Hepatolithiasis is a common disease in China with a high rate of residual stones up to 30％-90％ after surgery.Patients often require re-operation because the high rate of residual stones and stone recurrence.Because the calculi are deeply distributed in the liver,and the condition is often accompanied by anatomical variations,distortion and biliary strictures,traditional preoperative imaging examinations do not easily locate the lesioos precisely,making diaguosis and treatment difficult.In recent years,three-dimensional computed imaging and visual simulation have provided a novel preoperative diagnostie method for hepatolithiasis,and have offered a clearer radiologic basis for surgical planning.The value of digital medical technology in the diagnosis and treatment of hepatolithiasis is discussed in this article.

In the course of dissection the authors revealed several—from 2 to 8—perforating branches in the peroneal artery instead of only 1 as stated in the text-books. These branches,after perforating the interosseous membrane, supplied the extensor muscles of the leg and might form anastomosis with the anterior tibial artery.On the other hand,the anterior tibial artery was also found to send twigs to perforate the interosseous membrane, anastomosing with the peroneal artery or supplying the muscles of the back of the leg. These communications might be explained by the change in the course of the arteries of the leg during embryonic development.Any failure in the disappearance of the horizontal communications between the embryonic longitudinal vessels would result in a feature as found by the authors.

Objective To investigate the myocardial injury induced by bile duct obstruction and the protective effects ulinastatin(UTI). Methods Dynamic observation of of the levels of malondialdyhyde(MDA) and superoxide dismutase(SOD) of myocardial tissues, and the levels of serum TBil, alkaline phosphatase(ALP), MB isoenzyme of creatine kinase(CK MB), endotoxin (ET), and tumor necrosis factor(TNF ?) in bile duct obstruction(BLD) rats and UIT treatment rats. The left ventricles of the rats were obtained for light and electronic microscopic observation . Immunohistochemical staining method of ABC used was to locate the expression and distribution of TNF ? in myocardial tissues. Results After ligation of the common bile duct, serum TBIL, ALP, CK MB, ET, TNF ? levels and myocardium MDA gradully increased, while SOD levels gradually decreased, and the expression of TNF ? in myocardium increased. As compared with BDL group at the same phase, in UIT group, serum TBIL, ALP, CK MB, ET, TNF? levels and myocardium MDA in UTI treated groups decreased, while myocardium SOD increased, and the expression of TNF ? in myocardium decreased.Myocardial injuries of bile duct obstruction were aggravated as time progressed, and there were less myocardial injuries in UTI treated groups than in BDL groups at the same stage as shown with light and electronic microscopic observation.Conclusions UTI can effectively protect the myocardium from ET,TNF ? and free radical injury in bile duct obstucion rats.

Objective To investigate the clinical value of medical image-three dimensional visible system (MI-3DVS) in percutaneous transhepatic cholangioscopy lithotripsy (PTCSL) for the treatment of hepatolithiasis.Methods The clinical data of 66 patients with hepatolithiasis (55 were from the First People's Hospital of Shunde City and 11 were from the Zhujiang Hospital) were retrospectively analyzed.The images of computed tomography were three-dimensionally reconstructed with MI-3DVS.The location,number,size,shape of the stones were figured out,and the operation strategies of PTCSL were designed according to the types of the disease.The clinical value of MI-3DVS was evaluated according to the operation results and postoperative recovery of patients.All the patients were followed up via telephone or out-patient re-examination.Results Liver,biliary system,stones and blood vessels were three-dimensionally reconstructed with the MI-3 DVS,and the size,number,shape,location of the stones and location,degree,length of the biliary stricture and its anatomical relationship with adjacent blood vessels were clearly displayed.The coincidence rate of planned and actual operations was 95.5％ (63/66).The mean operation time,intraoperative blood loss,rate of stone clearance,complication rate and duration of hospital stay of 63 patients were (117 ± 9) minutes,(18 ± 1) ml,92.4％ (61/66),6.1％ (4/66) and (15 ± 4) days,respectively.All the patients were followed up till September 2012,the median survival time was 16 months (range,1-69 months),and the recurrence rate of hepatolithiasis was 9.1％ (6/66).One patient died of tumor metastasis and multi-organ dysfunction syndrome postoperatively.Conclusion MI-3DVS could effectively improve the safety and efficiency of PTCSL for patients with hepatolithiasis.

