were compared between the 9 months pre- and post-ERAS Cardiac implementation using prospectively collected, retrospectively reviewed data. ResultsComparing the pre- (N = 489) with the post- (N = 443) ERAS Cardiac groups, median postoperative length of stay was decreased from 7 to 6 days (P < .01). Total intensive care unit hours were decreased from a mean of 43 to 28 hours (P < .01). The incidence of gastrointestinal complications was 6.8% pre-ERAS versus 3.6% post-ERAS implementation (P < .05). Opioid use was reduced by a mean of 8 mg of morphine equivalents per patient in the first 24 hours postoperatively (P < .01). Reintubation rate and intensive care unit readmission rate were reduced by 1.2% and 1.5%, respectively (P = not significant). The incidence of hyperglycemic episodes was no different after ERAS Cardiac initiation. Patient satisfaction was 86.3% pre-ERAS versus 91.8% post-ERAS Cardiac implementation and work culture domain scores revealed increases in satisfaction across all measured indices, including patient focus, culture, and engagement. ConclusionsInitial clinical and survey data after the first year of a system-wide ERAS Cardiac program were associated with significantly improved perioperative outcomes. We believe this value-based approach to cardiac surgery can consistently result in earlier recovery, cost reductions, and increased patient/staff satisfaction.

Comparing the efficacy of intravenous ketorolac versus intravenous ibuprofen in relieving renal colic pain; a randomized clinical trial

Introduction: Various therapies have been used to relieve or improve the urinary colic pain, but many of these treatments have been limited due to side effects associated with the drugs. In this regard, opioid drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) have a higher priority than other treatments. Objectives: The aim of the present study was to compare the level of pain relief from renal stones after the administration of two types of NSAIDs, including intravenous ibuprofen versus intravenous ketorolac. Patients and Methods: In this clinical trial (identifier: IRCT20180108038276N1), 70 patients with renal colic pain were randomly treated with intravenous ketorolac (30 mg, n = 35) or with intravenous ibuprofen (800 mg, n = 35). The patient’s pain severity was assessed by the visual analogue scaling (VAS) method before and 20 and also 60 minutes after interventions. Results: Although pain severity considerably reduced within 60 minutes of prescribing ibuprofen and ketorolac, the trend of the change in pin score was not different between the two groups (P = 0.734). We found no significant difference in appearance of some side effects including nausea and vomiting, requiring use of ondansetron, need to prescribe additional analgesics. However epigastric pain and need to administrating H2 blockers were not revealed in the group receiving ketorolac, but these complications were found in 25.7% of the patients received ibuprofen indicating a significant difference (P = 0.002). Conclusion: A single dose administration of both intravenous ketorolac and ibuprofen is associated with significant improvement in renal colic pain within one hour after administration. However, due to the lower incidence of gastrointestinal complications in the administration of ketorolac compared to ibuprofen, the use of ketorolac in treatment and relief of renal colic pains is preferable.

The outcomes of long term home enteral nutrition (HEN) in older patients with severe dementia

European and international guidelines advice against initiating tube-feeding in patients with severe dementia. These recommendations are based on studies with important methodological limitations that evaluated the benefits of artificial nutrition in patients with percutaneous endoscopic gastrostomy almost exclusively in terms of the prolongation of survival. The aims of this study were to assess the harmful effects of home enteral nutrition administered via the nasogastric tube and percutaneous endoscopic gastrostomy in patients with advanced dementia in terms of mechanical, gastrointestinal and metabolic complications, to estimate the survival, to explore the risk factors for mortality and to compare the outcomes of patients with advanced dementia with those of patients without dementia. The retrospective observational study was carried out on 585 consecutive patients of the mean age of 85.6±6.9 years. They were treated using home enteral nutrition from 2010 to 2015 according to follow-up protocols adopted by the Clinical Nutrition Unit of an Italian geriatric research hospital (IRCCS-INRCA, Ancona). Incidence rates of mechanical, gastrointestinal and metabolic complications and survival rates in patients with severe dementia were compared to those in patients without dementia. The Cox proportional hazards model was used to evaluate the mortality risk factors. There was no difference between the incidence rates of complications in patients with severe dementia and those in patients without dementia. The incidence of mechanical complications was 1.35/1000 days for patients without dementia vs. 1.53/1000 days for patients with dementia (p=0.270), the incidence of gastrointestinal complications was 1.30/1000 days for patients without dementia vs. 1.35/1000 days for patients with dementia (p=0.984) and the incidence of metabolic complications was 0.36/1000 days for patients without dementia vs. 0.35/1000 days for patients with dementia (p=0.252). The Kaplan Mailer analyses showed that there was no evidence to support the theses on poorer prognosis of survival of patients with dementia (median survival was 193 days for patients without dementia vs. 192 days for patients with dementia, (p>0.05)). The female gender, advanced age, nasogastric tube, diabetes mellitus and chronic renal failure were identified as risk factors. Subjects whose Geriatric Nutritional Risk Index values were higher had a lower risk of mortality. The discussion on the appropriateness of enteral nutrition in patients with severe dementia is still open. Our results show that, if there is a medical prescription for tube-feeding and a patient's surrogate decision-makers express free and informed consent to the tube-feeding of the patient, enteral nutrition should not be contraindicated a priori if the patient has severe dementia. Regular follow-up is mandatory to guarantee adherence to the therapy and achieve its initial aims and to ensure that the principles of beneficence and nonmaleficence are respected.

