Objective To investigate the etiological factors and treatment of thoraco-gastric perforation (TGP) after esophagogastrostomy. Methods Retrospective analysis was carried out in 16 patients with thoraco-gastric perforation after esophagogastrostomy in our department from March 1974 to March 2004. The etiological factor, clinical feature, experiment test and the method of treatment were compared between TGP and patients of thoracic esophageal anastomosis leak (TEAL). Results Thoraco-gastric perforation occurs within 2～5 days postoperatively. Among these 16 cases, in 8, local necrosis of gastric wall was found which was caused by severe contusion and massive ligature. In 5, were penetrative injury of gastric wall caused by suture needle. In 3,unsuitable purse-string suturing of corner of greater or lisser gastric curvature. Hydropneumothorax occurred after thoraco-gastric perforation. Chest fluid was brown and turbid with putrefactive odor. With medium examination, anastomosis was normal, but medium and air bubbles were found outside of the stomach. Perforation were repaired and covered by pedicle tissue-flap in all cases. 15 cases were cured with no sequence. Conclusion TGP after esophagectomy were correlated with technique of surgery. TGP often occurs early after esophagogastrostomy. Transthoracic repairing of TGP should be done as soon as possible. The healing ratio of reparation was about 93.8%.

Fibrin glue or fibrin sealant has been used surgically as sealant for hemostasis for decades. At the same time, due to the biocompatibility of fibrin glue, it has been studied as a hydrogel drug delivery system, applied in clinical practice and biomedical engineering, especially suitable for local drug delivery for anti-tumor, antibiosis, wound healing, nerve regeneration, and bone healing after fracture. In recent years, novel functional vehicles such as liposomes, microspheres, and nanoparticles have been researched for the feasibility of combined use with fibrin glue. Drugs can be directly sent to the positions that need treatment by using fibrin glue as carriers. Additionally it can extend the residence time of drugs at the administration site and reduce administration frequency. The fibrin glue drug delivery system can also decrease blood drug concentration to avoid systemic adverse effects. This review will highlight recent research of fibrin glue as a drug delivery system.

Objective To analyze the related factors associated with the effect of Roux-en-Y gastric bypass in Goto-Kakizaki rats.Methods In GK rats undergoing Roux-en-Y gastric bypass,the weight,food intake,and the fasting blood glucose were retrospectively analyzed before surgery and 1,3,6,12,24 weeks after surgery,and the glycosylated haemoglobin concentrations were retrospectively analyzed before surgery and 4,12,24 weeks after surgery.According to preoperative glycosylated haemoglobin concentrations,GK rats were divided into 3 groups(group A,HbAlc 6.5％-7.9％; group B,HbAlc 8.0％-9.9％ ; group C,HbAlc ＞ 10％).Results The fasting blood glucose and the glycosylated haemoglobin concentrations significantly decreased 1 week after surgery(P ＜ 0.01),on 24 weeks after operation,the fasting blood glucose levels decreased from(12.1 ± 3.0)mmol/L to(7.6 ± 1.3)mmol/L,and the glycosylated haemoglobin concentrations declined from(9.2％ ± 1.8％)to(6.3％ ± 0.8％).Preoperative fasting blood glucose was(11.1 ± 2.2)mmol/L and(15.8 ± 2.3)mmol/L respectively,and the preoperative glycosylated haemoglobin concentration was(8.6％ ± 1.4％)and(11.5％ ± 1.4％)respectively(P ＜ 0.01).Non-conditional Logistic regression analysis identified preoperative glycosylated haemoglobin concentrations as an independent predictor for the cure rate(P ＜ 0.01); Differences were significant between group A and group C,and group B and group C on the efficiency of the surgery(P ＜0.01).Conclusions Significant correlation established between glycosylated haemoglobin concentrations and the efficiency of the surgery,especially for those rats with preoperative HbAlc ＜ 10％.

