As an aging society,China has an increasing number of elderly patients (≥80 years).Given the characteristics of pancreatico-biliary diseases in elderly patients,therapeutic endoscopic retrograde cholangiopancreatography (TERCP)has become the main approach for these patients.When TERCP is performed in elderly patients with pancreaticobiliary diseases,a more detailed strategy is needed in addition to active preoperative evaluation and emergency treatment of medical and surgical complications.TERCP provides a good therapy for elderly patients with pancreaticobiliary diseases,and it is simple,safe,and convenient.

In this paper, the theory of electrical character and adsorption of solidliquid interface was applied to study the preparation process for borneol-mi-croencapsule with co-coacervation using gelatin and arabic gum as materials. The optimum process conditions for preparing microencapsule was gained. This study method provided a reliable basis for raising the inclusion rate, decreasing the capsule materials in quantity and drawing up the process conditions.

Objective To evaluate the effects of different degrees of acute normovolemic hemodilution (ANH) on intrapulmonary shunting, oxygen delivery and consumption during one-lung ventilation(OLV) in dogs. Methods Twelve healthy mongrel dogs weighing 18-22 kg were anesthetized with Ⅳ pentobarbital sodium 20mg.kg-1, scopolamine 0.3 mg and pancuronium 0.2 mg. kg-1 and intubated with a left-sided Carlen' s tube. Correct positioning of the tube was verified by auscultation and by visual inspection after thoracotomy at the end of the experiment. The dogs were mechanically ventilated with 100% oxygen. PET CO2 was maintained between 4.67-6.00 kPa. ECG and rectal temperature were continuously monitored. An intravenous line was established for infusion of Lacted Ringer solution. SwanGanz catheter was inserted via femoral vein on one side for sampling of mixed venous blood and measurement of cardiac output (CO) by hemodilution technique and pulmonary artery pressure (PAP).Femoral artery on the other side was cannulated for measurement of mean arterial pressure(MAP) and arterial blood sampling. The body temperature was maintained between 35℃-39℃ during the experiment.Four degrees of ANH were achieved by blood withdrawal and replacement with an equal volume of gelofusin step by step: HD1 (Hct 35%), HD2 (Hct 25%), HD3 (15%) and HD4(7%-8%). The volume of blood to be removed was based upon the patients' estimated blood volume [EBV = body weight (kg) ×7% ], the beginning Hct(Hct0) and the target Hct (Hctt) V = EBV × (Hct0-Hctt)/Hctav. During each degree of hemodilution(HD) two lungs were ventilated(TLV) first followed by one-lung ventilation(OLV)Each ventilation condition was maintained for at least 15 min, then hemodynamics was measured and blood gas analysis including blood concentration of lactate of both arterial blood and mixed venous blood was performed, then Qs/Qt, oxygen delivery (DO2) and oxygen consumption(VO2) were calculated. Results With increasing hemodilution, MAP, pulmonary vaseular resistance(PVR), mean pulmonary arterialpressure(MPAP), PO2 and DO2 had a tendency to decrease, While oxygen extraction ratio(ERO2 ), blood lactate and Qs/Qt tended to increase. There were DO2-dependent VO2 and anaerobic metabolism during HD3 and HD4. PVR and MPAP increased significantly when one lung was being ventilated before HD and during HD1 and HD2 . During HD3 and HD4 there was little difference in PVR and MPAP between OLV and TLV. Qs/Qt increased by 74% (HD2), 164% (HD3) and 177% (HD4) during OLV. Conclusions The results show that both ANH and OLV can affect Qs/Qt and oxygenation. The degree of ANH should be limited to Hct 25 % during OLV.consumpation

