ObjectiveTo compare the therapeutic result between ERCP and conventional treatment for bile leakage after cholecystectomy.MethodsData of 35 cases with bile leakage after cholecystectomy were retrospectively studied,in which 18 patients underwent conventional therapy and surgery ( conventional group),and 17 others underwent ERCP (endoscopy group).The time of bile leakage closure,complication rate,and re-operation rate of the 2 groups were compared.ResultsIn conventional group,leakage location was identified in 7 cases and mean bile leakage closure time was 23 days.A second operation was performed in 8 cases and complications occurred in 7.In endoscopy gnoup,leakage location was identified in 13 cases and mean bile leakage closure time was 13 days.A second operation was performed in 2 cases and complications occurred in 3.Significant differences were found between 2 groups in regarding of the above references.Conclusion ERCP is accurate and valuable for diagnosis and treatment for bile leakage after cholecystectomy.

BACKGROUND: The observation of vascular endothelial growth factor gene expression of cerebrovascular diseases and ultrastructure of cells may be helpful to understand angiogenesis and its relative cellular factors involved in the pathogenesis at cellular and molecular levels. OBJECTIVE: To investigate the method of culture of human cerebral cap illary endothelial cell by separation of capillary fragment in vitro, and to ob serve vascular endothelial growth factor gene expression and ultrastructure of cells. DESIGN: A randomized controlled research on technique and method. SETTING: The neurosurgery department of a general hospital of a military area command of Chinese PLA and the neurosurgery department of a college hospital. PARTICIPANTS: Eighteen patients with arteriovenous malformation of brain(Spetzler Ⅱ-Ⅲ grade), as confirmed by aortocranial angiography before operation, in the Department of Neurosurgery, General Hospital of Shenyang Military Area Command of Chinese PLA were included. The material was obtained from fresh integrated specimen of arteriovenous malfor mation of brain with surrounding fresh brain tissues during the opera tion. Capillary endothelial cell was separated by homogenate, filtration and enzymatic digestion techniques. Cells grew well in culture flask and were divided into 4 groups(hypoxia state for 2, 4, 8 hours groups and control group). Each group contained four flasks.METHODS: Simulation of anoxia condition: volume faction 0.95 N2 and volume fraction 0.05 CO2. Expression of factor Ⅷ related antigen in cells was detected by immunohistochemistry. mRNA expression of vascular endothelial growth factor on endothelial in every group was observed by RT-PCR, protein content of vascular endothelial growth factor in supernatant detected by enzyme-linked immunoadsordent assay, and cellular ultrastructural change observed by transmission electron microscopy.MAIN OUTCOME MEASURES: mRNA expression of vascular endothelial growth factor on endothelial cell and protein content of vascular endothelial growth factor in supernatant in control group and every hypoxia groups; cellular ultrastructural changes.RESULTS: Under phase contrast microscope, cultured living cells had mono-layer pebble-like typical character. More than 90% of were factor Ⅷrelated antigen(FⅧ-RA) staining positive. mRNA and protein expression of vascular endothelial growth factor in hypoxia 4 hours group was 0.98 ±0. 19,( 180. 77 ± 20. 15) ng/L, which was significantly higher than in control group [0, (26. 20 ± 6.33) ng/L, P ＜ 0.01 ]. Eight hours later, expression decreased [(0. 35 ±0.07), (31.68 ±8.34) ng/L]; swollen mitochondrion, dilated endoplasmic reticulum, and lysosome vesiculation were found.CONCLUSION: Humane cerebral capillary endothelial cell can be cultured by separation of capillary fragment, which is easy to operate and the cellular purity is reliable. In the early stage of ischemia and hypoxia, expression of vascular endothelial growth factor is not enough to maintain cellular ultrastructure integrity. Cells may be injured along with the prolong of hypoxia.Zhao MG, Tang T, Gao YZ, Pu PY, Wei XZ. Culture of human cerebral capillary endothelial by separation of capillary fragment and the observation of vascular endothelial growth factor gene expression and cell ultrastructure. Zhongguo Linchuang Kangfu 2005; 9(21):211-3 (China) [www. zglckf. com]