Objective To study the risk factors of mortality in severe sepsis and septic shock patients. Methods 142 patients with severe sepsis and septic shock in ICU were observed and divided into alive group (98 patients)and dead group (44 patients)by using hospital mortality.The risk factors of mortality in severe sepsis and septic shock patients were assessed by binary logistic regression.Results Independent mortality risk factors were inotropic agents (OR =4.329,95%CI:1.045 -17.937,P =0.043),blood glucose >10 mmol/L (OR =3.771,95%CI:1.214 -11.710,P =0.022)and APACHE Ⅱ score (OR =3.098,95%CI:2.012 -4.760,P =0.000),while PaO2 /FiO2 after early goal -directed therapy (EGDT)was protective factor (OR =0.682,95%CI:0.500 -0.930, P =0.016).Conclusion Severe sepsis and septic shock patients with inotropic agents,blood glucose >10mmol/L, high APACHE Ⅱ score and decreased PaO2 /FiO2 after EGDT indicate poorly prognosis.

Objective To observe therapeutical effects of gastric bypass on non-obese type 2 diabetes patients.Methods From June 2008 to April 2010,data of 47 patients with both gastric lesions and non-obese type 2 diabetes mellitus undergoing gastric bypass in the Institute of General Surgery were studied.The patients were divided into 3 groups according to the operation type:total stomach resection plus Roux-en-Y anastomosis ( n =20),partial stomach resection plus Roux-en-Y anastomosis(n =13)and Billroth Ⅱ gastrectomy(n =14).They were followed for 6 months after surgery.Level of body mass index (BMI),fasting blood glucose (FBG) and GLP-1 was measured before operation and on the 1 st week,2nd week,1 st month,3rd month,and 6th month after operation.The level of glycosylated hemoglobin was measured before operation and on the 3rd and 6th month after operation.The prognosis of the patients on the 6th month after surgery was evaluated.Results Compared with preoperative level,FBG level in all the 3 groups significantly decreased on the 1 st week after surgery and maintained a similar level during the follow-up period (P ＜ 0.01 ).GLP-1 level was elevated after operation (P ＜0.01 or P ＜ 0.05).On the 3rd and 6th month after operation,glycosylated hemoglobin level in all the 3 groups significantly decreased (P ＜ 0.01 or P ＜ 0.05 ).The change of the above parameters was greater in groups undergoing Roux-en-Y anastomosis than in Billroth Ⅱ group(P ＜ 0.05 ).The control rate of T2DM for Billroth Ⅱ,partial stomach resection plus Roux-en-Y anastomosis and total stomach resection plus Roux-en-Y anastomosis was 78.5％(11/14),100％ (13/13) and 100％ (20/20)respectively on the 6th month after surgery,indicating Roux-en-Y gastric bypass had better effect of blood glucose control than Billroth Ⅱ (P ＜ 0.05 ).Postoperative BMI decreased significantly in all groups (P ＜ 0.05) and there was no statistical difference between all the groups (P ＞ 0.05 ).Conclusions All groups of gastric bypass are effective in terms of glucose control.Roux-en-Y gastric bypass is more effective than Billroth Ⅱ on diabetes control and its therapeutic effect is independent of weight loss.

Aim To study the effect of Baoxinbao film on endothelin(ET) and nitric oxide(NO) secretion in patients with stable angina pectoris(SAP).Methods 76 patients with SAP were randomly divided into two groups, with 40 cases in the baoxinbao group plastered with baoxinbao film and 36 cases in the isosorbide dinitrate group receiving isosorbide dinitrate. The levels of plasma ET and NO before and after treatment were observed. Results The concentrations of plasma ET were increased and plasma NO reduced significantly in the SAP patients respectively, as compared with those in the control group(all P

AIM: To observe the clinical curative effect of sparse wind clearing heat method combined with western medicine treatment on epithelial herpes simplex keratitis ( HSK) .
METHODS: A total of 75 cases ( 75 eyes ) of patients with epithelial HSK were divided into the treatment group 38 cases ( 38 eyes ) and the control group 37 cases ( 37 eyes) . The patients of the control group were treated with ganciclovir drop and symptomatic treatment. On the basis of the above treatment plan, the patients of the treatment group were treated with sparse wind clearing heat decoction. Clinical curative effect was observed and analyzed.
RESULTS:In the treatment group, curative rate was 79% and effective rate was 95%. In the control group, curative rate was 54% and effective rate was 78%. The differences had significant difference between the two groups (P<0. 05). The corneal lesion healing index in the treatment group was better than that in the control group (P<0. 05). At 6mo follow-up the recurrence rate was 10%in the treatment group, and the control group with 40%, and there was significant difference between the two groups ( P < 0. 05 ). The average healing time of the treatment group was 14. 74±8. 58d, and the control group was 19. 68 ± 8. 71d. There was significant difference between the two groups (P<0. 05).
CONCLUSION: Sparse wind clearing heat method combined with western medicine treatment on epithelial HSK has preferably curative effect.

