Objective To compare the therapeutic effect of laparoscopic radical cystectomy with orthotopic ileal neobladder (LRC-INB) vs open radical cystectomy (ORC-INB). Methods A total of 81 patients were evaluated including 33 undergoing LRC-INB (group A) and 48,ORC-INB (group B) from June 1994 to September 2004 at our institution.The parameters for analysis included operative time,surgical method,blood loss,therapeutic effect,complications and hospital stay.Statistics included t-test and chi-square analysis (P

Cholecystocholedocholithiasis is a common disease. The traditional treatment is open surgery which has its inherent invasiveness and slow recovery. The advent of laparoscopic and endoscopic techniques change surgery in many ways. Laparoscopic cholecystectomy is now the gold standard for cholecystitis, while endoscopic procedure is a treatment of choice for choledocholithiasis. To combine them as a laparoendoscopic rendezvous procedure treats cholecystitis and choledocholithiasis in a single stage, and results in a safe, effective and minimal invasive procedure.

Objective To present the initial experience and results of the laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder. Methods Fifteen patients (14 men and 1 women) with invasive bladder carcinoma underwent LRC with orthotopic ileal neobladder.The mean age was 59.5 years(range,39 to 71 years).The LRC with orthotopic ileal neobladder consists of 3 major steps,namely laparoscopic cystectomy,extracorporeal formation of ileal pouch and laparoscopic urethra-pouch anastomosis.With 5 trocars,the surgeon conducted the procedure through the 2 ports on the left side,and the assistants did so on the right side and hold the laparoscope.The bilateral pelvic lymphadenectomy were performed first.The ureters were dissected just outside the bladder.The radical cystoprostatectomy was performed for the male patients.The total bladder, uterus and appendage were removed for the female patient.A 4 to 5 cm median incision in lower abdomen was made to remove the surgical specimens and construct the ileal pouch.A 50 cm ileal loop was taken from the abdominal cavity,isolated,detubularized and reconfigured into “M” shaped pouch with running suture.The anti-refluxing ureter implantation was performed by inserting the 1 cm of ureter into the pouch and suturing them.For the first 4 cases,the urethra-neobaldder anastomosis was completed through the abdominal incision;while for the other 11 cases,the anastomosis was done under the laparoscope. Results The mean duration of surgery was 5 to 10 h with a mean of 6.5 h;the blood loss was 200 to 1000 ml with a mean of 387 ml.During a follow-up of 1 to 11 months,all patients were alive and asymptomatic with normal upper tracts and had no evidence of local recurrence or metastasis.4 to 6 weeks after surgery,all the patients with orthotopic ileal bladder had complete daytime continence,and nocturnal continence was achieved with 2 to 3 times voiding at night. Conclusions This procedure combines the advantages of minimally invasive laparoscopy with the speediness of open surgery.The laparoscopic cystoprostactomy has a magnified clear vision,which makes meticulous manipulation possible,and reduces bleeding,sphincter injury and nerve bundle injury.Shorter time of intestine exposure during the procedure is good for recovery of intestinal function and for reducing postoperative intestinal adhesion.External construction of ileal pouch shortens operation time remarkably.Ileal segment has long and mobile mesentery,thereby can be easily taken out through a small abdomen incision and anastomosed with urethra stump without tension,so it is more suitable for construction of a pouch.

Objective To evaluate the outcomes of M-shaped orthotopic ileal neobladder. Methods A total of 42 male patients with malignant bladder tumors underwent M-shaped orthotopic ileal neobladder after extraperitoneal total cystoprostatectomy.A segment of 45 to 50cm ileal loop was isolated,detubularized,and reconfigured in “M”- shape to form a pouch.Bilateral ureters were reimplanted by means of inserting the 1 cm distal segment into the pouch.The bottom of pouch was opened and anastomosed with the urethra. Results The 42 patients were followed up for 12 to 96 months with a mean of 44 months.38 cases(90.5%) were well continent during daytime,and 36 cases(85.7%) were continent at night.The volume of the pouch was (361?48)ml at 12 months postoperatively. Urodynamic examination showed that the peak voiding pressure was (86.8?21.4)cm H 2O(1 cm H 2O=0.098 kPa).The maximum flow rate (Q max ) was(18.4?6.1)ml/s.No remarkable ureter reflux and obstruction were found.No patient was detected to develop recurrent urethral carcinoma. Conclusions Extraperitoneal cystectomy can prevent the abdomen from tumor contamination and protect the operative field from intestine interference.The ureter-inserting reimplantation technique is a simple anti-reflux anastomosis with lower rate of ureteral stenosis.Isolating the neobladder and ureters from the peritoneal cavity can reduce the postoperative complications of adhesive ileus,internal hernia,and urine leakage to peritoneal cavity.The neobladder is similar to original bladder in position,volume,shape,and anti-reflux of ureter connection.

Objective To understand the effect of circumcision in reducing high-risk human papilloma virus (HPV) infection in male adults. Methods One hundred and twenty-eight married adults with phimosis who underwent circumcision enrolled in the case group and high-risk HPV of urethral discharge specimens were detected before and 2 years after operation. A total of 128 cases of phimosis without circumcision were recruited in the control group. High-risk HPV infection rates were compared between the two groups. Results The highrisk HPV infection rates in the two groups were comparable at baseline. In the circumcision group, high-risk HPV infection rate was 27. 3% preoperative and it significantly decreased to 12.5% two years after operation( x2 =8. 839 ,P =0. 005). In the control group,high risk HPV infection rate was 28. 1% at baseline and it was 25.0%two years later, with no significant difference (x2 =0.320,P = 0.671).Conclusion Circumcision can significantly reduce high-risk HPV infection. Promoting circumcision actively in our country may have an important role in preventing high-risk HPV infection.

