Objective To analyze the cause of the syndrome recurrences of postcholecystectomy.Methods Clinical data of 98 patients with syndrome recurrences of postcholecystectomy were retrospectively reviewed.Results Among 98 cases,95 cases were found with organic lesions.The recurrences included residual or recurrent calculi in extra or intrahepatic bile ducts,stricture of common bile duct,cystic duct remnant,chronic pancreatitis,cholangioduodenal fistula,cancer of biliary ducts,periampullary cancer.Conclusion MRCP and B ultra sound should be conducted before operations to localize the lesion sites.Detailed detection or cholangiography during operation may avoid the injury and incomplete surgery and reduce the recurrence.

Objective To assess the clinical efficacy of percutaneous transhepatic portal embolization (PTPE) before the extended right hemihepatectomy for the treatment of hilar cholangiocarcinoma. Methods We successfully carried out a percutaneous transhepatic portal embolization in a patient with hilar cholangiocarcinoma and liver cirrhosis. Hepatic hemodynamics, liver volume,liver functions, and pathological changes were recorded after the procedure. Results After PTPE, the patient developed an inflammatory response manifested by a transient fever (39.2 ℃ at peak on the 5th postoperative day) and a mild abdominal pain. There were no other complications such as nausea, vomitting, hemorrhage, or bile leakage. The volume of the left lobe increased from 417.0 ml to 522.4 ml (enlargement rate, 125.2%); the volume of the right lobe decreased from 1041.3 ml to 1017.4 ml (diminishment rate, 97.7%). The ratio of the left lobe to the whole liver increased from 28.6% to 33.9%. The velocity of blood flow of the left portal vein increased by 100% and 39% on the day of operation and the 6th day after operation, respectively (from 12.8 ml/s preoperatively to 23.2 ml/s and 17.1 ml/s). The values of ICG R15 and ICG-K returned to normal levels. On the 17th day after PTPE, the quantity of bile drainage from the left lobe exceeded that from the right lobe. The extended right hemihepatectomy was performed 34 days after PTPE. During operation, an obvious hypertrophy of the left lobe and a distinct demarcation line between the segment 5, 6, and 7 (S5,6,7) and other segments were observed. Postoperative recovery was uneventful. The pathological examination found stenosis and embolization of the portal vein, as well as the degeneration, necrosis, and apotosis of the liver cells in the embolized lobe. Conclusions Portal vein embolization can effectively induce the hypertrophy of the unembolized lobe, which increases the safety level of following extended hemihepatectomy in patients with impared liver functions.

ObjectiveTo investigate the feasibility and effectiveness of low central venous pressure (LCVP) in the operation of major hepatic resection.MethodsFourty-eight patients underwent major hepatic resection were randomized into two groups: LCVP and control group.In the LCVP group,CVP was maintained ≤5 cm H2O during the hepatic resection and then returned to normal after resection.In the control group,CVP was maintained normal between 6 -12 cm H20.The duration of hepatectomy,volume of blood loss,volume of blood transfused and renal function were compared between the two groups.ResultsFor the LCVP and control group,the time for hepatectomy was (45 ± 8 ) and ( 35 ± 5 ) min,respectively; the volumes of blood loss were ( 850 ± 160) and (436 ±280)ml,respectively; the blood loss during operation was (490 ± 130) and (270 ± 105 ) ml respectively.The differences were statistically significant (t values were 15.53,7.69 and 17.89 separately,P ＜0.05 ).No significant difference in the renal function was observed before and after the operation ( P ＞ 0.05 ).Conclusion Using LCVP technique during liver resection significantly reduced the operation time,blood loss and blood infusion.And there wa.s no obvious adverse effect on renal function.

Objective To investigate the therapeutic efficacy of Video-assisted thoracoscopic surgery (VATS)in treating hemopneumothorax. Methods 83 cases of hemopneumothorax treated with exploratory thoracotomy with the help of VATS were retrospectively analyzed. Results All the 83 cases were completed successfully by the VATS.22 cases were treated with bunamiody resection,42 eases were treated with lung repair operation,12 cases were treated with pleuropexy,5 cases were treated with albumingel injection,2 cases were treated with thoracotomy because of serious injury.All patients were followed up 1 year and were found in good condition. Conclusion VATS could treat bunamiody resection and lung repair operation,can stop the bleeding effectively, cause less injury,good therapeutic effect and quickly recovery.

Objective To observe the diagnosis and surgical treatment of substemal goiter. Methods The clinical data of 26 cases with substemal goiter underwent thyroidresection were retrospectively analyzed. Results All the 26 cases were treated by operation. 20 cases were operated by Lower collar incision. 6 cases were operated by ster-notomy. The pathological results showed nodular goiter in 18 cases,follicular adenoma in 6 cases,and papillary carcinoma in 2 cases. Conclusions Surgery via cervical collar incision was fit for most of retrostemal thyroid nodules,and sternotomy or thoracotoray were safely fit for large or carcinomatous substemal goiter. Most cases of retrostemal goiter could be removed by Lower collar incision.