Effects of enteral nutrition added with glutamine on gastrointestinal functions and prognosis of acute severe traumatic brain injury

Objective To investigate the effects of enteral nutrition added with glutamine on the incidences of gastrointestinal complications, intestinal mucosal barrier function and inflammatory responses in patients with acute severe traumatic brain injury (sTBI). Methods A prospective case control study was made on 107 patients with sTBI hospitalized from January 2016 to June 2017. The patients were divided into experimental group added with glutamine (n=54) and control group without glutamine (n=53) according to the random number table. The general data of the patients were recorded. After treatment, the incidences of gastrointestinal complications in both groups were compared. The serum levels of intestinal mucosal barrier function indices, namely, diamine oxidase (DAO), D-lactate acid, and intestinal fat acid binding protein (I-FABP) were evaluated by enzymology spectrophotometer method. Meanwhile, the serum levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were also tested with enzyme-linked immunosorbent assay (ELISA). Glasgow coma scale (GCS), acute physiology and chronic health evaluation II (APACHE II), and hospital stay in both groups were compared. Results The two group were comparable with respect to gender, age, injury reasons, body mass index, preoperative GCS, preoperative APACHE II, injury type and injury time (P>0.05). The experimental group had lower incidences of stress ulcer, gastric retention and diarrhea compared with the control group 14 days after treatment (P<0.05). Within 14 days after treatment, the serum levels of DAO, D-lactate acid and I-FABP were significantly decreased in the experimental group at days 7 and 14 after treatment (P<0.05). The serum levels of CRP, TNF-α and IL-6 in the experimental group were significantly decreased after treatment (P<0.05). The experimental group had better prognosis compared with the control group (P<0.05), with higher GCS scores [(9.3±0.7) points vs. (8.2±0.7) points], lower APACHE II scores [(15.3±1.1)points vs. (17.7±1.2) points] at day 14, and shorter hospital stay [(19.1±2.2)days vs. (25.3±2.4)days] (P<0.01). Conclusions Enteral nutrition added with glutamine can effectively reduce the incidence of gastrointestinal complications, as well as alleviate the intestinal mucosal barrier function damage and the inflammatory responses at early stage after sTBI, which possibly improves prognosis. Key words: Craniocerebral trauma; Enteral nutrition; Glutamine; Gastrointestinal tract; Prognosis