Objective To observe the effect of cervical plexus block combined with cervical vertebra traction treatment of cervical spondylosis of nerve root type .Methods 60 cases of nerve root type cervical spondylosis were divided into two groups by coin tossing:group A(n=32) cervical plexus block combined with cervical traction thera-py, group B( n=28) treated by cervical traction therapy ,according to the severity of pain compared two groups of treatment effect.Results after treatment,20d group 10d,30d,90d pain scores were (4.61 ±0.70)%,(3.71 ± 0.57)%,(3.30 ±0.65)%,(4.44 ±1.04)%,group B respectively (5.88 ±1.47)%,(5.61 ±1.35)%,(4.83 ± 0.86)%,(5.50 ±0.87)%,the difference between two groups was statistically significant (t=5.85,1.06,1.30, 7.51,all P<0.01).Conclusion The cervical plexus block combined with cervical traction for treatment of nerve root type of cervical spondylosis is better than the routine treatment of cervical traction ,which is suitable for promotion of primary health care units .

OBJECTIVE To understand environmental factors which cause nosocomial infection in ICU. METHODS Air sampling adopted by plain board exposure and hand and object appearance by cotton wool method according to Disinfection Technique Regulation published by Ministry of Health. RESULTS From 289 samples, 182 were qualified and pass ratio was 62.98%. Staphylococcus aureus and mixed opportunistic pathogens were the main bacteria on the air and objects. CONCLUSIONS Through monitoring and analyzing environmental factors of ICU nosocomial infection, to control the prevalence and outbreak of ICU nosocomial infection as well as reduce the chance of infection.

[ Objective ] To investigate the therapeutic effect of Chinese herbal medicines, which have the actions of dispersing stagnated liver-Qi and promoting bile secretion, clearing heat and removing damp, activating blood and removing blood-stasis, in the treatment of the third-level or above intrahepatic biliary duct stone. [Methods] After the routine surgical treatment including cholecystectomy, choledochotomy with T-tube drainage and choledochoscope lithotomy, 42 cases of third-level or above intrahepatic biliary duct stone received Dandao Paishi Mixture (DPM, mainly composed of Herba Lysimachiae, Radix Clematidis, Herba Artemisiae Scopariae, Radix Aucklandiae, Rhizoma Curcumae Longae, Radix Curcumae, etc.) for oral use. The effects of DPM on the intrahepatic biliary duct stone were evaluated after treatment. [Results] Before the treatment of DPM, the stones in third-level or above intrahepatic biliary ducts cannot be taken out; after the treatment of DPM, T-tube reverse biliary contrast examination showed that stones were removed in 39 (92.9%) cases, stones still existed in the common bile duct in 3 cases and then were removed by lithotomy through T-tube sinus of the common bile duct with Olympus fiber choledochoscope 8 weeks later. [Conclusion] DPM has good lytholytic and lithagogue effects for the treatment of third-level or above intrahepatic biliary duct stone and for intrahepatic biliary duct incarcerated stone. It can also reduce the postoperative residue of stone and recurrence rate.

The study focused on the therapeutic efficacy of Tibetan medicines on cerebral ischemia. The combined medication methods and administration habits in clinic for more than 10 years were simulated. Three typical Tibetan medicines, i.e., 25-Herb Shanhu pill, Wishful-Treasure pill and 20-Herb Chenxiang pill, were administered to the animal model of permanent middle cerebral artery occlusion in the morning, noon and evening, respectively. On the second day after the final administration, the activity of serum oxidative stress marker SOD and the content of MDA were evaluated. Infarct volumes were quantified through TTC staining. Inflammatory reaction maker NF-kappaB p65 gene and apoptosis. makers Bax and Cyct were selected to study the molecular mechanism of combined herbs with the immunohistochemistry technique. According to the result, the respective combination of 25-Herb Shanhu pill, Wishful-Treasure pill and 20-Herb Chenxiang pill in the morning, noon and evening showed unique advantages in reducing the damage of oxidative stress, infarct volumes, encephaledema caused by ischemia, inflammatory factor aggregation and inhibiting apoptosis, with consistent therapeutic efficacies in clinic.
Animals ; Brain Ischemia ; drug therapy ; metabolism ; Lipid Peroxidation ; Male ; Medicine, Tibetan Traditional ; Rats ; Superoxide Dismutase ; metabolism ; Time Factors ; Transcription Factor RelA ; physiology

Objective To investigate the effects of preventive chemotherapy for hepatocellular carcinoma (HCC) exceeding Milan criteria after liver transplantation. Methods The clinical data of 243 patients who had undergone orthotopic liver transplantation for HCC exceeding Milan criteria from April 2001 to July 2007 were retrospectively analyzed. Of all patients, 162 received preventive chemotherapy after transplantation. Results The 1- and 3-year survival rates and disease-free survival rates were not statistically different between patients who had received chemotherapy (78.5%, 63.7% ; 76.8%, 52.5% ) and those without chemotherapy (56.6%, 39.1%; 69.3%, 64.7% ) (X2 = 3.084, 0.444, P > 0.05). Cox regression analysis demonstrated that postoperative chemotherapy was not an independent factor affecting the survival rates of HCC patients without vascular invasion, but an independent factor affecting the survival rates of HCC patients with vascular invasion. Conclusions Early preventive chemotherapy could obviously increase the survival rate and delay the tumor recurrence of patients with HCC exceeding Milan criteria, especially for HCC patients with vascular invasion.