Tumor in the caudate lobe is difficult for surgical treatment due to its unusual local anatomy.As the development of surgical techniques,the success rate of caudate lobectomy is increased.In recent years,the concept of precision hepatectomy aiming to reduce the iatrogenic damage from hepatectomy and improving the recovery of patients on the basis of radical treatment has been raised.This article summarized the experiences of precision hepatectomy for the treatment of huge tumor in the caudate lobe which was performed in the Ruijin Hospital of Shanghai Jiaotong University.With the help of precision hepatectomy concept and techniques,a more satisfactory result both in safety and prognosis was achieved.

Objective: To observe the characteristic changes of specific immunological function of serum endo toxin level,spleen lymphocyte human leukocyte antigen(locus) DR(HLA-DR),limphopolesis and positive expression of caspase-3 in rats with sepsis and the effect of Xuebijing injection(血必净注射液) on their immunological function.Methods: Sepsis model was produced by cecal ligation and puncture(CLP).Seventytwo male SD rats were randomly divided into four groups: sham operation,model,levofloxacin and Xuebijing injection.Blood samples were taken from the vein in the abdominal cavity at 3,24 and 72 hours after the models were established, afterwards the rats were sacrificed and their spleens were taken out.Matrix development process was employed to examine the level of serum endotoxin,FACS flow cytometer was used to examine the expression level of HLA-DR,immunohistochemistry method was applied to examine the positive expression of caspase-3 in spleen,and the method of methyl thiazolyl tetrazolium(MTT) was employed to examine the lymphopoiesis.Results: The levels of serum endotoxin,lymphopoiesis and caspase-3 positive expression index in model group were obviously elevated than those of sham operation group,and percentage of HLA-DR was markedly lowered(all P

BACKGROUND: The maximal problem of patient with serious hepatitis and surgical doctor is whether they can get donator and rational therapy timely. Looking for the suitable preoperative therapy method to enhance the success rate of operation and improve patient's prognosis is the focus of this domain.OBJECTIVE: To investigate the therapeutic effect of artificial liver support system (ALSS) combining with allotransplantation of the liver on patients with serious hepatitis.DESIGN: Retrospective case analysis. SETTING: Organ Transplantation Center, the Third Affiliated Hospital of Anhui Medical University.PARTICIPANTS: Five male patients with serious hepatitis who underwent allograft liver transplantation were selected from Organ Transplantation Center, the Third Affiliated Hospital of Anhui Medical University form June 2004 to May 2005. Their age ranged from 25 to 48 years. Inclusion criteria: The diagnosis was in accordance with phase standard established at the National Infectious Disease and Parasitology Academic Meeting in September 2000; all patients had signs of routine liver transplantation; their patients fiercely requested the operation.METHODS: Plasma exchange (PE) combined with continuous veno-venous hemofiltration (CVVH) technique was used in this study. Donor who supplied lives was from 20-38-year patients. All of them and their family agreed to donate their organ and signed the donate file before operation. All of 5 patients were used classical no-by-pass orthotopic liver transplantation (OLT). MAIN OUTCOME MEASURES: They were follow-up visited for 21-32 months for rechecking liver and kidney function,RESULTS: All of 5 patients' operation was succeeded. One continued coma postoperative and his serum creatinine and urea nitrogen raised up progressively and complicated by pulmonary infection 1 week after operation and died 2 weeks after operation although given medical treatment hemodialysis positively. The rest recovered well. All of them discharged one month after operation smoothly.CONCLUSION: Allotransplantation of the liver is an utilizable method to treat serious hepatitis. ALSS can be used as an effective method of supportive treatment preoperatively.

Objective To evaluate the therapeutic results of percutaneous transhepatic stent angioplasty for portal vein stenosis following liver transplant.Methods From 2005 to 2007,7 patients developed portal vein stenosis following liver transplant.Percutaneous transhepatic stent angioplasty of the portal vein was performed in all patients.The therapeutic results were monitored by clinical follow-up and imaging examination.Results In seven patients,the percutaneous transhepatic stents were placed successfully.The follow up period ranged from 3 months to 34 months.Portal venous patency Was maintained in six patients(one patient died due to hepatic arterial thrombosis and ischemic insult to bile duct at three months following the stent placement).No complications due to stent angioplasty occurred.Conclusion Percutaneous transhepatic stent angioplasty is an effective and safe method for treatment of portal vein stenosis following liver transplant.