Objective To investigate the gene expression of vascular endothelial growth factor(VEGF) and ultrastructural changes in cultured endothelial cells from human cerebral microvessels under hypoxic conditions.Methods Human cerebral microvessels were isolated from freshly obtained specimens of normal brain adherent to resected cerebral arteriovenous malformations.The expression of factor Ⅷ-relative antigen(FⅧ-RA) in cultured cells was observed with immunocytochemistry.The level of VEGFmRNA in cells and released VEGF protein in cell supernatant were determined by RT-PCR analysis and ELISA respectively when they were exposed to hypoxic conditions(95% N_2,5% CO_2;two hours,four hours,eight hours) or maintained in basal condition.Ultrastructural changes in cells were also observed by electron microscopy.Results In inverted microscope the cultured cells showed contact inhibition and a rounded cobblestone appearance.More than 90% of them were stained strongly with antibodies against FⅧ-RA.Significant VEGF mRNA and protein accumulated when these cells were exposed to hypoxia for 4 hours.However,their VEGF expression was down-regulated after hypoxia for 8 hours and a number of vesicles and swollen mitochondria were present in the cytoplasm.Conclusion The level of VEGF expression may havesignificant relationship with ultrastructural changes in human cerebral endothelial cells under hypoxic conditions.

AIM:Long bone growth plate injury induced by wound and infection may cause limb reduction or angular deformity. Tissue engineering provides a promising treatment of growth plate injuries. In this study,we investigated the feasibility of establishing tissue-engineered growth-plate by allograft demineralized bone matrix(DBM) co-cultured with rabbit iliac growth-plate cells. METHODS:The experiment was performed at Department of Orthopaedics,Fourth Military Medical University of Chinese PLA from June 2005 to June 2006. ①Two 3-week-old New Zealand rabbits irrespective of gender(clean grade,2.0-2.5 kg) were selected. Growth plate cells were harvested from iliac crest epiphyseal cartilage of the rabbits by dissection and digestion with type Ⅱ collagenase. The third passage cells cultured were collected and incubated on allograft demineralized bone matrix. ② Histology,immunohistochemical staining and electronic scanning microscope(SEM) examinations were performed to observe cell growth on DBM 24 hours,7,14 and 21 days after culture. RESULTS:①Growth plate chondrocytes exhibited polygonal in monolayer culture,and immunohistochemical staining for type Ⅱ collagen was positive. ②SEM examination showed that twenty-four hours after coculture,the cells adhered to DBM scaffolds;Seven days after culture,the growth-plate chondrocytes rapidly proliferated and began to secret extracellular matrix;cells covered the whole scaffold and became overlapped on the 21st day. ③HE staining showed after 14 days of culture,growth plate cells adhered DBM scaffold in spherical shape with abundant cytoplasm. CONCLUSION:Tissue-engineered growth-plate is successfully constructed by allograft mineralized bone matrix co-cultured with rabbit iliac growth-plate cells.

Objective To compare the effect of difierent combinatio of mannitol, furesemide and albumin in reducing intracranial pressure in 451 patients with severe traumatic brain injury (sTBI). Methods A total of 451 patients with an admissiou Glasgow Coma Scale of or less from 5 medical centers were randomly divided into 5 groups, ie, Group A(250 ml 20% mannitol each time as control), Group B(125 ml 20% mannitol each time), Group C(alternate use of 250 ml 20% mannitol each time or 40 mg furosemide), Group D(alternate use of 125 ml 20% mannitol each time and 20 mg furosemide)and Group E(alternate use of 125 ml 20% mannitol and moderate or large dose of albumin). We monitored intracraniai pressure continuously and observed the changes of intracranial pressure, electrolytes, hemato-crit and renal function after use of 5 combinations of mannitol. Furosemide and albumin. Results Man-nitol and furosemide could independently reduce intracranial pressure after 1-3 hours (P<0. 05). Semis mannitol plus furosemide or albumin could more signifieantly reduce intracranial pressure, with statistical difference compared with full dose of mannitol. Semis mannitol and alternate use of mannitol and furose-mide in aspect of intracranial pressure reduction and persistence time(P<0. 05). Alternate use of man-nitol and furosemide begot higher incidence rate of electrolyte abnormality, compared with the other com-binations (P<0. 05). Rebound rate of intracranial pressure was higher in full dose of mannitol than other combinations (P<0. 05). Incidence of renal function abnormality was higher in combination involved al-bumin than alternative use of mannitol and furosemide as well as combination of semis mannitol and furo-semide (P<0. 05). Abnormality of electrolyte and renal function wag reversible. Conclusion The use of 125 ml 20% mannitol each time plus 20 mg furesemide is more reasonable than other combina-tions. Meanwhile, semis mannitol combined with moderate or large dose of albumin has certain advantages too.

