Objective　To investigate ideal procedure of reconstruction for the digestive tract after total gastrectomy.Methods:After total gastrectomy,the 25 centimeters length jejunum with vessel pedicle was dissociated and was inosculated between esophagus distal and duodenum proximal end.This procedure is simple and meet the physiological need.Results:28 cases of patients were curved recently without complications and death.All patients wre followed-up long term survey that they had no intestinal symptoms,reverse esophagitis and nutritional deficiency.Their body weights were increased significantly and could take part in labor.Conclusion:This procedure is the ideal reconstruction operation for the digestive tract after total gastrectomy.

AIM: To study the influence on the expression of proliferation cell nuclear antigen(PCNA) in rectal carcinoma through retention -enema with FUDR and 5 -FU. METHODS: 80 cases of rectal carcinomas were randomized into three groups: the FUDR group(30 cases), the 5-FU group(30 cases) and normal control group(20 cases), treated with FUDR(500mg), 5-FU(500mg) and normal saline(20ml ) everynight through retention - enema separately for serven days- Mucosa of rectal car cinoma were sampled and PCNA protein were simultaneously detected by imrnunohistochemical method on the first and eighth day. RESULTS: The expression of PCNA was significantly decreased in both FUDR group and 5 - FU group after treatment(P 0. 1). CONCLUSION:The cell proliferation of rectal carcinoma could be inhibited by FUDR and 5-FU through retention-enema. The effects of FUDR was more obvious than that of 5-FU in the same concentration. so the treating method through retention-enema with FUDR should be used as a routine therapeutic scheme befOre operation.

The level of lipid peroxides (LPO)and copper-zinc containing superoxide dismutase(SOD-I) in the gastric mucosa and serum was determined in 141 samples from 25 patients after conventional subtotal gastrectomy (11 cases of Billroth I and 14 cases of Billroth Ⅱ and 11 patients after pylorus and antroseromuscular flap preserving gastrectomy (PAFPG).Those of 11 normal subjects were examined likewise to serve as control.It was found that;1.The average LPO level was much higher and the average SOD-I level much lower in the gastric mucosa after conventional subtotal gastrectomy especially the Billroth type Ⅱ than in those after PAFPG.2.In 36 specimens of stump mucosa,the average LPO level was significantly higher in the tissue around the anastomotic ring than in that of the body of the stump;no marked difference of SOD-I level between the 2 was revealed.3.The LPO value in the stump mucosa was positively correlated to and the SOD-I value negatively correlated to the pH value of gastric juice.Thess findings suggest that the reaction of oxygen free radicals in the stump-mucosa may be influenced by the intragastric pH or by the type of digestive continuity reconstruction,and that the reaction of free radicals specially lipidperoxidation may play a role in the pathogenesis of the lesions in the anastomotic stoma.

0.05).Large amounts of E.coli and intestinal aerobics such as Veillonella spp.,Bacteriodes fragilis,and Clostridium spp.were detected in patients with B-Ⅰ and B-Ⅱ especially the latter but not found in those with PAFPG.These findings suggest that intragastric bacterial overgrowth,can exist in the hypoacidic stumps in the first one to three years afte conventional gastrectomy especially after B-Ⅱ,no such occurrence is found in those after PAFPG since it only moderately reduces the intragastric acidity.

Objective To screen and identify the anomously expressed proteins at protein level in colon mucosa of diarrhea-predominant irritable bowel syndrome(D-IBS)patients and healthy individuals.Methods Four D-IBS patients and four healthy individuals were included in the study.Biopsies of mucosa at the ileocecal junction and sigmoid colon were performed via colonoscopy.The specimens were cleaned with ice cold saline which contained 0.1% PMSF,and were snap frozen in liquid nitrogen.The two-dimensional gel electrophoresis(2-DE)was used to screen the anomously expressed proteins,and the two proteins which presented the greatest changes in each group were identified by mass spectrometry method.Results Proteomics maps of human colon mucosa were obtained successfully with 2-DE.Average protein spots were 336 in normal control group,and the matching rate among them was 92%,while in D-IBS group,the average protein spots were 426,and the matching rate was 95%.The average matching rate between the test group and the control group was 74%.It was found that the volume value of 24 proteins spots changed more than two folds.The protein expression was found to decrease in 3 spots and increase in 21 spots.Four proteins were chosen for analysis with mass spectrometry analysis.The two up-regulated proteins were identified as Immunoglobulin J chain and heat shock protein 27,while the other two down-regulated proteins were identified as hemoglobin beta subunit and fructose-bisphosphate aldolase A.Conclusion With 2-DE,proteomics maps of human colon mucosa have been obtained successfully.The proteome expressions of colon mucosa in D-IBS patients are remarkably different from that of the healthy individuals.The four identified proteins may play a certain role in the pathogenesis of D-IBS.

