Objective To investigate the difference in biliary composition between cholesterol polyps and cholesterol gallstones patients.Methods Totally 20 patients with cholesterol polyps(CP group),20 cases of cholesterol gallstones(CG group),and 10 adults without hepatobiliary diseases(control) were enrolled in this study.HITACHI-7060 automatic biochemistry analyzer was employed to determine the concentration of total bile acid(TBA),phospholipid(PL),and total cholesterol(TC) of the patients.Glycoprotein was detected by colorimetric method.Free Ca2+ and pH value were anlyzed using ORION-720A ionic acidimeter.And the contents of 8 conjugated bile acids in gallbladder bile were determined by using Agilent-1100 high performance liquid chromatography.Results The conentration of TC,cholesterol saturation index(CSI),and the ratio of(TCA+GCA)/(TCDCA+GCDCA+GDCA+TDCA) of the CP and CG groups were significantly higher than those of the control [TC:(14.0?0.5) mmol/L and(18.6?1.2) mmol/L vs(9.1?0.8)mmol/L,P

ObjectiveTo investigate the clinical features,early diagnosis and therapeutic methods of primary tumor of the duodenum.MethodsThe clinical data of 130 patients of primary tumor of the duodenum who were hospitalized in Peaking University Third Hospital from 1974 to 2010 were summarized.There were 30 cases of benign tumors and 100 cases of malignancy. ResultsMore than 90％ of primary tumors of the duodenum were located at the duodenal bulb and descendent part.59％ of malignant tumors were located in the area of duodenal papilla. The mean diameter of benign tumors was less than 2 cm compared with more than 3 cm in malignancies. Upper abdominal pain,jaundice,black stool,intestinal obstruction and abdominal mass were among the most common clinical manifestations. Jaudice was most common in papilla tumors,and intestinal obstruction and palpable abdominal mass often indicate advanced stage.Duodenofiberscopy combined with air barium double contrast radiography increase the diagnosis rate.Among the 30 benign cases,11 cases underwent simple tumor resection,14 cases received endoscopic tumor resection and 3 cases underwent pancreaticoduodenectomy.Resection rate and the 5-year survival rate was 100％. Of the 100 malignant cases,56 cases underwent standard pancreaticoduodenectomy,3 cases received pylorus preserving pancreaticoduodenectomy,9 cases underwent simple tumor resection and 12 cases received segmental duodenectomy.Resection rate was 84％.The 5-year survival rate was 46％ in 59 cases receiving Whipple's procedure.ConclusionsPrimary tumor of the duodenum lacks specific clinical features. Simple tumor resection and segmental duodenectomy can be done for benign cases, while pancreaticoduodenectomy is the therapy of choice for malignant cases.

Objective To investigate proper indications of endoscopic sphincterotomy (EST). Methods A retrospective review was made on 9 cases of EST with controversial indications from January 2005 to January 2006 in this hospital. There were 1 case of jaundice due to hepatitis and intrahepatic cholestasis, 1 case of intrahepatic and extrahepatic cholelithiasis, 1 case of common bile duct stones, 2 cases of bile duct obstruction due to malignant tumors at upper (1 case) or lower segment (1 case), 2 cases of papillary tumors, 1 case of choledochal cyst, and 1 case of gallstones accompanying common bile duct stones. Results Except for 1 case of jaundice due to hepatitis and intrahepatic cholestasis misdiagnoed as having obstructive jaundice, surgical indications presented in 8 cases. Of the 8 cases, 5 cases were given a surgical operation following EST, 1 case was inoperable because of worse general condition after EST, and a radical operation was given up in 2 cases of end-stage tumors. Conclusions Without complete relief of proximal bile duct obstruction, EST may worsen the patient’s condition instead of curing the biliary diseases. EST may be unnecessary for resectable tumors, especially in young patients.

Objective To study the proportion and sonographic features of various kinds of diseases in the polypoid lesions of the gallbladder (PLG) diagnosed by ultrasonography, and to explore the reliability of ultrasonography for the diagnosis of PLG. Methods A total of 556 cases of PLG diagnosed by ultrasonography were classified basing on the results of pathological examination. And the accordance rate between ultrasonography and pathological examination in the PLG with different size was analyzed. Results Among the 556 cases of PLG, 446 (80.2%) had cholesterol polyps, 86 (15.5%) adenomatous polyps, 18 (3.2%) inflammatory polyps, and 6 (1.1%) myoadenoma. In 97.3% of the cholesterol polyps, the diameter was less than 1.0 cm, and 64.6% of the cases had multiple polyps. In the cholesterol polyps, the accordance rate between ultrasonography and pathological examination was 91.3%. Of the adenomatous polyps, 61.6% had a diameter over 1.0 cm, and 34.0% showed atypical hyperplasia or malignancy. However, 25% of the malignancies were found in the adenomatous polyps with a diameter less than 1.0 cm. Conclusions More than 80% of PLG are cholesterol polyps and 15.5% are adenomatous polyps. Most of the PLG with malignant transformation sized over 1.0 cm in diameter. However, the adenomatous polyps with a diameter ranged from 0.7 to 0.9 cm also have malignant tendency. In the cholesterol polyps, the accordance rate between ultrasonography and pathological examination is 91.3%, showing that ultrasonography is reliable for the diagnosis of the disease.