Objective To discuss the effect of hemodilution on brain tissue oxygen pressure and prognosis in patients with severe craniocerebral trauma. Methods A total of 42 cases of severe craniocerebral trauma were randomized divided into two groups, ie, control group and treatment group, to observe the changes of brain tissue oxygen pressure ( PbtO2 ) , hematocrit (HCT) and 6-month Glasgow outcome scale (COS) after injury. Then, PbtO2, HCT and GOS were compared between two groups. Restilts ( 1 ) There was a positive correlation between PbtO2 and HCT when HCT was lower than 0.25( r =0. 732 ,P ＜0. 001 ) in the treatment group; while a negative correlation was found between PbtO2 and HCT when HCT was higher than 0.25(r = - 0. 698 ,P＜0. 001 ). (2) Compared with control group, the index of brain tissue oxygen in treatment group was obviously higher ( t = 2.27, P = 0. 029 ) , with better prognosis (X2= 5.09, P ＜ 0.05 ). Conclusion Hemodilution can significantly increase brain tissue oxygen supply and improve the prognosis of cases of severe craniocerebral trauma.

In order to investigate the susceptible factors of posttraumatic epilepsy (PTE) and the surgical treatment, the relative factors of 18 cases of intractable PTE and 35 cases of non-PTE patients with posttraumatic seizures (PTS) and the surgical treatment of PTE patients were studied retrospectively. The results showed that there was significant difference in the degree of unconsciousness after head injury, incidence of intracerebral hematoma and acute subdural hematoma between PTE group and non-PTE group. Of the 18 cases of PTE undergoing surgical treatment, the effectiveness of 11 cases was satisfactory and that of the remaining 7 was not. Between the two groups, there was difference in the localization of interictal epileptic discharge (IED) and ictal discharge (ID) as demonstrated by preoperative EEG. It was concluded that PTE was associated with the severity of head injury and intracranial hematoma. The localization of epileptogenic loci by preoperative EEG presumably contributed to the PTE surgical effects.
Adolescent ; Adult ; Aged ; Brain Injuries ; complications ; Child ; Electroencephalography ; Epilepsy ; etiology ; surgery ; Female ; Humans ; Intracranial Hemorrhage, Traumatic ; complications ; Male ; Middle Aged ; Retrospective Studies ; Tomography, Emission-Computed, Single-Photon ; Treatment Outcome

Objective To investigate the efficacy of sequential ERCP and laparoscopy for acute biliary pancreatitis (ABP).Methods A total of 80 patients with ABP were randomly divided into 2 groups to receive sequential ERCP and laparoscopy (observation group,n=40) or traditional surgery (control group,n=40).Clinical data including abdominal pain relief time,recovery time of white blood cell,blood amylase and liver function,hospital stay,complication rate and mortality were analyzed.Results ERCP failed in 1 patient in observation group,and the remaining 39 patients (97.5％) were recruited into the study.There were significant differences between 2 groups in regarding of abdominal pain relief time (7.7±2.7 d vs.11.4±3.7 d),recovery time of white blood cell ( 9.7±2.6 d vs.13.3±3.9 d ),blood amylase ( 8.2±2.1 d vs.12.5±3.3 d ),liver function ( 12.5±5.1 d vs.21.3±6.5 d ),hospital stay ( 16.1±5.1 d vs.23.3±7.6 d ) and rate of complication ( 12.8％ vs.30.0％ ).There was no significant difference in morbidity between 2 groups (5.1％ vs.7.5％).Conclusion Sequential ERCP and laparoscopy is effective for ABP.