Objective To investigate the indications and suitable surgical operation routes of total gastrectomy for gastric carcinoma and the reconstruction procedure of digestive tract following total gastrectomy.Methods The clinical data of total gastrectomy by abdominal incision in 170 patients with GC from 1991 to 2001 were reviewed.Results Radical total gastrectomy was prfomed in 132 cases,palliative total gastrectomy in 38 cases,total gastrectomy with combined re section of other organs in 18 cases,Roux en Y esophagojejunostomy in 110 cases following total gastrectomy.Interposition with jejunum in 60 cases following total gastrectomy.There are 20 cases with dumping syndrome and 6 cases with reflux esophagitis occurring in Roux en Y esophagojejunostomy,but none of cases occurs in those by interposition with jejunum.Conclusions (1)Transabdominal incision is the better choice for patients of GC,especially gastrocardiac carcinoma.(2)The total gastrectomy can raise the survival rate and quality of life of patients with GC,if the indications are stricted.(3)Interposition with jejunum following total gastrectomy is superior to Roux en Y esophagojejunostomy.

BACKGROUND: Crohn's disease is complex and lack of specificity; meanwhile, it is related to diseased regions, areas,severity and complications in intestine. Otherwise, it is difficult to diagnose. The etiological factors are still unclear and radical therapy is lack recently. Therefore, clinical manifestations and therapeutic measures of Crohn' disease at home are different from those abroad.OBJECTIVE: To compare the clinical characteristics and therapeutic differences between the Chinese and American patients with Crohn's disease.DESIGN: Retrospective case analysis.SETTING: Department of Digestion, General Hospital of Chinese PLA.PARTICIPANTS: A total of 85 Chinese patients with Crohn's disease were selected from General Hospital (the 301 Hospital) of Chinese PLA from 1985 to 2004; meanwhile, a total of 68 American patients with Corhn's disease were selected from Cleveland Clinic Florida (CCF) from 1985 to 2004. Diagnostic criteria were based on WHO standards and all patients were diagnosed according to endoscope, X-ray manifestations and pathological characteristics.METHODS: Clinical data, including age, sex, family history, external manifestations of intestine, diseased regions and characteristics, drug treatment and surgical therapy, were compared between Chinese and American patients.Otherwise, enumeration data were compared with Chi-square test.MAIN OUTCOME MEASURES: Age, sex, family history, extra intestinal manifestations, diseased regions and characteristics, drug treatment and surgical therapy of Crohn's disease.RESULTS: ① General status and extra intestinal manifestations of intestine: The ratio of male and female patients in the 301 hospital was 1.74:1 and in CCF was 1:1.43. The incidences of positive family history and extra intestinal manifestations were 7% and 34%, which were higher in CCF than those in the 301 hospital (1%, 14%, x2=4.631 2, 8.315 0,P ＜ 0.05). ② Diseased regions and pathological characteristics: The terminal ileum was involved at most (69%) and no patients had perianal diseases in the 301 hospital and the main pathological characteristics were ulcer (66%) and obstruction (14%). Those were higher than those of patients in CCF (25%, 4%, x2=25.309 2, 4.024 6, P＜ 0.05).Compared with the 301 hospital, the patients in CCF had more pathological changes in colon and rectum and more perianal diseases and intra-abdominal fistulas were involved (51%). The incidences of perianal diseases and intra-abdominal fistulas were 51% and 9%, which were higher than those of patients in the 301 hospital (0, 6%, x2=38.429 0, 0.148 2, P ＜ 0.05). ③ Therapy: The main selections of medicine were sulfasalazine salicylazosulfapyridine (SASP, 54%), 5-aminosalicvlic acid (5-ASA, 19%) and metronidazole (21%) in 301 hospital, but in CCF, steroids (60%),azathioprine (34%) and infliximab (46%) were the main selections of medicine. Rates of surgical therapy were higher in CCF than those in the 301 hospital (96%, 49%, x2=36.145 9, P ＜ 0.01).CONCLUSION: There are significant differences in clinical characteristics and therapeutic measures between Chinese and American patients with Crohn's disease, which is one of the reasons for the two hospitals to take different treatments.

