Pancreaticoduodenal anastomotic dehiscence complicated with peritoneal hemorrhage following pancreaticoduodenectomy is a serious complication which threatens patients'life.Prevention and mangement of pancreaticoduodenal anastomotic dehiscence and peritoneal hemorrhage is the focus in the surgical treatment.Operation is the most reliable treatment for bleeding.While reoperation is difficult for most surgeons and the risk of fistula and rebleeding after reoperation exist.Some procedures will affect the endocrine and exocrine function of pancreas.We applied pancreaticojejunal bridge drainage for most patients with hemorrhage after pancreaticoduodenectomy.This procedure is easy,safe,and can protect the pancreatic function.

Objective To summarize the experiences of middle pancreatectomy. Methods Eleven female and 4 male with a mean age of 49.4 years (23.8-73.1 years) who underwent middle pancreatectomy from January 2001 to October 2005 were collected. Eight patients with neuroendocrine tumor (non-function of 5 cases), 5 with serous cystadenomas and 2 with mucinous cystadenomas were included. The proximal apical end of pancreas was sutured, while distal end of pancreas was anastomosed to a Roux-en-Y jejunal loop. Results Mean operative time was 275 min (179-370 min), mean length of resected pancreas was 45 mm (30-60 mm) and max diameter of tumor was 23 mm (15-40 mm). Complication after operation was pancreatic fistula 4 cases (26.7%), in which 3 cases (20.0%) had intraabdominal blood. The mean time of follow-up was 23 months (3 months-5 years). one patient was died of multiple organs failure for pulmonary infections in month 3 after operation, and the others were alive without novo-diabetes. Conclusion Middle pancreatectomy is an effective operation for benign and borderline tumors of neck and body of pancreas without a significant increase of postoperative morbidity.

Objective To review the experience in perioperalive management of 324 consecutive cases of pancreatico-duodenectomy(PD).Methods The clinical data of 324 cases of PD were analyzed retrospectively.All underwent PD successfully,275 cases received the standard PD,while,49 cases had pylorus preserving PD.Digestive tract reconstruction was done by Child method.Pancreatointestinal anastomosis was performed by pancreas stump intussussception in 303 cases,and end-to-side anastomosis in 21 cases.Results The 30 day mortality rate was 0.3%(1/324).Complicalion rate was 8.0%,included one case of liver dysfunction,7 cases with pancreatic fistula and intraabdomind bleeding,1 case of stenosis of pancreaticoenteral anastomosis,3 cases with pancreatic dysfunction,4 cases with gastroenteral anastomosis ulcer,6 cases with delayed gastric emptying,1 with reflux of bile and 3 with lymphatic fistula.Conclusions Perioperative managemen for pancreaticoduodenectomy is crucial for patient prognosis.Carful perioperative management can decrease postoperative complications and ensure smooth recover of these patients.

Objective To investigate the therapeutic time window and the dose response effects of epirubicin on the expression of c-FLIP in breast cancer.Methods MCF-7and MDA-MB-231 breast cancer cells were divided into two groups: epirubicin groups were treated with 4.0,2.0,1.0,0.5 and 0.25mg/L of epirubicin,and control groups were treated with 0.9% sodium chloride solution at the same dose.After treatment for 24,48 and 72 h,the incubated cells were collected for the measurement of c-FLIP by RT-PCR,and for examination of percent of apoptosis cells with flow cytometry.ResultsA dose-time-dependent pattern was observed.The expression of c-FLIP in MCF-7and MDA-MB-231 breast cancer cell lines declined gradually as the epirubicin concentration increased and treatment time was prolonged.Percentage of apoptosis breast cancer cells increased gradually as the epirubicin concentration was increased and treatment time was prolonged,and percentage of apoptosis cells was the highest when breast cancer cells were treated with 2 mg/L epirubicin for 72 h.ConclusionsEpirubicin can promote apoptosis of breast cancer cells by inhibiting the expression of c-FLIP,and its inhibitory effect is most pronounced when breast cancer cells are treated with 2 mg/L epirubicin for 72 h.

Objective To explore the therapeutic modalities and clinical characters of acute pancreatitis (AP) in the middle or late stage of pregnancy.Methods There were 26 cases of AP in the middle or late stage of pregnancy, among which 18 cases (69.2 %) received conservative therapy, and 8 cases (30.8 %) underwent operation for removal of necrotic tissue and termination of pregnancy.Results Two cases of both fetus and mother death occurred, whereas 24 mothers were cured. 15 (57.7 %) fetuses were healthy but 11(42.3 %) died.Conclusions The women in middle and late stage of pregnancy are inclined to pancreatitis because of hormonal changes, especially in those with history of cholecystitis and cholelithiasis. The main method of management is active non-operative therapy and surgical intervention when necessary, so as to decrease the tragedy of both maternal and fetal death.

