Objective To study the genetic susceptibility in patients with postpartum thyroiditis(PPT)by genotyping their human leukocyte antigen(HLA)-DP and -DQ alleles.Methods The polymerase chain reaction-sequence based typing(PCR-SBP)method was used to analyze the distribution of HLA-DPA1,HLA-DPB1,HLA-DQA1 and HLA-DQB1 alleles among 52 PPT patients(31 clinical patients,21 subclinical patients)and 82 healthy controls.Compare the allele frequencies between various patient groups and the control population.Results There was no significant difference between patient group and control group.Conclusion Perhaps PPT is not associated with HLA-DP and HLA-DQ alleles.

Objective To assess the diagnostic value of delayed CT contrast enhancement patterns in hilar cholangiocarcinoma based on two phased dynamic incremental CT scanning. Methods Fifty two patients with suspected hilar tumor and bile duct obstruction underwent spiral CT scan. The scan time for one revolution of the X ray tube was 1 second. To elucidate the delay time for optimal imaging, all proved cholangiocarcinoma with delayed (6、8、10、15、20、30 minutes) post equilibrium phase contrast enhanced CT scans were acquired with unenhanced, dynamic contrast enhanced, and delayed images. Degree of delayed enhancement was compared with that of surrounding liver parenchyma. Results (1) 8～15 minutes after IV injection of contrast material was the delay time for optimal imaging. (2) Of 29 cholangiocarcinomas, the early CT showed hypoattenuating (lower than that of liver parenchyma) in 23 tumors, isoattenuating (equal to that of the liver) in 4 tumors, and hyperattenuating (higher than that of liver) in 2 tumors. The delayed CT scan showed isoattenuating in 8 tumors, hyperattenuating in 21 tumors, and no hypoattenuating. Most of delay imaging of hilar cholangiocarcinoma may appear hyperattenuating ( U=-4.307 3, P

Objective To assess surgical strategies and its therapeutic effect on treating tumors invading of the great vessels. Methods 23 patients underwent tumor resection along with reconstruction of great vessels from Jan. 2001 to Dec. 2005 were retrospectively reviewed. Results 19 cases (82.6%) experienced radical resection along with reconstruction of great vessels, 4 cases (17.4%) underwent palliative resections. 20 cases (86.9%) were followed up by various imaging examination methods. 4 cases (17.4%) died perioperatively and 7 cases (30.4%) had complications in perioperative period. Up to Aug. 2005, the postoperative survival times in patients were from 1.5 to 59.0 months. 3 cases (15.0%,3/20) existed more than 48 months, 4 cases (20.0%,4/20) more than 36 months, 6 cases (30.0%,6/20) more than 24 months, 9 cases (45.0%,9/20) more than 12 months and 12 cases(55.0%,11/20)more than 6 months. No complications related to vascular graft occlusion and tumor recurrence next to grafts occurred in these patients. In 2 cases appeared partial thrombosis in grafts in perioperatively. Conclusion Combination of radical resection of tumor and reconstruction of great vessels could extend survival time and improve quality of life in selected patients with tumor invading thoracic and abdominal great vessels.

OBJECTIVETo investigate the distribution of the internal mammary artery and its branches by the multi-slice spiral CT angiography, and to explore the feasibility of transferring pedicled transverse rectus abdomials myocataneous (TRAM) flap for breast reconstruction through resection of inferior costicartilages.

METHODS30 female patients received abdominal CT angiography. (1) The distance between internal mammary artery and the sternum midline were recorded; (2) The position and the numbers of branches from bilateral internal mammary arteries at the level of 5th, 6th, 7th rib was observed; (3) The points where the superior epigastric artery gets through the rectus abdominis muscle were located.

RESULTS( The average distance between left internal mammary artery to the sternum midline is from 1. 66 cm (0. 62-2. 39 cm ) to 2.34 cm (0.69-3.36 cm) at the level from 4th to 6th intercostal space. The average distance between right internal mammary artery to the sternum midline is from 1.55 cm(0. 66-2. 29 cm) to 2.29 cm(0. 73-3. 67 cm) at the level from 4th to 6th intercostal space; ) The number of branches is the most at the level of 6th intercostal space; (3) There are 235 branches in the superior epigastric artery.

