objective To evaluate endoscopic surgery for high risk patients over 70 years old with severe acute cholangitis. Methods From October 1991 to October 2003, 84 high risk patients over 70 years old suffering from severe acute cholangitis were included and divided into laparotomy surgery (ST) and endoscopic surgery (ET) group. Results 80 patients were cured. The care rate was 81.2% in ST group and 91.6% in ET group. The mortality rate was lower in ET compared with ST (9.1% vs 18.8%). The rate of complication was reduced from 37.5% in ST group to 13.9% in ET group. The average duration of drainage was reduced from 49.4 days in ST group to 18.6 days in ET group. The total treatment days were shortened from 46.2 days to 22.8 days comparing ST with ET. Conclusions Endoscopic surgery should be the first choice for the senile and high risk patients with severe acute cholangitis. Endoscopic surgery was convenient, with mininal injury, safe and effective, and period of treatment was shortened, especially for elderly or critically ill patients, as well as those with MODS or previous billiary operations.

MEDLINE,Ovid,CNKI,and Vip Database were retrieved for articles of diuretics induced hyponatremia.6 retrospective studies,2 prospective studies,and 31 case reports were included.Pearson correlation coefficient of the cumulative dose and serum sodium level was-0.121 (P =0.757).It is suggested that serum sodium level should be closely monitored while administrating diuretics,especially in patients with high-risk of hyponatremia.

Objective To evaluate the anatomic relationships between the portals and radial nerve of three different operations of antrolateral approach elbow arthroscopy.Methods The dissections were pedormed in 10 formalin soaked adult cadaver elbows.The distances from the three different antrolateral portals to the radial nerve in extension and flexion 90° position were measured.The portal A was located at 3 cm distal and 1 cm anterior to the lateral epicondyle;the portal B was located at 2 cm distal and 2 cm anterior to the lateral epicondyle;the portal C,1 cm distal and 1 cm anterior to the lateral epicondyle.Results The nearest distances from the anterolateral portal A,B,and C to the radial nerve in extension position were (2.30 ± 0.95) mm,(3.00 ± 1.56) mm,and (3.60 ± 1.65) mm,with significant differences (F =11.097,P =0.001).Statistical difference in distances from the anterolateral portal to the radial nerve between portal A and C was found (P =0.006).No statistically significant difference was seen between A and B or B and C (PA-B =0.134,PB-c =0.072).The distances from the anterolateral portal A,B,and C to the radial nerve in flexion 90° position were (4.40 ± 2.01) mm,(6.10 ± 1.79) mm,and (7.90 ± 1.85) mm,with significant differences (F =54.775,P =0.000).There were statistically significant difference among the three approaches (PA-B =0.000,PA-c =0.000,PB-c =0.002).The distances increased when the position changed from extension to flexion 90° for portal A (t =-5.161,P =0.001),portal B (t=-8.188,P=0.000),and portal C (t =-10.167,P =0.000).Conclusion The anterolateral portal 1 cm distal and 1 cm anterior to the lateral epicondyle is the safest apporach.

Objective To evaluate the efficacy and toxicity of chemotherapy containing paclitaxel in patients with advanced breast cancer.Methods Chemotherapy containing paclitaxel was used in 30 patients with advanced breast cancer.Paclitaxel was administered by iv infusion at a dose of 135*!mg/m 2 in 3-hour every 3～4 weeks for an average of 4 sessions. All patients received premedication of dexamethasone, diphenhydramine and cimetidine to prevent allergic reactions. Results The overall response rate was 43%(13/30),including complete remission(CR) in 3(10%) cases and partial remission(PR) in 10(33%). The average duration of remission was 1.6 months in CR cases and 5 months in PR cases respectively.The major toxicity associated with paclitaxel administration includes neutropenia,myalgia,arthralgia, numbness of hands and feet,alopecia and flushing of face. Conclusion Paclitaxel is an effective agent for treatment of advanced breast cancer and its side effects are tolerable.

To explore the relationship between the activity of polyol pathway and diabetic microangiopathy, the level of red blood cell sorbitol(RBCS)in 106 patients with NIDDMwas determined. The results indicated that the level of RBCS in diabetic patients was significantly increased, and was positively correlated with 24-h urinary albumin excretion rate(UAER)and the degree of diabetic retinopathy(DR). Besides,the value of RBCS in patients with both pro-teinuris and DR or proteinuria was markedly higher as compared with that in patients with either proteinuria or DR,and the concentration of RBCS in the patients with DR of proteinuria was also significantly higher than those wth neither proteinuria nor DR. In addition.it was also found that the value of RBCS gradually elevated with the aggravation of UAERand DR. These findings suggest that the elevation of RBCS level plays an important role in the formation and development of diabetic microangiopathy.