BACKGROUND: A better understanding of medical students' attitude towards living liver donation in China would be of importance significance in the development of organ transplantation. OBJECTIVE: To investigate the medical students' attitude toward living liver donation in China and to analyze the factors that affect such an attitude.METHODS: A random sample of 250 medical students was taken and stratified by grades with 50 students in each grade. The attitude was evaluated by a modified psychosocial questionnaire from Spain. The questionnaire was completed anonymously and was self-administered. A bivariate analysis including the Student's t test and the Chi-square test was performed using SPSS software. RESULTS AND CONCLUSION: The questionnaire completion rate was 97.2% (n=243) for the medical students. Among the respondents, only 13.2% (n=32) of them were in favor of unrelated living liver donation. Another 66.3% (n=161) were only in favor if the donation was for a relative. Of the rest, 6.6% (n=16) did not agree with living liver donation, and the remaining 14.0% (n=34) were undecided. The factors related to this attitude were the decision of donating the organs of a family member (P=0.002), attitude toward deceased donation (P=0.000), a willingness to receive a donated living liver organ if one were needed (P=0.000), attitude toward living kidney donation (P=0.000). The medical students have a favorable attitude toward living liver donation in China. The students' attitude toward other types of organ donation and the willingness to accept living donated liver influence their attitude toward living liver donation. There is a great lack of education about the organ donation and transplantation for the medical students in China and more education programs should be incorporated into their traditional curriculum.

Objective To compare the effect of perioperative intravenous injection of Analgecine on the analgesic efficacy and complications of patient-controlled intravenous analgesia ( PCIA ) of different doses of fentsnyl in postoperative lumhotomy patients.Methods 200 patients underweat hmbotomy in general anesthesia were randomly divided into four groups with fifty cases each.Fentanyl 1.0mg in group A,fentanyl 0.5mg in group B,fentanyl 1.0mg in group C,fentanyl 0.5mg in group D.The drugs in each group were diluted to 100ml and infused by pumps.Besides,the patients in group C and D were injected with analgecine 3.6u and 7.2u at the night before the operation,preoperation and postoperation respectively.The visual analog scale(VAS),times of PCA and incidence of side effects were recorded during the period of postoperative 24 hours.Results The VAS of group B at 2h after operation was (5.2 ± 1.9 ) points,which was significandy higher than that of group A,C and D( P ＜ 0.05 ),VAS became similar 4h later( P ＞0.05).The demanding times for supplemental bolus in group B were also significantly higher than that of A,C and D( P ＜ 0.05 ).The incidence of nausea,vomiting,itching,somnolence in group B and D were significantly less than those in group A and C( P ＜0.05 ).No respiratory depression or abnormal bleeding occurred in the four groups.Conclusion Perioperative intravenous injection of analgecine had a better effect on PCIA of fentanyl and could reduce fentanyl requirement and its side effects in lumbotomy patients.

Objective:To study the expression of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2) in hilar cholangiocarcinoma.To discuss the relationship of MMP-2 and TIMP-2 expression with the metastasis and prognosis of hilar cholangiocarcinoma.Methods:Immunohistochemical S-P method was used in the examination of MMP-2 and TIMP-2 expression in 78 hilar cholangiocarcinoma.The relationships of MMP-2 and TIMP-2 expression with the pathological differentiation,metastasis and prognosis were analyzed.Results:The positive rate of MMP-2 expression was 72% ,and that of TIMP-2 was 76%.According to Ridit analysis,the degree of MMP-2 expression were correlated with the pathologic differentiation and lymph-node metastasis of hilar cholangiocarcinoma.The high expression of MMP-2 existed in the low pathologic differentiation and the high rate of lymph-node metastasis of hilar cholangiocarcinoma.The high expression of TIMP-2 existed in the high pathologic differentiation and the low rate of lymph node metastasis of hilar cholangiocarcinoma. MMP-2 and TIMP-2 expression had a significance correlation(r=0.708,P

Objective The purpose of this study was to discuss the therapies for hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.Methods After three cases of pancreatoduodenectomy,the disruptions of pancreatojejunal stoma resulted in serious pancreatic leakage and the hemorrage in abdominal cavity.During all the second operations,the drainage-tube insertions into the main pancreatic ducts were used to lead the pancreatic juice into the neighboring loop of jejunum.Results Afer the operations,the supportive treatment,continuous irrigation of peritoneal cavity and pancreatic enzyme inhabition were given to the patients of these cases and all of the patients were successfully cured.Conclusions The bridge-crossing internal drainage which inserts drainage-tube into the main pancreatic duct was a convenient and effective therapy and method to rescue the hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.While the patients' lives were saved,their functions of pancreas were preserved and the qualities of life were improved after the operations.

Objective: To explore the clinical significance. Methods: The double-antibody sandwich ELISA technique. Result: The serum interleukin-6(IL-6) levels of patients with cholangiocarcinoma are significantly higher than those in benign biliary disease and normal controls (P<0.05). Conclusion: Serum IL-6 levels of patients with cholangiocarcinoma are significantly increased ,it is one of the important parameters for clinical evaluation in patients of cholangiocarcinoma.