Objective:The aim of this study was to evaluate the impact of preoperative hypoalbuminemia on the development of intraabdominal septic complications(IASCs)after primary anastomosis for patients with Crohn’s disease(C...Objective:The aim of this study was to evaluate the impact of preoperative hypoalbuminemia on the development of intraabdominal septic complications(IASCs)after primary anastomosis for patients with Crohn’s disease(CD).Methods:All CD patients undergoing bowel resection with a primary anastomosis during the study period from 2007 to 2015 were enrolled.The association of preoperative hypoalbuminemia(<30 g/L)with the risk for IASCs were assessed using both univariate and multivariate analyses.Results:A total of 124 eligible patients were included,117(94.4%)of whom had available preoperative albumin level.Preoperative hypoalbuminemia occurred in 13(11.7%)patients.The duration fromdiagnosis to surgery was longer for patients with preoperative hypoalbuminemia than those without(p=0.012).Patients with preoperative hypoalbuminemia weremore likely to have a history of preoperative use of 5-aminosalicylic acid(p=0.013)and have an intraoperative finding of small bowel obstruction(p=0.015).Of all patients,24(19.4%)developed postoperative IASCs.Univariate analysis showed that patients with preoperative hypoalbuminemia had an increased risk for IASCs(p=0.012).Multivariate analysis confirmed the association between preoperative hypoalbuminemia and IASCs(odds ratio 4.67,95%confidence interval:1.28–17.04,p=0.02).Similar findings were also obtained when preoperative albumin level was analysed as a continuous variable(p=0.019).Conclusions:Preoperative hypoalbuminemia is a significant predictor for the development of postoperative IASCs in CD patients after bowel resection with a primary anastomosis.Favorable preoperative nutrition status might lessen the risk for IASCs.展开更多
Inappropriate use of antibiotics leads to microbial resistance.Single-dose antibio-tic prophylaxis prior to laparoscopic cholecystectomy is well known for reducing the risk of postoperative infection in high-risk pati...Inappropriate use of antibiotics leads to microbial resistance.Single-dose antibio-tic prophylaxis prior to laparoscopic cholecystectomy is well known for reducing the risk of postoperative infection in high-risk patients despite some conflicting aspects.High-risk patients are those who are older than 70 years,have diabetes mellitus,whose operation time exceeded 120 minutes,have acute cholecystitis,experienced iatrogenic intraoperative gallbladder perforation resulting in bile or gallstone spillage,suffered from obstructive jaundice,or were deemed immuno-compromised.For gallbladder perforation,one dose of antibiotic prophylaxis is sufficient.Therefore,guidelines are needed and must be strictly followed.Prophy-lactic treatment is not needed for patients at low risk of developing sepsis fo-llowing elective laparoscopic cholecystectomy,although the opposite is suppor-ted.Similarly,superficial surgical infections are related to low morbidity.Patients without risk factors have a very low risk of infection.Thus,the routine use of anti-biotic prophylaxis in elective laparoscopic cholecystectomy is not recommended.展开更多
AIM： To evaluate whether multiple determinations of intramucosal pH （pHi） in acute pancreatitis （AP） patients could provide additional information of the disease severity during early hospitalization. METHODS： T...AIM： To evaluate whether multiple determinations of intramucosal pH （pHi） in acute pancreatitis （AP） patients could provide additional information of the disease severity during early hospitalization. METHODS： Twenty-one patients suffering from acute pancreatitis were monitored by gastric tonometry in the first 72 h after hospital admission. RESULTS： In the survivor group （n = 15） the initially low phi values returned to normal level （pHi ≥ 7.32） within 48 h （median pHi： d 1： 7.21; d 2： 7.32; d 3： 7.33）. In contrast, pHi values in the non-survivor group n = 6） were persistently either below or in the low normal range （median pHi 7.12; 7.12; 7.07 respectively）, but pHi differences between the two groups reached significance only after 24 h （P 〈 0.01）. Mucosal acidosis detected at any time during the monitored period was associated with the emergence of single or multiple organ dysfunction （P 〈 0.01）. CONCLUSION： Prolonged gastric mucosal acidosis was associated with remote organ dysfunction and failure in Acute Pancreatitis, however, correlation with the fatal outcome became significant only 24 h after admission. Due to its non-invasive nature gastric tonometry may supplement the pro-inflammatory markers to achieve a multi-faceted monitoring of the disease.展开更多
基金This work was supported by the National Natural Science Foundation of China(No.81400603)Guangdong Natural Science Foundation(No.2015A030310190)the Science and Technology Planning Project of Guangdong Province(No.2015B020229001).
