Ionized calcium is a divalent cation involved in many critical cellular processes,such as regulating intracellular enzyme activity,signal transduction,gland secretion,hormone-receptor bind and activating clotting mechanism,but ionized hypocalcaemia is commonly found in critically illness,for instance serious trauma,major operation,sepsis and severe pancreatitis.The article reviews ionized hypocalcaemia with correlation of the prognosis and ill severity of surgical serious patients.

This article analyzes the characteristics of lymph node metastasis in proximal advanced gastric cancer,in order to guide the extent of stomach resection (proximal or total gastrectomy) and the resection of spleen or splenic preservation. The metastasis of lymph node in proximal advanced gastric cancer has certain characteristics, which can provide a significant guidance for lymphadenectomy. Total gastrectomy plus splenectomy is a feasible radical surgery for proximal advanced gastric cancer, because of the requirement of lymphadenectomy.

Forecasting the colorectal cancer prognosis mainly based on the accurate pathological stages,the primary carcinoma infiltrated depth,the cell differentiation degree and the capillaries infiltrated in histology result,and the outcome can be obtained latter 3-7 days after the opemtion.But in traditional lymph node inspection method,identifying the quantity and the anatomy locality of metastasized lymph node normally costs long time,sometimes cannot obtain the result.M addition,to identify the stage of the cancer is a key point to determine the assistant chemotherapy is useful or not,for both doctor and patient,because the excessive treatment and the insufficient treatment are both harmful to the patient.Now overseas has an abvoad study showes that regional lymph node metastasis have something to do with the concentration of(Carcinembryonic,CEA)in the lymph node.The CEA concentration can be obtained simply and directly.So,testing the CEA concentration in lymph node may become a new method in the diagnosis of lymph node metastasis for patients with colorectal cancer.

Procalcitonin is a biomarker to diagnose the extent and severity of systemic bacterial infection.Procalcitonin is applied in diagnosis and treatment of systemic inflammatory response syndrome and severe acute pancreatitis.The article reviews application of procalcitonin in clinical surgery and guides use of anti-bacterial agents.

Tetanus is a potentially fatal but largely preventable disease through immunisation.Despite efforts by the World Health Organization to eradicate the disease,tetanus(particularly severe tetanus)remains a worldwide cause of morbidity and mortality.Timely diagnosis and appropriate intensive care management are essential to ensure survival.Recently,with progress in the treatment of severe tetanus,the mortality has been decreased significantly.

Microalbuminuria is regarded as a reflection of increased capillary permeability associated with the systemic inflammatory response syndrome. It is obversed that many medical diseases such as diabetes,kidney disease and cardiovascular disease may result in microalbuminuria and reported microalbuminuria with correlation of the prognosis of the serious patients. This article reviews ,microalbuminuria with correlation of the prognosis of the serious patients, the value of predicting illness severity in the serious patients.

Objective:To study the perioperative anticoagulant therapy for patients in prevention of moderate or high risk of pulmonary embolism(PE)after general surgery.Method:1146 patients who had undergone major general surgery were divided into a non-anticoagulant therapy group and an anticoagulant therapy group.There were 743 patients without the anticoagulant therapy during Jan.2005 to Aug.2008,a preventive anticoagulant therapy was performed on 403 patients who recived 5 000IU(142 patients at moderate risk of PE)or 10 000IU(261 patients at high risk of PE)low molecular weight heparin(LWMH)subcutaneous injection after major general surgery during Jan.2006 to Nov.2008.Result: Five cases died and 2 survived among 7 PE patients.Hemorrhage occurred in 3 out of 403 cases(0.7%),but no PE occurred among 403 patients administered with the LWMH anticoagulant therapy.The incidence of PE in the patients reciving LWMH decreased from 0.9%to 0(P

The treatment strategy for infected acute necrotizing pancreatitis is that enables recovery but at the same time limits the morbidity and mortality.The current gold standard remains open necrosectomy.Recent literature contains scattered reports of percutaneous drainage,endoscopic,and laparoscopic approaches to managing patients with this condition.This review addresses the role of minimally invasive approaches and treatment strategy in patients with infected acute necrotizing pancreatitis.

Objective In this study we reported our experiences for patients with unresectable advanced hilar cholangiocarcinoma by intracavitary irradiation therapy and discussed some problemsin practice.Method 15 cases with unresectable advanced hilar cholangiocarcinoma were treated with laparotomy and operative dilatation of malignant stenosis and cathetenizing and then followed by intracavitary irradiation therapy.Result 15 cases treated by intracavitary irradiation therapy diedfrom liver function failure with biliary cirrhosis 3～18 months (average 8 months) later. None of the case died from cancer dissemination. Conclusion The patients with advanced holar cholangiocarcinoma could well tolerant of the intracavitary irradiation therapy, but they deteriolated from biliary cirrhosis about 8 months later,not from tumor dissemination.

Objective To sum up the experience of diagnosis and management of postoperative abdominal bile collection of biliary fluid .Methods Analysis of 36 cases admitted in our department with postoperative abdominal biliary fluid collection were studied and treated in our department.Clinically,these cases can be divided into three groups according to their manisfestation,including asymptomatic cases,acute diffuse peritonitis and cases with obscure clinical course.The clinical feature and morbidities of these three groups were compared.Result The morbidities of cases detected collections of biliary fluid and managed in time were significant lower than that of the cases detected and managed out of time.Conclusions Clinically postoperative collection of abdominal biliary fluid might be divided into asymptomatic cases,acute diffuse peritonitis and cases with obscure course by us,it is for the sake of early diagnosis and immediate management.The diagnosis in time and immedate aspiration or drainage will save the patient from adverse morbidities.