Objective To investigate which subfamily genes of T cell receptor (TCR) V? expand predominantly during the course of experimental allergic neuritis (EAN). Methods Using RT-PCR and in situ hybridization techniques,the expression levels of TCR V? 2,6,8,10,14 in the peripheral blood,lymph nodes,peripheral nerves of group EAN and those of the control group were compared. Results In group EAN,the expression of TCR V? 6?8 mRNA increased at the early phage(41.1?1.1 and 74.4?1.9 vs 25.9?1.5 and 26.1?1.6) and became more significantly at the peak of the disease,and resolved to normal at the recovery phage in the lymph nodes.But they amounted up gradually from the early stage to the peak,and then decreased a little in the infiltrating T-lymphocytes in peripheral nerves,the difference was significant.In addition,the expression of TCR V? 8 was notably higher than that of TCR V? 6 in the levels of mRNA. Conclusion The subfamilies of TCRV? genes which restrict the development of EAN due to recognizing the specific antigens are TCRV? 8 and TCRV? 6. T lymphocytes specifically expressing TCR V?6?8 genes are activated and clonally proliferated in the lymph nodes,and then migrate to the involved peripheral nerves,which might induce a series of immune lesions consequently.

Objective To evaluate the endoscopic managements of acute cholangitis of severe type (ACST) accompanied with multiple organ dysfunction syndrome (MODS). Methods A total of 122 ACST patients accompanied with MODS from January 2000 to October 2008 underwent endoscopic treatment in two time periods. In critical phase, emergent endoscopic retrograde cholangiopancreatography (ERCP) plus en-doscopic naso-biliary drainage (ENBD) were performed to correct critical situation of the patients. After sta-bilization, endoscopic sphincterotomy (EST) plus stone removal, EST plus stent placement, or laparoscopy was performed according to the causes of ACST. Results Emergent endoscopic managements succeeded in all patients of critical phase. At third day post-operation, a reduction in white blood cell count, serum total bilirubin, body temperature, and rate of patients with shock, mental symptoms and purulent bile juice was a-chieved. Recovery rate of dysfunction organs was 60.2% at one week after emergent procedure, and 82. 6% at 2 weeks post-operation. Selective EST plus stone removal was performed in 36 patients with a success rate n one session at 91.7%. Laparoscopic cholecystectomy was performed in 85 patients with a success rate of 95.3%. Stent was placed in 16 patients with an effective rate of 81.3% at 3 months post the procedure. No severe complication or death occurred during the whole therapeutic course. The 6-month survival rate of 10 cancer cases was 70%. Conclusion Therapeutic ERCP plus ENBD is the first choice for acute severe cholangitis accompanied with MODS, while EST plus biliary lithotomy, or EST plus stent placement, or com-bined laparoscopy are ideal methods for subsequent treatment.

Objective To evaluate the value of flow cytometry ( FCM) for the differential diagnosis between myelodysplasia (MDS) subtype refractory cytopenia with multiple dysplasia (RCMD) and aplastic anemia (AA). Methods The flow cytometric data of bone marrow samples from 168 cases of RCMD and 77 cases of AA were analyzed retrospectively in blind, and its results were compared with gold standard to evaluate its diagnosis values. Results The specificity of abnormal of single immunophenotype in the surface of granulocytes and myeloblasts was high (range 75.3% -100% ) , but the sensitivity was very low (range 5.4%-50% ). In parallel tests, the sensitivity and specificity of the combination of CD+34 cells≥1% , myeloblasts ≥3% , abnormal expression of CD117 in granulocytes and loss of CD13 in myeloblasts or increased intensity of CD33 in granulocytes were higher than other combinations. The sensitivity and specificity of above combination were more than 62% and 92% , respectively. In the scoring method,different score was given to 8 markers according to different diagnostic value, which were CD+34 cells ≥1 % ,myeloblasts≥3% , abnormal expression of CD117 in granulocytes, loss of CD13 in myeloblasts, increased intensity of CD33 in granulocytes, loss of CD13 in granulocytes, loss of CD10 in granulocytes, and decreased SSC in granulocytes. The sensitivity and specificity were both high if we defined that the total score ≥1.5 was RCMD and the score < 1. 5 was AA. Conclusions The value of abnormal of single immunophenotype for differential diagnosis between RCMD and AA is low. Parallel tests can increase the diagnostic sensitivity obviously and not decrease the specificity. CD+34 cells≥1% , myeloblasts≥3% and abnormal expression of CO117 in granulocytes were the most important markers. The scoring method is precise to distinguish RCMD from AA.

OBJECTIVETo correct the minor breast ptosis with minimal breast scar.

METHODS32 cases with minor breast ptosis were corrected by subfascia breast augmentation with periareolar incision and anatomic mammary implant.

RESULTBreast ptosis was completely or mostly corrected in all the patitents with periareola scar, avoiding the vertical breast scar. Except for short-time effusion in 2 cases, no other complication happened.

CONCLUSIONSSubfascia breast augmentation with periareolar incision and anatomic mammary implant can effectively correct minor breast ptosis with minimal breast scar and less complication.

Adult ; Breast Implantation ; methods ; Cicatrix ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Nipples ; surgery

Female ; Humans ; Liability, Legal ; Middle Aged ; Occupational Diseases ; diagnosis ; Occupational Health ; legislation & jurisprudence ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; diagnosis ; etiology