Pelvic exenteration for primary and recurrent malignancies in urology department

Objective The objectives of present study is to investigate the safety and efficacy of pelvic exenteration (PE) for the treatment of pelvic malignancies in urology department. Methods From April 2010 to December 2014, 20 patients with primary or recurrent pelvic malignancy accepted anterior pelvic exenteration (APE) or total pelvic exenteration(TPE) surgery, including 7 males and 13 females, ranged from 35 to 87 years old with an average of 65 years old. Ten case accepted APE and 10 for TPE. The ilium conduit was done in 5 cases for APE and 6 cases for TPE as urinary diversion, cutaneous ureterostomy was done in 5 cases for APE and 4 cases for TPE as urinary diversion. There were 6 cases primary tumor in APE group and 3 primary tumors in TPE. All of the patients had 13 cases of the urinary tract tumor group, and none of the urinary tract tumor group in 7 cases. There were 4 cases received preoperative chemotherapy in the urinary tract tumor group. No case received preoperative radiotherapy. 3 cases received preoperative chemotherapy in none of the urinary tract tumor group, 3 cased received preoperative radiotherapy. After induction of general anesthesia using a laryngeal mask for airway management. All patients took the abdominal incision, then dissected lymph nodes on both sides of the iliac vessels, freed bilateral ureters to the end of the swollen bladder, separated the peritoneal space.The bilateral vas deferens was cutted and ligated, then isolated and ligated the seminal vesicles between the posterior wall of the bladder and the anterior wall of the rectum.Lateral ligaments of bladder was cuted, then cuted ligament of prostate and puboprostatic ligament, sutured and cut deep vein of penis. Urethra of apex prostate was freed and cuted. Female patients needed to free the uterus and the posterior wall, cut the cardinal ligament and round ligament of uterus, isolate the posterior wall of the uterus to the posterior vaginal wall. Rectal resection adopted Miles operation.And sigmoid colostomy was performed on the left side of the abdominal wall. The perioperative characters, pathological results and patients′ survival data were collected and analyzed. Results The average operation time for APE was 3.8 hours and 5.2 hours for TPE (P=0.173). Median length of hospital stay was 17.9 (7-47) days. The median blood loss was 300ml (80-2 500 ml) for APE and 400ml (50-6 000 ml) for TPE (P=0.909). The median follow-up time was 12.5 months (1-41months). The estimated 2-year survival rate for APE was 55.6% and 45.0% for TPE (P=0.642). Urinary system tumors group and non urinary system tumors group were analyzed and compared, The median survival time was 28 months and 13 months (P=0.538) in the two groups.The incidence of gastrointestinal complications of urinary system tumors and non-urinary system tumors was 7.7% and 28.6%, incision complications was 7.7% and 28.6%. Complications of urinary diversion only occurred in the non urologic tumor group, the incidence was 14.3%. The incidence of transfusion in two groups was 46.2% and 28.6%. Conclusions Pelvic exenteration (APE and TPE) could be a safe and reliable choice for local advanced primary and recurrent pelvic malignancy. Even for the recurrent malignancies, the survival results of the patients were satisfactory. Key words: Pelvic malignancy; Anterior pelvic exenteration; Total pelvic exenteration

Effects of bundle care on improving tolerance of enteral nutrition in postoperative patients with gastric carcinoma

Objective To explore the effects of bundle care on improving the tolerance of enteral nutrition (EN) in postoperative patients with gastric carcinoma. Methods Totally 180 patients who received laparoscopic surgery for gastric carcinoma in the Department of Gastrointestinal Surgery of Anhui Provincial Hospital from May 2016 to January 2017 were equally divided into a control group and an observation group according to the random number table. Patients in the control group received conventional nursing with enteral nutrition, while patients in the observation group received bundle care on the basis of conventional nursing. The time of first anal exhaust, time of oral intake, incidence of gastrointestinal complications, completion of daily EN consumption, duration of hospital stays, hospital expenses and satisfaction after surgery were then compared between the patients in the two groups. Results The time of first anal exhaust and oral intake of the patients in the observation group was (62.77±17.29) and (62.77±10.11) h, respectively, earlier than that of the patients in the control group, [ (68.30±23.11) and (67.29±17.92) h; t=2.03, 2.08; P<0.05]. The incidence of sickness or emesis, abdominal distension and diarrhea of the patients in observation group was (4.44%, 11.11%, 5.56%) , lower than that of the patients in the control group, [ (13.33%, 22.22%, 5.56%) ; χ2=4.39, 4.72, 4.77; P<0.05]. The completion rate of daily EN consumption of the patients in the observation group was (98.74±1.07) %, better than that of the patients in the control group [ (93.71±1.24) %, t=27.57, P<0.01]. The average duration of hospital stays of the patients in the observation group was (7.12±1.36) days, shorter than that of the patients in the control group [ (9.02±2.21) days; t=6.95, P<0.01]. The hospital expense of the patients in the observation group was (38 100±11 200) RMB, less than that of the patients in the control group, [ (41 200±10 900) RMB; t=2.25, P<0.05]. The patients in the observation group showed higher satisfaction 3 days after surgery and at discharge than the patients in the control group (P<0.05) . Conclusions Bundle care can help to improve the EN tolerance, shorten the time of anal exhaust and the duration of hospital stays, reduce hospital expenses, and enhance patients' satisfaction in the process of early enteral nutrition after surgery. Key words: Stomach neoplasms; Enteral nutrition; Perioperative nursing; Bundle care; Tolerance

The outcomes of pediatric liver retransplantation from a living donor: a 17-year single-center experience.

