Objective To explore the application value of acute normovolemic hemodilution(ANH) combined with salvaged autotransfusion in surgical patients with ectopic pregnancy.Methods From Mar.2015 to Apr.2016,46 surgical patients with ectopic pregnancy,receiving ANH combined with salvaged autotransfusion,were enrolled as observation group,and 39 surgical patients with ectopic pregnancy,receiving allogeneic blood transfusion were enrolled as control group.The baseline data,including age,body mass index(BMI),preoperative hemoglobin(Hb),abdominal pain time and menopause time were collected.The amounts of blood loss and blood transfusion were recorded.Preoperative and postoperative levels of white blood cells(WBC),C-reaction group(CRP) and erythrocyte sedimentation rate(ESR) were detected.Results The baseline data,including age,BMI,preoperative Hb,abdominal pain time and menopause time of the two groups were without statistical difference(P>0.05).The preoperative preexisting blood volume was (559±128)mL and the intraoperative blood collection was(510±103)mL in observation group.The cases and volume of banked blood infusion in observation group were lower than those in control group(P<0.05).Preoperative levels of CRP,ESR and WBC of the two groups were not statistical different(P>0.05).The levels of CRP and ESR at the postoperative 1st,3rd and 5th day and WBC levels at the postoperative 1st and 3rd day were higher than those before operation in the two groups(P<0.05).The levels of CRP and ESR at the postoperative 1st,3rd and 5th day in observation group were significantly lower than those in control group(P<0.05).Conclusion (Department of Gynaecology,the Fourth People's Hospital of Langfang City,Langfang,Hebei 065700,China)

[Objective] In order to guide the clinical syndrome differentiation and treatment, and provide the basis for further research on the ideological system of Wu Weikang, a famous professor of Longjiang medical school, the article studied Wu Weikang's experiences in the treatment of nephropathy and discussed the three basic prescriptions of him for treatment of kidney diseases. [Methods] The article discussed experiences in the treatment of nephropathy and academic thought on the basic of the three prescriptions of Wu Weikang such as eight-ingredients detoxification decoction ,yinqiao dihuang decoction and jiawei shenqi decoction. [Results] According to the common pathogenesis and kidney disease clinical symptoms, Professor Wu Weikang often chooses eight-ingredients detoxification decoction,yinqiao dihuang decoction and Jiawei Shenqi decoction as the basic prescriptions applied to the treatment of the dampness-heat of bladder syndrome, kidney deficiency and dampness-heat of bladder syndrome, and edema syndrome due to kidney yang deficiency, and the curative effect is remarkable. [Conclusion] Eight-ingredients detoxification decoction ,yinqiao dihuang decoction and Jiawei Shenqi decoction are the three prescriptions commonly used to treat the nephropathy by professor Wu Weikang in clinic. These prescriptions are widely used in clinic and highly effective. Practical experiences of these prescriptions will be elaborated here, so as to extract their essences to guide clinical practice.

With the development of imaging technology,the reports of spontaneous isolated superior mesenteric artery dissection become more frequently,but there is no consensus on the therapeutic plans which consist of conservative therapy,endovascular treatment and surgical treatment.Therefore,the related questions of the spontaneous isolated superior mesenteric artery dissection will be discussed in order to improve the diagnosis and treatment of vascular diseases of digestive tract with a review of literatures.

Since Reich completed the first laparoscopic hepatectomy (LH) in 1991,LH has been developed rapidly with the continuous improvement of surgeons' technique and the technological changes in devices and related processes.This article elaborates on the safety and efficacy of LH,the value of 3D visualization,3D printing technology,and 3D laparoscopic technology in guiding precise hepatectomy,control of hemorrhage during LH,and safety and efficacy of robotic hepatectomy.

Adolescent ; Adult ; Carotid Artery, Internal ; surgery ; Carotid Body Tumor ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Methods ; Middle Aged ; Time Factors

Objective To observe on the variance of serum IL-18 level and lymphocyte subpopulations in the patients with obese diabetic(T2DM).Methods The diabetic obese group contained 31 cases,the non-diabetic obese group contained 33 cases,healthy normal body weight group contained 23 cases,the blood glucose(FPG),insulin (FPI),blood total cholesterol(TC),triglyceride(TG),IL-18 and the cell population of lymphocyte subpopulations CD3+and CD4+、CD8+ in peripheral blood were determined,the insulin sensitivity index were calcnlated.Results Compared with the healthy normal body weight group,the blood fat,FPG,FPI,IL-18 of T2DM patients significantly increased,there were significant statistical difference(P ＜ 0.05 or P ＜ 0.01).The ISI significantly decreased(P ＜ 0.01).Compared with the non-diabetic obese group,the blood fat and IL-18 of T2DM patients significantly increased (P＜0.05).Compared with the diabetic obese group,the subpopulations cell population of CD3+、CD4+、CD8+ in the non-diabetic obese group significantly decreased,the ratio of CD4+/CD8+ significantly increased,there were significant statistical difference(P＜0.05 or P＜0.01)in the two groups comparison.Compared with the non-diabetic obese CD4+/CD8+ significantly increased(P＜0.05).Conclusion T2DM patients should prevent the hyperinsulinemia,control blood sugar,reduce insulin resistance,sustain normal lipid metabolism,boost immune function.