0 05); T?RI mRNA expression was increased at the 1st, 3rd and 7th day, while T?RⅡ mRNA expression was increased at 1st and 3rd , and decreased at the 7th day, compared with normal and sham operation group (P

Objective To investigate the ultrastructural features and it's significance of the skip area with giant cell arteritis(GCA).Methods 20 GCA patients and 7 non-GCA patients underwent temporal artery biopsies. The sections were stained with HE and methylene blue(MB) for light microscopy(LM), doubly stained with uranyl acetate and lead curate for electron microscopy (EM). 20 GCA patients were divided into skip area GCA group(14 cases) and active inflammatory cell infiltration GCA group(6 cases) according to the definition of skip area or skip lesion. The ultrastructural changes of each group were observed by EM and assessed by using 4 grades from 0 to 3 scores.Results The scores of ultrastructural changes were as follows: the skip area GCA group, 0 in 1 patient, 2 to 6 in 9 patients, and 8 to 9 in 4 patients; the active inflammatory cell infiltration GCA group, 7 to 15 in 6 patients; the non-GCA group, 0 to 1 in 6 patients, and 5 in 1 patient. The scores of the three groups were tested by H check, the difference was evidently significant( P0.05) in comparison with active inflammatory cell infiltration GCA group.Conclusions At electron microscopic level, the skip area of temporal artery biopsy with GCA showed obvious pathological changes, especially in the intima of artery. The results suggest that the investigation of ultrastructure features of the skip areas of temporal artery with GCA may be benefit for the diagnosis and treatment of this disease.

Objective To investigate the efficacy and safety of laparoscopic radiofrequency ablation (RFA) therapy for hepatocellular carcinoma.Methods Clinical data of 78 hepatocellular carcinoma patients undergoing laparoscopic radiofrequency in Beijing China-Japan Friendship Hospital from May.2008 to July.2010 were reviewed retrospectively.Age ranged from 31 to 87 years,41 were male and 37 were female.Intraoperative ultrasound-guided needle biopsy was performed and diagnosis of hepatocellular carcinoma was established in all cases before RFA was carried out.Data analysis was performed using software SPSS or OriginPro7.Necrosis,local recurrence of the tumor and the cumulative survival rate were analyzed by Kaplan-Meier test and x2 test.Results The median follow-up time was 16 months after RFA treatment.Tumor size,proximity to intrahepatic vessels and combination with TACE were factors that influence local recurrence.The complete ablation (CA) rate was remarkably higher in tumors ＜ 3 cm than in tumors ＞ 3 -5 cm (90.5％ vs 71.4％,x2 =4.291,P =0.038 ).Tumors adjacent to major vessels had a significantly lower CA rate as compared with those not adjacent to them (63.6％ vs 91.9％,x2 =6.351,P =0.012).The CA rate were 88.9％ in the TACE ± RFA group and 75.0％ in the RFA group ( x2 =1.567,P =0.211 ).The mean overall survival were 48.7 ± 2.4 months,the cumulative survival rate was 86.1％ at 1 year、76.9％ at 2 years、60.3％ at 3 years、51.8％ at4 years and 33.1％ at 5 years.Conclusions Laparoscopic RFA is safe,mini-invasive and effective for unresectable hepatic carcinoma with a favorable long term survival.

A series of oxazole[5,4-d] pyrimidine derivatives were designed and synthesized to discover novel compounds with antitumor activity.Compounds 8a-8m were synthesized using acetamidine hydrochloride as the start material.The structures of synthesized compounds were confirmed by IR,1H NMR,EI-MS and elemental analysis.The antiangiogenesis activities of the synthesized compounds were determined by MTT in human umbilical vein endothelial cell (HUVEC).The in vitro antitumor activities of the synthesized compounds were determined by MTT assay in A549,HepG2 and U251.Compounds 8c,8d,8g,8i and 8l were found to inhibit the proliferation of all the tested cell lines.Compound 8l exhibited noteworthy activities in A549,HepG2 and U251 cell lines with IC50value lower than the positive reference sunitinib,suggesting that compound 8l might be the promising antitumor agent for further investigation.

OBJECTIVE: To establish HPLC method for the determination of thioguanosine in human red blood cells. METHODS: The determination was performed on Hypersil ODS colum. The mobile phase consisted of methanol-water (10∶90) with detection wavelength at 342nm. 6-Thioguanine(6-TG)was generated from thioguanosine through heating and hydrolyzing. 6-TG was extracted into 0.1mol/L hydrochloric acid for sample injection assay with external reference method for the quantification. RESULTS: The linear range of 6-TG was 30～1 200pmol/8?108RBCs. Its optimum hydrolyzing time was 1 hour and optimal extraction pH value ranged from 11 to 12. The content of phenyl mercury acetate in the extraction solution was 1.3mmol/L. CONCLUSION: Under optimized conditions, HPLC method for the determination of thioguanosine is fast, accurate and sensitive.