Objective To investigate the feasibility and indications of laparoscopic liver resection. Methods Five patients with small hepatocellular carcinoma in the left lateral lobe underwent laparoscopic liver resection from April 2002 to April 2003. The Endo-vascular GIA was employed to transect the liver parenchyma from the right side of the lesion. The resected liver tissues and tumor were removed via the prolonged incision. Results Laparoscopic hepatectomy was successfully accomplished in 3 cases, while conversions to open surgery were required in 2 cases because of severe hemorrhage or excessive thickness of resecting marge. There were no exudation or bile leakage on the cut surface of laparoscopic hepatectomy. The length of duration of laparoscopic hepatectomy ranged from 60 min to 90 min. The patients were dismissed 3～5 days after the surgery. No complications occurred. Conclusions Liver tumor in the left lateral lobe can be removed laparoscopically.

Objective: To compare two methods (microbial assay and radioimmunoassay) for measuring plasma folate concentrations, and to examine the relationship between plasma folate levels, and alcohol consumption, tobacco use and body mass index, and the risk of hyperhomocysteinemia in China. Methods: We used a microtiter plate microbial assay and a radioimmunoassay to measure the folate concentration in 88 plasma samples. After comparing the results of these two methods and fitting a regression line, we examined the geographical, seasonal, and gender differences in folate concentration of plasma collected from 2 422 adults in south and north areas in China, and evaluated the association of plasma folate concentration, with alcohol consumption, cigarette smoking, and body mass index, and with the risk of hyperhomocysteinemia, using the data from the two assays. Results: The data from the two assays had a linear relationship ( r =0.879, P =0.000); the regression was Y =0.683 X +0.308 (where X and Y were nature logarithmic transformations of plasma folate by microbial assay and radioimmunoassay, respectively); however, the mean plasma folate levels by microbial assay were much higher than those obtained by radioimmunoassay. Both data sets showed similar plasma folate distributions among Chinese adults, associations with other risk factors, and the risk of hyperhomocysteinemia. We estimated that 19.9% of the Southerners and 67.1% of the Northerners had plasma folate concentrations by radioimmunoassay lower than the 6.8 nmol/L used to define plasma folate deficiency. Conclusion: There is a linear relationship between plasma folate levels determined by microbial assay and radioimmunoassay, but because of the different levels obtained in the two assays, it is difficult to use the microbial assay results to evaluate folate status at this time. The use of 10.5 nmol/L as a cut off for plasma folate deficiency by microbial assay needs further study.

Stroke is a common neurological diseases with high morbidity,high mortality and high morbidity characteristics,which brings great suffer and economic burden to the patients and families,and has become an important research topic in contemporary medical profession.Treatment directly affects the prognosis of patients with cerebral infarction,and thus it is very important to find the most effective treatments and methods.Currently,thrombolytic therapy in acute cerebral infarction have carried out a large number of experimental studies,and achieved good results.This paper reviewed the thrombolytic therapy in acute cerebral infarctionincluding the time window,methods and drugs of thrombolysis,and the influencing factors of outcomes were also summarized and discussed.

AIM To establish anti-osteosarcoma antibody producing hybridoma cell lines and to study the characterization of the monoclonal antibodies. Methods BALB/c mice were immunized with human osteosarcoma cells OS-9607 and the immunized spleen cells were fused with SP2/0 cells to raise hybridoma. The propert of antibody and it's cytotoxic effect were studied respectively with immunohistochemistry methods using OS-9607 and normal hepatocytes、 Western Blot methods and MTT method. Results A hybridoma cell line named 3D9 was established and it secreted high quality mAbs steadily. 3D9 cell had all the characteristics of hybridoma. The mAb's corresponding antigens was specifically and highly expressed in human osteosarcoma. With enzyme-labeled immunohistochemical staining on formaldehyde -fixed sections from human osteosarcoma,it was found that 83％ of the specimens expressed the corresponding antigen. Most of them were expressed on the nuclear of cells, no positive expression was observed in kinds of normal tissues. Western Blot showed 3D9's corresponding molecule weight is Mr54 000. MTT assay proved that the cytotoxicitis of effective groups were higher than control groups. Conclusion A high quality hybridoma is cultured and the mAb secreted by it has osteosarcoma specificity and obvious cytotoxic effect. It may be a new biochemical mark of osteosarcoma, and it's clinical prospect of immunotherapy will be wide.

Posterior reversible encephalopathy syndrome is a clinical imaging syndrome associated with multiple pathogenic factors.The main clinical manifestations were headache,seizures,psychotic symptoms,visual disturbance,disturbance of consciousness,etc.The parieto-occipital reversible white matter lesions are the main manifestations of the imaging.If this disease can be diagnosed and treated in time,the clinical symptoms and imaging changes of most patients can be disappeared.If the diagnosis and treatment cannot be obtained in time,it may happen some irreversible damage,serious and even life-threatening,so it is very important to strengthen the understanding,diagnosis and treatment of this disease.At present,the pathogenesis of the disease is still not clear,now reviewed its pathogenesis and imaging manifestation in order to strengthen the clinician's understanding of the disease's pathophysiological mechanism and improve the level of diagnosis.

