Objective To explore injury control in the abdominal injury with serious multiple injuries in the early diagnosis and treatment level.Methods Retrospectively analyzed 100 patients with abdominal injury with severe multiple trauma diagnosis and treatment for summing up experience.Results Phase Ⅰ results of 80 cases of abdominal surgery,the 20 patients with chest and abdominal surgery,the merger of trauma surgery 26 cases Ⅰ,Ⅱsurgery in 19 cases,cured 91 cases(91.0%),9 patients died(9.0%),the causes of death combine severe brain injury 4 csaes(44.4%),severe hemorrhagic shock in 3 cases(33.3%,deaths in the 2 cases),multiple organ failure after operation 2 cases(22.2%).Complications after abdominal surgery:stress ulcer 29 cases(29.0%),abdominal wound cracked 15 cases(15.0%),low-nutrition of 25 cases(25.0%),18 cases of intestinal obstruction adhesions(18.0%).Conclusion Surgery damage control applications can be effective in redueing the mortality rate in the abdominal injury with serious multiple injuries.

Objective To compare the clinical efficacy between endoscopic thyroidectomy via breast approach conventional open thyroidectomy in patients with nodular goiter. Methods A series of 70 patients with unilateral nodular goiter divided into two groups, either receiving endoscopic thyroidectomy through breast approach(endoscopic group,35 cases),or conventional open thyroidectomy(open group,35 cases). The therapeutic efficacy was compared between the two groups. Results The operating time of endoscopic group was significantly longer in the endoscopic group (100.4±26.6)min than in the open group (73.5±14.5) min(t=5. 627, P=0. 000). The postoperative drainage volume in the endoscopic group (66.7±24.9) ml significantly more than that in the open group ( 13.3±6.4)ml( t = 14. 403, P = 0. 000 ). The postoperative hospital stasignificantly longer in the endoscopic group (4.3±1.1 )d than in the open group (3.6±0.9)d(t=2.886, P=0.005). And a satisfactory cosmetic result was achieved in significantly more patients in the endoscopic group(9/24 cases) than in the open group(34/51 )(x2 = 7.235, P=0.007). There was no significant difference in intraoperative loss between the endoscopic group (22.5±15.3)ml and the open group (18.3±7.5 )ml(t=1.273, P=0.207), a consumption of analgesics between the endoscopic group (9/24 eases) and the open group(21/51 cases) (X2=0.028, P=0.867), respectively. No severe complications was encountered ,such as massive hemorrhage,injuries of the recurrent or sularyngeal nerve, or parathyroidgland injury. Conclusion Both breast approach endoscopic thyroidectomy and conventional open thyroidectomy are safe and effective, former gives better cosmetic outcomes.

Objective To discuss the manifestations,diagnosis and management of acute superior mesenteric artery embolism.Methods The clinical data of 22 cases of acute superior mesenteric artery embolism(admitted) in our hospital in recent 10 years were analyzed retrospectively.Results The preoperative diagnostic rate was 77.3%.Among them,2 cases who refused operation died(100%);20 cases were subjected to operation,in whom 5 cases underwent simple resection of necrotic bowel and 3 of them died(60%),while 15 cases were subjected to resection of necrotic bowel after removal of the embolus and 5 of them died((33.3)%).The overall mortality was rate 45.5%.Conclusions Acute superior mesenteric artery embolism should be suspected in every patient with sudden abdominal pain,especially in those who have organic cardiac disease.CTA is an effective method for diagnosis of acute superior mesenteric embolism.Early diagnosis and prompt embolectomy are the key points to improve the therapeutic effects.

Objective To investigate the clinical and immunohistochemical features,diagnosis and treatment of gastrointestinal stromal tumor(GIST). Methods Clinic and pathological datas of 38 cases with GIST were retrospectively analyzed. Results The most common clinal maifestions were abdominal pain,distention or discomfort in 24 cases(50%), abdominal mass in 10,melena and liematemesis in 8 cases. The tumor was located in the stomach in 20 cases, the small infestine in 14,the colorectum in 4.All the cases underwent operation. Conclusion Endoscopy and imaging examination are main methods to detect GIST. Surgical resection is the main mothod of pathologic diagnosis and treatment.

