Portal vein thrombosis is a common though serious complication after splenectomy in patients with liver cirrhosis and portal hypertension.Its pathogenesis may be primarily associated with the coagulation mechanism and the changes of hemorheology.The clinical presentations of portal vein thrombosis after splenectomy depend on the course of disease,as well as site and degree of obstruction.The principle of treatment is to improve microcirculation,relieve the platelet aggregation and prevent further progress of the thrombosis.But in clinical settings,signs and symptoms of portal vein thrombosis were generally atypical.Any misdiagnosis or delayed treatment may expose the patients under risk.This article focuses on the risk factors,potential mechanisms and recent progress on the prevention of post-splenectomy portal vein thrombosis.

The technique of Radiofrequency ablation (RFA) has been widely applied as alternative treatment for non resectable hepatocellular carcinoma (HCC) and has equivalent efficacy in prognosis.However,because of the restriction of current heat ablation technique and tumor's special location in liver,it is difficult for some physicians to obtain the ideal of one-off complete ablation.Therefore,incomplete destruction of tumor and multiple ablation processes resulted in miserable consequence in prognosis.So,to achieve one-off complete ablation,it is essential to evaluate the anatomy location of the tumor before RFA procedure and to establish the specified approach and adjuvant method.This article is to systematically analyze the theoretical hypothesis of this technique and to explore possible strategy for a safe approach based on characteristics of liver anatomy and combined with the professional advantages of hepatobiliary surgery.

Focal nodular hyperplasia (FNH) is one of the most common benign liver tumors.It has no potential for malignant transformation and an extremely low rate of rupture or hemorrhage.However,its nature and pathogenesis are still controversial.Accurately diagnosing atypical lesions of FNH based on clinical presentation and radiographic studies are still difficult.This review aims to analyze current literature of FNH and to discuss the new progress of pathologically and clinically relevant advice regarding diagnosis and management.

Radical resection is crucial in the surgical treatment of adenocarcinoma of the body and tail of pancreas.It usually refers to negative resection margin and dissection of regional lymph nodes.In recent reports,the definition of R0 margin has been updated,and radical antegrade modular pancreatosplenectomy (RAMPS),which was first described by Strasberg et al,contributes to achieving negative tangential margins.In some cases,extended radical resections were adopted in an attempt to achieve R0 margin.However,it would increase operation related morbidity and mortality,which should be taken into account before the procedure.Lymph nodes metastasis is an important prognostic factor.Extended lymph nodes dissection does not seem to bring survival benefits,while itg helpful in assessing the tumor stages and patients' prognosis.Laparoscopic distal pancreatectomy (LDP) has been applied in the treatment of ductal adenocarcinoma of the pancreas in reports with small sample sizes.But it remains controversial whether LDP is superior comparing to conventional open methods in regards to oncological outcomes.Curently,surgery is the promising method that may cure adenocarcinoma of the body and tail of pancreas.Highlighting radical resection will bring more survival benefits to patients.

Objective To explore more safe and effective method for the treatment of common bile duct stones combined with cavernous transformation of the portal vein (CTPV).Methods We report 2 cases of post-treated patients in this series.In order to avoid severe bleeding caused by dissection of bile duct,we applied different methods to remove common bile duct stones compared with traditional operation.We removed common bile duct stones in one patient through cystic duct approach during operation.Two years later,we performed endoscopic duodenal incision (endoscopic sphincterotomy,EST) for him because of lower common bile duct stenosis with sand like stone.Another patient,on the other hand,we conducted the duodenal papilla incision during operation and removed common bile duct stones with choledochoscope through the bottom of common bile duct.Result Of the two patients,all of the three kinds of operation had good curative effects.Conclusions For the patients with common bile duct stones combined with CTPV,we should select appropriate treatments to avoid dissection of bile duct in front of the dilated and tortuous collateral veins during the operation,which is the key to guarantee the safety and success of the operation.EST is the preferred method of the treatment.Open operation with choledochoscopy via cystic duct approach or duodenal papilla incision through distal common bile duct to perform stone extraction also appears to be effective and safe.

Liver transplantation is one of the main treatments for acute and chronic liver failure currently.In recent years,with the lack of donor liver transplantation and the in creasing number of patients,the major donator of liver transplant is brain dead patients.In brain-dead state,organ functions de cline gradually.Changes in hemodynamics and immunity could lead to inflammation and alter hormone release.Organ survival and patients'prognosis can be unpredictable.The study of the above phenomenal mechanisms is still at an early stage.This article summarized the current liver transplant treatments by explai ning the pathophysiology of donor organ damage and reviewing the prognosis.The aim of this article was to provide a perspective for future study on this topic.