Objective To seek an effective and safe therapy for acute variceal hemorrhage of patients with Child class C cirrhosis. Methods One hundred and nine Child class C cirrhotic patients with an acute hemorrhage from esophageal varices were reviewed. Sixty - one patients received medical therapy;29 patients were underwent sur- gical operations and 19 patients received TIPSS. Results The surgical group had a higher mortality rate during hos- pitalization(65. 5 % ) than either of the other groups(36. 1 % and 26. 3 % respectively ). The rebleeding rates during hospitalization were 24. 1 %, 36. 1 % and 15. 8 % respectively in the surgical group, medical group and TIPSS group. Rebleeding rate during following- up period were 33. 0%, 36. 1 % and 21 .4% respectively. The rebleeding rate was significantly higher in the medical group than that in either of the other groups during the two phases. Kaplan - Meier survival analysis didn' t show significant difference among the three groups. Conclusions The results showed that TIPSS is a good alternative to surgical or medical therapy for patients with Child class C cirrhosis and acute vericeal bleeding.

Objective To investigate the feasibility and practicability of the precondition using high-dose of Tacrolimus (FK506) before the bone marrow transplantation (BMT) for macrochimerism specific tolerance. Methods One hundred male C57BL/6 mice and 60 female BALB/C mice were respectively used as donors and recipients of skin transplantation, and another 15 male ICR mice were used as the third germ line to detect the specificity of tolerance. Sixty recipient mice were divided randomly into 5 groups: blank control group, FK506 group, BMT group, experimental group (FK506+BMT) and third party donor control group, with 12 mice in each group. Before the skin transplantation, high-dose abdominal injection of FK506 (3 mg/kg?2 d) was performed in recipient mice. On the transplantation day a bonus of 2?10 7 bone marrow cells were injected through the tail vein. Then a short period of low-dose FK506 (0.5 mg/kg?7 d) was administrated for maintenance treatment. The survival time of skin grafts, reject reaction against the third party skin, and mixed lymphocyte culture (MLC) were observed. The polymerase chain reaction (PCR) was employed for the detection of macrochimerism. Results Routine dose of bone marrow cells infusion or short period of FK506 administration led to neither prolonged survival time of grafts nor the formation of macrochimerism. The skin graft survival time was significantly prolonged in the experimental group (24 0?1 5 d), as compared with the blank control group (9 6?1 1 d), the FK506 group (10 5?1 6 d), the BMT group (10 3?1 5 d), and the third party donor control group (9 8?1 1 d), respectively ( P

Objective To study the long-term effect of different surgical procedures for juxtapapillary duodenal diverticula accompanying biliopancreatic diseases. Methods The study included 86 cases of juxtapapillary duodenal diverticula accompanying biliopancreatic diseases treated with different operations from April 1982 to October 2001.The 5-year incidence of postoperative cholangitis was retrospectively analyzed using the life table method. Results There were 45 cases of treatment of biliopancreatic diseases without management of the diverticula,9 cases of Roux-en-Y choledochojejunostomy,11 cases of subtotal gastrectomy with gastrojejunostomy(Billroth Ⅱ),and 13 cases of sphincteroplasty,with their incidences of cholangitis in 5 years being 52.0%,40.0%,75.0%,and 66.7%,respectively. Other procedures were carried out in 8 cases.There was no statistically significant difference in incidences of cholangitis in 5 years among these procedures(?~2=1.49,P=0.8287). Conclusions Management of juxtapapillary duodenal diverticula is not required in patients without the stenosis of the papilla.If postoperative cholangitis cannot be explained with biliary diseases,surgical procedures should be performed depending on the patient's individual condition and the surgeon's experience.The incidences of cholangitis in 5 years among these procedures are not significantly different.

OBJECTIVE To analyze the risk factors of pulmonary infection after liver transplantation and improve treatment strategy.METHODS Forty six adult patients who underwent liver transplantation were divided into two groups: pulmonary infection group and non-pulmonary infection group.An analysis was performed for the commonly used variables.RESULTS The frequency of pulmonary infection after liver transplantation was 43.5%,the mortality rate in the patients who developed pulmonary infection was 60%.Intraoperative total fluid perfusion, mechanical ventilatory time,serum creatinine,albumin,abdominal bleeding,and hydrothorax after liver transplantation were risk factors of pulmonary infection(P

Objective To evaluate the accuracy of Doppler ultrasound (BUS), computer tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of hepatocellular carcinoma. Methods A total of 74 patients with hepatocellular carcinoma and cirrhosis who received a liver transplantation was included in this study. We compared the postoperative pathological results with preoperative imaging findings (BUS, CT, and MRI). An assessment was made in respect of the accuracy in tumor size (a diagnostic accordance was defined as

Objective To investigate the long term result of orthotopic liver transplantation for advanced hepatocellular carcinoma, and to evaluate the predictability of Pittsburg scoring system. Methods 46 patients of advanced hepatocellular carcinoma received orthotopic liver transplantation in our center during October 2000 to December 2004. Data were collected and the 1-year and 3-year survival rates, were evaluated by Kaplan-Meier method. Based on the Pittsburg Scoring System, all cases were divided into 4 groups. The length of survival of each group was observed respectively, and differences were compared with Log-rank test. Results 3-year survival rate and tumor-free rate of all 46 patients were 46.7% and 38.8%, respectively. The mean tumor-free time was 27.7 months, and the mean survival time was 32.5 months. Among the 4 groups, no death or tumor relapse was detected in cases of grade 1 and grade 2 (group I) up to the present, whereas the 1-year tumor-free rate of grade 5(group IV) patients was only 12.5%, and no patient survived over 2 years. The 1-year and 3-year tumor-free rate among grade 3 and 4 (group II and III) patients were both about 65% and 40%, the mean tumor free time was about 32.5 and 24.3 months respectively, and there was no significant difference between 2 groups. In these two groups, the longest tumor free time was 58 months. Conclusions Some of the patients with advanced hepatocellular carcinoma still have the chance to survive tumor-free for a long time after liver transplantation. Pittsburg scoring system has more predictability than Milan criteria, especially in cases of grade 1, 2 and 5, but not so satisfactory in cases of grade 3 and 4.