Objective To study the efficacy of surgical treatment in hilar cholangiocarcinoma patients. Methods One hundred and four cases underwent surgical treatment of hilar cholangiocarcinoma were retrospective enrolled in the study from 1998 to 2008, including 45 cases of radical resection, 38 cases of palliative resection, vitro bridge drainage in 21 cases, 93 cases of postoperative patients. Ninty-three patients were followed up for 5 - 67 months, the different procedures of the treatment was summerized. Results Oneyear survival rate of radical resection and palliative resection was 80. 0% ( 32/40 ) and 86. 8% ( 33/38 ),respectively. No significant difference between the two groups (P ＞0. 01 ) were found; 2-year survival rate was 67. 5% (27/40) and 39. 5% ( 15/38), with significant difference between the two groups (P ＜0. 01 ) ;3-year survival rates were 37.5% ( 15/40 ) and 13.2% ( 5/38 ), with significant difference between the two groups (P＜0. 05). Palliative resection had higher 1-year survival rate than in vitro bridge drainage(P ＜ 0.01).Conclusion Surgical treatment of hilar cholangiocarcinoma is the most effective way to prolong the survival time of radical resection, radical surgery had better efficacy than palliative surgery, and palliative surgery is superior to external drainage. In patients of severe jaundice combined with biliary drainage infection, preoperative bridge drainage would improve the safety.

OBJECTIVETo investigate the value of serum inflammatory markers in the diagnosis of acute appendicitis (AA) in children.

METHODSBlood samples were collected from 51 children with AA and 16 children with nonsurgical abdominal pain (NSAP) to examine white blood cell count (WBC), serum C-reactive protein (CRP), interleukin-6, and tumor necrosis factor-α (TNF-α).

RESULTSWBC count, CRP, IL-6 and TNF-α increased significantly in children with severe AA (phlegmonous or gangrenous, and perforated appendicitis). ROC curves showed that IL-6 or TNF-α had a greater contribution than WBC count to the diagnosis of severe appendicitis.

CONCLUSIONIL-6 and TNF-α can provide complementary information to assist the clinical decision of emergency operation for children with AA.

Appendicitis ; blood ; diagnosis ; Biomarkers ; blood ; C-Reactive Protein ; metabolism ; Child ; Child, Preschool ; Female ; Humans ; Inflammation ; blood ; diagnosis ; Interleukin-6 ; blood ; Lymphocyte Count ; Male ; Tumor Necrosis Factor-alpha ; blood

Objective To investigate the causes and prevention measures for patients with portal hypertension hypersplenism undergone splenectomy plus pericardial devascularization and post-operative portal vein thrombosis (portal vein thrombogenesis,PVT).Methods 178 cases of splenectomy plus devascularization from July 2013 to May 1994 in Cangzhou Central Hospital of Hebei Province,including 102 cases of early postoperative application of low molecular heparin anticoagulant for the prevention group,76 cases without anticoagulant medicine as control group.33 cases with PVT found by B ultrasound or CT scan,were treated with urokinase body intravenous thrombolysis,hepatic artery catheterization thrombolysis,intestinal resection of + Fogarty catheter embolectomy vein stump treatment respectively.Results The total incidence of thrombosis was 18.5％ (33/178),prevention group was 8.8％ (9/102),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ thrombus,in 1 cases,no intestine necrosis.The control group thrombosis rate was 31.6％ (24/76),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ,thrombosis in 17 cases,5 cases of intestine necrosis,two groups of thrombosis rate were significantly differences (x2 =14.932,P =0.000).Thrombus disappeared completely in 7 cases,the thrombus grading decreased in 2 cases in the preventive group after thrombolysis,and thrombus disappeared completely in 6 cases,11 cases of thrombosis degraded in the control group after treatment of thrombolysis,1 case cured by TIPS with thrombolysis and thrombectomy,1 case died of sudden digestive tract bleeding,Among 5 cases of intestinal necrosis,4 cases died and 1 case undergone abdominal exploration being found with intestine & colon necrosis.Conclusions There are a variety of factors causing PVT after splenectomy and devascularization.Early anticoagulation can significantly reduce the incidence of PVT,early discovery and treatment can prevent severe outcome.

