Objective To study and summarize the cause and reoperative method of massive hemorrhage of upper gastrointestinal tract after gastrectomy. Methods The clinical data of 11 cases patients with massive hemorrhage of the upper gastrointestinal tract after gastrectomy from August 1986 to June 2000 were analyzed retrospectively. Results 5 cases were anastomotic bleeding,3 cases injured gastric remnant mucosa bleeding,2 cases ulcer bleeding after bancroft gastrectomy, 1 case overlooked leiomyoma bleeding.All patients were cured with reoperation.Conclusions To prevent post operative bleeding is the key. The evaluation of the condition of patients with massive hemorrhage of the upper gastrointestinal tract,timing of reoperative intervention,and the selection of proper operative method are also very important.

Objective To study the pretreatment with prostaglandin E1 ( PGE1 ) on acute superior mesenteric ar-tery ( SMA) ischemia reperfusion injury of intestinal cell in rats. Methods 18 healthy male SD rats were randomly divided into control group, sham operation group and experimental group. IRI of SMA model was made by clamping the SMA for one hour and two hours after reperfusion in the control group and the experimental group,respectively. PGE1(20 μg/kg) was injected from the tail vein in the control group and the experimental group. Character of pa-thology of small intestine was examined. The expression of Bax and Bcl-2 in small intestine cells and change of IF-ABP and DAO in serum were detected. Results Pathologic changes showed that there was no change in the control group;while in the sham operation group,chorionic epithelium mucosa ulceration and hemorrhage and necrosis oc-curred more seriously than that in the experimental group. Expression of Bax and Bcl-2 was higher in the sham op-eration group and the experimental group than that in the control group(P<0. 05), and it was obviously lower in the experimental group than in the sham operation group(P<0. 05). The content of IFABP and DAO in blood ser-um:it was higher in the sham operation group and the experimental group than in the control group ( P<0. 05 ) , and it was lower in the experimental group than in the sham operation group(P<0. 05). Conclusion PGE1 can relieve the alvine necrosis caused by rats' mesenteric reperfusion injury after acute artery ischemia and thus protect damaged mucosa of small intestine.

ObjectiveTo study the clinical significance of splenectomy in cirrhotic patients undergoing hepatic resection for PLC.Methods26 PLC patients with portal hypertension and hypersplenism were randomly divided into two groups: incidental splenectomy group ( n =11), and hepatectomy only group ( n =15). Postoperative blood picture and liver function was compared.ResultsThe WBC and PLT count significantly elevated after splenctomy, (8 9?1 6)?10 9 /L, (310?32)?10 9 /L; vs. (3 7?1 4)?10 9 /L and (104?41)?10 9 /L respectively (all P

Objective To study T lymphocyte subsets immunological condition of spleen in primary hepatocellular carcinoma (PHC) with liver cirrhosis. Methods T lymphocyte subsets such as CD4,CD8,CD4/CD8 in peripheral and spleen venous blood in 31 cases of PHC with liver cirrhosis were detected by FCM.and 13 patients with liver cirrhosis were observed as the control group. Results In 6 patients with stage Ⅰ liver cancer, CD8 of peripheral venous blood significantly decreased (P

ObjectiveTo study the changes of immune function after hepatectomy for hepatocellular carcinoma(HCC) in patients with liver cirrhosis.MethodsPatients with liver cirrhosis were used as control group,CD4?CD8?CD4/CD8? and protein expression level of IFN ??IL2?IL10 in peripheral blood from 18 advanced HCC cases with liver cirrhosis before and after heaptectomy were detected by flow cytometry(FCM) and ELISA.Results Postoperative CD4(33?3)%?CD4/CD8(1 1?0 1)?IL2(71?11)?pg/ml?IFN ?(90?15)?pg/ml level elevated compared to that of pre operation 〔CD4(29?4)%?CD4/CD8(0 9?0 3)?IL2(57?15)?pg/ml?IFN ?(78?13)?pg/ml〕(all P

OBJECTIVE To investigate the distribution and antibacterial resistance of nosocomial infection from a new hospital pathogens,and provide reference for clinical rational use of drugs.METHODS Statistical methods were used to analyze the data of pathogen′s formation,distribution and antibacterial resistance of a new hospital.RESULTS A total of 1852 clinical isolates were collected from Mar 2005 through Mar 2007,of which Gram-negative microorganisms and Gram-positive cocci accounted for 71.0 % and 29.0%,respectively.The most commonly encountered pathogens were Pseudomonas aeruginosa,Escherichia coli,Klebsiella spp,Acinetobacter,Staphylococcus aureus and coagulase-negative Staphylococcus.Except Acinetobacter,up to 6% strains of Gram-negative microorganisms were resistant to the imipenem,meropenem and piperacillin/tazobactam;Gram-positive cocci were still highly sensitive to vancomycin and teicoplanin.CONCLUSIONS A new hospital is similar with other hospitals in the data of formation,distribution and antibacterial resistance of nosocomial infection pathogens.