Objective To study the feasibility of laparoscopic resection of colorectal cancer.Methods A(retrospectively) analysis of the clinical data of 110 patients with colorectal cancer treated by laparoscopic(resection) during last three years was made.Of them,24 cases were converted to open operation.In 86 (cases),laparoscopic resection of colorectal cancer was completed.Among them,5 cases underwent right(hemicolectomy),2 cases left hemicolectomy,10 cases sigmoidectomy,22 cases Dixon′s operation,46 cases of Miles operation,and 1 case total colorectomy.Results No patient died within 30 days postoperatively in this series.The average operation time was 225(120-360) min with average 135(20-400) mL blood loss.The average number of lymph nodes excised was 8.7(1-30).The average number of positive lymph nodes was 2.2(0-24).Six cases had intraoperative complications,including 1 case of ureteral injury and 5 cases of intra-abdominal bleeding.These patients were immediately converted to open surgery.There were 6 cases with postoperative complications,among them,2 cases of urinary leakage,2 cases of massive bleeding and 2 cases of intestinal obstruction.All of them recovered after reoperation.The time of bowel funtion(recovering) was 12-72h after operation.The hospital stay after operation was 8.6(7-15)days.The median follow-up was 14.3 months(range 1-33) for 100(90.9%) patients.There was no port-site tumor(metastasis) and no tumor recurrence at the small abdominal incision.Six to fifteen months after opteration,3 cases had diffase peritoneal metastases.1 case of Miles resection had perineal metastasis 3 months after(surgery).Conclusions Laparoscopic resection of colorectal cancer is technically feasible,and have(advantages),such as less surgical trauma,less bleeding,less gastrointestinal interference and quicker(recovery).Laparoscopic radical operation for colorectal cancer can meet the requirements of safety and radical operation.

Objective To investigate the reconstruction procedures of digestive tract following total gastrectomy.Methods The clinical data of pylorus ring preserving and jejunum interposition for the reconstruction of digestive tract following total gastrectomy in 17 cases of fundus and/or cardia carcinoma in past 3 years in our hospital were reviewed. Results There was no operative death,and no stomach fistula or constriction occurred in this series.All the 17 patients were discharged with recovery. Half a year after the operation, all the patients can eat about 200-300g each time, and 3-4 times a day. Patients′ subject feeling was good; no retrosternal burning pain occurred after meal; no symptoms of bile reflux or empty disorder happened. Conclusions The reconstruction of digestive tract following total gastrectomy using pylorus ring preservation and jejunum interposition should be effective if strict indications are adopted.

ObjectiveTo determine the dose of butorphanol at which 50％ and 95％ effective dose (ED50 and ED95) of patients inhibition uterine contraction pain on analgesic artificial abortion.Methods Twenty-six patients undergoing analgesic artificial abortion were sequentially given different doses butorphanol so that the ED50 and ED95 could be determined by up-and-down sequential test.Anesthetic depth was observed when giving propofol with 200 mg/min speed,uterine contraction pain at awaking immediately,10,20 min after awaleing.Data was analyzed by Probit regression analysis for calculating ED50 and ED95..ResultsButorphanol could restrain uterine contraction pain on analgesic artificial abortion and the ED50 was 246 μg with the 95％ confidence interval of 201 μg to 281 μg,the ED95 was 324 μg with the 95％ confidence interval of 287 μg to 548 μg.ConclusionED50 and ED95 value can be expected as a parameter to optimize analgesic artificial abortion.