ObjectiveTo evaluate the effect of early anticoagulation therapy in the prevention of portal venous system thrombosis (PVT) in portal hypertensive patients undergoing splenectomy plus portaazygous devascularization. MethodsAt our hospital from August 1994 to July 2011,157 patients underwent splenectomy plus devascularization. Among them 89 cases (beginning 2000 )receiving intravenous low molecular dextran 500 ml daily for 7 days starting immediately postoperatively,and after 48 h subcutaneously low molecular weight heparin calcium 4250 U every 12 hours for 7 - 14 d were in group A.Before 2000,the 68 cases receiving no postoperative anticoagulation therapy were in the control group (B).After 3 - 12 months follow-up,PVT was evaluated and compared between the two groups. ResultsIn group A thrombosis incidence was 8％ (7/89),of which class Ⅰ, Ⅱ thrombosis accounted for 71％(5/7),class Ⅲ and up thrombosis accounted for 29％ (2/7),there was no bowel necrosis case; In group B thrombosis incidence was 29％ (20/68),class Ⅰ,Ⅱ thrombosis accounted for 20％ (4/20),class Ⅲand above thrombosis accounted for 80％ (16/20),3 cases suffered from intestinal necrosis,the difference was statistically significant (P ＜ 0.01 ). ConclusionsMultifactors lead to postoperative PVT formation,early postoperative,anticoagulation therapy is safe,and effective in the prevention of postoperative PVT.

