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

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.

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 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 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 investigate the effect of liver transplantation on hepatitis B associated diseases and the efficiency of prevention and treatment on the re-infection of hepatitis B.Methods The data of 17 patients undergoing liver transplantation were analyzed after treatment of lamivudine and hepatitis B immune globulin (HBIg). Results Of the 17 cases of hepatitis B pretransplantation, 2 cases were positive for HBsAg. Liver function was normal in all patients.Conclusions Liver transplantation is an effective therapy for hepatitis B. Lamivudine and HBIg could effectively prevent and treat the re-infection of hepatitis B after liver transplantation.

Objective To investigate the relationship between dose and trough blood concentration of tacrolimus after orthotopic liver transplantation and the changes of time-dependent concentration. Methods The doses and trough blood concentrations of tacrolimus from 20 patients who survived longer than 1 year were summarized retrospectively.Results The initial oral doses of 0.15 mg?kg -1?d -1 as suggested by most surgeons led to 53.4 % of the measured whole blood concentrations in the first postoperative week were higher than 15 ?g/L, 23.3 % of them within 10 ?g/L to 15 ?g/L and 23.3 % of them lower than 10 ?g/L. The ratio of trough concentration/dose was increased gradually after transplantation and reached its peak at the second postoperative month, which was higher than those in the following month 3, 4, 5, 6, 7, 8 and 11 significantly (all P

Objective To establish a non-irradiated precondition strategy for successful donor specific transplantation tolerance induced by bone marrow transplantation which may be introduced to clinical application by a murine model.Methods Male C57BL/6 and female BALB/c mice were used as skin transplant donors and recipients respectively. In all, 11 groups were studied: group 1, control mice with skin graft and without any other treatment; group 2, mice receiving only donor bone marrow transplantation (DBMT) before skin transplantation; groups 3～5, mice administrated by only high dose FK506, CsA or CTX respectively and then skin transplantation; groups 6～8, mice receiving DBMT preconditioned by high dose FK506, CsA or CTX respectively and followed by skin transplantation. Both skin and bone marrow donors were male C57BL/6 mice in above 8 groups. Mice in groups 9～11 were treated almost equally to groups 6～8 except that skin grafts were from the third party ICR donors to prove specificity of tolerance. Every group included 6 recipients. Survival time of skin graft was recorded. Macrochimerism were examined by PCR method.Results Neither standard dose DBMT nor high dose immnodepressants alone could prolong skin graft survival, and macrochimerism was not detected, either. But skin graft survival time was significantly prolonged and macrochimerism was also detected in mice of 6～8 groups. Survival time of skin graft from the third party mice was not prolonged. Conclusions Bone marrow transplantation preconditioned with high dose immunosuppressants and without irradiation can induce donor specific transplantation tolerance and prolong murine skin graft survival. It may work through the mechanism of establishment of macrochimerism.

Objective To study perioperative managements and clinical outcome of liver transplantation for hepatocellular carcinoma with thrombosis and cancer emboli in portal vein.Methods From July 2000 to December 2002, 10 cases of hepatocellular carcinoma having thrombosis or cancer emboli in portal vein before operation were subjected to orthotopic liver transplantation (OLT) in our hospital. Nine patients underwent anastomosis of low portal vein by end-to-end method after cleaning the thrombosis and emboli, and one underwent cavoportal hemitransposition.Results Nine of the 10 patients recovered without recurrence of portal thrombosis. One died of portal thrombosis recurrence on the 8th postoperative day and one died of infection on the 60th postoperative day. During the follow-up period of 3 to 31 months, hepatocellular cancer recurred in 7, 12, 13 and 25 months after operations in 4 patients. The remaining 4 patients survived without tumor recurrence.Conclusion Portal thrombosis and cancer emboli are not the absolute contraindications in liver transplantation. Appropriate managements can get satisfactory results.