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22 November 2007, Volume 27 Issue 12 Previous Issue    Next Issue
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Evolution of antimicrobial resistance among predominant pathogen of ventilatorassociated pneumonia isolated from intensive care unit LIANG Ying-jian,ZHU Ran，ZHANG Zhi-dan,et al 2007, 27(12): 1-1014.  Abstract ( )   PDF (510KB) ( )   Objective:To investigate the etiology and antimicrobial resistance of predominant pathogen of ventilatorassociated pneumonia (VAP) isolated from intensive care unit. Methods:The bacteria isolated from sputum specimen and antimicrobial resistance of patients with VAP admitted between January 2003 and December 2006 in the Department of Intensive Care Unit of the First Affiliated Hospital of China Medical University were analyzed retrospectively. Results:During the period, the incidence of VAP in ICU was 191%.Pseudomonas aeruginosa，Burkholderia cepacia,Acinetobacter baumannii and Stenotrophomonas maltophilia were the most frequently isolated bacteria of VAP.Staphylococcus aureus increased steadily from 2003 to 2005 and then decreased in 2006.The total number of isolated Chryseobacterium meningosepticum decreased in 2005-2006.While the number of Klebsiella pneumoniae increased in 2005-2006.The resistance rate of Pseudomonas aeruginosa to antibiotics increased progressively in 2004 (above 75%) and to imipenem exceeded 40% during 4 years.Acinetobacter baumannii was less resistant to imipenem and levofloxacin.The resistance of Stenotrophomonas maltophilia to compound sulfamethoxazole,ciprofloxacin and levofloxacin was the lowest.Methicillinresistant Staphylococcus aureus composed the biggest part of all isolated Staphylococcus aureus. Conclusion:The main pathogens of VAP in ICU are nonfermenting gramnegative bacilli.The predominant pathogens are Pseudomonas aeruginosa,Burkholderia cepacia,Acinetobacter baumannii and Stenotrophomonas maltophilia.The pathogens distribution and infection spectrum have changed during 4 yeas.

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Ultrasound or CTguided percutaneous catheter drainage for treatment of infected necrotizing pancreatitis:an analysis of 31 cases CHEN Huanwei,CUI Weizhen,ZHEN Zuojun,et al. 2007, 27(12): 1-983.  Abstract ( )   PDF (2457KB) ( )   Objective:To investigate the efficacy and safety of percutaneous ultrasound or CTguided catheter drainage for treatment of acute infected necrotizing pancreatitis and peripancreatic fluid collections. Methods:The clinical data of 31 patients with acute infected necrotizing pancreatitis admitted between January 2002 and December 2006 in the First People’s Hospital of Foshan was analyzed retrospectively.All of patient with peripancreatic infected fluid collections were treated with ultrasound or CTguided percutaneous catheter drainage. Results:Twentyfive of the 31 patients were cured with percutaneous catheter drainage with the cure rate of 80.6% (25/31).Two patients died with one from intracerebral hemorrhage and one from respiratory and renal failure.Four patients failed to required surgery drainage.Among them,two patients recovery and two died from multiorgan failure.The total cure rate was 87.1%(27/31).The total mortality was 12.9%(4/31).The drainage duration time was from 7 to 90 days (mean 23 days).The drainage was performed for one to four times. No catheterrelated complications occurred. Conclusion:Percutaneous catheter drainage is a safe and effective technique for treating acute infected necrotizing pancreatitis and peripancreatic fluid collections.It can avoid conventional surgery drainage for most of selected patients.

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Clinical significance of early lactate clearance in patients with severe sepsis after surgery XU Xiangdong,WU Jianfeng,GUAN Xiangdong,et al. 2007, 27(12): 1-992.  Abstract ( )   PDF (280KB) ( )   Objective:To evaluate the correlation between the prognosis and the early lactate clearance in severe sepsis patients after surgery. Methods:The clinical data of 206 patients with severe sepsis after surgery admitted between July 2004 and June 2007 in the First Affiliated Hospital of Sun Yat-sen University was analyzed prospectively.APACHEⅡ score,the mortality and the lactate clearance after 6 hours were measured.The patients were divided into survival group and nonsurvival group,low lactate clearance group and high lactate clearance group. Results:There was no statistical difference among those groups in age,sex,APACHEⅡ score and the baseline of lactate.The early lactate clearance in survival group was significantly more than that in the nonsurvival group （28.8±11.7 vs 15.2±11.2%，P<0.01）.The mortality was in high lactate clearance group significantly less than that in the low lactate group (26.7% vs 51.1%,P<0.001). Conclusion:The early lactate clearance is a good prognostic factor of severe sepsis after surgery.