Objective To investigate the feasibility of establishing a digital model of juxtahepatic vena cava.Methods The clinical data of 120 participants (without liver diseases) who were admitted to the Cangzhou Central Hospital from January 2013 to May 2013 were collected.The results of computed tomography were analyzed.The diameters of juxtahepatic vena cava on different levels (P1 plane:inferior vena cava at the entrance to the right atrium,P2 plane:the upper margin of the roots of hepatic veins,P4 plane:lower boundary of liver,P5 plane:confluence of renal veins and inferior vena cava),and the circumference of the inferior vena cava and the lengths between these levels were recorded.A digital model of juxtahepatic vena cava was established by these data on the premise that the juxtahepatic vena cava was engorged.All data were analyzed using the analysis of variance,paired sample t test and independent samples t test,and correlation and regression were used in analysis of relations between there data.Results Data of the P1 plane and P2 plane were both missed in 3 cases,and the data of the P4 plane was missed in 8 cases.The theoretical diameter of hepatic vena cava at the P1,P2 and P4 planes were (28.1 ± 4.0) mm,(28.7 ± 3.5) mm and (23.5 ± 2.7) mm,respectively.The median diameter of hepatic vena cava at the P5 plane was 24.3 mm.The juxtahepatic vena cava was a 3 dimensional structure of cylinder with a slightly protruding middle part.There were significant differences in P1D-P2D,P2D-P4D,P1D-P4D (F =77.5,P ＜ 0.05).There were significant differences between P2D-P4D and P1D-P4D (t =14.893,11.210,P ＜ 0.05).The median length of hepatic vena cava between P1 and P2 planes was 7.5 mm.The lengths of hepatic vena cava between P1 and P4 planes,P2 and P4 planes were (85.2 ± 11.0)mm and (78.2 ±9.8)mm,respectively.The median length of hepatic vena cava between the P4 and P5 planes was 10.0 mm.P1D-P2D,P2D-P4D,P2D-P5D and P4D-P5D were positively correlated (r =0.862,0.308,0.186,0.788,P ＜ 0.05),while P1D-P4D and P2D-P5D did not correlated (r =0.180,0.118,P ＞0.05).P2D was correlated with the body weight,and P5 D was correlated with the age (r =0.200,0.130,P ＜ 0.05).The P1 D,P2D,P4D and P5 D of the inferior vena cava were (28.5 ± 3.7) mm,(29.0 ± 3.4) mm,(23.9 ± 2.8) mm and (24.3 ± 2.6) mm in males,and (27.8 ±4.2) mm,(28.5 ± 3.6) mm,(23.1 ± 2.5) mm and 24.0 mm in females.There were no significant difference in P1D,P2D,P4D and P5D between males and females (t =0.911,0.809,1.588,1.902,P ＞ 0.05).The length between P1 and P2 planes was negatively correlated with P1D and P2D (r =-0.245,-0.160,P ＜ 0.05),while the length between P4 and P5 planes was positively correlated with P1D (r =0.149,P ＜ 0.05).The length between P2 and P4 planes was positively correlated with P2D (r =0.195,P ＜ 0.05).The length between P1 and P2 planes did not correlated with the age,height and body weight (r =-0.092,-0.047,-0.033,P ＞ 0.05).The lengths between P2 and P4 planes,P1 and P4 planes were negatively correlated with the age (r =-0.343,-0.371,P ＜ 0.05),but positively correlated with the body weight (r =0.271,0.208,P ＜ 0.05).The length between P4 and P5 planes was positively correlated with the height and body weight (r =0.154,0.255,P ＜ 0.05).There were no significant difference in the lengths between P1 and P2 planes,P1 and P4 planes,P2 and P4 planes,P4 and P5 planes between males and females (t =-1.046,-1.274,-0.908,1.375,P ＞ O.05).The length between P2 and P4 planes was similar to the length of retrohepatic vena cava.The length between P2 and P4 planes(mm) =71.23-0.293 × age (years) +0.32 × body weight (kilogram).Conclusion The establishment of digital model of juxtahepatic vena cava based on the computed tomography imaging data is feasible,which provides basis for clinical investigation.

Objective: To learn about the construction and staffing of the school health system in Chinese institutions for disease prevention and control, and to provide basic information for the school health system, team capacity building and work development. Methods: Electronic questionnaire was used to collect the setting and staffing of school health departments (including school health centers and departments/rooms) at the provincial, prefecture and county (district) levels in the centers for disease control and prevention. Statistical analysis was made on the proportion of school health, the number of staff and the characteristics such as age, education, major and working years in the provincial, prefecture and county (district) levels. Results: Among the 3 313 institutions, the proportion of independent school health departments was 10.8%, and those of the provincial, prefecture and county (district) levels were 74.2%, 15.0%, and 9.6%, respectively. Among the institutions with separated department, the average number of staff members was 4.4, while the number of staff was 2.5. The average age of school health workers was 40.4 years old, and the proportion of male and female employees was 45.2% and 54.8%. The proportion of personnel who have been engaged in school health work for less than 5 years on average was as high as 65.1%. The majors of the staff were mainly public health ( 40.4 %), 54.0% of the provincial staff had a master s degree or above, and 47.8% and 58.7% of the staff at the prefecture and county (district) levels were junior college or below respectively.The proportion of provincial level personnel with intermediate and senior titles was 69.6%, and the proportion of municipal and countylevel personnel at the junior level and below was 52.2% and 56.2% respectively. Conclusion The proportion of independent school health departments within centers of disease control and prevention across China was low. There is a serious shortage of school health personnel, and there are problems such as low levels of education and professional titles, especially in county (district) level institutions. It is urgent to strengthen the construction of the school health system of the centers for disease control and prevention in China.