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ABSTRACT: To determine the impact of cirrhosis on trauma patients and define the factors predicting death.
The data on patients admitted to the trauma center from January 2000-2005 were studied retrospectively. The clinical variables were recorded and compared to identify the factors differentiating cirrhotic trauma survivors from non survivors. Child's classification criteria were derived from the reviewed charts of cirrhotic trauma patients to evaluate their predictive value in cirrhotic trauma. Trauma registry was also used to generate a trauma control group by matching for age, sex, abbreviated injury score (AIS) over the same period of time. The outcome variables compared were mortality rate, time of ICU and hospital stay. Results were expressed as mean +/- SD. These data were analyzed by SPSS.11.0 statistical software. Univariate analysis was performed to identify significant medical factors for survivor and non survivors subjected to chi-square test. Fisher's exact test and Student's t test were performed to determine the statistical difference between cirrhotic and control groups. P < 0.05 was considered statistically significant.
Poor prognosis of traum patients was associated with one or more of the following findings: ascitcs, yperbilirubinemia (more than 2 mg/dL), hypoalbuminemia (less than 3.5 mg/dL), and prolonged prothrombin time (more than 12.5 s). Although Child's classification was used to predict the outcome in cirrhotic patients undergoing portacaval shunt procedures, no significant difference was found in mortality rate as a function of Child's classification.
Cirrhosis is associated with a higher mortality, a longer time of ICU and hospital stay of trauma patients. It seems that treatment of trauma patients with pre-existing severe liver disease is a challenge to surgeons.
World Journal of Gastroenterology 12/2007; 13(42):5654-8. · 2.47 Impact Factor
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ABSTRACT: To study the effect of albumin administration on lung injury in trauma/hemorrhagic shock (T/HS).
Sixty experimental animals were randomly divided into three groups: rats undergoing laparotomy without shock (T/SS); rats with T/HS and resuscitation with blood plus twice the volume of shed blood as Ringer's lactate (RL), and rats with T/HS and resuscitation with blood plus additional 3 mL of 50 g/L human albumin. Expression of polymorphonuclear neutrophil (PMN) CD11b/CD18, intercellular adhesion molecule-1 (ICAM-1) of jugular vein blood and the severity of lung injuries [determined mainly by measuring activity of lung tissue myeloperoxidase (MPO) and lung injury score (LIS)] were measured after a 3-h recovery period.
All three groups showed a significant difference in the expressions of CD11b/CD18, ICAM-1, and severity of lung injury. The expressions of CD11b/CD18 in T/SS group, T/HS + RL group, T/HS + albumin group were 17.76% +/- 2.11%, 31.25% +/- 3.48%, 20.36% +/- 3.21%, respectively (F = 6.25, P < 0.05). The expressions of ICAM-1 (U/mL) in T/SS group, T/HS + RL group, T/HS + albumin group were 258.76 +/- 98.23, 356.23 +/- 65.6, 301.01 +/- 63.21, respectively (F = 5.86, P < 0.05). The expressions of MPO (U/g) in T/SS group, T/HS + RL group, T/HS + albumin group were 2.53 +/- 0.11, 4.63 +/- 1.31, 4.26 +/- 1.12, respectively (F = 6.26, P < 0.05). Moreover, LIS in T/HS + RL group, T/HS + albumin group was 2.62 +/- 0.23, 1.25 +/- 0.24, respectively. The expressions of CD11b/CD18, ICAM-1 and MPO in T/HS + RL group were significantly increased compared to T/SS group (P = 0.025, P = 0.036, P = 0.028, respectively). However, administration of 3 mL of 50 g/L albumin significantly down-regulated the expressions of CD11b/CD18, ICAM-1 and lung injury index (MPO and LIS) when compared with the T/HS + RL rats (P = 0.035, P = 0.046, P = 0.038, P = 0.012, respectively).
The infusion of albumin during resuscitation period can protect lung from injury and decrease the expressions of CD11b/CD18, ICAM-1 in T/HS rats.
World Journal of Gastroenterology 11/2006; 12(42):6884-8. · 2.47 Impact Factor
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ABSTRACT: To study the correlation between liver fibrosis severity and biliary drainage in patients with choledocholith.
