Objective To explone the cause and countemeasuer of complication following laparoscopic cholecystectomy. Methods The cause and management of complications in 1227 casesof laparoscopic cholecystectomy were analyzed retrspectively. Results Related complications were found in 13 cases,including 2 cases of severe complications with bile duct injuryes,2case with bile leakage,5case with hemorrhage and 3 case with enteric perforation, 1 of that patients died for complications. Conclusion Proper selection of patients, identification of local anatomical relationship, to ensure a clear surgical site revealed, flexibly deal with the condition of patients is the key to reducevarious complication.

Objective To summarize and evaluate the experience and near-term outcomes of microsurgical treatment of myelomeningocele in the lumbar and sacral region in children.Methods Clinical data of 35 cases of myelomeningocele from October 2005 to November 2006 were analyzed retrospectively.The spinal cord and the cauda equine nerves were dissected microsurgically from the surrounding tissues.The duraplasty was performed and the thecal sac was reconstructed.The tight filums were released simultaneously in 8 cases and a ventriculoperitoneal shunt was placed in 10 children with severe hydrocephalus. Results The microsurgical repair was implemented and the spinal cord was released successfully in all the 35 cases.Among 10 cases of vesicorectal dysfunction,there were 3 cases of improvement of rectal sphincter functions after operation.Out of 9 cases of equinovarus,the tension of varus was decreased in 4 cases and no obvious functional improvement was observed in the rest of 5 cases.Leakage of cerebrospinal fluid from the incision occurred in 2 cases,and in the remaining cases the incision healed by first intention.The 10 cases of severe hydrocephalus were cured with ventriculoperitoneal shunting,including a delayed shunt insertion in 9 cases and a single-stage insertion in 1 case,in which a postoperative infection was encountered and a re-operation of ventriculoperitoneal shunting was given. Conclusions For children with myelomeningocele,a surgical treatment should be given as early as possible.A delayed shunt insertion 1~2 weeks after myelomeningocele repair is safe and effective.The duraplasty and optimized closure of the subcutaneous tissue are important for preventing cerebrospinal fluid leakage.

Objective To compare the efficacy of carotid endarterectomy(CEA)and carotid artery stenting(CAS)for the treatment of high-risk atherosclerotic carotid artery stenosis.Methods We retrospectively studied the surgical outcomes of 58 patients with high-risk atherosclerotic carotid artery stenosis.Among the cases,32 received CEA and 26 underwent CAS.All of the patients were followed up with carotid ultrasonography,CTA or DSA in 30 days,6 months,and 1 year after the procedures,their neurological function was assessed meanwhile.Cumulative incidence of death,stroke,or myocardial infarction within 30 days after the surgical intervention and death or ipsilateral stroke events between 30 days and 1 year were set as the primary endpoint of the study.And the secondary endpoints were the CEA or CAS-correlated complications or severe restenosis within 1 year after the treatment.The outcomes of the two groups were compared.Results The primary endpoint occurred in 3 patients in the CEA group(9.4%)and 4 in the CAS group(15.4%)(?2=0.086,P= 0.769).And the secondary endpoint was found in 4 of the CEA group(12.5%)and 4 of the CAS group(15.4%)respectively(?2=0.000,P=1.000).Conclusions For the patients with high-risk carotid artery stenosis and coexisting conditions,CEA is as safe and effective as CAS.

Congenital bilateral perisylvian syndrome(CBPS) is rare in literature,especially in China.In this article,we report the clinical and treatment of a patient with CBPS and discuss its mechanism,clinical features and therapy.This patient was a 28-year-old man.His main clinical features were pseudobulbar palsy,cognitive deficits and intractable epilepsy.MRI shows bilateral thickening of the cortex around the sylvian fissures which were deeper than normal and polymicrogyria.The electroencephalogram demonstrated slow spike in right temporal lobe and left frontal lobe.Rhythmal 4 Hz ? waves exist in left frontal and parietal lobe.As the epilepsy was poorly controlled by antiepileptic,section of the corpus callosum was carried out.After callosotomy,there was pronounced seizure reduction and intelligence development improvement.CBPS is characterized by pseudobulbar palsy,cognitive deficits,and bilateral perisylvian abnormalities in imaging studies.If intractable epilepsy is combined,callosotomy may be effective.

