Acute pancreatitis is one of the most common acute abdominal disease requiring acute hospitalization worldwide.As severe acute pancreatitis associated with mortality up to 30％,rational diagnosis and management requires up-to-date evidence-based treatment guidelines.The Guidelines for the surgical management of acute pancreatitis composed by the International Association of Pancreatology (IAP) was published in 2002,since then there have been substantial improvements in the management of acute pancreatitis.The collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these guidelines using an evidence-based approach in 2013 and published their new guidelines 2013 IAP/APA evidence-based guidelines for the management of acute pancreatitis few months ago.This paper presented the understandings of this new guidelines and compared with related guidelines abroad.

Objective To evaluate the rationale of pancreatoduodenectomy for the treatment of chronic local pancreatitis in the head of pancreas.Methods Eleven patients underwent pancreatoduodenectomy for chronic local pancreatitis in the head of pancreas with 7 cases treated by Whipple′s operation and 4 by pylorus preserving pancreatoduodenectomy.Results Postoperative stress ulcer and wound infection occurred and were cured subsequently in one each.Postoperative follow up showed good quality of life in all the 11 patients.Conclusions Pancreatoduodenectomy is an effective cure for patients suffering from chronic local pancreatitis of the head of the pancreas refractory for conservative therapy.

Objective To investigate how to prevent deep-vein thrombosis(DVT) after total knee replace-ment(TKR).Methods Deep vein thrombosis in 87 patients after TKR from 2004 to 2007 in the Third Hospital Affiliated to Suzhou University was retrospectively analyzed.Results Amony the 87 patients,13 were found having deep vein thrombosis,5 of 38 using low-molecular-weight beparin after TKR having deep vein thrombosis,6 of 35 cases using aspirin after TKR having deep vein thrombosis,5 of the 10 eases using mechanical preventive measures having deep vein thrombosis.The difference between low-molecular-weight heparin and aspirin group was not statistically significant.Conclusion Using low-molecular-weight heparin before TKR can prevent the occurrence of deep-vein thrombosis.Using epidural anesthesia,and a low-molee-ular-weight heparin drugs or aspirin after TKR can better prevent the formation of deep-vein thrombosis.

Objective To investigate the mechanism of acute patella bone cartilage fracture,and further study its diagnosis and treatment of clinical significance.Methods Collecting 21 cases of the acute patella bone cartilage fracture from July 2005 to December 2007.Eleven patients were male and ten were female,with the mean age of 31.6 (16～46) years.All the patients were treated using the arthroseopic microfracture technique after MR examination.Results All patients were followed up 6 to 18 months,did not show patellofemoral joint pain. Evaluated by Tagner rating,excellent outcomes were found in 17 cases,good in 4 cases,satisfactory results in 100% cases.Conclusion The arthroscopic microfracture technique in treatment of the patella cartilage fracture method is simple,easy to operate,can significantly improve knee function and pain,as well as the quality of life.

0. 05). No significant difference was found in maternal and neonatal complications between the ANCA( + ) and ANCA(－) subgroups in S-PE subjects. But those 4 cases who developed renal function insufficiency patients were ANCA( + ). Conclusions ANCA might be associated with renal diseases in preeclampsia women, and further studies is required to determine whether ANCA is involved with the pathogenesis of preeclampsia.

We report a case of a 35-year-old right-handed male patient with drug-resistant mesial temporal lobe epilepsy who developed ipsilateral occipital hematoma after right temporal anterior lobectomy and amygdalohippocampectomy. Patient did not report taking any drugs with anticoagulant effect, such as aspirin or valproate. There was no past history of hypertension and the pre-operation tests were normal. Pre-operative brain magnetic resonance imaging revealed no abnormality in the right occipital lobe. Overdraining of cerebrospinal fluid may have triggered this remote cerebellar hemorrhage.