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Study of the relation between dangerous factors and postoperative pulmonary complications in perioperative patients combined with chronic obstructive pulmonary diseases ZHENG Hao,ZHU Ran,ZHANG Zhi-dan,et al. 2007, 27(12): 1-983.  Abstract ( )   PDF (2395KB) ( )   Objective:To analyze the relation between surgery and postoperative pulmonary complications (PPC) and relation between preoperative every lung function index,artery oxygen pressure and PPC in abdominal perioperative patients. Methods:Fifty-four abdominal perioperative patients combined with chronic obstructive pulmonary diseases (COPD) admitted between September 2002 and November 2004 in the First Affiliated Hospital of Chinese Medical Universtiy were divided into groups according to their ages,BMI,operation hours and operated site respectively.The incidence of PPC in each groups were compared by χ2 test.SPSS11.12 software was used for multivariate analysis between preoperative lung function,artery oxygen pressure and PPC incidence and between preoperative lung function,artery oxygen pressure and postoperative mechanical ventilation time. Results:The incidence of PPC was 55.6(30/54).The incidence of PPC had not significant difference between >70 years old group and ≤70 years old group (P>0.05).The incidence of PPC in patients with BMI ≥24 was significantly more than that in patients with BMI <24 (P<0.05).The incidence of PPC in patients with operation time ≥2h was significantly more than that in patients with operation time <2h (P<0.05).The incidence of PPC in patients performed upper abdomen operation was significantly more than that in patients performed lower abdomen operation (P<0.05).Preoperative arterial partial pressure of oxygen (PaO2) and lung function were negative correlated with PPC incidence.The lung function was negative correlated with postoperative mechanical ventilation (MV) time. Conclusion:The incidence of PPC is high in the abdominal perioperative patients combined with COPD.PPC incidences in patients overweighting (BMI≥24),in patients with operation time ≥2h and in patients with upper abdominal operation are high.The worse the preoperative lung function,the higher the PPC incidence.The worse the preoperative lung function，the longer the postoperative MV time.

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Distal pancreatectomy with spleen and the splenic vessels preservation:an analysis of 9 cases DAI Cuncai,MIAO Yi,CHEN Jianmin,et al. 2007, 27(12): 1-980.  Abstract ( )   PDF (466KB) ( )   Objective:To investigate the feasibility and safety of distal pancreatectomy with spleen and splenic vessels preservation for the tumor of body and tail of the pancreas. Methods:The clinical data of 9 cases of distal pancreatectomy with preservation of the spleen and splenic vessels performed from January 1996 to March 2007 in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. Results:Among them,4 cases of nonfunction insulinomas,3 cases of pancreatic cystadenomas,1 case of chronic pancreatitis and 1 case of pancreatic adenocarcinoma were included.The pancreas was transected at the level of neck or body to the right side of the lesion,with the exposure of the splenic artery and vein.Adequate mobilization of distal pancreas and the splenic vessels and branches toward the splenic hilum was performed.The body and tail of the pancreas was removed and the spleen and splenic vessels were preserved. The distal pancreatectomy with spleen and splenic vessels preservation was performed in all cases successfully.The size of the masses was from 4.0cm×3.5cm×3.0cm to 12.0cm×10.0cm×8.0cm.The mean operation time was 4.2 hours,and the mean blood loss volume was 350mL.The mean postoperative hospital stay was 13 days.The blood platelet count was from 79×109/L to 270×109/L.Postoperative pancreatic fistula occurred in 3 cases with the drainage volume of 10-50mL/day.They all accepted primary conservative treatment and two cases recovered by the simple drainage.One case experienced abdominal hemorrhage on the 30th day postoperatively and underwent emergency laparotomy with the removal of the spleen and splenic vessels. Conclusion:It is suggested that distal pancreatectomy with the spleen and splenic vessels preservation would become the method of choice for the treatment of benign and borderline tumors located in the body and tail of the pancreas.

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Clinical study of intersphincteric resection in the sphinctersaving operation for ultralow rectal cancer LU Xiao-ming,NIU Yan-feng,LIU Jin-lin,et al. 2007, 27(12): 1-980.  Abstract ( )   PDF (437KB) ( )   Objective:To explore the safety,feasibility,oncological outcomes and anal function of intersphincteric resection (ISR) in the sphinctersaving operation for ultralow rectal cancer. Methods:The clinical data of 42 selected patients with ultralow rectal cancer performed intersphincteric resection between 2000 and 2004 in Union Hospital of Huazhong University of Science and Technology was analyzed. Results:Abdominal operation was performed according to the TME principles.The rectum and internal anal sphincter were transected through intersphincteric plane at the level 2 cm below the lower edge of tumor via anus under direct vision.The further intersphincteric mobilization was made proximally above the level of external anal sphincter,then coloanal anastomosis was performed after removal of specimen.All cases were followed up to obtain the data of tumor recurrence and anal function prospectively. Thirtyseven patients were performed operation successfully.Perioperative complications occurred in 5 cases,including acute pulmonary embolization (n=1),pelvic muscular bleeding (n=1) and anastomotic leakage (n=3).Thirtysix patients were followed up and the median followup duration was 40 (rang,24-60) months. Anastomotic recurrence occurred in 3 patients (8.33%) and one of them died.One died of synchronous lung and peritoneal metastasis in 24 months.Two died of liver metastasis in 16,24 months postoperatively.One died of abdominal and inguinal lymph node metastasis in 16 months postoperatively.A satisfactory sphincter function was obtained in most cases in 6 months postoperatively. Conclusion:Intersphincteric resection is an alternative sphinctersaving operation for most patients with ultralow rectal cancer.