Objective To explore the curative effect of knee flexion deformity on spastic cerebral palsy treatment method.Methods All of 30 patients with spastic cerebral and knee flexion deformity were randomly divided into two groups:traditional operation group and modified operation group,using the commonly used operation (In 15 cases,with traditional hamstring post surgery) and) modified operation (In 15 cases,with modified hamstring post surgery),two groups of patients were treated with Ilizarov external fixation drafting device in the correction of knee flexion deformity after soft tissue release.Adjustment began 7 days after the soft tissue release operation of external fixation,and stretched approximately 0.2 degrees each time,3 times/d,until knee flexion deformity was corrected to hyperextension for 10 degree and maintained for 3 weeks,and the flexion contracture degree of knee joint was measured every 2 weeks;then the Ilizarov external fixation drafting device was removed.Then wear a walking straight leg brace for more than 3 months,until the knee walking function is good.Clinical evaluation included the joint pain index,walking function index,knee flexion deformity degree and range of joint motion score of Dimeglio standard.Results Flexion contracture deformity of knee joint in 30 cases (60 knees) was corrected when Ilizarov external fixator was removed,knee extension to 0 degrees-5 degrees.The two groups of patients had the knee flexion angle range of-1.2 degrees to 13.3 degrees,with an average of (7.32°±3.41°) after removed of the walking straight leg brace,in which 4 cases (8 joints) got recurrent deformity of 10°-15° at the time of removing of the walking straight leg brace.Knee activity significantly was improved at the end of treatment.60 cases of knee joint activity were close to normal,with flexion of 100 degrees to 135 degrees,extension of 0 degrees to 10 degrees.Two groups of patients were statistically significantly improved before and after surgery.Curative effect comparison:The walking function index of the modified operation group was obviously superior to that of the traditional operation group,there was significant statistical difference.There were no statistically significant differences in pain index,knee flexion,and range of joint motion.Conclusion For the treatment of flexion deformity of the knee joint in spastic cerebral palsy,traditional surgery using the semitendinosus and gracilis,post and semimembranosus lysis,combined with the Ilizarov draft external fixation could improve the walking function of the patients,simplify the surgical incision and reduce trauma.As a result,modified hamstring post surgery is an ideal,effective treatment method.

Objective To explore the risk factors influencing the prognosis of patients with acute poisoning by analysis of clinical data of 356 patients in order to provide the scientific evidence for planning therapeutic strategies in ICU.Methods The clinical data of 356 patients with acute poisoning were collected during the period from January 1,2005 through December 30,2009,and the clinical findings from close observation were filled into the tables of specially designed “ Clinical observation of acute poisoning patients”.Some risk factors of 356 cases with complete clinical data were studied by single-factor analysis and Logistic multiple regression,such as gender,age,mode and cause of poisoning,kind of poison agents,time elapsed from poisoning to admission into the hospital,time elapsed from poisoning to admission into ICU,length of hospital stay,cardiopulmonary resuscitation,mechanical ventilation,APACHE Ⅱ score.Results Three hundred fifty-six patients with complete data were divided into survival group (n =260) and death group (n =96).Univariate analysis showed the length of hospital stay (5.72 ± 4.37) d,APACHE Ⅱ score (10.27 ±7.77),time elapsed from poisoning to admission into ICU (17.16 ± 31.22)h in the survival group,and the length of hospital stay (3.53 ± 5.79) d,APACHE Ⅱ score (18.78 ±8.66),time elapsed from poisoning to admission into the ICU (37.21 ±67.35) h in the death group (P ＜0.05 or P ＜ 0.01).The differences in rates of CPR,mechanical ventilation and kind of poison agents between the two groups were statistically significant (P ＜ 0.05).Multivariate Logistic regression analysis revealed that the length of hospital stay,APACHE Ⅱ score,rates of cardiopulmonary resuscitation,mechanical ventilation and kind of poison agents were positively correlated with prognosis of patients with acute poisoning (P ＜ 0.05).Model to predict mortality was established:Y =-0.817-0.137X1 +0.140X3 + 2.133X4 + 1.039X5-0.291X6.Conclusions Hospital stay,APACHE Ⅱ score,cardiopulmonary resuscitation,mechanical ventilation and kind of poison agents were independent risk factors for predicting prognosis.APACHE Ⅱ score system and Logistic regression analysis can be used to evaluate the severity and prognosis of patients with acute poisoning.