CONCLUSIONSThis imaging study of internal mammary artery explores the feasibility of transferring pedicled transverse rectus abdominals myocataneous flap for breast reconstruction. It has important significance in the breast reconstruction using TRAM flap with lengthened pedicle.

Abdominal Muscles ; blood supply ; Epigastric Arteries ; anatomy & histology ; diagnostic imaging ; Female ; Humans ; Mammaplasty ; Mammary Arteries ; anatomy & histology ; diagnostic imaging ; Multidetector Computed Tomography ; Rectus Abdominis ; anatomy & histology ; diagnostic imaging ; Sternum ; anatomy & histology ; diagnostic imaging ; Surgical Flaps

Objective To measure the leakage rate in the process of expansion in vivo and in normal saline and the over-expansion property of the expander.Methods We chose 17 cases that were treated with the skin expansion.We recorded total injected saline volume intentionally in these cases before the second surgery,and recorded the remainder of the volume of saline postoperatively.We injected normal saline into 8 expanders,respectively,exceeding 50％ of the volume-rating;and subsequently put these expanders into plastic bucket filled with saline.30 days after,we measured the remaining volume of the normal saline.We injected 100 ml normal saline into 4 expanders,respectively,of which nominal volume was 100 ml,and then left these expanders in saline and measured the remainder volume of the saline 30 days later.In the second time,we injected 150 ml and repeated the abovementioned process.It was repeated 7 times until the injection volume reached 400 ml.We processed the data and depicted a curve of effective expansion.Results The results showed that the leakage rate reached (29.0+12.5) ％ in vivo.Experiments in vitro confirmed that 85.0％ (8.0/9.4) of the saline leaked through the injection port and 14.8％ (1.4/9.4) leaked through the membrane of the expander.In addition,over-expansion performance index test confirmed that the over-expansion property of an expander was about twice the nominal volume.Conclusions The expander is not completely sealed structure.Normal saline can leak through the injection part and the membrane of the expander.The over-expansion property of an expander is limited.When the volume injected into the expander exceeds a certain value,the effective expansion performance is not increased with it.

Objective To analyze the complications of breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap (TRAM flap) and latissimus dorsi flap (LDF).Methods From databases such as CNKI,SinoMed,PubMed,VIP and Cochrane Library and manual search of articles on breast reconstruction with pedicled TRAM and LDF from 1992 to 2002 for the language of both Chinese and English,1493 cases were collected.47 cases were selected after they all were inspected by the excluded and included standards.RevMan 5.0 software was used to perform the Mantele-Haenszel fixed effect model.Results Ten studies reporting outcomes of pedicled TRAM and LDF were used to estimate relative risk (RR) and 95 ％ confidence interval (CI) for complications.There was a 1.7 times increase in the risk of partial flap necrosis (relative risk,1.72; 95 ％ CI,1.02to 2.88) in pedicled TRAM flap patients compared with LDF patients.There was no difference in the risk for fat necrosis (relative risk,1.01; 95 ％ CI,0.60 to 1.72) and total flap loss (relative risk,2.13; 95 ％ CI,0.82 to 5.54) between pedicled TRAM flap and LDF patients (P＞0.05).Conclusions Compared with the pedicled TRAM flap,partial flap loss risk of breast reconstruction with LDF is lower,and the risk of fat necrosis and total flap loss have no statistical difference (P＞0.05).

Objective To locate the points where the superior epigastric artery perforates the rectus abdominis muscle by using the spiral CT,in order to evaluate its control on abdominal complications after breast reconstruction.Methods Fifty cases had received abdominal spiral CT angiography,respectively.Then the coordinate system was established,with the umbilicus as the origin,the umbilicus horizontal line as X axis,vertical umbilical level line as Y axis.The point where superior epigastric artery perforates the rectus abdominis muscle in the coordinate system was located as described above.Results There were 392 perforating points in the rectus abdominis muscle in all 50 cases,with a mean of 7.84 perforators per patient.In the first quadrant,the points where superior epigastric artery perforate the rectus abdominis muscle were located in the range from 1.45 cm to 5.47 cm on the X axis,and in the range from 2.52 cm to 16.38 cm on the Y axis,respectively.In the second quadrant,the points where superior epigastric artery perforates the rectus abdominis muscle were located in the range from 2.02 cm to 6.80 cm on the X axis,and in the range from 2.30 cm to 14.46 cm on the Y axis,respectively.Conclusions The spiral CT angiography has high sensitivity and specificity,it can locate the point where the superior epigastric artery perforates the rectus abdominis muscle,which can avoid to cut extra rectus abdominis muscle.It is significant to reach best postoperative effect with the lowest donor site complications.