Objective: To observe the clinical effect of Tongfu granules(通腑颗粒) on the gastro- intestinal dysfunction in patients with multiple organ dysfunction syndrome(MODS).Methods: The trial was prospective,multi-centric and clinically controlled.One hundred and forty patients with MODS who had been selected were randomly divided into two groups: mosapride citrate group and Tongfu granules group.Respectively at 0 hour,the 48 th hour,the 7 th day or before death, the following scoring systems were calculated: the intestinal dysfunction score,acute physiology and chronic health evaluationⅡ((APACHEⅡ)) score and Marshall score.The duration of mechanical ventilation,hospitalization in intensive care unit(ICU) and the prognosis within 28 days were recorded.Results: After treatments,the intestinal dysfunction score,(APACHEⅡ) score and Marshall score of all patients decreased,at the same time,the therapeutic effects of Tongfu granules group were more significant than those in mosapride citrate group(P20 scores.The mortality was elevated with the increased number of dysfunction organs.Conclusion: Tongfu granules can ameliorate the severity of the disease situation andimprove the prognosis of patients with MODS.

OBJECTIVE To study the characteristic change of the expression of caspase 3 of spleen in different sepsis rats.METHODS We designed sepsis model by cecal ligation puncture,divided into five groups,sampled tissue in 3,24 and 72 h after model built,and compared the change between groups.We employed the immuno-histochemistry to examine the positive expression of caspase 3 in spleen,and examined the index of apoptosis in different groups.RESULTS The result showed that three traditional Chinese medicine compounds could significantly cut down the expression of caspase 3 in spleen lymphocyte.CONCLUSIONS The three traditional Chinese medicine compounds could decrease the apoptosis of lymphocyte,and adjust the immunity.

Objective:To investigate the efficacy and mechanism of static progressive stretch (SPS) with different parameters in the treatment of stiff knee in rats.Methods:Fifty-six male 8-week SD rats were randomly divided into an operation group ( n=48) and a blank group ( n=8, normal feeding rats without any treatment). The knee joints of the rats in the operation group were fixed with Kirschner wire for 4 weeks to create models of right knee flexion stiffness. The 42 rats with successful modeling were randomly divided into 6 groups ( n=7): the model group was executed and sampled after successful modeling, the spontaneous recovery group was not given any treatment after successful modeling, group T1 was given SPS treatment for 20 min once per day, group T2 was given SPS treatment for 30 min once per day, group T3 was given SPS treatment for 20 min once every 2 days, and group T4 was given SPS treatment for 30 min once every 2 days. After 16 days, the range of knee motion, number of myofibroblasts, and positive proportion of transforming growth factor- β1 (TGF- β1) in the joint capsule were detected and compared between groups. Results:The ranges of knee motion in the spontaneous recovery group and the 4 SPS treatment groups were significantly greater than those before treatment ( P<0.05), and the improvements in the range of knee motion in the 4 SPS treatment groups were significantly greater than that in the spontaneous recovery group ( P<0.05). The range of knee motion in group T2 (112.29°±1.89°) was improved the most significantly. The number of myofibroblasts was (23.72±10.75)/HP, which was significantly smaller than that in T3 group [(55.72±33.56)/HP] or in T4 group [(50.72±33.34)/HP] ( P<0.05). The positive proportions of TGF- β1 in the joint capsule in the 4 SPS treatment groups were significantly lower than that in the model group, and the positive proportion of TGF- β1 in the joint capsule in group T2 (0.51%±0.38%) was significantly lower than those in group T3 and T4 ( P<0.05). Conclusions:As SPS treatment can reduce the expression of TGF- β1 in the joint and inhibit the excessive proliferation of myofibroblasts to alleviate the pathological changes in a stiff knee, it has a significant effect on the stiff knee in rats. The SPS treatment for 30 minutes and once per day may lead to the best efficacy.