Objective To evaluate the viability of Cryptococcus in cerebrospinal fluid of patients with cryptococcal meningitis.Methods Electron microscopy,animal inocul ation and neutral red staining of the cere-brospinal fluid specimens were empl oyed.Results Transmission electron microscopy r evealed intact cells and budding cells of cryptococcus which appeared frequently during the early treatment.Edema of cytoplasm and d isar-rangement of structure of capsule we re often found during the later thera py.All mice inoculated experimenta lly with the cerebrospinal fluid specimens were positive on direct examination b ut negative in routine culture were i nfected.A definite number of deep blood-red fu ngal cells were observed in many spec imens.Conclusion These findings add a new approach for dynamic studying o f the viability of Cryptococcus in cerebrospinal fluid of patients with Crypto-coccal meningitis and provide an imp ortant parameter for evaluating therapeutic effect.

Polymerase chain reaction(PCR) was used for the first time in China for the diagnosis of cryptococcal meningitis by amplification of specific sequence of the rDNA genes of C.neoformans.All 11 strains of C.neoformans yielded a specific 136 bp fragment but 21 non-C,neoformans strains did not. The sensitivity of the amplification was about 10 cfu.With the aid of the rDNA-PCR,23 of the 23 cere- brospinal fluids (CSF) specimens which had been confirmed C.neoforrnans positive by smear and/or cul- ture were PCR-positive(100%),and 13 of the 14 CSF specimens which had been confirmed C.neofor- mans negative by smear and culture were PCR-negative (93%).The results of the present study suggest that rDNA-PCR is a sensitive and specific method for rapid diagnosis of cryptococcal meningitis.

Objective To evaluate the effect of local resection for the tumor of Vater ampulla. Methods seventeen cases of Vater ampullary tumor were subjected to tumor local resection from November 1987 to December 1998, including 3 adenomas and 14 adenocarcinomas confirmed by pathology. Two methods of excision for the tumor were performed, including through duodenum to perform the tumor local resection in 16 cases, and through common bile duct in 1 case. Results Bile duct infection occurred in 3 cases. There was no death in this series. 12 of the 17 cases (70.6%) had been followed up for 4～61 months, median survival time was twelve months. In three benign cases ,one died with another disease 17 months postoperatively, two still alive well 38 and 7 months after operation respectively. In 14 malignancy, 9 cases (64.3%) had been followed up. Of the 9 cases, 6(66.7%) alived ≥ 12 months, 4 (44.4%) 24 months, two(22.2%) 60 months. Conclusions Local resection of the Vater ampulla tumor has advantages, such as small damage ,less bloodlass, quick recovery and less interference of the body, but it must be performed by rich experienced surgeons. It is suitable for patients with a small benign tumor, or in the high risk patients whose carcinoma showed no invasion or metastasis, and it also can be performed in patients such as those with atypical hyperplasia and suspious malignant tumor.

Objective To compare the effects among 1A29, CsA and their combined use on rejection after liver transplantation and hepatocellular apoptosis in rats. Methods The stable rat model of liver transplantation was established. Rats of the same strain were employed as the control group. The effects of 1A29, CsA and their combined use on rejection after liver transplantation were determined in both groups. Meanwhile, the hepatocellular apoptosis was recorded and evaluated. Results No rejection was found between the rats of the same strain (SDSD), while different levels of rejection was seen between the rats of different strains (WistarSD). Biochemical test showed a significant increase in levels of enzyme spectrum and bile in the blood. An apparent pathological change due to rejection was also observed. CsA of optimal dose (10mg/kg) effectively suppressed the rejection while 1A29 of optimal dose did not. When used alone, CsA of sub-optimal dose had no effect on rejection. On the contrary, the combined use of CsA of sub-optimal dose and 1A29 of optimal dose could significantly inhibit the rejection. There was a marked increase of the hepatocellular apoptosis in the liver graft rejected by the recipient. However, the level of hepatocellular apoptosis showed no remarkable change in the liver graft without rejection due to use of immunosuppressors. Conclusions Hepatocellular apoptosis is closely related to rejection of the liver graft. The apoptosis is not significantly correlated to application of 1A29. The use of 1A29 can result in significant decrease in dose of CsA. Using 1A29 alone can not effectively inhibit the rejection after liver transplantation.