Objective To investigate the value of presurgical functional magnetic resonance imaging(fMRI) in identifying the eloquent brain areas and guiding the resection of cerebral tumors located in these areas.Methods A total of 10 patients(aged 51.3 years on average) with tumors near to the brain functional areas were enrolled in this study,among which 7 had weakness in the limbs,2 had convulsion,and 1 suffered from facial palsy.The preoperative Karnofsky scale of the patients was 82 on average.Before the fMRI,the patients have been confirmed as having tumors involving functional areas.They were treated by total or subtotal resection according to the anatomical relationship between activated areas and the tumor.Injuries to the activated areas should be avoided during the operation.After the treatment,the muscular strength,Karnofsky scales of the patients were tested.Postoperative MRI was carried out in all of the patients,and the results were compared with that before the operation.Results As shown by fMRI,the activated areas were compressed and dislocated by the tumor in 8 of the 10 patients.The minimal distance between the edge of the tumor and the activated spots was 0-26 mm(mean,13.6).Seven of the patients received total resection of the tumor,while the other 3 underwent subtotal resection.After the surgery,the muscular strength was improved in 7 cases;the convulsion disappeared in the 2 patients who had symptom before the treatment;and the one who had facial palsy was improved.One month after the surgery,the mean Karnofsky scale of the patients was 93.Re-examination by MRI performed one week after the operation showed that the tumor was disappeared in 7 patients,and reduced by 95% to 99% in the other three.Conclusions fMRI is valuable in the preoperative evaluation of the brain functional area near to a cerebral tumor.It can be used to guide the tumor resection while preserving the motor areas.

Meningomyelocele combined with squamous cell carcinoma is rare in literature. In this article,we report the clinical and treatment of a patient with meningomyelocele and squamous cell carcinoma and discuss its mechanism,clinical feature,therapy and prognosis.The patient was a 11-year-old Chinese boy.At the time of his birth he was noted to have a lumbosacral meningomyelocele,which was disrupted and the cerebral spinal fluid flew out when the child was six.The wound surface abrased and exudated repeatedly.Two months before admission,the meningomyelocele was disrupted again and the condition got worse.Inspection showed a meningomyelocele in the lower lumbar region 10 cm in diameter,consisting of a cauliflower-shaped swelling and a central crater containing black slough.The area smelled foul and was constantly draining serosanguineous fluid.Magnetic resonance imaging showed meningomyelocele associa-ted with spinal dysraphism and tethered cord syndrome.After thorough preparation,operation was undertaken.A perpendicular skin incision,which was carried down to the lumbar aponeurosis,allowed the main bulk of the tumour to be undercut and removed.The quick frozen pathological examination confirmed that it was squamous cell carcinoma.The skin and subcutaneous tissue were fruther resected and the vertebral canal explored until frozen section showed the excision edge was clear.Skin closure was achieved by a bi-pedicle advancement flap,some 10 cm wide and the secondary defect was closed with a thigh skin graft.Histological examination showed that the massive outgrowth was a well-differentiated squamous cell carcinoma.The postoperative recovery was uneventful and the wounds healed by primary intention.Although meningomyelocele combined with squamous cell carcinoma is rare in literature,the possibility of can-cerization should be considered when there is a long-term and non-healing ulcer (Marjolin ulcer) with foul smell in a meningomyelocele patient.

In this paper,through the questionnaire analysis of teachers' teaching quality,the author got to know the students were contented with the teaching quality and there were some problems in the classroom teaching. Moreover,the author offered a few advises to improve the teaching level and teaching quality.

Objective To study the effects of cinobufacin(cino) combined with fluorouracil(5-FU) on inhibiting proliferation and inducing apoptosis of human gastric carcinoma cells in vitro. Methods The experiment was divided into control group,cinobufacin group,5-FU group and cino+5-FU group. Cell morphological variation,cell inhibitory rate, cell cycle and ratio of apoptotic cell of human gastric carcinoma cell line BGC-823 were studied by cell culture, inverse microscopy, fluoroscopy, MTT assay and flow cytometry on different concentrations of cino and 5-FU. Results Cino could markably inhibit proliferation of human gastric carcinoma cells in time-and dose-dependent response. The cino+5-FU group inhibited the rate of proliferation of BGC-823 cells was significantly more than either cino or 5-FU alone group(P

0.05).Compared with control group, cell inhibition rate significantly increased in rhGH+L-OHP group (63.2% vs. 50.8%,P

Objective To establish a simple ,stable acute liver injury model induced by CCl4 to observe effects of hepatocyte transplantation .Methods CCl4 plant oil with different concentration of 20% and 50% was used in mice by intraperitoneal injection , of which the dose was 2 mL/kg ,and then materials were taken at different time points respectively .Mice survival rate ,alanine amin-otransferase (ALT) ,aspartate aminotransferase (AST) and the pathological changes of the liver were detected .Results Mice sur-vival rate in 20% CCl4 intraperitoneal injection was significantly higher than that of 50% .ALT and AST in experiment group were significantly higher than that of control group ,but there was no significant difference between two experimental groups .Pathologi-cal examination showed that mice liver cells showed typical cytoplasmic ,ballooning ,scattered punctate ,piecemeal necrosis and in-flammatory cell infiltration in 20% CCl4 intraperitoneal injection ;while in 50% CCl4 ,there was obvious fibrosis ,in addition to the mentioned heavier lesions .Conclusion 20% -50% CCl4 intraperitoneal injection in 2 mL/kg dose can induce different degrees of relatively stable liver injury ,and its concentration determines the degree of liver injury .Acute liver injury induced by 20% -50%CCl4 was an ideal model for hepatocyte transplantation experiment .