Objective To observe the incidence of residual gallbladder in patients undergone cholecystectomy through laparotomy (OC),mini-incision laparotomy cholecystectomy (MC) or laparoscopic cholecystectomy (LC),and to explore the causes,diagnosis,prevention and treatment of residual gallbladder.Methods The clinical data of 241 patients undergone laparotomy cholecystectomy (OC group),231 patients undergone mini-incision laparotomy cholecystectomy (MC group) and 290 patients undergone laparoscopic cholecystectomy (LC group) were retrospectively analyzed,and the incidence of residual gallbladder was compared among the three groups.Results Residual gallbladder was found in 32 patients after the surgical procedures,with 4 in OC group (1.7%),13 in MC group (5.6%) and 15 in LC group (5.2%),respectively.Statistical analysis showed that the incidence of residual gallbladder was lower in OC group than in MC and LC group (P0.05).Multivariate analysis showed that severity of inflammation before the operation,operative methods and operator's experience were correlated with the incidence of residual gallbladder.All the 32 cases were diagnosed by ultrasonography,computed tomography (CT),magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP).24 patients were cured with surgical procedure,and the symptoms disappeared during a follow-up period of 6 months to 9 years;other 8 cases were treated with conservative management and the results were unsatisfactory.The pathological examination showed no tumor or malignant change in the excised specimen.Conclusions Residual gallbladder is not a negligible complication of cholecystectomy.Effective control of inflammation of the gallbladder,selection of a proper time and procedure of operation,and the operation done by an experienced surgeon can reduce the incidence of residual gallbladder,and reoperation is the effective treatment for it.

Objective To discuss the technique and clinical value of laparoscopic splenectomy (LS) without using Endo-GIA combined with pericardial devascularization for the treatment of cirrhotic portal hypertension. Methods From March 2005 to October 2006, 23 patients with cirrhotic portal hypertension-induced lower esophageal varices were treated with LS combined with pericardial devascularization. In 18 of the cases, the spleen was resected by disconnection of the secondary splenic pedicle without using endo-GIA. During the operation, the splenic vessels were separated and disconnected by using absorbable clip or ligation respectively. And then the lesser omentum was cut using ultrasonic knife, and the pericardial varices devascularization was performed using the absorbable clips or ultrasonic knife. Finally, the spleen was placed into a bag, broken into small pieces, and removed from an enlarged trocar hole. Results The operation was completed successfully in the 18 cases. The mean operation time was 255 min (range,180-320 min). The mean intraoperative blood loss was 450 ml (range, 200-1600 ml). After the operation, 2 patients developed plural effusion, 1 had subphrenic abscess, and 2 had mild ascites. The subphrenic abscess was cure by ultrasonography-guided puncture. The mean hospitalization was 7.5 days (range 6 to 17 days). No mortality occurred. All the patients were followed up for an averge of 16.4 months (range 5 to 24 months). No patient died after the operation. The mean hospital stay was 7.5 days (6-17 days). The cases were followed up for 5-24 months (mean, 16.4 months). One patient developed rebleeding 20 months after the operation, and was cured by injecting sclerosing agent under a gastroscope. The other 17 cases had no hemorrhage after the operation.Conclusions It is a low-cost and superior method to disconnect the secondary splenic pedicle without using endo-GIA in LS combined with pericardial devascularization for the treatment of cirrhotic portal hypertension.

Pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation is rarely seen.The clinical symptoms of this disease are unspecific.Combination of X-ray radiography,computed tomography and gastroscopy could make definite diagnosis.Differential diagnosis between pylorus obstruction and peptic ulcer,gastric cancer and duodenal obstruction should be done before operation.On April 13,2012,a patient with pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation was treated at the Second Hospital of Jiaxing,the imaging characteristics of the disease were summarized to provide referrence for the diagnosis and treatment of this disease.

Superior mesenteric vein (SMV) thrombosis is a relatively rare disease. Most patients may be successfully treated with anti-coagulation alone. However, bowel stricture may develop due to intestinal ischemia which may require surgical treatment. This report describes a rare case of small bowel stricture occurring one month after successful treatment of SMV thrombosis. After segmental resection of strictured bowel, the patient's post-operative course was uneventful.

