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 discuss the clinical characteristics, radiological characteristics, diagnosis, and treatment of hepatocellular carcinoma with bile duct tumor thrombus (HCCBDTT), and to improve the level of diagnosis and treatment for it. Methods Clinical data of 2 cases of HCCBDTT admitted in March 2016 and July 2016 in our hospital were analyzed retrospectively, and the related literatures were reviewed. Results Two cases of HCCBDTT were misdiag- nosed as hilar cholangiocarcinoma before operation, and then proved to be HCCBDTT after operation. The 2 cases were both alive during the follow-up period (20 months and 13 months respectively). Conclusions HCCBDTT patients should be comprehensively analyzed basing on the clinical data for diagnosis, and avoiding misdiagnosis. Active surgical treatment can effectively improve the quality of life in HCCBDTT patients, and prolong the survival time.
ObjectiveTo review the association of gut microbiota and postoperative gastrointestinal dysfunction (GID) in patients after abdominal surgery and to provide a new idea for the pathogenesis, prevention, and treatment of postoperative GID in patients after abdominal surgery.MethodThe related and latest literatures were reviewed by searching the literatures on “intestinal flora” “gut microbiota” “intestinal microbial population” “brain-gut axis” “gastrointestinal function” “gastric paralysis” “intestinal paralysis” and “ileus” from January 1, 2000 to April 2, 2021 in Chinese and English databases.ResultsGut microbiota diversity was closely related to postoperative GID symptoms in patients after abdominal surgery. Gut microbiota regulated gastrointestinal motility and mucosal barrier function by metabolizing food to produce metabolites such as 5-hydroxytryptamine, melatonin, short-chain fatty acid, succinic acid, lactic acid, and so on.ConclusionsThe imbalance of gut microbiota is closely related to postoperative GID in patients after abdominal surgery. However, the relevant bacterial metabolites that have been found are limited at present, and the relevant mechanism needs to be further investigated.
Objective To investigate the clinical characteristics and diagnosis and treatment of fungal pulmonary embolism, and to improve the understanding of this disease. Methods The diagnosis and treatment of two patients with fungal main pulmonary embolism in the First Affiliated Hospital of Guangzhou Medical University were summarized and analyzed. Literatures were retrieved from Wanfang database, China national knowledge internet database and Pubmed database with search terms of “pulmonary embolism AND mucor”, “pulmonary embolism AND aspergillus”, “pulmonary embolism AND fungi”, “pulmonary embolism AND Candida”, “pulmonary embolism AND cryptococcus”. Results Case 1, a 53-year-old female was referred, with cough, high fever, breathlessness for 2 years, chest pain for 1 year. The patient had rheumatoid arthritis and systemic lupus erythematosus history with long term prednisone treatment. Finally, the patient was diagnosed main pulmonary artery embolism (aspergillus) and disseminated aspergillosis. Although treatment with voriconazole, amphotericin B, and caspofungin were given for more than 1 year, the patient died with uncontrolled aspergillus infection. Case 2, a 67-year-old female was referred with cough, chest distress, chest pain for 8 months, breathlessness for 6 months. The patient had a history of chronic viral hepatitis C. Finally the patient was diagnosed as main pulmonary artery embolism and pulmonary valve endocarditis (aspergillus, mucor). The patient underwent pulmonary artery lesion resection and tricuspid valvuloplasty (DeVega method). After surgery, the patient was delivered with amphotericin B and posaconazole for 3 months. During the follow-up period of 1 year, the patient recovered almost totally without relapse signs. A total of 42 cases of fungal pulmonary embolism from 1980 to 2021 were retrieved (including 2 cases in this article), and 6 of these cases were main pulmonary artery embolism. Of all the cases, the median age was 49 years and 22 (54.3%) were males. 20 cases were immunocompromised. The infection pathogens included: Aspergillus (21, 50%), Candida (11, 26.2%), Mucor (7, 16.7%), and Aspergillus combined with Mucor (1, 2.5%), Coccidioides spp (1, 2.5%), and Cryptococcus (1, 2.5%). Fifteen cases were complicated with infection other than cardiopulmonary. Twenty-two cases were treated with surgery combined with antifungal medicine, and 9 cases with antifungal medicine alone. Twenty-two cases were dead and the overall mortality rate was 52.4%. There were statistically significant differences in the effects of fungal species, dissemination of other organs other than the heart and lung, and surgical treatment on the survival rate. The survival rate of different fungal species was significantly different. Dissemination to organs other than the heart and lungs reduces survival, whereas surgical treatment improves survival. Conclusions Fungal pulmonary embolism, a disease with high mortality, rarely involves the main pulmonary artery. The possibility of fungal pulmonary embolism should be considered when the cause of pulmonary thrombosis is unknown and the anticoagulant effect is poor. Although there is no unified treatment at present, early surgical combined with standard antifungal treatment may improve the prognosis of patients.