Objective To analyze the clinical characteristics of twin reversed arterial perfusion sequence (TRAP),and investigate its prenatal evaluation and clinical management.Methods Karyotype results and ultrasound data of 25 TRAP cases were retrospectively reviewed,including estimated weight and umbilical blood flow of acardiac twin,cardiac function and middle cerebral artery peak systolic velocity of pump twin.Various managements and the outcomes were analyzed.Results (1) Karyotype of amniotie fluid were tested in 16 pump twins.Mosaicism was found in 1 case (46,XX[36]/46,XY [14]).(2) According to the ultrasound evaluation,large acardia accounted for 87.0％ (20/23) cases.Abundant blood perfusion (inter-twin difference of umbilical resistance index ≤0.20) was indicated in 86.4％ (19/22) cases.Decompensation of cardiac function was suggested in 66.7％ (10/15) pump twins.Fetal anemia of pump twin indicated by middle cerebral artery peak systolic velocity＞1.5 multiples of the median was diagnosed in 75.0％ (12/16) cases.(3) The acardiac twin with abundant blood perfusion was more likely to be a large acardia than those without [94.7％(18/19) vs 1/3,Fisher exact test,P=0.04]; More pump twin with large acardia tended to have cardiac decompensation than non-large acardia pump twins [83.3 ％ (10/12) vs 0/3,Fisher exact test,P=0.02].(4) Eleven patients chose to terminate their pregnancies after being diagnosed.In 14 cases who continue the pregnancies,the survival rate of pump twin was 64.3％ (9/14).In 3 cases of non-large acardia without cardiac decompensation of pump twin,the patients selected conservative observation resulting in 2 term deliveries and 1 termination of pregnancy due to for exacerbation.Among 11 cases with large acardia,which the pump twins were complicated by cardiac decompensation or anemia,five cases selected conservative observation.One ended in spontaneous abortion; three exacerbated (one termination and two cesarean section before term with living births) ; one was stable until delivery.Another 6 cases received bipolar cord coagulation,and successful interruptions of acardiac blood flow were achieved in 5 cases among which 4 pump twins survived.Conclusions Prenatal diagnosis,cardiac function and fetal anemia of pump twin,together with the growth and blood supply of acardia are important indexes for prenatal evaluation of TRAP,on which our prompt management should be based.

Objective: To explore the clinical value of non-invasive monitoring of cerebral hemodynamics for evaluating intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with moderate to severe traumatic brain injury (TBI). Methods: Transcranial Doppler (TCD) was employed to detect the hemodynamics of bilateral middle cerebral arteries, including systolic blood fl ow velocity (Vp), diastolic blood fl ow velocity (Vd), average fl ow velocity (Vm), pulsatility index (PI) and resistance index (RI) in 52 patients with moderate to severe TBI. At the same time, the CPP, ICP and mean arterial blood pressure (MABP) were monitored. The correlations between hemodynamics and MABP, ICP as well as CPP were analyzed. Results: The PI and RI were positively related to the ICP (r=0.881, P<0.0001; r=0.789, P<0.0001). Multiple stepwise regression analysis showed PI was closely associated with ICP (ICP=-8.593+24.295PI; t=13.216, P<0.0001) and signifi cant correlation was also found between CPP and PI as well as MABP (CPP=15.596-22.886PI+0.910MABP; F= 76.597, P<0.0001). Conclusion: Non-invasive monitoring of cerebral hemodynamics by TCD can refl ect the real time changes in the ICP and CPP and may be used as an effective tool to monitor the ICP and CPP. This method is non-invasive, safe, cheap, repeatable and applicable in clinical practice.