Objective To evaluated the effect of hyperbaric oxygenation therapy(HBO)on the RhoA ex- pression and nerve function after transient focal cerebral ischemia in a rat model of middle cerebral artery occlusion. Methods One hundred and twenty-six healthy Sprague-Dawley rats were used and randomly divided into a sham op- eration group(shame group,n=42),a treatment group(n=42),and a control group(n=42).The animal model of middle cerebral artery occlusion(MCAO)was established by using the Zea-Longa method with the animals in the treatment and the control groups,and sham operation was performed with those in the sham group.HBO was applied to the animals in the treatment group.The RhoA protein expression was observed by using immunohistochemistry technique,and the neurological function was evaluated by Bederson's scale at different time points after MCAO.Re- sults(1)Weakly positive expression of RhoA could be located in bilateral cortex and the basal ganglia in the sham group.The expression of RhoA in the treatment group and control group was increased as early as 6 hours after MCAO when compared with that of the sham group,and peaked at 48 h after MCAO and decreased after then,but was still higher than that of the shame group at 7th day to 14th day after MCAO.It was also found that the expression of RhoA of the treatment group was significantly lower than that of the control group(P

OBJECTIVETo investigate the classification criterion and surgical treatment strategy of intrathoracic esophageal injury caused by foreign body.

METHODSEighty-four patients with intrathoracic esophageal injury caused by foreign body in our department from January 1980 to April 2004 were divided into 4 grade: grade I was non-penetrated injury of esophagus (18 cases); grade II was esophageal perforation with mild mediastinitis (39 cases); grade III was esophageal perforation with severe intrathoracic infection (17 cases); grade IV was aortoesophageal fistula (10 cases). Based on the degree of esophageal injury and the extension of inflammation, operative procedures were selected including esophagotomy, esophageal reparation, esophagectomy, mediastinal drainage, reparation of fistula and replacement of aorta.

RESULTSPatients in grade I and II were all cured . One death occurred in grade III (1/17), the same in Grade IV was 9 (9/10).

CONCLUSIONSClassification of esophageal injury caused by foreign body is helpful to the decision of surgical treatment strategy. The prevention of aortoesophageal fistula is the key point of reducing of mortality.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Esophageal Perforation ; classification ; etiology ; surgery ; Esophagectomy ; Esophagoscopy ; Esophagus ; injuries ; surgery ; Female ; Foreign Bodies ; complications ; Humans ; Infant ; Injury Severity Score ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Objective To investigate the clinical efficacy of electroacupuncture plus indirect moxibustion treating lumbar intervertebral disc herniation of blood stasis type. Method Sixty patients diagnosed with lumbar intervertebral disc herniation (blood stasis type) were randomized to treatment and control groups, 30 cases each. The treatment group received electroacupuncture plus medicine separated moxibustion and the control group, electroacupuncture alone. treatment was given once daily, 10times as a course. Pre- and post-treatment JOA lumbar scores were compared in the patients after two courses of treatment. The clinical therapeutic effects were evaluated in the patients using the TCM Criteria of the Diagnosis of and Therapeutic Effect on Diseases. Result Lumbar function was improved significantly in both treatment and control groups of patients (P<0.01) but improved more significantly in the treatment group than in the control group (P<0.05). The total efficacy rate was 96.7% in the treatment group and 83.3% in the control group. There was a statistically significant difference in the total efficacy rate between the two groups (P<0.05). Conclusion Electroacupuncture plus indirect moxibustion is a better way to treat lumbar intervertebral disc herniation of blood stasis type. Its therapeutic effect is better than that of electroacupuncture alone.