Objective To investigate the clinical features, diagnosis, and surgical methods of left-sided appendicitis (LSA). Methods We retrieved LSA-related literatures through Pubmed, Google Scholar English databases, Wanfang, CNKI, VIP, and SinoMed databases (published from January 1981 to June 2017), as well as 2 cases of LSA who treated in Beibei Traditional Chinese Medical Hospital, to analyze the clinical characteristics of LSA and its diagnosis and treatment methods. Results There were 92 articles in a total of 212 LSA patients were retrieved, and 2 cases treated in Beibei Traditional Chinese Medical Hospital, a total of 214 LSA patients were included in the analysis. Pain fixed position of LSA: 139 cases (65.0%) located in left-lower quadrant, 30 cases (14.0%) located in right-lower quadrant, 8 cases (3.7%) located in peri-umbilical, 15 cases (7.0%) located in mid-lower abdomen, 15 cases (7.0%) located in left-upper quadrant, 3 cases (1.4%) located in right-upper abdomen, 2 cases (0.9%) located in mid-upper abdomen, 2 cases (0.9%) located in pelvic cavity, respectively. LSA had occurred in association with several types of abnormal anomalies: 131 cases (61.2%) suffered from situs inversus totalis (SIT), 53 cases (24.8%) suffered from midgut malrotation (MM), 21 cases (9.8%) suffered from cecal malrotation, 4 cases (1.9%) suffered from long appendix, 2 cases (0.9%) suffered from free ascending colon, and 3 cases (1.4%) were unclear. The diagnosis of 114 LSA cases (53.3%) before operation was correct, in which the correct diagnosis rates of SIT-LSA and MM-LSA were 74.8% (98/131) and 22.6% (12/53), respectively. Three patients (1.4%) underwent conservative treatment, and 211 patients (98.6%) underwent surgical treatment, including 25 cases (11.7%) of laparoscopic surgery, 145 cases (67.8%) of open abdominal surgery, and unknown of 41 cases (19.1%). Laparotomy incision: abdominal incision in 74 cases (51.0%), ventral midline incision in 16 cases (11.0%), the left side of the anti McBurney incision in 43 cases (29.7%), right McBurney incision in 12 cases (8.3%). Conclusions LSA mainly occurs in association with 2 types of congenital anomalies: SIT and MM. There is some difficult to make diagnosis for abnormal anatomy and inaccurate pain location of LSA, so it is easy to cause the delay in diagnosis or misdiagnosis. For LSA, the choices of laparoscopy or laparotomy operation methods are applicable.
Objective To study the effects of different carbon dioxide pneumoperitoneum pressure and time on abdominal cavity infection bacteria of peritonitis in rats, including bacteria growth and bacterial translocation. Methods Sixty Sprague Dawley rats were injected with Eseherichia coli into the abdominal cavity to establish models of intra-abdominal infection. To give 3 types of pneumoperitoneum pressure for the experimental group: 15 mm Hg (1 mm Hg=0.133 kPa) for high pressure group, 5 mm Hg for low pressure group, and blank control group for no-pneumoperitoneum. To give 2 types of experimental period: 1 h and 3 h. These 60 Sprague Dawley rats were randomly divided intomoperi 6 groups by random number table. They were treated by different pneumoperitoneum pressure and time. All rats were killed at the end of the carbon-dioxide pneumo-peritoneum experiment. Peritoneal lavage fluids and portal vein blood were taken for microbiological examinations and culture. The endotoxin content in portal vein blood was detected too. Results ① Bacteria content: bacteria counts of different pneumoperitoneum pressure groups were obviously different (F=9.02, P=0.020), bacteria counts of different experimental period groups were obviously different (F=8.47, P=0.003), the effect of time was different in different pneumoperitoneum pressure groups (F=8.07, P=0.020). ② Bacterial translocation: Bacterial translocation occurred in all 6 groups. Blood culture positive rates were similar between 1 h group and 3 h group at 3 types of pneumoperitoneum pressure groups (P>0.05). The positive rate of blood culture in high pneumoperitoneum group was significantly higher compared with the no-pneumoperitoneum group (P<0.05). ③ The endotoxin content: the endotoxin content of different pneumoperitoneum pressure groups were obviously different (F=14.70, P<0.01), the endotoxin content in plasma increased obviously in high pressure group compared with low pressure group (P=0.018) and no-pneumoperitoneum group (P<0.01), the endotoxin content in plasma increased obviously in low pressure group compared with no-pneumoperitoneum group (P=0.005). The endotoxin content of different experimental period groups were obviously different (F=148.90, P<0.01), the endotoxin content in plasma increased obviously in 3 h group compared with 1 h group. There were no significant difference in the effect of time with different pneumoperitoneum pressure groups (F=0.14, P=0.874). Conclusion CO2pneumoperitoneum promoted intestinal bacterial endotoxin and bacterial translocation in peritonitis of rats, which increased with the pressure and time.
