Objective To explore the advantages and disadvantages of transvaginal hysterectomy for patients with non-prolapsed uterus,and explore the cause and preventive measurements of the complications of transvaginal hysterectomy.Methods The complications of transvaginal hysterectomy ( group TVH ) in 110 patients with non-prolapsed uterus and of transabdominal hysterectomy ( group TAH ) in 120 patients were compared with each other.These patients were chosen randomly from June 2006 to April 2010.Results In the TVH group,rectum hurt occurred in one patient,prolapse of fallopian tube in one patient and celiac internal bleeding in one patient.The preoperative diagnosis were not consistent with the postoperative diagnosis in four patients.Two patients encountered with postoperative residual end bleeding and four patients with vaginal residual end polyps.In the TAH group,three patients had postoperative diagnosis inconsistent with their preoperative diagnosis.In addition,there were four abdominal wall incision liquefaction ( including two phase suture in two patients),three postoperative bronchial lung infection and two residual end polyps.No celiac internal bleeding and visceral injury occurred in this group.Conclusion TVH has a higher risk of visceral injury and postoperative bleeding than TAH.These complications should be avoided when treating the patients with TVH technique.

38 cases of Benign Monoclonal Gammopathy (BMG) representing 17.9% were screened from 212 cases of M-proteinemia by laboratory examinations. Among the 38 cases, 17 cases had increase of IgG, another 17 cases of IgA and 4 cases of IgM. Their average M-proteins were 1.42, 0.88 and 1.84 g/dl respectively.The salient points of differential of benign or malignant M-proteinemia were also discussed. The recommended sequential laboratory diagnostic procedure of BMG were as follows: tatol serum protein determination, plasma protein zone electrophresis, urine protein analysis, immunoglobulin quantitation and immunoelectrophresis or selective electrophresis.

Objective To develop an assay of PCR-produet direct sequencing to detect hepatitis B virus (HBV) YMDD mutation, and compare the results gained by the sequencing and traditional real-time fluorescent PCR assays. Methods Serum samples were collected from 103 patients with chronic hepatitis B. HBV DNA were extracted from sers. YMDD mutation was detected by a commercial real-time PCR assay. Meanwhile, HBV reverse transcriptase-encoding gene was amplified by a nested PCR assay. The PCR products were directly subjected to sequencing at two directions, and the sequencing results were analyzed by NTI program. Using Kappa test, comparison was made between the results of rtM204-site mutations obtained by the direct sequencing and YMDD mutations by the real-time fluorescent PCR. Results The direct sequencing assay proved to be highly effective with bread range of detection in viral load from 500 to 1010copies/ml. And it may simultaneously avoid inhibitory effect caused by high viral load. The coincidence rates between two assays were 100% for YIDD, 97. 1% for YVDD, 76. 2% for YIDD/YVDD coexistence (Kappa = 0. 853, P < 0. 01). Conclusions The direct sequencing assay for HBV drug-resistant mutation detection is highly sensitive with broad dynamic range. It has high coincidence rate with real-time fluorescent PCR assay with advantage of detecting YMDD, YIDD and YVDD mutations simultaneously.

BACKGROUND: Tumor recurrence in liver transplant recipients greatly affects prognosis of liver transplantation with hepatocellular carcinoma (HCC). How to prevent tumor recurrence has aroused increasing attention. Arsenious acid chemotherapy is considered effective on treating moderate or advanced liver cancer, but its utilization following liver transplantation remains few. OBJECTIVE: To explore the role of arsenious acid on tumor recurrence in liver transplant patients with primary HCC extending Milan criteria. RESULTS AND CONCLUSION: All patients were routinely followed up for 3-32 months. Thirty recipients were presented with tumor recurrence, 16 in the chemotherapy group and 14 in the non-chemotherapy group. Tumor recurred in lung, liver graft and bones in most cases. The total recurrence rate was similar in these two groups, but chemotherapy could delay recurrence after transplantation (P=0.026). There was no significance in 6-month, 1-year survival rate between two groups, but the 2-year survival in the chemotherapy group was higher (P=0.037); 6-month tumor-free survival rates in the two groups had no significance, 1-year and 2-year tumor-free in the chemotherapy group were significantly higher than those in the non-chemotherapy group (P=0.030, 0.023). Intravenous arsenious acid chemotherapy can delay tumor recurrence and prolong survival in liver transplant patients with HCC extending Milan criteria.

Objective To investigate the characteristic of movement disorders,so as to improve their diagnosis and treatment. Methods The clini?cal data of patients with movement disorders that admitted in the dystonia and Botox outpatient department were analyzed. Results Cases of involun?tary movement were significantly more than the primary dystonia,and case of primary hemifacial spasm was dominant(163 cases,61.05%). Among the 66 cases of primary dystonia,blepharospasm was ranked the first(19 cases),the second was spasmodic torticollis(18 cases),and the third was Meige syndrome(12 cases).There was no statistical significance in the gender distribution among primary hemifacial spasm,blepharospasm,spas?modic torticollis and Meige syndrome. Instead,there was statistical significance in the treatment methods(P<0.05),and there was statistical signifi?cance in the mean treatment and onset age(P<0.05). Of the 163 cases with primary hemifacial spasm,the mean onset age was 44.22±12.22 years, and the ratio of men to women was 1∶2.4. There were statistical significances in the mean onset age and duration among the patients with different severity degrees(all P<0.05). Conclusion Primary hemifacial spasm,blepharospasm,spasmodic torticollis and Meige syndrome are the com?mon disease in outpatient department. The primary hemifacial spasm is dominant,women are more than men,and the onset age and/or duration are proportional to the severity degree.

