Objective To investigate the reasons for the changes of serum ALT, AST after laparoscopic cholecystectomy. Methods 69 patients admitted in Oct, 1999 were randomly divided into two groups. The gallbladder was resected with monopolar cautery laparoscopically and cystic bed was routinely coagulated in 35 patients, group a. The gallbladder was removed with microscissors and the cystic artery was clipped with titanium clip in 34 patients, group B. Hepatic tissue in bulk of 1cm X 1cm and close to the gallbladder bed was sampled for histological study for all patients in the two groups. The serum ALT and AST levels were measured on the 1st, 5th ,postoperative day. Results Comparing with group B, the serum ALT and AST levels in group A were significantly higher on the 1th postoperative day ( P

The ?-radioactive seed brachytherapy source has been widely employed in the implantation therapy for the prostatic carcinoma and the ophthalmic lesions.In this study the dosimetric parameters for characterization of a low-energy interstitial brachytherapy source 125I were calculated according to dose calculation formalism recommended by AAPM TG-43U1.For data processing,a 0.28 cm active length was used for the geometry function.The dosimetry parameter air-Kerma strength,dose rate constant,radial dose function and anisotropy function were estimated by means of the EGS5 Monte Carlo code.The results obtained from this study are in good agreement with the corresponding values recommended by TG-43U1 and with the data reported by Dolan,et al.

BACKGROUND:It has been an urgent problem of how to promote cartilage repair of the knee and shorten the total course through a tissue engineering approach. Fortunately, microfracture plus stem cel transplantation may open up a new path for this issue. OBJECTIVE:To investigate the clinic feasibility of arthroscopic microfracture technique plus stem cel transplantation for repair of articular cartilage injury of the knee. METHODS:From October 2010 to March 2012, a total of 16 patients with articular cartilage injury of the knee were enrol ed, including 12 males and 4 females, with the average age of 38.6 years (16-52). Al cases of cartilage injury were confirmed by arthroscopy. Autologous bone marrow was extracted from patients at 2 weeks before treatment to isolate, culture and amplify bone marrow mesenchymal stem cel s in vitro. The cel culture solution of 3-5 mL (about 107 cel s) was harvested. The articular cavity was clean by arthroscopy and microfracture technique was performed at the area of cartilage injury that was then covered with hemostatic gauze through a minimal y invasive incision and the prepared bone marrow mesenchymal stem cel s were injected. The knee was bandaged with the elastic bandage after aspirating the joint cavity effusion by vacuum suction. Functional exercises were performed early by CPM.RESULTS AND CONCLUSION:After fol ow-up of 4-18 months, there were 13 cases of excel ent, 2 cases of valid and 1 case of ineffective. According to Lysholm knee scores, the average scores were improved from 42 points (33-67 points) to 89 points (75-99 points) at 4 weeks after treatment. The function was satisfied and al patients were fol owed up without recurrence or worse. Under the arthroscopy, the combination of microfracture technique and autologous bone marrow mesenchymal stem cel transplantation is proved to be effective for articular cartilage injury of the knee and it can notably improve the clinic symptoms and recover the function of the knee.

Objective To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods CEPP experiences of 1?046 patients in 6?600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO 2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results Of the 1?046 patients, 1?028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.

Objective　To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods　CEPP experiences of 1046 patients in 6600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results　Of the 1046 patients, 1028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions　CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.

Objective To investigate the surgical indication,approach,resection methods and complications of total sacrectomy via posterior approach for primary malignant sacral tumors involving high level (S1,S2).Methods 5 cases of primary malignant sacral tumors treated by total sacrectomy via posterior approach and iliolumbar reconstruction from March 2010 to March 2011 were analyzed retrospectively.There were 3 males and 2 females.The mean age was 41,ranging from 32 to 55.The imageology examination showed osteolytic destruction,among which there were 4 cases of obvious soft tissue mass,1 case of obvious sacral foramina expansion with bone damage.MRI showed 1 case of the tumors in S1-S5,1 case of the tumors in S1 、S2,1 case of the tumors in S1-S3.The smallest tumor was 9.2 cm×7.6 cm×4.1 cm,while the largest was 22.0 cm× 19.0 cm× 16.0 cm.Preoperative TTNB were done on the 5 patients.Pathological diagnosis:2 cases of chordoma,1 case of malignant neurilemmoma,1 case of chondrosarcoma and 1 case of malignant hemangioendothelioma.5 patients had sacrococcygeal pain or lumbocrural pain before the surgery.Visual analogue scale (VAS):2 cases of 2,2 cases of 6 and 1 case of 8.Ilium stability reconstructions were all performed on 5 patients with spine pedicle screw-rod system.Results The mean operation time was 6.5 hours (range,4.5-11 hours),with the mean intraoperative blood loss of 3 700 ml (range,2 000-7 200 ml).There was no perioperative death.The mean follow-up time was 17 months (range,9-23 months).There were 2 cases of wound complications 2 weeks after surgery and healed by second intention with washing and drainage after debridement.There was no deep infection.1 case of rectal injury,which was performed with colostomy during the operation,and stoma returned 12 weeks after surgery.4 cases of sciatic nerve symptom of lower limbs and plantar flexion dyskinesia after bilateral S1 nerve roots resection.The patients walked with ankle brace fixed after the surgery.There was 1 case of implant breakage and no obvious spine down.5 patients had functional disability in sphincter after surgery.1 case of hemangioendothelioma recurred locally 9 months later.Local radiotherapy was performed since there was no reoperation indication.The patient is currently on the 13th month follow-up and survives with tumors.Compared with combined approach,the selection of posterior approach alone has relatively strict surgery indications.Conclusion Total sacrectomy via posterior approach is an effective way to treat the primary high-level malignant sacral tumors.The good surgical resection boundary is important to achieve the good oncology prognosis.The occurrence rate of postoperative complication is high,which has great influence on patients' postoperative neurological function.

