Cholecystocholedocholithiasis is a common disease. The traditional treatment is open surgery which has its inherent invasiveness and slow recovery. The advent of laparoscopic and endoscopic techniques change surgery in many ways. Laparoscopic cholecystectomy is now the gold standard for cholecystitis, while endoscopic procedure is a treatment of choice for choledocholithiasis. To combine them as a laparoendoscopic rendezvous procedure treats cholecystitis and choledocholithiasis in a single stage, and results in a safe, effective and minimal invasive procedure.

Activities of N-acetyl-?-glucosaminidase (NAG) in sera of normal subjects and patients with hepatocellular carcinoma (HCC) and other diseases were microquantitatively determined by spectrophotometry. The results showed that after the reaction for 4 h, activity of serum NAG in patients with HCC (397.10 ? 174.97 nmol/ml) was obviously higher than that in normal subjects (280.00 ? 63.83 nmol/ml). The elevation of serum NAG in HCC patients had no relationship with their serum a-fetoprotein. However, the increase of serum NAG activity in some patients with benign liver diseases was always accompanied by the abnormality in their liver functions. It is suggested that serum NAG has some referable values in the diagnosis of HCC.

To study the immunopathological characteristics and differential diagnosis of hepatic angiomyolipoma(AML).Methods:Thirty-six surgically resected hepatic AML were investigated clinicopathologically and immunohistochemically with 10 antibodies.Results:Hepatic AML occurred in 21 females and 15 males,with the mean age of 41.6 years(26-60 years old).The patients with AML often had no special symptoms even had large space-occupying lesions in the liver.The diameter of AML was 2.5 cm to 14 cm(mean 6.8 cm).Histologically,AML was composed of varying heterogeneous mixture of 3 tissue components:blood vessels,smooth muscle and adipose cells.Extramedullary hemopoiesis sometimes existed.According to tissue components,AML was subcategorized into mixed type(19.4%,n=7),lipomatous type(11.1%,n=4),myomatous type(66.7%,n=24),and angiomatous type(2.8%,n=1).The epithelioid smooth muscle cells were sensitive to HMB-45(100%),SMA(100%),and CD117(66.7%) staining.Conclusion:Hepatic AML often contains smooth muscle elements,which have varied morphological features and should be carefully differentiated from hepatocellular carcinoma,mesenchymal hamartoma，and tumors with rich fat or blood vessels.Immunohistochemical staining with HMB-45 and SMA are the best available markers for the diagnosis of hepatic AML.

Objectives To evaluate the methodology of preoperative diagnosis for Mirizzi syndrome. Methods Fifteen cases of Mirizzi syndrome were retrospectively investigated. The data of semeiology and imaging including B-type ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) and MR cholangiopancreatography (MRCP) were compared with each other and analyzed. Results Preoperative data were consistent with and suggestive of Mirizzi syndrome in 93% (14/15) of cases, and in 67% (10/15) of cases, respectively. Conclusions Preoperative B-type ultrasound is the primary examination. ERCP and MRCP further elevate preoperative definite diagnosis. In patients with preoperative tentative diagnosis of Mirizzi syndrome, jaundice lasting for more than 7 week is suggestive of cholecystocholedochal fistula.

Objective To study the prevention and treatment of intra- or post- operative complications of radiofrequency ablation (RFA) for hepatic malignancy. Methods A series of 353 patients with primary hepatic carcinoma or secondary hepatic malignancy verified by pathological examinations and clinical manifestations underwent 452 times of RFA between October 1999 and March 2003, including 344 cases of percutaneous RFA and 9 cases of RFA during open surgery. There were 198 cases of primary hepatic carcinoma previously unoperated, 81 cases of recurrent hepatic carcinoma after surgery, and 74 cases of secondary hepatic malignancy. All the patients were followed up to make out short- or long-term surgical complications. Results Complications happened in 12 cases: skin burn by the electrode (2 cases), pneumothorax (1 case), right hydrothorax (1 case), vena cava thrombus (1 case), right bile duct injury and stricture (1 case), gastric external fistula (1 case), bile leakage in the left lateral lobe of the liver (1 case), hepatic abscess (1 case), external fistula of the ascending colon resulted from hepatic abscess (1 case), internal fistula of the duodenum, liver and right thorax resulted from hepatic abscess (1 case), and intra-abdominal hemorrhage (1 case). The incidence of complication was 2 65% (12/452) and the complication-related mortality was 8 33% (1/12). Conclusions RFA is a kind of minimally invasive procedure. But RFA especially percutaneous RFA may involve some risks for patients with the tumor located at the porta hepatic or the surface of the liver, or adhered to hollow organs, especially those who had a history of abdominal operation and adhesions of hollow viscera to the liver. Some complications can be prevented and effectively treated in the event of proper selection of patients, careful performance during the surgery, intensive postoperative care, effective hemostasia and efficient infection prevention.

Objective To evaluate the effect of ginsenoside pre-treatment on serotonin (5-hydroxytryptamine,5-HT),5-HT2A receptor (5-HT2A R),and 5-HT transporter (serotonin transporter,SERT) in serum,platelet lysate and brain tissue homogenates in SD rats with myocardial infarction (MI) or depression.Methods Eighty SD rats were randomized treated with ginsenoside or normal saline (NS).After 4 weeks,the rats were,then,randomized to four subgroups:the MI,the depression,the MI in combination with depression and sham subgroups.5-HT,5-HT2A R and SERT levels were detected in serum,platelet or brain.Results In the NS pre-treatment groups,serum 5-HT levels in sham rats (237.1 ± 32.0)pg/ml were higher than in MI (58.0 ± 11.6) pg/ml,depression (72.8 ± 2.3) pg/ml,and MI with depression rats (62.5 ± 10.2) pg/ml (all P =0.000).Pre-treatment of ginsenoside increased serum and platelet 5-HT in MI,depression and MI with depression rats compared with each corresponding NS treated subgroups (all P ＜ 0.005).However,treatment of ginsenoside lowered the 5-HT2A R expression in MI,depression,and MI with depression subgroups both in platelet and brain tissue homogenates compared with each corresponding NS treated subgroups (all P ＜ 0.05).As to SERT in platelet,treatment of ginsenoside increased its levels in depression rats (P =0.019),but lowered the levels in MI rats (P =0.001) compared with NS treated rats.There were no differences in brain 5-HT and SERT between ginsenoside and NS treated groups.Conclusions The 5-HT system responses differently to ginsenoside treatment under different cardiac and mental stress conditions.Ginsenoside plays an important role in regulation of 5-HT system.