Objective To assess the quality reports on acupuncture in the treatment of postherpetic neuralgia. Methods MEDLINE, CBM, CMCC and CNKI from 1994 to 2006 were searched electronically. Handsearching was also done. The retrieved articles were assessed in terms of several factors, including the type of clinical research, methodology, diagnostic criteria, inclusion/exclusion criteria, effectiveness measurements, calculation of sample size, follow-up, etc. Results Among the 109 included articles, only 6 were true randomized controlled trials. There were 17 quasi-randomized controlled trials, 13 non-randomized concurrent controlled trials, 1 case-control study and 63 narrative studies. 29 of the reports clearly described the diagnostic criteria, 14 mentioned the inclusion/exclusion criteria, 79 reported the effectiveness measurements, none mentioned the calculation of sample size, 24 reported the follow-up outcomes, and only 1 mentioned adverse reactions. Conclusion More prospective, multicenter, large-scale, high-quality randomised trials are needed, and recommendations should also be made for future evaluations of methodological quality.
ObjectiveTo compare the early effectiveness and safety of simultaneous bilateral and staged bilateral unicompartmental knee arthroplasty (UKA) in treatment of anteromedial compartment osteoarthritis.MethodsThe clinical data of 31 patients with bilateral anteromedial compartment osteoarthritis who underwent bilateral UKAs between January 2015 and January 2017 was retrospectively analyzed. Of them, 17 patients were treated with simultaneous bilateral UKAs (simultaneous group) and 14 patients with staged bilateral UKAs (staged group). There was no significant difference in gender, age, body mass index, osteoarthritis grading, and preoperative hip-knee-ankle angle, knee society score (KSS), visual analogue scale (VAS) score, and range of motion (ROM) of knee between the two groups (P>0.05). The operation time, blood loss, hospitalization stay, minimum hemoglobin value during 10 days after operation, and hospitalization cost were recorded. The staged group was compared by the sum of two operations. The effectiveness was evaluated by KSS score, VAS score, ROM at 3, 6, 12 months after operation, and patient satisfaction scores were recorded at 12 months after operation.ResultsThe operation time, hospitalization stay, and hospitalization cost of the simultaneous group were significantly lower than those of the staged group (P<0.05). There was no significant difference in blood loss and the minimum hemoglobin value during 10 days after operation between the two groups (P>0.05). Superficial infection occurred in 1 side of 1 case (7.1%) in staged group. Postoperative delirium occurred in 1 case (5.9%) in simultaneous group. There was no significant difference in incidence of postoperative complications between the two groups (P=1.000). Patients in both groups were followed up 12-32 months (mean, 24.7 months). There was no significant difference in KSS score between the two groups at 3 months after operation (t=0.896, P=0.392). KSS scores were significanly higher in simultaneous group than in staged group at 6 and 12 months after operation (P<0.05). There was no significant difference in ROM and VAS scores between the two groups at 3, 6, and 12 months after operation (P>0.05). At 12 months after operation, the patient satisfaction scores were significantly higher in simultaneous group than in staged group (P<0.05). X-ray films showed no loosening of the prosthesis in the two groups.ConclusionSimultaneous bilateral UKAs has the same security as staged bilateral UKAs. Meanwhile knee function recovery was better, hospitalization stay and hospitalization cost reduced, and patient satisfaction was higher in simultaneous bilateral UKAs.