A follow-up study on seven patients with liver fibrosis due to choledocholith was made. The data, including biochemical tests (aspartate aminotransferase, alanine aminotransferase) and liver histological features before and after biliary drainage, were collected and studied. The fibrosis severity was scored on a scale from 0 to 3, with 0 denoting none, 1 portal and periportal fibrosis, 2 the presence of numerous fiber septa, and 3 cirrhosis. The average liver fibrosis severity scores of the first and second biopsy were compared with statistical method.
The first, second liver fibrosis severity scores of these seven patients were 2,1; 2,1; 1,0; 1,1; 2,1; 2,1; 1,0 respectively. The results showed that the average liver fibrosis severity score of the second liver biopsy decreased significantly compared with the first liver biopsy (n = 7, t = 4.25, P<0.05).
Liver fibrosis due to choledocholith may regress after biliary drainage.
World Journal of Gastroenterology 04/2005; 11(13):2013-5. · 2.47 Impact Factor
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ABSTRACT: Choledocholith is prevalent in some Asian countries and may lead to liver fibrosis and portal vein hypertension. Biliary drainage is an effective treatment for choledocholith. The aim of this study was to assess the impact of biliary drainage on liver fibrosis due to choledocholith.
Eight patients with liver fibrosis caused by choledocholith were followed up by biochemical tests (aspartate aminotransferase, alanine aminotransferase) and liver biopsy before and after biliary drainage, respectively. The severity of the fibrosis was scored on a scale from 0 to 3 (0: denoting none; 1: portal and periportal fibrosis; 2: the presence of numerous fiber septa; and 3: cirrhosis). The results were analyzed statistically.
The severity scores of liver fibrosis in the 8 patients were 2,1; 2,1; 1,0; 1,1; 2,1; 1,1; 2,1; 1,0 before and after biliary drainage, respectively. The results showed that the average severity of liver fibrosis decreased significantly after biliary drainage (n=8, t=4.573, P=0.003).
Liver fibrosis due to choledocholith may regress after biliary drainage.
Hepatobiliary & pancreatic diseases international: HBPD INT 03/2005; 4(1):104-7. · 1.08 Impact Factor
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ABSTRACT: To study how intestinal lymph after trauma-induced shock (TIS) interferes with expression of neutrophil adhesion factors (CD11b and CD18) and causes lung injury.
Thirty-two adult healthy Sprague-Dawley rats were randomly divided into four experimental groups. Groups 1 and 2 included rats with TIS caused by hitting the mid-upper part of both side femoral bones with a 2,500 kg raw- iron, and with or without ligation of mesenteric lymph duct. Groups 3 and 4 included rats with sham-TIS and with or without ligation of mesenteric lymph duct. Expression of neutrophil CD18 and CD11b in at 1 and 3 h after a 90-min TIS/sham-TIS was evaluated. These rats were killed at 3 h after TIS/sham-TIS, and lungs were taken immediately. The main lung injury indexes (the MPO activity and lung injury score) were measured.
The expressions of CD18 and CD11b at 1 and 3 h after a 90-min TIS and the main lung injury indexes were significantly increased compared with those in the sham-TIS groups (P<0.05). Moreover, at 1 and 3 h after TIS, the expressions of CD18 (32.12+/-1.25 and 33.46+/-0.98) and CD11b (29.56+/-1.35 and 30.56+/-1.85) were significantly decreased in rats with ligation of mesenteric lymph duct, compared with those (52.3+/-1.12 and 50.21+/-1.25, and 42.24+/-1.24 and 42.81+/-1.12, respectively) in those without the ligation (all P<0.05). The main lung injury indexes in rats with TIS with ligation of mesenteric lymph duct (0.96+/-0.12 and 6.54+/-0.35) were also significantly decreased, compared with those (1.56+/-0.21 and 9.56+/-0.23) in rats with TIS without the ligation (both P<0.05). However, there was no significant difference in expressions of CD18 and CD11b and the main lung injury indexes between the two sham-TIS groups.
Previous ligation of mesenteric lymph ducts prevents or alleviates the up-regulated expression of PMN CD18 and CD11b and the lung injury induced by TIS. Our findings also indicate that neutrophil adhesion molecule activation and lung injury during TIS appear to be caused by some factors that are released or produced by post-ischemic intestine through the mesenteric lymph pathway.
World Journal of Gastroenterology 11/2004; 10(21):3221-4. · 2.47 Impact Factor