文摘Objective:The aim of this study was to evaluate the impact of preoperative hypoalbuminemia on the development of intraabdominal septic complications(IASCs)after primary anastomosis for patients with Crohn’s disease(CD).Methods:All CD patients undergoing bowel resection with a primary anastomosis during the study period from 2007 to 2015 were enrolled.The association of preoperative hypoalbuminemia(<30 g/L)with the risk for IASCs were assessed using both univariate and multivariate analyses.Results:A total of 124 eligible patients were included,117(94.4%)of whom had available preoperative albumin level.Preoperative hypoalbuminemia occurred in 13(11.7%)patients.The duration fromdiagnosis to surgery was longer for patients with preoperative hypoalbuminemia than those without(p=0.012).Patients with preoperative hypoalbuminemia weremore likely to have a history of preoperative use of 5-aminosalicylic acid(p=0.013)and have an intraoperative finding of small bowel obstruction(p=0.015).Of all patients,24(19.4%)developed postoperative IASCs.Univariate analysis showed that patients with preoperative hypoalbuminemia had an increased risk for IASCs(p=0.012).Multivariate analysis confirmed the association between preoperative hypoalbuminemia and IASCs(odds ratio 4.67,95%confidence interval:1.28–17.04,p=0.02).Similar findings were also obtained when preoperative albumin level was analysed as a continuous variable(p=0.019).Conclusions:Preoperative hypoalbuminemia is a significant predictor for the development of postoperative IASCs in CD patients after bowel resection with a primary anastomosis.Favorable preoperative nutrition status might lessen the risk for IASCs.
文摘Inappropriate use of antibiotics leads to microbial resistance.Single-dose antibio-tic prophylaxis prior to laparoscopic cholecystectomy is well known for reducing the risk of postoperative infection in high-risk patients despite some conflicting aspects.High-risk patients are those who are older than 70 years,have diabetes mellitus,whose operation time exceeded 120 minutes,have acute cholecystitis,experienced iatrogenic intraoperative gallbladder perforation resulting in bile or gallstone spillage,suffered from obstructive jaundice,or were deemed immuno-compromised.For gallbladder perforation,one dose of antibiotic prophylaxis is sufficient.Therefore,guidelines are needed and must be strictly followed.Prophy-lactic treatment is not needed for patients at low risk of developing sepsis fo-llowing elective laparoscopic cholecystectomy,although the opposite is suppor-ted.Similarly,superficial surgical infections are related to low morbidity.Patients without risk factors have a very low risk of infection.Thus,the routine use of anti-biotic prophylaxis in elective laparoscopic cholecystectomy is not recommended.
基金Supported by the Hungarian National Scientific Research Fund (OTKA), No. T 016630, and the Hungarian Ministry of Health(ETT), No. 276/2001
文摘AIM： To evaluate whether multiple determinations of intramucosal pH （pHi） in acute pancreatitis （AP） patients could provide additional information of the disease severity during early hospitalization. METHODS： Twenty-one patients suffering from acute pancreatitis were monitored by gastric tonometry in the first 72 h after hospital admission. RESULTS： In the survivor group （n = 15） the initially low phi values returned to normal level （pHi ≥ 7.32） within 48 h （median pHi： d 1： 7.21; d 2： 7.32; d 3： 7.33）. In contrast, pHi values in the non-survivor group n = 6） were persistently either below or in the low normal range （median pHi 7.12; 7.12; 7.07 respectively）, but pHi differences between the two groups reached significance only after 24 h （P 〈 0.01）. Mucosal acidosis detected at any time during the monitored period was associated with the emergence of single or multiple organ dysfunction （P 〈 0.01）. CONCLUSION： Prolonged gastric mucosal acidosis was associated with remote organ dysfunction and failure in Acute Pancreatitis, however, correlation with the fatal outcome became significant only 24 h after admission. Due to its non-invasive nature gastric tonometry may supplement the pro-inflammatory markers to achieve a multi-faceted monitoring of the disease.