ObjectiveTo summarize the clinical experience of simultaneous pancreas and kidney transplantation (SPK) after liver transplantation for patients with diabetes and uremia.MethodsThe clinical data of two patients who received SPK after liver transplantation were retrospectively analyzed.The two male patients had type 2 diabetes mellitus before liver transplantation,and suffered from endstage uremia due to diabetic nephropathy and immunosuppressant-induced toxicity.Rapid technique for combined abdominal multiple viscera procurement was performed.Kidneys,pancreas,duodenum segment and spleen were procured.Renal allograft was placed in the left iliac fossa,whereas pancreas allograft in the right iliac fossa. The pancreatic allograft exocrine secretion was drained into the proximal jejunum via a side-to-side duodenojujunostomy. Quadruple immunosuppressive regime including IL2 receptor monoclonal antibody induction,tacrolimus (Tac),mycophenolate mofetil (MMF) and steroid were used in case 1,and ATG and methylprednisolone were used in case 2.ResultsSPK was successfully applied to these two patients without serious surgical complications such as pancreatitis,graft and pancreatic fistula. The immunosuppressive regimen was based on tacrolimus with ATG induction,MMF and steroids.In the second case,serum creatinine level was decreased to the normal range within 1 week after the operation and then elevated continuously even he received empirical anti rejection treatment,Tac was tampered and rapamycin was used when the renal graft biopsy indicated drug toxicity,and creatinine level was decreased 3 weeks after the operation and recovered to the normal range at 5th week post-transplant. Both of the two patients achieved euglycemia with insulin independence about 10 days after the operation.And now these two patients have been followed up for 36 and 9 months,and the grafts function of the liver,kidney and pancreas was normal. Conclusion Immunologic reaction in patients undergoing simultaneous pancreas and kidneytransplantationafterlivertransplantationseemsmorecomplex, andareasonable immunosuppressive regimen is important to improVe the outcome.

Objective To explore the causes and management of intra-abdominal hemorrhage after orthotopic liver transplantation (OLT). Methods Clinical data of 638 OLT patients were analyzed retrospectively from January 2004 to December 2008 in the First Affiliated Hospital of Sun Yat-Sen University. The diagnosis and treatment of postoperative intra-abdominal hemorrhage after OLT were reviewed. Results Among the 638 patients, 53 suffered from posttransplant intra-abdominal hemorrhage,the morbidity was 8. 3% (53/638). Thirty-one cases suffering from bleeding on raw surfaces or around the liver due to impairment of coagulation function were treated by non-surgery methods, 22 cases who suffered from active postoperative intra-abdominal hemorrhage due to surgical factors underwent laparotomy and bleeding control operation after failure of anti-shock treatments such as hemostatic drugs, blood reperfusion.Among the 53 patients who suffered from intra-abdominal hemorrhage, 12 patients died, and the main causes were serious infections and multiple organ dysfunction syndrome. The mortality associated with intraabdominal hemorrhage was 22. 6%. Conclusions Intra-abdominal hemorrhage at different locations were found after OLT, and the fatal rate is quite high. Timely and appropriate treatments especially laparotomy may improve the prosnosis of these patients.

Objective To evaluate the impact of steatotic hepatic grafts on postoperative early liver function and prognosis.Methods Clinical data of 35 cases receiving steatotic liver grafts in our hospital were retrospectively analyzed.The donor liver grafts were divided into 3 groups based on the degree of fatty infiltration(＜20%group,20%～40%group,≥40%group).Results were compared with that from control normal grafts(41 cases).Liver function parameters including AST,ALT,TB,PT on the day of surgery and 1,2,3,7 days later were monitored among the 4 groups,as well as the incidence of delayed nonfunction (DNF),and 3 and 6 months patient survival rate.Analysis of the correlation between degree of donor steatosis and liver function after operation was carried out.Resuits There was significant difference in postoperative ALT、AST、TB、PT level between≥40%group and 20%～40%group,and between 20%～40%and group＜20%group.There was no significant difference among the groups in DNF occurrence rate and 3 month.6 month patient survival rate.Correlation analysis suggested that the degree of donor steatosis was positively correlated with the damage of liver function.Conclusions Grafts with≤20% steatosis was safe,whereas≥20% especially ≥40% steatosis carries a high risk of posttransplant liver dysfunction even delayed nonfunction.

Objective To investigate the diagnosis,and management of aspergillosis infection in orthotopic liver transplant recipients.Methods The clinical data of 776 cases of orthotopic liver transplantation patients from 2000 to 2006 were collected and analyzed retrospectively.Results Aspergillosis infection occurred in 13 patients(1.68%),among those there were pulmonary aspergillus infection in 7 cases,hepatic aspergillus infection in 2,cerebral aspergillosis in one and multi-organ aspergillosis in 3.Liposomal amphotericin B was the main therapy especially for cases at early stage.7 patients died of aspergillosis and the aspergillosis-related mortality was 53.8%.Conclusion Early diagnosis and management remain the key for the prevention and cure for aspergillus infection and decreasing mortality.The use of anti-fungal therapy should follow the principle of eliminating the local infection,adjusting immunosuppressive regimen and use of sensitive anti-fungal drugs.Anti-fungal drugs should be started early,with sufficient dosage and long-term.