AFP from fetal serum and serum of patients with primary hepatic cancer were purified by affinity chromatography. Then, the lentil lectin-reactive and nonreactive variants of these purified glycoproteins were prepared by affinity chromatography with immobilized lectin. Glycopeptides and oligosaccharides were prepared from variants by protease treatment and hydrazinolysis, respectively, and subjected to carbohydrate and amino acid analysis. A small difference in the carbohydrate compositions of each variant was observed. Analysis of chemical compositions of AFP variants is useful for the differential diagnosis between benign liver diseases and primary hepatic cancer.

Objective:To explore the value of MR-cine for assessment of the duodenum peristalsis in the patients with functional dyspepsia.Methods:25 patients with functional dyspepsia were selected according to the diagnostic criteria of RomeⅢ of functional gastrointestinal disorders (FGIDs)as case group and 25 cases of healthy volunteers who had been screened out in clinic were used as normal control group. After fasting for 8 h,supine position was performed.1.5TGEHDxMR was used to scan the coronal,axial and oblique coronal fast steady state precession (FIESTA)sequence of gastric and duodenal descending part.The images of 5 and 15 min after drinking 600 mL mannitol solution (concentration 2.5%)were collected and sent to MR AW4.4 workstation.The duodenal motility in the patients with functional dyspepsia was measured by recording the times of duodenum and measuring and calculating the percentage occlusion of duodenum contractions (PDC). Results:After drinking mannitol, the oblique coronal scan of all subj ects clearly displayed the anatomical structure and peristaltic wave of descending part of duodenum. After drinking 5 and 1 5 min of mannitol,the peristaltic wave frequencies in case group were lower than those in normal control group. The descending duodenum PDC of the patients in case group was significantly lower than that in normal control group (P<0.01)5 min after drinking. The PDC in normal control group 15 min after drinking was lower than 5 min (P<0.05);the duodenal PDC 15 min after drinking of mannitol had no statistical difference between case group and normal control group (P>0.05).Conclusion:MR-cine can evaluate preliminarly the duodenum peristalsis of the patients with functional dyspepsia. The diagnosis of FGIDs can be further studied by using the noninvasive MR-cine examination technique.

Purpose To explore the ADC value in distinguishing prostate cancer (PCa) and benign prostatic hyperplasia (BPH) by reviewing related articles. Materials and Methods The studies about the diffusion-weighted images in distinguishing the prostate cancer and benign prostatic hyperplasia were enrolled from the websites of Elsevier Science, PubMed, Springer-Link, Wiley Online Library, Medline and CNKI from 2000 to 2011, with DWI, prostate, cancer, carcinoma and hyperplasia as search terms. According to the uniform inclusion and exclusion criteria, the correct studies were chosen and the parameters including the mean values and standard deviations of ADC value were extracted. Meta-analysis was done by using Stata 11 software. Results A total of 7 studies met the inclusion criteria, including 4 English articles and 3 Chinese articles. The fixed-effect model was used due to no heterogeneity. The standardized mean difference (SMD) was-1.357 and 95%confidence interval (95%CI) was (-1.604,-1.109, P=0.000). Conclusion DWI can be helpful in distinguishing the prostate cancer from the benign prostatic hyperplasia, and the ADC value of PCa is lower than that of BPH.

The purpose of this study was to retrospectively analyse the results of 1102 primary liver cancer (PLC) patients underwent liver resection in the past thirty years and to search some effective approaches for improving the longterm effect or PLC treatment. 95% were with hepatocellular carcinoma (HCC), 85.2% with cirrhosis of hepatitis and 25.6% with tumor equal to or smaller than 5 cm in diameter. The mortality rate (MR) within 1 month after operation was 1.8%, the operative MR was 8.8% before 1977 and only 0.4% after that. The total 5-year survival rate (SR) was 28.2% while in the group of small tumor (≤5cm), it was 75.0%. Our experience was as follows: (1) Early diagnosis and early resection of PLC is the key point for improving the operative result of longterm survival. In 282 cases of small cancer, tumor resection rate was 90.0%. Of 48 cases of tumor equal to or smaller than 3 cm in diameter, the 5-year SR was 83.3%. (2) .Rehepatectomy for recurrent liver cancer is an important approach for improving the surgical result. In our series, recurrent rate within 5 years postoperation was 72.3% in larger tumor group and 34.5% in small tumors. There were 78 cases undergoing reoperation in a total number of 170 times of rehepatectomy with 54.7% of 5-year SR after the 1st operation and 34.6% after the 2nd one. (3) For unresectable large tumors, two-stage operation is an important development in liver surgery. We had 26 cases of such patients with 60.0% of 5-year SR. (4) Improvement of operating techniques plays an important role in reducing postoperative complications, lowering operative mor- tality and obtaining better operative result. (5) Postoperative comprehensive treatments are also important for solidating operative effect and preventing tumor recurrence.