Objective To evaluate the treatment of advanced liver cancer by intraoperative argon super cryosurgery system (ASCS) Methods A total of 24 cases suffering from advanced liver cancer were treated by ASCS during operation Nine cases were treated by ASCS only, nine by ASCS in combination with liver artery or portal vein chemotherapeutic pump, four were treated by ASCS with tumor resection and chemotherapeutic pump placement, other two cases received tumor resection together with lymph nodes′ ASCS and pump placement Results The procedure was successful in all 24 cases, complications such as bleeding of puncture aperture, thorax effusion, bile leakage and hepatic coma, were successfully managed Twenty two cases have survived 6 12 months, 17 cases for 12 17 months 9 cases for 18 24 months, 5 cases for more than 24 months Conclusion Intraoperative ASCS provides a new alternative to the treatment of advanced liver cancer with acceptable complication rates

BACKGROUND: Meseuchymal stem cells (MSCs) have extremely strong self-duplication ability and multidirectional ifferentiation potential. When bone marrow stromal cells (BMSC) are isolated and cultured in vitro, implanted in vivo, the distribution and colonization are still unclear, which is concerned with whether BMSC can be usedas target cells in clinic.OBJECTIVE: To explore the capacity of colonizing to the liver after allografting of green fluorescent protein (GFP) labeled MSCs of rats by different approaches.DESIGN: Factorial design.SETTING: Department of General Surgery, Second People's Hospital of Guangdong Province, Postdoctoral Workstation of Sun Yat-Sen University;Department of General Surgery, Zhujiang Hospital, Southern Medical University; Department of Organ Transplantation, Third Hospital Affiliated to Sun Yat-Sen University.MATERIALS: The experiment was performed at the Staff Room of Pharmacology, Basic Department, First Military Medical University of Chinese PLA from January 2003 to December 2004. A total of 36 clean adult SD rats were selected and randomly assigned into 5 groups: CCL4 plus portal vein transplantation group (n=6), portal vein transplantation control group (n=6), CCL4 plus caudal vein transplantation group (n=6), caudal vein transplantation control group (n=6) and mixed group (n=12).METHODS: ① MSCs were obtained from rat marrow and labeled with GFP. After amplifying in vitro, MSCs suspension was implanted with thin needle, with the volume of 0.5 mL/100 g. ②CCL4 plus portal vein transplantation group: In 3 days before MSCs transplantation, the rats were administrated with 20 g/L CCL4 2.5 mL/kg by gastric perfusion every day. The dose was double at the first time. Labeled MSCs were implanted from portal vein. Portal vein transplantation control group: Before transplantation the MSCs were bred commonly, and the labeled MSCs were implanted from portal vein. CCL4 plus caudal vein transplantation group: In 3 days before MSCs transplantation, the rats were administrated with 20 g/L CCL42.5 mL/kg by gastric perfusion every day. The dose was double at the first time. Labeled MSCs were implanted from caudal vein. Caudal vein transplantation control group: Before transplantation the MSCs were bred commonly, and the labeled MSCs were implanted from caudal vein. Mixed group: On the basis of the former 4 groups, 2 rats were implanted with non-labeled MSCs; Another 2 rats fed with CCL4 for 3 days and normal feed were established, without MSCs transplantation. ③At days 3 and 7 after transplantation expression of transplanted MSCs in liver of rats of each group were examined with fluorescent quantitative PCR.MAIN OUTCOME MEASURES: ①Results of MSCs isolation, purification, in vitro amplification and phenotype identification, ②result of GFP-labeled MSCs, ③observation of growth of rats following allografting of MSCs, and ④result of quantitative identification of GFP positive DNA amount in hepatic tissues of each group.RESULTS: Totally 36 experimental SD rats were involved in the result analysis. ①Percoll gradient separating medium was applied to isolate bone marrow of rats. The obtained cells were transferred and amplified,and then mostly showed coincident shuttle shape. Cells did not express CD34 and CD45, but CD29, CD44 and CD90 of MSCs, which were noncommitted stem cells in non-differentiating status that were different from hemopoietic stem cells in bone marrow. ②The green fluorescent cells appeared 24 hours after MSCs transfection. From hour 48 to 72 the number of positive cells significantly increased, with strong intensity.The transfection efficiency was 20%-30% under high-power field, and most of the cells were with green fluorescence. But green fluorescent cells did not appear in the MSCs cells as control. ③After allografting of labeled or non-labeled MSCs of rats with different approaches, at day 1 the rats were listless with bad food appetite, less mobilization; At day 2mostly of them had normal diet and mood, but there was no significant difference in rats of each group. ④The rats in each group with the exception of mixed group had green fluorescent protein positive cells in liver at days 3 and 7. The number of green fluorescent protein positive DNA was higher in liver tissues in the CCL4 plus portal vein transplantation group and CCL4 plus caudal vein transplantation group than in the portal vein transplantation control group and caudal vein transplantation control group (P＜0.05).CONCLUSION: Duration and amount of stem cells colonizing in liver may be associated with liver injury, while not related to the implantation approach. In normal animals with uninjured liver the stem cells can colonize in liver, and the amount is associated with transplantation approach and post-transplantation duration.

