Objective To explore the technique of laparoscopic reoperation in the treatment of common bile duct stones.Methods A retrospective analysis of the clinical data of 54 cases of common bile duct stones undergoing laparoscopic common bile duct stone surgery in our hospital from January 2011 to December 2015 was conducted.Through the choice of puncture hole, the exposure of the liver surface and the confirmation of the common bile duct, T-tube drainage and primary suture of common bile duct were carried out for the treatment of bile duct stone.Results The laparoscopic operations were successful in 52 cases, while conversions to open surgery were required in 2 cases.During the operation, the amount of bleeding was about 40-150 ml (average, 70 ml), the operation time was 75-180 min (average, 120 min), and the postoperative gastrointestinal function recovery time was 24-48 h (average, 27±13 h).There were 1 case of duodenal perforation injury, 2 cases of bile leakage, and 2 cases of residual stones after operation, which were cured with laparoscopic repair, prolonged drainage time, and choledochoscope treatment via abdominal sinus.Postoperative hospital stay was 6-9 d (average, 7±1.5 d).A total of 54 cases were followed up for 3-24 months (mean, 14.8 months).All the patients recovered well, without bile duct stricture or stone recurrence.Conclusion As long as the application of skilled laparoscopic surgery methods and separation of surgical area skills, laparoscopic bile duct surgery for the treatment of common bile duct stones is safe and feasible.

Objective To evaluate the clinical efficacy and safety of different courses of topical tacrolimus 0.1％ ointment in facial corticosteroid-dependent dermatitis and to observe the rebound in patients after treatment with these regimens.Methods A total of 104 patients with facial corticosteroid-dependent dermatitis were randomly divided into 3 groups to be treated with topical tacrolimus 0.1％ ointment twice daily for 4,8 and 16 weeks respectively.The patients were followed up every 2 weeks within the early 4 weeks of treatment and every 4 weeks thereafter.The rebound phenomena was observed in patients on week 4 after the withdrawal of tacrolimus.Results Finally,90 patients completed this trial,including 32 patients in the 4-week group,29 patients in the 8-week group and 29 patients in the 16-week group.No significant differences were observed between the 4-,8- and 16-week groups in the total reponse rate (75.00％,82.76％,86.21％,respectively,x2 =1.35,P ＞ 0.05).The rebound rate in the 16-week group significantly differed from that in the 4- and 8-week group (20.69％ vs.46.88％ and 41.38％,both P＜ 0.05),while no statistical difference was noted between the 4- and 8-week groups.Local burning and itching were reported in 31.73％ of these patients,and all of these irritant reactions occurred within the first week of treatment.Conclusions Topical tacrolimus 0.1％ ointment is safe and effective for the treatment of facial corticosteroid-dependent dermatitis.The total response rate does not increase with the extended treatment course,and 4 weeks of treatment is enough for the marked and stable improvement of facial corticosteroid-dependent dermatitis,but the rebound rate is likely to be reduced by extended treatment course.

Objective To explore the clinical features of drug hypersensitivity syndrome(DHS). Method Retrospective analysis of 18 cases of DHS was made in detail including clinical situation, laboratory examination, treatment instance,duration and prognosis. Results The earliest symptoms of all patients were skin rash and fever, which occurred in 2 to 8 weeks after the administration of the drugs, accompanied with superficial lymphadenopathy in 13 patients, liver dysfunction in 14 patients, renal impairment in 11 patients, leukocytosis in 13 patients and eosinophilia in 10 patients. The skin lesions were multiform. The common eruption was purpura-like erythemas, accompanied with swelling and repeated desquamation. The suspected drugs were as follows: allopurinol in 11 cases, carbamazepine in 4 cases, phenytoin in 2 cases and minocycline in 1 case. Corticosteroid was the first line of treatment Conclusions DHS is a clinical syndrome to have characteristic symptom and a relatively severe disease. It is crucial to discontinue the suspected drugs promptly and to start sufficient dose of corticosteroid.

Objective To analyze the results of syphilis serology test among inpatients and to provide information for the control of syphilis.Methods Syphilis serology test results of inpatients from Jan.2010 to Nov.2012 in a tertiary general hospital were collected and retrospectively analyzed.The serum samples were screened by Treponema pallidum (TP) antibody enzyme linked immunosorbent assay (ELISA) and syphilis toluidine red unheated serum reagin test (TRUST) simultaneously.The TP-ELISA positive samples were confirmed by Treponema pallidum particle agglutination test (TPPA).Difference of measurement data was compared with analysis of variance.Results A total of 81 946 cases were collected,among which 1618 cases were positive of anti-TP.The positive rate of anti-TP was 2.27％ in the year 2010,1.58％ in 2011,and 2.11％ in 2012.For male and female patients,the positive rates of anti-TP were 2.38％ and 1.69％,respectively (x2 =48.97,P=0.00).The positive rates of anti-TP in the age groups of ≤19 years,20-39 years,40-59 years,60-79 years,and ≥80 years were 2.83％,0.94％,2.14％,2.37％,and 3.63％,respectively.The titer of TRUST was relatively lower in anti-TP positive inpatients.The anti-TP positive patients with TRUST titer ＜ 1∶8 accounted for 84.65％ in the age group of ≤19 years,79.69％ in the 20-39 years group,81.69％ in the 40-59 years group,86.12％ in the 60-79 years group,and 87.45％ in the age group of ≥80 years.The highest anti-TP positive rate (3.63％) was observed in the age group of ≥80 years with the lowest percentage (12.55 ％) of TRUST titer ≥1∶8.The lowest anti-TP positive rate (0.94％) was observed in the 20-39 years group with the highest percentage (20.31％) of TRUST titer ≥1∶8.Conclusions The characteristics of syphilis serological positivity vary depending on genders and ages.The prevention and control measures for syphilis should be strengthened,especially in the senior population.