The effects of sepsis on the liver include hypoxic hepatitis caused by ischemia and shock, liver cell damage caused by excessive inflammation, and cholestasis caused by changes in bile metabolism. Among them, cholestasis is a common complication in patients with sepsis. Cholestasis and jaundice in patients with sepsis are associated with an increased risk of infection, leading to an increased mortality rate. So far, the exact mechanism of sepsis with cholestasis is still unclear, so this article briefly reviews the mechanism of cholestasis during the early stage of sepsis.

Objective To study the reasons of the conversion to laparotomy during laparoscopic cholecystectomy. Methods Correlative literatures were retrieved from 1994 to 1999, and were tabulated and critically appraised in terms of sample size, outcomes, and the causes of the conversion to laparotomy. Results In the 5260 cases of LCs, 169(3.21%) converted to laparotomy. The data examined revealed a bile duct injury in 22 cases (13%), bleeding in 25(14.8%), severe adhesion in 81(48%), acute choecystitis in 16(9.5%), bile leakage in 3 (1.8%), gastric cancer in 1(0.6%), carcinoma of gallbladder in 10(6%), distension of common bile duct and choledocholith in 4 (2.4%), fistula of gallbladder in 2 (1.2%), injury of stomach or bowel in 4(2.4%), unsatisfactory pneumoperitoneum in 1 (0.6%). Conclusions The major causes of the conversion to laparotomy during laparoscopic choecystectomy are severe adhesion, injury of bile duct and bleeding.

Objective To investigate the general conditions of the injury of blood vessels during laparoscopic cholecystectomy in China. Methods The cases of the injury of blood vessels complicated with laparoscopic cholecystectomy and its locations and reasons were reviewed according to articles published in the last years in CMCC. Results There were 86 cases (0.26%) of blood vessel injury in 33584 paitnets received laparoscopic cholecystectomy. The positions of bleeding included cystic artery (47), cholecyst bed (24), puncture port (6), hepatic vein(2), hepatic artery(1), and others places(6). 5 patients died of the bleeding Conclusions The injury of blood vessels complicated with laparoscopic cholecystectomy was considered as one fatal technical complication. It is one of the major causes of laparotomy and reoperation.

In order to study the relationship between sex hormone and gynecomastia, the levels of plasma sex hormone in the male patients with gynecomastic were determined by using radioactive immune assay. Seventy-eight gynecomastic patients were regarded as the experimental group which was divided into 3 subgroups: the youth group with the age ≤30 years old, the middle-aged group with the age ranging from 30 to 60 years old and the old-aged group with the age ≥60 years old in the light of age and 24 normal men served as control group. The results showed that the levels of E2 and E2/T in the gynecomastia patients were much higher than in the control group (P<0.05, 0.01)；In the experimental group, the ratio of T reduction in the old-aged group was much higher than in the youth group or the middle-aged group（P<0.05). In conclusion, gynecomastia was related to the dysfunction of the level of sex hormone, to a large extent, with the increasing of estrogen. In addition, senile gynecomasti was closely related with the decreasing of male hormone.

Objective: To compare the effectiveness of chitosan and sodium hyalurate in preventing intestinal adhesion. Methods: Forty five SD rats were randomly divided into A, B and C groups. During operation, chitosan, sodium hyalurate or normal saline was applied on injured part of ileum respectively. Biopsy was taken on the 14th postoperative day. Results: The severity of adhesion in group A and B were significantly lower than in group C( P

Objective To review the relationship between absence of expression of DPC4/SMAD4 gene and pathogenesis of pancreatic carcinoma(PC). Methods A summerized paper was made on the review of relative literatures. Results and Conclusions A new gene DPC4 (located on chromosome 18q21.1 region) has been identified as a candidate tumor suppression gene. SMAD4 belongs to the evolutionarily conserved family of SMADs proteins that are crucial intracellular mediators of signals from the transforming growth factor ?(TGF-?). In TGF-? super family signal pathways, SMAD4 plays a pivotal role .There is a close relationship between absence of expression of DPC4 gene and pathogenesis of pancreatic carcinoma.

Comprehensive therapy is the leading method to improve the overall survival for patients with advanced gallbladder cancer, especially the study of new chemotherapy regimen are on demand.From 2010 to 2011, a phase Ⅲ study of new chemotherapy regimen in the treatment of advanced gallbladder carcinoma would be undertaken nationwide to assess the clinical outcome and safety, in 31 clinical centers led by the department of General Surgery of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, and a total of 260 patients would be accrued for this study.Chemotherapy consists of 2 regimes, conventional regime(cisplatin, epirubicin, and 5-fluorouracil, leucovorin)and new regime(conventional regime plus somatostatin).At present, the study has been approved by Clinical Trial Registration Platform of National Institutes of Health in U.S.A., and more than 30 patients are rolling in the study.The clinical trial could provide the high-quality evidence of EBM(evdence based medicine)for the chemotherapy of advanced gallbladder caner, and it will be one of the important components in the large-scale clinical study of chemotherapy for the advanced gallbladder cancer in China and worldwide.

Objective:To study the factors in primary liver carcinoma complicated with cholecystitis or cholecystolithiasis after hepatectomy. Methods: Clinical and follow-up data were analyzed in 400 patients. Results: Cholecystitis or cholecystolithiasis were found in 86 cases after hepatectomy (20.75%).Incidence of cholecystitis or cholecystolithiasis in patients complicated with hepatitis B, posthepatic cirrhosis, ascites and porta hepatis occlusion was higher than that in non-hepatitis B,non-posthepatic cirrhosis and ascites patients. There was no obvious difference in incidence between with blood transfusion or without and the length of porta hepatic occlusion. Conclusion: It is concluded that multiple factors participates in this process,including proneness to the disease before operation, mechanic reason,insufficient blood supply of gall bladder, etc .Depressed function of cholecyst constriction,cholestasis and changes of bile components may lead to the inflammation of cholecyst and the formation of gallstone.

Objective To elucidate the effect of postoperative early enteral nutrition support (ENS) on cellular immunity function and nutritional status of gastrointestinal (GI) cancer patients.Methods Twenty patients with GI cancer were at random divided into two groups: enteral nutrition group (EN-group, 10 cases), parental nutrition group (PN-group, 10 cases). PN-group was given total parental nutrition (TPN).In EN-group,Since the 1st postoperative day Neutrinos(r) was infused, the infused volume was increasingly added from 500 ml/d to 1 500 ml/d, the infused rate was step-by-step increased from 21 ml/h to 63ml/h. T-cell subgroup, NK cell, IL-2, PA, RBP were measured in the day before operation and on the 2nd ?4th ?8th postoperative day.Results ① The serum RBP,PA levels were obviously decreased postoperatively (P

ObjectiveTo observe the immunotherapeutic effects of dendritic cells vaccine pulsed with tumor cell lysate on mice with pancreatic carcinoma. Methods Dendritic cells (MTSC4)were pulsed with tumor cells lysate. The immune preventative and immnotherapeutic effects of DC vaccines on mice with pancreatic carcinoma were assessed. Results After vaccination of the DC vaccines, mice remained tumor-free for at least 25 days in DCs vaccines group,but in other groups the subcutaneous implantation tumorigenesis were found beginning 3 to 9 days. CTL stimulated by DC vaccines effected cytolytic activity against pancreatic carcinoma cells. The survival period was obviously prolonged in DCs vaccines group (56?9)?d than in other groups (P