PurposeLiver retransplantation is the only therapeutic option for patients with graft failure after liver transplantation. The aim of this study is to evaluate the outcomes of pediatric retransplantation from living donor at a single center.MethodsBetween December 1998 to August 2015, retransplantation from a living donor was performed for 14 children (<18 years of age) at Kumamoto University Hospital. The characteristics of the retransplantation recipient and the clinicopathological factors between primary transplantation and retransplantation were analyzed to detect the prognostic factors.ResultsIn retransplantation, the operative time was longer and the amount of blood loss was greater in comparison to primary transplantation. The 1-, 3-, and 5-year survival rates from the date of retransplantation were 85.7, 85.7, and 78.6%, respectively. The rates of re-laparotomy after primary transplantation, bile leakage and postoperative bleeding after retransplantation were higher than after primary transplantation. Among the three patients who died after retransplantation, the operative time, the rate of re-laparotomy after primary transplantation and the incidence of gastrointestinal complications were higher in comparison to the surviving patients.ConclusionPediatric retransplantation from a living donor is an acceptable procedure that could save the lives of recipients with failing allografts when organs from deceased donors are scarce. To ensure good results, it is essential to make an appropriate assessment of the cardiopulmonary function and the infectious state of the patients before Re-LDLT.

Radioembolization: Is Prophylactic Embolization of Hepaticoenteric Arteries Necessary? A Systematic Review.

PurposeTo study the effectiveness of prophylactic embolization of hepaticoenteric arteries to prevent gastrointestinal complications during radioembolization.MethodsA PubMed, Embase and Cochrane literature search was performed. We included studies assessing both a group of patients with and without embolization.ResultsOur search revealed 1401 articles of which title and abstract were screened. Finally, eight studies were included investigating 1237 patients. Of these patients, 456 received embolization of one or more arteries. No difference was seen in the incidence of gastrointestinal complications in patients with prophylactic embolization of the gastroduodenal artery (GDA), right gastric artery (RGA), cystic artery (CA) or hepatic falciform artery (HFA) compared to patients without embolization. Few complications were reported when microspheres were injected distal to the origin of these arteries or when reversed flow of the GDA was present. A high risk of confounding by indication was present because of the non-randomized nature of the included studies.ConclusionIt is advisable to restrict embolization to those hepaticoenteric arteries that originate distally or close to the injection site of microspheres. There is no conclusive evidence that embolization of hepaticoenteric arteries influences the risk of complications.

Incidence Of Hypotension In Patients With Multiple Myeloma During High Dose Chemotherapy and Autologous Stem Cell Rescue