Objective To evaluate the efficacy of anterolateral decompression and internal fixation on the treatment of old thoracolumbar vertebrae fracture with associated incomplete paraplegia. Method the clinical findings of 26 cases with old thoracolumber vertebrae fracture with associated incomplete paraplegia treated by anterolateral decompression and internal fixing were reviewed retrospectively. Results All cases were followed up for 6 months through 2.5 years. The angle of kyphosis was 23?preoperatively and 6?postoperatively. According to Frankel's grading, there were two cases at grade A, three at grade B, five at grade C, seven at grade D, nine at grade E before operation and one at grade A, three at grade B, four at grade C, six at grade D and 12 at grade E after operation. Conclusion Anterolateral decompression and internal fixation is the treatment of choice for the old thoracolumber vertebrae fracture associated with incomplete paraplegia, especially for spinal deficit generated by displacement of the middle column.

SUMMARY We described 1 case of autoimmune lymphoproliferative syndrome ( ALPS) , first diagnosed in our hospital, and reviewed the recent literature. The 11-month old male patient presented with a histo-ry of splenomegaly and hepatomegaly since 1 month after birth. He suffered recurrent infectious diseases including cytomegalovirus infection, parvovirus B19 infection and chronic diarrhea disease. Besides, his symptoms included hemolytic anemia and thrombocytopenia. The laboratory abnormality indicated an ex-panded population of alpha/beta double-negative T cells (DNTs) (27. 18% of lymphocytes, 35. 16% of CD3 + T lymphocytes) in peripheral blood, and autoantibodies including antinuclear antibody, double-stranded DNA and rheumatic factor were positive. Hyper gamma globulinemia and positive direct Coombs tests were seen in the patient. His parents were both healthy and denied autoimmune diseases. We iden-tified a heterozygous point mutation in exon 3 of the FAS gene carrying c. 309 A>C, resulting in a single base pair substitution in exon 3 of FAS gene which changed the codon of Arg103 to Ser103 . Unfortunate-ly, we were unable to obtain the gene results of the child' s parents. The patient was treated with glu-cocorticoids in our hospital and with mycophenolatemofetil in other hospital. And we were informed that his anemia condition relieved through the telephone follow-up, but he still suffered recurrent infections, hepatomegaly and splenomegaly still existed. As we all know ALPS is characterized by defective lympho-cyte apoptosis, and thus cause lymphoproliferative disease and autoimmune disease, and increase the risk of lymphoma. It is more likely to be misdiagnosed as other diseases. ALPS should be suspected in the case of chronic lymphadenopathy, splenomegaly and autoimmune features. Flow cytometry approach is helpful for the diagnosis. Immunosuppressive drugs are the necessary treatment.

Objective To investigate the significance of procalcitonin (PCT) and C-reactive protein (CRP) in the early diagnosis of sepsis in patients with percutaneous nephrolithotomy (PCNL). Methods One hundred and ninety-eight patients who had underwent PCNL were divided into sepsis group (148 cases) and control group (50 cases). The PCT and CRP 6 h before and after operation were compared between 2 groups, and the receiver operating characteristic curve was drawn. The area under curve (AUC), optimal diagnostic boundary value, susceptibility and specificity were calculated. Results The PCT and CRP before operation in sepsis group were significantly higher than those in control group:(3.911 ± 2.011) ng/L vs. (1.353 ± 0.311) ng/L and (54.85 ± 8.75) g/L vs. (38.65 ± 10.76) g/L, and there were statistical differences (P<0.01). The AUC of PCT was 0.974, and the AUC of CRP was 0.853. The optimal diagnostic boundary value of PCT was > 1.65 ng/L, and the susceptibility and specificity were 97.91% and 91.01%; the optimal diagnostic boundary value of CRP was > 43.54 g/L, and the susceptibility and specificity group were 93.51% and 79.21%. Conclusions For patients with sepsis after PCNL, PCT is more significant than CRP for early diagnosis. PCT detection can be used as an important auxiliary examination for clinical diagnosis of sepsis, which could help clinicians to detect and treat the sepsis early and can greatly improve the survival rate of patients.

OBJECTIVE:To evaluate the rationality of vancomysin use in the hospital where the authors work.METH-ODS:50patients taking vancomysin between May.2005and Nov.2005were studied.The pathogenic examination,monitoring of drug concentration in blood,indices of renal function,combined use of drugs as well as adverse effects in these patients were reviewed and analyzed statistically.RESULTS:On the whole vancomysin use in our hospital was safe.CONCLUSION:Vancomysin use will be made safer by monitoring drug concentration in blood,individualizing drug administration,and timely correcting the aggravating factors of kidney injury.