Objective To investigate strategies of diagnosis and treatment of ureter endometriosis. Methods From 1983 to 2010, the cases registered in Peking Union Medical College Hospital and confirmed as ureter endometriosis by surgery were enrolled in this study. Clinical manifestatios, preoperative examinations, surgical categories and routes, surgical and pathological findings, post-operative medical treatment, relapse and relating factors were collected and studied. Results Totally 46 patieuts with ureter endometriosis underwent one or two surgeries. Forty-eight per cent (22/46) of patients were not be diagnosed with ureter endometriosis pre-operatively, and 46% (21/46) only presented dysmenorrhea or even no symptoms. Ureterolysis (72%, 33/46) and laparotomy (63%, 29/46 ) were the most common surgical category and surgical approach. There were 64% (25/39) of patients had left ureter involved and 80% (37/46) had extrinsic ureter endometriosis. Fifteen per cent (7/46) of patients had relapsed disease with median recurrent time of 24 months (13 -49 months), and they all received second surgeries. Logistic regression analysis showed that only gonadotropin releasing hormone analogue agents were related with recurrence when compared with those patients without medical treatment post-operatively significantly ( OR =23.2, 95% CI:2. 4 -221.7, P =0. 002). Conclusions Ureter endometriosis was related with reproductive tract endometriosis. It has insidious process resulting in difficulty for early diagnosis. It's important to treat pelvic deep infiltrating endometriosis and ovarian endometrioma to prevent ureter from further involvement. Post-operative treatment of pelvic endometriosis is the key point of preventing relapse of ureter endometriosis.

Objective To investigate the characteristics and trends of surgical management on endometriosis in Peking Union Medical College Hospital From 1983 to 2009. Methods The medical documents of patients with endometriosis diagnosed by surgical pathology were studied retrospectively in Peking Union Medical College Hospital (PUMCH). The ratio of different surgical approaches (laparoscopic and laparotomic surgery) and surgical categories (conservative, semi-radical or radical surgery) were compared in all the cases with endometriosis to investigated alterations trends of approaches and methods of surgery. Results Totally integrated records of 13 972 patients underwent surgeries on endometriosis were reviewed and consisted of 24. 974% (13 972/55 945) of all gynecologic surgeries. 59. 490% of cases (8312/13 972) were treated by laparoscopic approach, which were significantly higher than the rate of 37.700%(15 824/41 973) of laparoscopic approaches in the other gynecologic diseases (P<0.01). The proportion of laparoscopic surgeries in all endometriosis surgery was 67.31% (947/1407) between 2005 and 2009, which were significantly higher than 55. 98% (510/911) of laparoscopic surgeries between 2000 and 2004 (P<0.01). Conservative surgery (i.e.,with uterus and ovaries intact) consisted of 64. 014%(8663/13 533) of endometriosis surgeries. The proportion of conservative surgeries was 66. 24% (4176/6304) between 2005 and 2009. The proportion of laparoscopic approaches consisted of 81.10% (7026/8663) of conservative surgeries and 26. 30% (1281/4870) of semi-radical or radical surgeries (P<0.01).The average number of annual surgeries, the average number of annual laparoscopic surgeries and its proportion in endometriosis, and the average number of annual conservative surgeries and its proportion in pelvic endometriosis between 2005 -2009 were all increased significantly than those at range of 1983 to 1999 and 2000 to 2004. The rate of severe complication 0. 351% (49/13 972) was observed in all endometriosis surgeries. Conclusion Surgery was the major treatment of endometriosis in PUMCH, laparoscopic surgery was the major approach and conservative surgery was the major surgery type.

Objective To describe the surgical technique in reconstructing anterior cruciate ligament (ACL) with six strands harmstring tendon graft fixed by bioabsurbable rigidfix cross pins under arthroseopy and to e-valuate its efficacy. Methods From March 2005 to June 2008,39 patients with ACL injury were treated with ACL reconstruction by transplantation of six strands autogenous harmstring tendon , fixed by bioabsorbable rigidfix cross pins in femoral side. There are 22 male and 17 female,ages from 22 to 55 (the average age is 37). 19 cases were hurt in traffic accident, and another 20 cases in accidental injury. The state of illness is 7 days to 38 months. 13 cases merge the meniscus rupture, and 4 cases of meniscus suture,8 partial meniscectomy, 1 meniscectomy were performed simultaneously ;4 cases associating with the medial collateral ligaments Ⅲ degree injure underwent medial collateral ligament neo-plasty or reconstruction ;no cases merge posterior cruciate ligament injury, the patients were followed up 12 to 51 months , Pre-and post-operative knee joint function and stability were evaluated according to the Lysholm scoring scale system and the results of KT-2000 arthrometer , the clinical results and the reliability of the fixation were analyzed. Results 32 patients were followed-up and there is no limitation of the extention in the knee joints. The flexation of the knee joint is greater than 120°,and the anterior drawer test in 90° of flexation were negative in all patients. The postoperative Lachman test was strong positive in 1 case, negative in 26 cases and positive in 5 cases. The Lysholm scores was (92.6±4.2) points. The results of KT-2000 arthrometer: 31 cases 0-4.5 nun, average 3.2 mm;1 case 6. 5 mm. Conclusions It is a safe and reliable method to reconstruct ACL with six strands harmstring tendon graft fixing by bioabsorbable rigidfix cross pins under arthroscopy, and this procedure can obtain primary stabilization and long term stabilization of the autografts.