Objective To investigate the therapeutic effects of Tongxinluo and its influence on the expression of CD40 and CD40L in artherosclerosis rabbits. Methods 60 male rabbits were divided into three groups randomly,20 of each group: normal control group, model group and Tongxinluo group. The rabbits in model group and Tongxinluogroup were used to prepare the atherosclerosis model induced by high-cholesterol diet. The levels of ET-1, NOwere measurde. Before and 12 weeks after durg treatment,serum total cholesterol ,plaque areas and ratios of intima/media thickness were detected. The expression of CD40 and CD40L mRNA were determinated by quantitive RT-PCR. Results Serum total cholesterol level of Tongxinluo group was decreased compared with model group ( P < 0. 05 ), and they were both much higher than those of normal control group ( P < 0. 01 ); as compared with the model group, aortic plaque areas and ratios of intima/media thickness in Tongxinluo group reduced significantly [ (0.56 ± 0. 07) vs ( 1.16±0.08),P<0.01;(36.88±2.38)% vs (76.58 ±2.86) %,P <0. 0l] ;The expression of CD40 and CD40L mRNA also decreased in Tongxinluo group with statistic significance[ (0.798 ± 0.115 )、 (0. 592 ± 0. 132) vs (0.686±0. 132) 、(0.498 ±0. 108) ,P <0. 01 ) ]. Conclusion Tongxinluo had the ability to anti-artherosclerosis and its possible mechanism was down-regulate the expression of CD40 and CD40L.

Objective To evaluate the effects of endoscopic treatment on chronic pancreatitis. Methods 33 cases with chronic pancreatitis having received endoscopic treatment in a 2 years' period were retrospectively analyzed. The diagnosis was confirmed in all the patients by clinical examination, lab tests, CT, ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP). According to the patients' condition, various treatment measures including endoscopic pancreatic sphincterotomy (EPS), endoscopic papillo-sphincterotomy (EST), pancreatic stenting (PS), pancreatic stone extraction, naso-pancreatic drainage (ENPD), pancreatic duct stricture dilation, etc, were used individually or jointly. Results 18 cases received EPS and 27 underwent EST. Pancreatic duct stone extraction by basket or balloon was performed in 6 cases, PS in 13, ENPD in 5, and pancreatic duct dilatation in 9 cases. The endoscopic drainage by transgastric placement of a stent was done in a patient with a huge pseudocyst. Abdominal pain disappeared or markedly relieved in 29 cases after treatment. Marked improvement after treatment was shown by lab examination and imaging. Conclusion The combined application of various treatment measures for chronic pancreatitis through endoscopic approach is a safe, minimal-invasive and effective procedure.

Objective To evaluate the clinical value of endoscopy for the treatment of acute obstructive suppurative cholangitis. Methods Data of 182 patients suffering from acute obstructive suppurative cholangitis, in whom endoscopic treatment was undertaken, were retrospectively analysed. Results All patients received endoscopic sphincterotomy (EST). Among them, 25 patients underwent endoscopic retractor-biliary drainage (ERBD), 140 patients received endoscopic naso-biliary drainage (ENBD), and in 17 cases endoscopic metal retractor-biliary drainage (EMBD) was done. The treatment was successfully in all patients. The clinical findings were markedly improved after treatment in all of them. Conclusion Endoscopic treatment was a fast, safe, effective and economic method for the treatment of acute obstructive suppurative cholangitis.

Objective To evaluate the efficacy and clinical application value of endoscopic transpapillary cyst drainage(ETCD)on huge pancreatic pseudocysts(HPP)and pancreatic abscess.Methods According to unification standard from 2003 Jun to 2006 Jun,to select 10 disquisitive cases,in which patients with uninfected HPP were 8 cases and that with infected HPP was 1 case,and pancreatic abscess was 1 case.ETCD was adopted in all cases.The clinical treatment process and the change of relative investigation subjects were retrospectively studied.Results Endoscopic transpapillary treatment failed in 1 case,postoperative infection of HPP occurred in 2 cases and acute pancreatitis was found in 1 case.Mean follow-up was 16.5 months in 8 cases.Finally,four patients had complete resolution of HPP,3 cases had partial resolution,and the remains cavity of HPP was formed in 1 caes.Acute grave pancreatitis were cured in 2 cases and Chronic pancreatitis had resolution in 6 cases.Conclusion ETCD was safe and efficient in HPP and pancreatic abscess.Postoperative infection of HPP was the familiar complication,and obstruction of drainage path of HPP was major cause.So the crux of complications precaution and treatment was that the drainage path of HPP was unhindered.