Objective To analyze risk factor of bile duct injury (BDI) during laparoscopic cholecystectomy (LC). Methods A retrospective population-based cohort study was carried out on 13878 patients undergoing LC from Apr 1994 to Dec 2003. Patients were divided into BDI group and non-BDI group. Factors with statistically significant differences between groups in anivariable analysis were selected to construct a multivariate logistic regression mode. Result Among 13878 LC procedures 38 BDI (0.27%) were identified. Factors which were of significant differences between groups in anivariable analysis includ diameter of common bile duct(?~2=5.92, P

Objective To investigate the variation of the thioredoxin system (Trx),and the role of it in transient out-ward potassium current (Ito) channels in left ventricular myocytes of diabetes mellitus (DM) in rats. Methods Forty-five SD rats were divided into DM group and control group. DM group were treated with streptozotocin (STZ) to induce DM model. The values of left ventricular end diastolic diameter (LVEDD), end-systolic diameter (LVESD), fractional shortening (LVFS), ejection fraction (LVEF) and heart rate (HR), QRS duration and corrected QT (QTc) interval were detected by echocardiogra-phy (UCG) and electrocardiogram (ECG) in two groups. The left ventricular myocardial tissue samples were taken to detect the Trx,glutaredoxin (GRX),thioredoxin reductase (TrxR) and glutathione reductase (GR) by using UV spectrophotometer. The level of free thiol (P-SH) of total cardiac protein was detected by 5, 5′-dithio-bis-2-nitrobenzoic acid method. Ito of the cardiomyocytes was recorded by whole-cell patch-clamp method. After being incubated in vitro with insulin(Ins), treated with TrxR inhibitor-auranofin(AF) and 13-cis-retinoic acid(RA), the changes of Ito of the cardiomyocytes were observed. Results Compared with control group, the values of heart rate (HR), left ventricular minor axis decurtaion rate (LVFS), left ventricular ejection fraction (LVEF) and TrxR were lower in DM group. The values of LVEDD, LVESD, QRS and QTc inter-vals, Trx, Grx and P-SH were higher in DM group than those of control group. Ito density was significantly higher in DM+Ins group than that of DM group, Ins+RA group and Ins+AF group when the stimulation voltage ≥ 0 mV (P ＜ 0.05). Conclusion The impaired Trx system in diabetic rat myocardium was the electrophysiological basis of the reduced ventric-ular function and arrhythmia. And Ins was able to reverse the decreased Ito of cardiomyocytes in DM rats.

Superior mesenteric vein (SMV) thrombosis is a relatively rare disease.Most patients may be successfully treated with anti-coagulation alone.However,bowel stricture may develop due to intestinal ischemia which may require surgical treatment.This report describes a rare case of small bowel stricture occurring one month after successful treatment of SMV thrombosis.After segmental resection of strictured bowel,the patient's post-operative course was uneventful.