With the development of modern imaging technologies,three-dimensional (3D) reconstruction techniques based on the computed tomography (CT) or magnetic resonance imaging (MRI) data has been gradually applied in clinical diagnosis and treatment of hepatobiliary diseases.In order to study the characteristics of the 3 D model of portal branches and collateral circulation in various types of portal hypertension,the data of 64-slice spiral CT scan of5 patients with portal hypertension were collected and imported to the abdominal medical image three-dimensional visualization system (MI-3DVS) for sequence segmenting and 3D reconstruction,and then the results of 3D models were compared with operation findings.The 3D models were vividly,visually and clearly displayed the portal system and the collateral circulation,which is helpful in the diagnosis and treatment of the portal hypertension.

Objective To study the medical image three dimensional visualization system(MI-3DVS)in the diagnosis and treatment of hepatolithiasis.Methods The data of 64-slice spiral computed tomography of 54 patients with hepatolithiasis who were admitted to the Zhujiang Hospital of the Southern Medical University from August 2008 to August 2010 were collected.The liver and bile duct were three dimensionally(3D)constructed.Preoperative diagnosis and pathological classification were made according to the results of the 3D model of liver and bile duct.The optimal surgical procedure was determined by simulating operations based on the 3D model.The compliance of simulated operation and actual operation was observed,and residual stones were detected by cholangiography.Results Of the 54 patients,11 were with type Ⅰ,5 with type Ⅱ(including 2 patients with type Ⅱ a and 3 with Ⅱ b),38 with type E.There were 23 patients with intrahepatic bile duct stricture and 27 with atrophy-hypertrophy syndrome complex.The anatomy of intra-and extrahepatic bile duct,dilation and stricture of the bile duct,site,size and number of the bile duct stones were clearly displayed in the MI-3DVS.The compliance rate of simulated surgery and actual surgery was 94%(51/54).There was no residual stones in 51 patients who received elective surgery and the rate of residual stone of the 54 patients was 6%(3/54).Conclusion Acurate preoperative diagnosis and intraoperative precise operation can be achieved and the rate of residual stone can be reduced by using the MI-3DVS.

Objective To assess the feasibility of semi-quantitative scoring system for contrast-enhanced ultrasound (CEUS)quantitative analysis's color images in the differential diagnosis of breast nodules.Methods Totally 244 BI-RADS 4 breast solid lesions received CEUS before core needle biopsy or surgical resection were included.A semi-quantitative scoring system for color images of CEUS quantitative analysis were built.The scores were given as follows:1 )Color type and its distribution (0 to 4);2)Color scope (0 to 1 );3)Color margin (0 to 1 );4)Color shape (0 to1 ).The total score for each lesion would be from 0 to 7.And the differenital value between benign and malignant lesions were assessed.Results The total semi-quantitative scores of 102 malignant tumors (5.1 ±1 .7)was significant higher than that of benign lesions (3.34±0.7)(P < 0.05 ).In 102 malignant lesions,the total scores of 81 lesions (79.41 %)were more than 4 points,and in 142 benign lesions,the total scores of 89 lesions (62.67%)were less than 4 points.Depending on the Wilcox rank sum test (Mann-Whitney)analysis,the distribution of total scores between benign and malignant lesions was significant different (P <0.000 1).Total score 4 was selected as the best cutoff,the area under ROC curve was 0.749,on which the sensitivity,specificity and accuracy were 79.4%,62.7% and 69.67%,respectively.Conclusions The semi-quantitative scoring system of CEUS quantitative analysis color images showed good sensitivity but not satisfied specificity and accuracy in differential diagnosis between malignant and benign breast lesions.

OBJECTIVETo assess the value of protective hepatectomy based on three-dimensional (3D) reconstruction technique in the treatment of hepatolithiasis.

METHODSThe image data of 64-slice spiral CT scan were obtained from 21 patients with hepatolithiasis and processed using the MI-3DVS software for 3D reconstruction and visible simulation surgery of protective hepatectomy. The actual protective hepatectomy for hepatolithiasis was performed based on the preoperative surgical plan according to the 3D model and the simulation hepatectomy. The consistency between the actual hepatectomy and the simulation surgery was evaluated, and the operating time, lengths of postoperative hospital stay, estimated blood loss, calculus depletion rate and intra- and postoperative complications were recorded.

RESULTSThe consistency rate between the actual procedures of hepatectomy were carried out with a total consistency with the preoperative surgical simulation, and the normal functioning liver tissues were retained in all the 21 patients. The operating time of the procedures was 215.2∓51.3 min, the average postoperative hospital stay was 10.7∓4.3 days, estimated blood loss was 301.4∓60.7 ml, and the calculus depletion rate was 95.2%. The procedure was associated with an incidence of intra- and postoperative complications of 19.0%.

CONCLUSIONProtective hepatectomy for hepatolithiasis based on 3D technique allows efficient calculus depletion, lesion removal, elimination of strictures, and total bile drainage, and also protects the maximum functional liver tissue and reduces the surgical complications.

Adult ; Aged ; Aged, 80 and over ; Bile Ducts ; Cholelithiasis ; diagnostic imaging ; surgery ; Female ; Hepatectomy ; methods ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged ; Software ; Tomography, Spiral Computed ; Treatment Outcome