Objective To explore the value of combined biliary and duodenal stenting in the palliative treatment of pancreatic head carcinoma. Methods From August 2003 to July 2005, four patients who were diagnosed as pancreatic head carcinoma presenting obstructive jaundice were treated with biliary stenting. When duodenal obstruction occurred due to the growth of the carcinoma , duodenal stents were placed to relieve the obstruction. Results The biliary and duodenal stents were successfully positioned in all 4 patients. After biliary stents were inserted, the level of total bilirubin value of each patient decreased by 50% in 24 hours and returned to normal range within 1 week. When the biliary stents were occluded, stent replacement or restenting was performed, and relief of obstructive jaundice was thus achieved. After duodenal stents were inserted, the symptoms of duodenal obstruction were relieved and the patients were able to tolerate peroral solid food. When the duodenal obstruction recurred, a second coaxial duodenal stent was inserted. Three duodenal stents were placed in one patient because of rgrowth in size of the carcinoma. No complications related to stenting were observed. Two patients were followed up until their death with survival time of 24 months and 22 months, respectively, who were free of jaundice and duodenal obstruction at the end of their life. Two patients are still in follow-up period (16 months and 9months after stenting, respectively), who are now free of jaundice and duodenal obstruction. Conclusion Biliary stenting combined with duodenal stenting can improve the life quality of patients with pancreatic head carcinoma and is an effective palliative treatment for these patients.

Objective To evaluate the possibility,efficacy and safety of endoscopic balloon dilation(EBD)for the treatment of common bile duct stones.Methods EBD of the sphincter of Oddi and removal of the stones by balloon,basket net and mechanical lithotripsy were performed in 47 patients with common bile duct stones.In order to prevent the possible complicated pancreatitis,Sandostatin,endoscopic nasobiliary drainage(ENBD)and small sphincterotomy were used according to the patients conditions.Results The success rate of EBD for the treatment of common bile duct stones was 91 5%(43/47)in our group.During one EBD session the common bile duct was cleared in 41(87 2%)of 47 cases.Incomplete duct clearance was achieved in 2(4 3 %)cases,both of whom underwent repeated EBD with successful duct clearance without undergoing endoscopic sphincterotomy(EST).Mechanical lithotripsy was required in 27(57 4%)of the 47 cases for stones greater than 1 0cm in diameter.Failure to clear the common bile duct with EBD in 4 cases(8 5%)was primarily related to large stones size (≥2 0cm),in whom EST was required to clear the duct.No perforation or hemorrhage was observed.Temporal hyperamylasemia was observed in 11 patients,only 1 of whom was accompanied by abdominal pain,which was rapidly relieved through conservative treatment.Conclusion EBD for the treatment of common bile duct stones is possible,effective and safe.

objective To evaluate endoscopic surgery for high risk patients over 70 years old with severe acute cholangitis. Methods From October 1991 to October 2003, 84 high risk patients over 70 years old suffering from severe acute cholangitis were included and divided into laparotomy surgery (ST) and endoscopic surgery (ET) group. Results 80 patients were cured. The care rate was 81.2% in ST group and 91.6% in ET group. The mortality rate was lower in ET compared with ST (9.1% vs 18.8%). The rate of complication was reduced from 37.5% in ST group to 13.9% in ET group. The average duration of drainage was reduced from 49.4 days in ST group to 18.6 days in ET group. The total treatment days were shortened from 46.2 days to 22.8 days comparing ST with ET. Conclusions Endoscopic surgery should be the first choice for the senile and high risk patients with severe acute cholangitis. Endoscopic surgery was convenient, with mininal injury, safe and effective, and period of treatment was shortened, especially for elderly or critically ill patients, as well as those with MODS or previous billiary operations.