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Application of minimally invasive techniques in the management of severe acute pancreatitis:an analysis of 113 cases CHENG Zhengjun,BIE Ping,FENG Chunlin,et al. 2007, 27(12): 1-989.  Abstract ( )   PDF (2218KB) ( )   Objective:To investigate the role of minimally invasive technique in the management of severe acute pancreatitis (SAP). Methods:The clinical data of 113 cases of SAP admitted in two equivalent periods (between April 2004 and November 2005,between November 2005 and June 2007) in Southwest Hospital of the Third Military Medical University were analyzed retrospectively.The therapeutic effects were compared. Results:With the application of minimally invasive technique in the management of SAP,the mortality of SAP between November 2005 and June 2007 was 5.08%,which was obviously lower than 22.00% between April 2004 and November 2005.Surgeries and complications(e.g.pancreatic pseudocyst,fungous infection and so on) also decreased obviously. Conclusion:To some extent, minimally invasive techniques may take the place of some surgeries in the management of SAP.

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Clinical study of the arterial blood supply of pancreas and the vascular reconstruction of pancreatic graft SI Zhong-zhou,QI Hai-zhi,LI Jie-qun,et al. 2007, 27(12): 1-989.  Abstract ( )   PDF (2224KB) ( )   Objective:To investigate the arterial blood supply of pancreas and provide the theory for the vascular reconstruction of pancreatic graft. Methods:Three hundreds cases of digital subtraction artery (DSA) photograms made between January 2000 and February 2006 in Xiangya Second Hospital of Central South University were analyzed and summarized retrospectively. Results:(1)In 300 DSA photograms,it could identify the superior pancreaicduodenal artery (SPD.a) only once.The aberration rate of anterior superior pancreaicduodenal artery (ASPD.a) and posterior superior pancreaicduodenal artery (PSPD.a) was 6.33% and 5.06% respectively.(2)The differentiation origin of inferior pancreaicduodenal artery (IPD.a) and its branches was mostly the 1st jejunal artery.The aberration rate origin from the 1st jejunal artery of IPD.a,anterior inferior pancreaicduodenal artery (AIPD.a) and posterior inferior pancreaicduodenal artery (PIPD.a) was 19.51%,17.54% and 12.28% respectively.(3)The conditions of dorsal pancreatic artery (DP.a) was complex.The aberration rate of DP.a was 23.61%. Conclusion:The arterial blood supply of pancreas was complex.During the vascular reconstruction of pancreas transplantation,the artery chosen to reconstruct should not only meet with the requiring of integrity blood of pancreas,but also reduce the incidence of surgical complications.

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Effect of carbohydrateelectrolyte solution on the fluid balance and glucose metabolism in patients after major abdomen operations WANG Xin-ying,LI Ning,PENG Nan-hai,et al. 2007, 27(12): 1-992.  Abstract ( )   PDF (432KB) ( )   Objective:To evaluate the effect of carbohydrateelectrolyte solution on the fluid balance and glucose metabolism in patients after major abdomen operations. Methods:Sixty-three adult patients after major abdominal operations between December 2006 and May 2007 in the Research Institute of General Surgery of Nanjing General Hospital of Nanjing Military Command of PLA were enrolled and randomly divided into two groups: test group (n=31) and control group (n=32).The test group accepted the fluid therapy of carbohydrateelectrolyte solution, while the control group accepted the fluid of compound electrolyte and glucose solution for 3 days of 1500 mL.The blood glucose before infusion,at 0h and 2h after infusion in three days after operation were assayed. The serum glucose-6-phosphate dehydrogenase,zinc,renal and liver function,urine glucose and ketobodies were measured before infusion and on the fourth day after infusion.The vital signs and other adverse reaction were recorded during infusion periods. Results:There was no difference in general characters of patients between two groups.Three patients in the control group and one patient in the test group withdraw from the study.The increase of serum glucose was observed in the two groups after operation,in which the increase in the test group was significantly smaller than the control group.The decrease of glucose6phosphate dehydrogenase in the test group was smaller than that of the control group.The blood zinc was significantly elevated after infusion in the test group than in the control group (P=0.021). Conclusion:The carbohydrateelectrolyte solution can not only supplement the blood volume in patients after major abdominal operations,but also increase the blood zinc at the condition of smaller elevated blood glucose.