BackgroundThe median age of patients diagnosed with multiple myeloma (MM) is 69. Up to 60-80% of patients in this age group have hypertension (HTN) (Burt VL et al. Hypertension 1999), and are on anti-hypertensive medications. A standard treatment for MM is high dose melphalan (HDM) chemotherapy with autologous stem cell transplant (ASCT), which often results in gastrointestinal complications that can result in hypovolemia.The combined effect of anti-HTN agents and ASCT-related complications may result in blood pressure (BP) ranges that are precariously low. To date, the incidence of hypotension in the setting of ASCT for MM is unknown. In this case series of 102 patients who received ASCT for MM, we compare the characteristics of those who became hypotensive with those who did not. MethodsWe reviewed the charts of 102 consecutive MM/AL amyloid patients admitted for HDM chemotherapy with ASCT at Mount Sinai Hospital between May 2011 and June 2013. May 2011 was chosen as the date of inclusion because at this time, electronic medical records were implemented, allowing for detailed review of vital signs and other clinical data.Patients were classified into two groups. Patients included in group 1 demonstrated a drop in BP which was defined as meeting at least 1 of the following criteria:A) One or more anti-HTN medications were discontinued during ASCTB) Although normotensive on admission for ASCT, the median systolic or diastolic blood pressure (SBP or DBP) on date of discharge was ≤ 100 or 60 mm Hg respectivelyC) A decrease in SBP of ≥ 20 mm Hg was observed between admission and dischargePatients who did not meet any of the above criteria were classified into group 2. Baseline and peri- SCT characteristics of the two groups were compared using the chi square test. ResultsOf the 102 patients analyzed, 6 had AL amyloid and the remaining 96 had MM. 43 met at least one inclusion criteria for group 1 and the remaining 59 were classified as group 2. Specifically, of the patients in group 1, 18 met inclusion criteria A, 21 met inclusion criteria B, and 23 met inclusion criteria C. Among the patients in group 1 who met 2 criteria: 4 patients met criteria A and B, 4 patients met criteria A and C, and 9 patients met criteria B and C.Baseline characteristics including median age (64 and 63), gender distribution (55.8% and 47.5% females respectively), and a history of HTN (41.9% vs. 37.3%) were comparable in both groups (p>0.05). The median length of stay was 17 days in both groups.The incidence of gastrointestinal complications was comparable in both groups including diarrhea 72.1% vs. 62.7%, mucositis 14.0 % vs 8. 5%, and Clostridium difficile infection 9.3% vs. 6.8%. The ensuing weight loss in the 2 groups was also comparable 2.4 kg and 1.9 kg respectively.The incidence of infectious complications was similarly comparable in the 2 groups with fever 51.1 % vs 61% and bacteremia occurring in 7.0% vs 11.9%. Of the 43 patients in group 1, one patient had shock requiring ICU transfer for vasopressors in the setting of adrenal insufficiency and sepsis/bacteremia.Interestingly, of the 102 included patients, only 15 were reported to have clinically significant hypotension on the discharge summary. Of these 15 patients, 3 experienced transient hypotension, (i.e. for 1 -2 days,) with rapid normalization of pressure, and therefore, did not meet our inclusion criteria of persistent hypotension. ConclusionsAlthough the incidence of hypotension in this series of MM patients undergoing ASCT was 42%, only 15% had documentation of this occurrence in the discharge summary.Interestingly, there were no statistically significant differences in the risk factors for ASCT associated hypotension in the 2 groups, including gastrointestinal and infectious complications.Given the unexpectedly high incidence of hypotension during ASCT, consideration should be given to the following: 1) Prior to SCT, anti-HTN medications should not be added (as is sometimes done for perioperative clearance) or titrated up; 2) During ASCT, anti-HTN medications may need to be discontinued; 3) Prior to discharge from ASCT, physical therapy/orthostatic evaluation and risk of falls from new relative hypotension needs to be assessed, especially in the setting of recovering thrombocytopenia.Although further studies are required, we hypothesize that fatigue, presyncopal events, and falls post SCT could be minimized with increased attention to HTN management peri ASCT. Disclosures:Chari:Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Millenium : Membership on an entity's Board of Directors or advisory committees; Onyx: Membership on an entity's Board of Directors or advisory committees.

The influence of the enhanced enteral nutrition on nutritional status and immune function in children with HIV/AIDS

Objective To investigate the effect of enhanced glutamine (Gln) enteral nutrition intervention on the nutrition status and T lymphocytes-mediated immune function in children with HIV/AIDS.Methods According to the inclusion criteria,60 children with AIDS were randomly divided into observation group(Gln improved group 30 cases) and control group (conventional enteral nutrition group 30 cases).Before intervention and 28 days after intervention,the nutrition related index,index of cellular immunity and serum Gln changes were detected in two groups.Results In the observation group 28 days after intervention,the TLC and serum level of Gln was (2.81 ± 0.25) ×109/L,(7.2 ±2.1) μmol/L,which were significantly higher than those in the control group (2.53 ±0.24) × 109/L,(5.5 ± 1.2) μmol/L (P ＜ 0.05).In observation group,ALB was (40.5 ± 3.1) g/L,the percentage of CD4+ was (39.0 ± 7.5) ％,CD4+/CD8+ ratio was (1.6 ± 0.8),which were significantly higher than those in the control group (38.6 ± 2.1) g/L,(35.3 ± 9.9) ％,(1.2 ± 0.6) (P ＜ 0.01).Observation group had lower incidence rate of gastrointestinal complications (16.7％ vs 40.0％,P ＜ 0.01).Conclusion Enhanced enteral nutrition intervention can improve nutritional status in children with HIV/AIDS,raise the level of T lymphocyte immunity,reduce the incidence of gastrointestinal complications,which was worthy of clinical promotion. Key words: Acquired immunodeficiency syndrome; Enteral nutrition; Glutamine; T-Lymphocytes; Child