Objective To sum up our preliminary experience on radical surgery for the treatment of Budd Chiari syndrome under genuine direct vision. Method A total of 13 cases were enrolled in this study with age ranging from 17 to 48 years, and history from 3 months to 5 years. There was inferior vena cava (IVC) membranous obstruction in 3 cases, right hepatic venous membrane (HV) in 1 case, IVC membrane with distal thrombosis in 6 cases, long segment of thrombosis of IVC in 2 cases, IVC tumor thrombus extending to right atrium in 1 case of retroperitoneal tumor. Result All lesions were successfully resected. Extracorporeal circulation was used in one case, cell saver was used in 2 cases. No blood transfusion was needed except for one case receiving bank blood transfusion of 2000 ml, and the other one of 400 ml. One patient died of renal failure during perioperative period. Disappearance of the symptoms and sigh after operation was found in all the other cases. Conclusion This new radical surgery gives access to the lesions under clear direct vision facilitating the correction.

Objective To investigate the effect of tissue expansion in facial congenital giant nevus.Methods From October 2014 to October 2016,7 cases of facial congenital giant nevus patients were treated with expanded skin flaps,including single expansion and secondary expansion.Partial excision and skin tissue expansion were used to drastically remove giant pigmented nevi on body or extremities of infants.There were some points for attention during the surgery:the size and location of the partial excision and expander should be designed reasonably;no tumor-manipulation and non-tension principle should be taken great notice,and expanders should be linked up with one another when several expanders were used at the same time,so as to reduce the possibility of forming the envelop,which was favorable for the second surgery of transfer of a skin flap.Results All cases of giant pigmented nevi excision were on the face,which were completely removed from the patients.The areas of the nevi were from 7 cm × 5 cm to 15 cm × 13 cm.All patients were followed up for 3-12 months (mean 6 months).All flaps survived well.Expander exposure was happened in 2 cases with no bad results.One case of scar received late repair due to surgical scars and all got satisfactory results.Conclusions Tissue expansion is an ideal method in the treatment of facial congenital giant nevus.

Objective To investigate the expression of chemokine-like factor 1(CKLF1) in the balloon injured aorta of Sprague-Dawley rats.Methods Balloon expansion induced aorta injury model was established in 80 male Sprague-Dawley rats.Model rats were randomly divided into 8 groups.Rats were sacrificed at the postoperative periods of 12 hours,1 day,3 days,1 week,2 weeks,4 weeks,6 weeks,and 8 weeks respectively.Sham injury operation was applied to 5 rats as control.The ratio of intimal area (IA) and medial area (MA) was calculated to determine the extent of neointimal hyperplasia.Expression of CKLF1 was examined at protein level with immunohistochemistry and at mRNA level with RT-PCR.Software IPP6.0 was used to examine the mean optical density of positive staining.With β-actin expression as an internal control,semi-quantity of CKLF1 expression was calculated by CKLF1/β-actin.Results Visible neointima was noticed at 1 week postoperation.Extend of intimal hyperplasia(IA/MA)was most remarkable at 4 weeks and receded afterwards. Immnohistochemistry study showed that expression of CKLF1 was stronger in the neointima than in the media(P=0.016).The expression was most obvious in the neotima at 1 week postoperation.RT-PCR showed peak expression at 3 days postoperation and declined gradually but still at a higher level than control(P<0.05).The extent of intimal hyperplasia(IA/MA)was positively correlated to the expression of CKLF1(R=0.70,P=0.188).Conclusion The expression of CKLF1 was up regulated in balloon injured rat aorta.The expression was more obvious in the neointima than in the media.CKLF1 may play a role in the development of intimal hyperplasia.