Objective To determine the resectability of recurrent gastric malignant tumor and its clinical value, and to search an effective way to cure recurrent gastric malignant tumor. Methods The clinical data of 18 cases of sucessfully resected local regional recurrent gastric malignant tumor were analysed retropectively. Results In the 18 cases of recurrent malignant gastric tumor, 6 received total gastrectomy and lymphadenectomy, 5 received body and tail pancreatectomy plus splenectomy with lymphadenectomy, 2 got tumor resection in gastric bed, and the other 5 got periceliac tumor resection with lymphadenectomy. Pathology evidence revealed that 14 of them were gastric adenocarcinoma and the other 4 were gastric sarcoma. They were all recovered and got well when discharged. Follow up results revealed that resection of recurrent malignant gastric tumor could survive 16.4 months (7～38 months) averagely.Conclusions Patient's life quality and survival time could be improved if the local regional recurrence was resectable and other subsidiary therapeutic methods were used.

Objective To study the clinical manifestations,diagnosis,treatments and prognosis of the pulmonary change in mixed connective tissue disease(MCTD).Methods From January 1996 to June 2008,112 patients with definite MCTD in Second Affiliated Hospital of Harbin Medical University were retrospectively studied,and the clinical feature about pulmanary manifestations,echocardiography feature,radiology features and treatments were reviewed and analyzed.44 patients were followed up.Results 48(5 male)had pulmonary manifestation.The median age of onset of symptoms was 39 years and the median duration of disease was three years.The most common manifestation was pleural effusion and(or)pachynsis pleurae(21 cases,18.8%).16 patients(14.3%) had interstitial lung disease,and 8 cases(7.1%)had pulmonary hypertension.The cardinal symptom was short breath.Thirteen patients(11.6%)had dyspnea,4 cases(3.6%)had chest pain,and 4 cases(3.6%)had cough.Reductions of pulmonary function or abnormalities of ultrasonographic image were noted in 25(52.1%)of 48 patients with pulmonary involvement of MCTD who had not any complaint of respiratory symptoms.Six patients had reductions in diffusing capacity of the lung for carbon monoxide(DLCO),17 patients had pulmonary abnormality on chest X ray or CT,and two patients had pulmonary hypertension on doppler echocardiography.Conclusion Pulmonary involment of MCTD may contribute to prognosis seriously.DLCO was the most sensitive parameter.Pulmonary hypertension was the most common cause of death.

Objective To explore the clinical features of hepatocellular carcinoma (HCC) during pregnancy. Methods Clinical data of 4 patients with HCC in pregnancy were retrospectively analyzed.Results All 4 patients were positive for hepatitis B surface antigen. A marked increase in maternal serum a-fetoprotein (AFP) was found in 3 patients (310.1-5630.0 ng/ml ). Three patients were diagnosed at their advanced stages and died of disease in the 4th, 6th and 7th months, respectively. One patient diagnosed as having early HCC underwent curative surgery and has been without recurrence for 26 months. Conclusion The overall survival of patients with HCC in pregnancy is grim because most patients are diagnosed in the advanced stage. Surveillance with AFP and ultrasonography should be recommended for pregnant woman for the detection of early HCC, especially in hepatitis B virus carriers from high endemic areas, to improve patient survival.

Objective To investigate the value of three-dimensional visualization system in the treatment of hilar cholangiocarcinoma.Methods The clinical data of 10 patients with hilar cholangiocarcinoma who were admitted to Chenggong Hospital of Xiamen University from January 2012 to September 2012 were retrospectively analyzed.The two-dimensional computed tomography images were converted to three-dimensional images with the three-dimensional visualization system,and then the volume of liver and tumor size,volume of liver to be resected,remnant liver volume were measured.Surgical procedure was planned based on the three-dimensional images,and the difference between the actual and planned surgical procedures was analyzed.The correlation between actual liver resection volume and predicted liver resection volume was analyzed by calculating the Pearson correlation coefficient.Results The mean liver volume,tumor size,predicted liver resection volume and remnant liver volume of the 10 patients detected by the three-dimensional visualization system were (1496 ± 162) ml,(67 ± 18) ml,(335 ± 241)ml and (1140 ± 197)ml,respectively.The average error rate of predicted liver resection volume was 6.4％.Surgical plan was made in accordance with the principle of curative hepatectomy,including 4 cases of left semihepatectomy,2 cases of right semihepatectomy,3 cases of partial liver resection and 1 case of palliative liver resection.The coincidence rate between the planned and actual surgical procedures was 9/10.R0 resection was performed on 7 patients,R1 resection on 1 patient and palliative resection on 2 patients.One patient received restrictive portal vein arterialization.Preoperative evaluation of the anatomy of blood vessels,bile ducts and tumors based on three-dimensional images was confirmed with operative findings.The accuracy of tumor typing by the three-dimensional visualization system was 8/10.The actual liver resection volume was (325 ± 258) ml,which was positively correlated with the predicted liver resection volume (r =0.902,P ＜ 0.05).Conclusion The three-dimensional visualization system is helpful in the treatment of hilar cholangiocarcinoma.