Gastrointestinal complications after cardiac surgery: 10-year experience of a single Australian centre

Gastrointestinal (GI) complications after cardiac surgery are uncommon, but are associated with high morbidity and mortality as well as significant hospital resource utilization. We analysed a prospectively collected database containing all adult cardiac surgery procedures performed from July 2001 to March 2011 at Monash Medical Centre and Jessie McPherson Private Hospital. Patients with post-operative GI complications were compared to patients without GI complications who were operated in the same period. The incidence of GI complications was 1.1% (61 out of 5382 patients) with an overall 30-day mortality of 33% (versus 3% in the non-GI complication group). The most common complications were GI bleeding, gastroenteritis and bowel ischaemia. Patients who had GI complications were significantly older, had higher incidence of renal impairment, chronic lung disease and anticoagulation therapy and were more likely to be in cardiogenic shock. Emergency procedures, combined coronary artery bypass grafting and valve surgery and aortic dissection cases were more common in the GI complication group. The GI complication group also had higher incidence of return to theatre, renal failure, stroke, septicaemia and multi-organ failure. GI complications after cardiac surgery remain an uncommon but dreadful complication associated with high mortality. Our findings should prompt a high degree of clinical vigilance in order to make an early diagnosis especially in high risk patients. Further studies aiming to identify independent predictors for GI complications after cardiac surgery are warranted.

Effects of norepinephrine on oxygen metabolism and postoperative outcomes in elderly patients undergoing fluid-restricted abdominal surgery

Objective To investigate the effects of norepinephrine on oxygen metabolism and postoperative outcomes in the elderly patients undergoing fluid-restored abdominal surgery.Methods After hospital ethics committee approval,and written informed consent was obtained from all patients,40 elderly patients,aged ＞ 64 yr,with a body mass index of 18-24 kg/m2,undergoing elective colorectal surgery,were randomly divided into 2 groups (n =20 each):routine fluid administration group (group A) and restricted fluid administration group (group B).In group A,lactated Ringer's solution was given routinely.Lactated Ringer's solution was given at a rate of 5 ml· kg- 1 · h- 1 and small dose of norepinephrine was infused intravenously at 0.01-0.03 μg· kg- 1 · h - 1 simultaneously during the surgery,and MAP was maintained ≥65 mm Hg in group B.Intraoperative blood loss was replaced with the equal volume of 6％ hydroxyethyl starch 130/0.4.Before the surgery ( baseline),1 and 2 h after beginning of the surgery,and while leaving postanesthesia care unit,mean arterial pressure (MAP),heart rate (HR),cardiac index (CI) and central venous pressure (CVP) were recorded,and arterial and central venous blood samples were drawn for blood gas analysis.Oxygen delivery index (DO2 I ),oxygen consumption index (YO2I) and oxygen extraction ratio (ERO2) were calculated.The gastric mucosal pH was determined before the surgery and 1 h after beginning of the surgery.Blood samples were taken form the peripheral vein to determine the concentration of Hb,serum albumin,blood urea nitrogen (BUN) and creatinine (Cr) concentrations before the surgery and 1 day after the surgery.The extubation time,duration of stay in hospital,the time when the patients passed the flatus,pulmonary complications,gastrointestinal complications,and wound infections were recorded.Results Compared with group A,CI,Hb,ScvO2 and DO2I were significantly increased,CVP and ERO2 were decreased during the surgery,the concentrations of Hb and serum albumin were significantly increased,1 day after the surgery,and the incidence of pulmonary complications and wound infections was significantly decreased after the surgery in group B (P ＜ 0.05 ).There were no significant differences in gastric muscosal pH,the indexes of renal function,extubatiotn time,the time when the patients passed the flatus,duration of stay in hospital and the incidence of gastrointestinal complications between the two groups ( P ＞ 0.05).Conclusion When small dose of norepinephrine is used to treat perioperative hypotension induced by fluid restriction,it can increase oxygen delivery,and reduce the incidence of postoperative complications,and has no adverse effects on gastrointestinal microcirculation and oxygen consumption in the elderly patients undergoing colorectal surgery. Key words: Norepinephrine; Fluid therapy; Oxygen consumption; Aged; Prognosis