Objective:To investigate the clinical characteristics of two Han families with familial vitreous amyloidosis (FVA) and the gene mutation.Methods:A pedigree investigation was performed.Two Han Chinese families with FVA treated in Xiangya Hospital of Central South University from January 2015 to December 2018 were collected.General examination and ophthalmic examination were performed among 112 members of the two families.Peripheral blood samples were collected from 32 family members (15 patients in MZ001 pedigree, 7 patients in MZ002 pedigree, and 5 persons with normal clinical phenotype from each pedigree) for DNA extraction, polymerase chain reaction (PCR) amplification, transthyretin ( TTR) gene screening and sequencing.Vitreous biopsy following three-channel 23-gauge pars plana vitrectomy was performed on the two probands in the two families.Vitreous specimens were sent for pathological examination.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Xiangya Hospital of Central South University (No.201412463), and written informed consent was obtained from all subjects before any medical examination. Results:In MZ001, there were 15 cases of the 63 members presented bilateral vitreous opacity at an average age of (43.6±5.8) years.No lesion was found in nervous system, cardiovascular system, kidney or liver in general inspection.The vitreous of the proband (Ⅲ13) was so sticky that could not be totally removed during vitrectomy.The vitreous specimen showed positive Congo red staining.Ⅲ13 had elevated intraocular pressure after vitrectomy and was diagnosed as open-angle glaucoma.Gene sequencing revealed Gly83Arg mutation in the exon 3 of TTR gene.In MZ002, 7 cases of 49 members had bilateral vitreous opacity at an average age of (50.4±5.5) years, among which, 3 cases appeared symptoms of limb numbness and decreased muscle strength.The vitreous body of the proband (Ⅱ11) in MZ002 pedigree was looser and easier to remove during vitrectomy than that of Ⅲ13 in MZ001 pedigree.Vitreous specimen of Ⅱ11 was positive with Congo red staining.Gene sequencing revealed an Ala36Pro variant in the exon 3 of TTR gene. Conclusions:Gly83Arg or Ala36Pro mutation of TTR gene can cause FVA.Different mutations can lead to different clinical phenotypes such as age of onset, clinical symptoms and complications of other systems.

Objective:To analyze the clinicopathological characteristics, diagnosis and prognosis of meningioangiomatosis (MA), and to investige the possible origion of spindle cells.Methods:Seventeen cases of MA were collected at Xuanwu Hospital of Capital Medical University and the First Affiliated Hospital of Fujian Medical University, from June 2012 to March 2020. The clinical manifestations, radiologic, histopathologic, immunohistochemical features and patients′ outcome were analyzed. The presumed origin of spindle cells was evaluated by immunohistochemical staining.Results:Of the 17 patients, 9 were males and 8 were females. The age ranged from 3 to 56 years old. Thirteen patients presented with seizure as the initial symptom. The lesions were solitary and located in the cerebral cortex. Histopathologically, there were proliferation of small blood vessels and perivascular spindle cells in the cerebral cortex. The spindle cells had no obvious atypia, mitoses and necrosis. Four cases were combined with transitional meningioma. Immunohistochemically, the proliferative perivascular spindle cells were positive for vimentin in all cases, and focally positive for EMA and SSTR2. Ki-67 proliferation index was low. Neurofibrillary tangles were demonstrated by AT8. All 17 patients received surgical treatment and were followed up for one to 93 months. None had seizure attacks or tumor recurrence.Conclusions:MA is a rare slow-growing intracranial lesion, and the perivascular spindle cells could be derived from meningothelial cells, and MA is often associated with degeneration of the cerebral cortex and meningioma. The patients have good prognosis after surgical treatment.

Objective:To investigate the clinicopathological features of central nervous system (CNS) mesenchymal chondrosarcoma (MCS).Methods:Nine cases of CNS MCS were collected at the First Affiliated Hospital of Fujian Medical University from September 2010 to September 2020. The clinical,imaging,histopathological and immunohistochemical features were reviewed. NCOA2 gene rearrangement was evaluated by fluorescence in situ hybridization (FISH).Results:There were three male and six female patients, with age range of 1 to 59 years (median 31 years). Six cases were intracranial and three cases were intraspinal, and the tumors showed dural attachment. They were often diagnosed as meningioma basing on preoperative imaging. Microscopically, the tumors showed a characteristic biphasic histologic pattern composed of undifferentiated mesenchymal small cells and well-differentiated hyaline cartilage islands. The small cells area were positive for SOX9 (9/9), CD99 (8/9), and without BRG1 and INI1 deletion. The cartilaginous component expressed SOX9 (9/9) and S-100 protein (8/9). NCOA2 gene break apart signal was identified in five cases (5/5). Eight patients were followed up for 4-124 months. Three patients (3/8) had recurrences within one year and two patients died of the tumor.Conclusions:CNS MCS is an extremely rare malignant neoplasm with a propensity to dural involvement. Preoperative imaging has low diagnostic accuracy. CNS MCS should be differentiated from other CNS small round cell tumors and chondrosarcoma. FISH detection of NCOA2 gene rearrangement will assist the diagnosis of MCS.