Objective To investigate the expression of soluble triggering receptors expressed on myeloid cells-1 ( sTREM-1 ) in intraperitoneal drainage fluid of patients with abdorminal trauma and its predictive value for post-traumatic sepsis. Methods A total of 80 abdominal trauma patients were served as the trauma group and 25 patients treated with subtotal gastrectomy as the control group.Intraperitoneal drainage fluid sTREM-1,serum sTREM-1,procalcitonin (PCT) and C-reactive protein (CRP)at 0,24,48,72 hours after admission were determined in two groups for assessing their value in early prediction of post-traumatic sepsis. Results The levels of drainage fluid sTREM-1,serum sTREM-1,PCT and CRP in the trauma group were significantly higher than those in the control group (P ＜ 0.05 ).Drainage fluid sTREM-1 showed the area under the receiver operating characteristic (ROC) curve,sensitivity and specificity for 0.84,77％,and 83％ in the prediction of post-traumatic sepsis,which was superior to the serum sTREM-1,PCT and CRP. Conclusion Intraperitoneal drainage fluid sTREM-1 has high accuracy in predicting the sepsis in abdominal trauma patients.

ObjectiveTo investigate the correlation between PTEN and p27 expression in gastric carcinoma. MethodsImmunohistochemistry was applied to examine the expression of PTEN and p27 in 49 cases of human gastric carcinoma,49 cases of tumor-side ward mucosa and 13 cases of normal gastric mucosa.ResultsPositive expressive rates of PTEN and p27 protein in colorectal carcinoma were 61.22 ％(30/49)and 57.14 ％ (28/49),which were lower than those in tumor-side ward mucosa [91.84 ％(45/49) and 93.88％(46/49)]and normal colorectal mucosa [100 ％(13/13)and 100 ％(13/13)](P＜ 0.05). The expression of PTEN and p27 in gastric carcinoma correlated with each other (r=0.580,P=0.005),and which were associated with degree of differentiation of carcinoma,PTNM stage and lymph node metastasis of the tumors.Conclusion The abnormal expression of PTEN and p27 participate the malignant conversion process of the gastric mucosa cell and the expression levels of PTEN and p27 protein may be used to evaluate the pathologic biology behavior of gastric carcinoma.

Objective To investigate the effects of treatment on end-stage liver disease and diabetes mellitus by simultaneous liver-pancreas-duodenum transplantation with the pancreas of the recipients reserved.Method Simultaneous liver-pancreas-duodenum transplantations were carried out in three patients with the pancreas of the recipients reserved.The diseases of the recipient 1,2,and 3 were alcoholic liver cirrhosis and diabetes mellitus,chronic hepatitis B liver cirrhosis and diabetes mellitus,and chronic hepatitis B liver cirrhosis and diabetes mellitus complicated with renal function failure.The recipient 3 received simultaneous renal transplantation.Result The recipient 1 suffered from pancreatitis after the operation and discharged with normal liver function and blood glucose levels,and he was treated with insulin at 4th year after the operation.Intestinal fistula occurred in the recipient 2 and drainage was done without acute peritonitis,the liver allograft was experienced an acute rejection episode treated by intravenous bolus methylpredisolone at 19th month after operation,but gastrointestinal perforation happened and the patient died of acute peritonitis.In the recipient 3,peripancreatic effusion and pancreatitis happened and were treated by drainage,and the recipient survived to now with normal liver and kidney functions,but given insulin at first year after operation.Conclusion It is effective to implement simultaneous liver-pancreas-duodenum transplantation with the pancreas of the recipients reserved on the patients with end-stage liver disease and diabetes mellitus.However,how to maintain the pancreatic endocrine function after the transplantation for a long period awaits further investigation.

Objective To discuss the improvement of surgical techniques and adjustment of immunosuppressive regimen for combined liver and intestinal transplantation.Method A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation.Ostomy of graft was performed instead of intestinal anastomosis during the operation.The anastomosis of graft and autologous intestine was performed 8 months after transplantation.Hospital and follow-up data of the patients were analyzed retrospectively.Result The functions of liver and small bowel recovered smoothly after operation.Slight rejection occurred one month after operation with normal function of intestine but dysfunction of liver.In the first month after operation, abdominal infection was controlled by intraperitoneal drainage with open surgery.Immunosuppression protocol was administrated with alemtuzumab for induction plus maintenance treatment with tacrolimus, and mycophenolate mofetil was added because of renal dysfunction 2 years after transplantation.The patient was followed up for nearly 3 years with good quality of life without rejection and infection.Conclusion Combined liver and intestinal transplantation could improve patient's life quality and extend the survival time through the improvement of surgical techniques and individual immunosuppressive regimen.