Objective To analyze the cases of anaphylactic death cases and explore the standards of judi-cial expertise of anaphylactic death for providing evidence for judicial expertise. Methods Fifty-nine cas-es death due to allergic reaction in Shanghai were collected. And details of medical history, clinical manifestation of anaphylactic reaction and postm ortem exam ination findings were review ed for all cases. Results In the 59 cases, there were 58 cases died from drug allergy, including 77.6% of them were an-tibiotics. The rates of treating in standard hospital and illegal clinic were 37.3% and 61.0%, respectively. The allergic sym ptom s were dyspnea and facial cyanosis. The time from contacting allergens to death ranged from 1 m in to 3 d. The concentration of total serum IgE ranged from 50 to 576.92 IU/m L . The results of clinical manifestation and pathological anatomy had obviously changes. Conclusion B ased on the exclusion of all other cause of death and synthetically analysis of details of cases, medical history, clinical manifestation and anatomy, the conclusion of anaphylactic death can reached. The details of cas-es including clinical history, exposure to allergens, and clinical manifestation play an im portant role in diagnosis of anaphylactic death.

Finite element method (FEM) is an effective mathematical method for stress analysis, and has been gradually applied in the study of biomechanics of human body structures. This paper reviews the construction, development, materials assignment and verification of FEM model of cervical vertebra, and it also states the research results of injury mechanism of whiplash injury and biomechanical re-sponse analysis of the cervical vertebra using FEM by researchers at home and abroad.

Objective To explore the related risk factors for bypass graft occlusion in patients within 1 year after coronary artery bypass grafting,in order to provide the basis for the prevention of postoperative bypass graft occlusion.Methods Clinical data of 197 cases treated with coronary artery bypass grafting were collected,and the incidence rate of bypass graft occlusion and its related risk factors were analyzed.Results Graft occlusion occurred in 28 (14.2％) of 197 patients.The incidence rate of bypass graft occlusion were much higher in patients with BMI ≥24 kg/m2,smoking,hypertension,hyperlipemia,diabetes,peripheral vascular diseases and cerebrovascular disease than in patients with BMI ＜24 kg/m2,non-smoking,patients without hypertension,hyperlipemia,diabetes,peripheral vascular diseases or cerebrovascular disease (20.0％ vs.9.8％,22.4％ vs.10.8％,21.2％ vs.3.8％,31.1％ vs.9.2％,23.4％ vs.9.8％,25.5％ vs.10.7％,26.3％ vs.11.3％,x2 =4.106,4.534,11.735,13.658,6.615,6.486,5.656,respectively,P=0.043,0.033,0.001,＜0.001,0.010,0.011,0.017).Smoking,diabetes,hyperlipidemia,peripheral vascular diseases and cerebrovascular disease were the independent risk factors for bypass graft occlusion.Conclusions Many risk factors are related with short-term postoperative bypass graft occlusion in patients with coronary artery bypass grafting.The corresponding control measures should be conducted to decrease the risk of postoperative bypass graft occlusion,aiming directly at the risk factors,especially the independent risk factors.

Objective To investigate the cause of and management for bile leakage after laparoscopic cholecystectomy (LC). Method Thirty-four bile leakage cases out of 12 000 LC procedure performed in our department were retrospectively analyzed. Results Common bile duct (CBD) transection injury in 6 cases was retrieved by Roux-en -Y choledochojunostomy. Bile leakage caused by clip exfoliation in 3 cases necessitated a reexploration. Injury on CBD lateral wall or right hepatic duct in 7 cases was successfully treated by repair and T-tube stenting. Twenty-one cases of aberrant duct or accessory duct injury were cured by conservative therapy. Subdiaphragmetic abscess developed in 3 cases were cured by puncture and aspiration. Anastomotic stricture in one case after Roux-en-Y choledochojunostomy was cured by redoing Roux-en-Y choledochojunostomy. Conclusions Bile duct injury is the most common cause of bile leakage after LC. Patent drainage, bile duct repair and T tube stenting or choledochojejunostomy are the main method in treating bile leakage after LC.