Objective　To study the effects of glucose and lipid metabolism on gallstone formation. Methods　Twenty five patients with gallstones and 25 normal volunteer controls were studied from January to April in 1998. The patients were well matched the control with sex and age (1∶1). In the study, Body Mass Index (BMI) and Waist-to-Hip circumference ratio (W/H) were measured. Blood glucose, glucosylated hemoglobin (HbA1C), insulin, C peptide and all parameters of lipids were detected at fasting state. The glucose,insulin, C peptide were detected again at 2-hour after taking 75g glucose orally. Results　The result showed there was no difference on BMI and W/H between the patients and controls. HbA1C、mean fasting and 2-hour glucose concentration were not in significantly different between the two groups (P>0.05, P>0.2, P>0.1 respectively). There were 10 patients with abnormal glucose metabolism (7 with NIDDM, 3 with IGT), but only 4 controls were abnoumal (one with NIDDM, three with IGT). The difference was significant (P<0.05). Furthermore, the mean fasting and 2-hour insulin concentration of gallstone group was higher than that of the control (P<0.02, P<0.05). And the gallstone group had a higher fasting C peptide concentration than control (P<0.05). There was no statistical difference on the parameters of plasma lipid between the tow groups. Conclusion　The study suggests that diabetes mellious and hyperinsulinemia acted as an important role on gallstone formation.

Objective To study the indication and means in dissection lymph nodes of the No.10 and No.11 without splenectomy in radical gastrectomy for gastric cancer. Methods According to the location, type of pathology, clinical and pathological classification, lymphatic drainage and spread of gastric carcinoma togather with the immunological function of spleen, selection of operative procedure without splenectomy should be considered, so the related literatures were reviewed. Results Retained spleen had been shown to improve 5 year survival of patients with gastric cancer of stage Ⅰ,Ⅱ and Ⅲ,splenectomy had been shown to improve 5 year survival of patients with gastric cancer of stage Ⅳ,whose carcinoma was infiltrating splenic and the lymph nodes of the No.10. The complications of different means of dissection of the lymph nodes made no difference.Conclusion Dissection of the lymph node without retained spleen or allogenic spleen transplantation is indicated for the patients with cancer of stage Ⅳ,whose spleen is invaded by the tumor.

Objective To evaluate the role of contrast enhanced CT (CECT) scanning in the diagnosis and treatment planning of some rare liver tumors. Methods We retrospectively reviewed the CECT imaging features of 10 cases with rare tumors of the liver proved by surgical pathology in 8 cases or by liver biopsy in 2 cases, with correlation of relevant clinical manifestations, laboratory results and surgical findings. Results Three cases were histopathologically proved to be benign, and 7 cases were malignant. On CT images, the liver lesions were mixed cystic solid in 5 cases, totally solid in the other 5. Eight cases demonstrated heterogeneous enhancement, while 2 cases of liver lymphoma had no enhancement. The anatomic relationship of tumors to intrahepatic vasculature, the compression and infiltration of neighboring abdominal structures were accurately delineated by CT as compared with findings at operation. Clinical manifestations and laboratory findings were not useful for the qualitative diagnosis of rare liver tumors, except for hepatocellular carcinoma. Conclusion CECT is very useful for the detection of rare liver tumors and the fine depiction of local extent of these tumors. When correlated with clinical and laboratory information, it helps to differentiate rare liver tumors from hepatocellular carcinoma. But its role in the characterization of rare liver tumors is limited.

Objective To explore the clinical features and sum up the laws of the hepatic focal nodular hyperplasia (FNH) in its diagnosis and treatment. Methods FNH was an uncommon benign hepatic tumor that often posed diagnostic dilemmas. We analyzed retrospectively the clinical, imaging of ultrasound, imaging of computed tomography (CT) and magnetic resonance images (MRI), and pathological materials of 21 patients with FNH proven by the pathological diagnosis during 5 years from April 1996 through April 2001 in two hospitals. Results The diagnosis of FNH remained a challenge for clinicians and surgeons. Rate of correct diagnosis of FNH was low preoperatively (19.0%). The lesions of FNH were seen in males and females (m/f: 14/7). Only three female patients (3/7) had the history of taking oral contraceptive. Patients with FNH were largely young and middle age persons (81.0% under 50 years), discovered by accident (57.1%), without infection of the hepatitis B virus (95.2%) and with normal liver functions (100%) and serum AFP levels (100%). Color Doppler ultrasound showed blood vessels passing through the lesion (80.0%) and there was abundant in blood (66.7%). CT scan showed that the lesion had transient immediate enhancement in 60.0% of patients and had homogeneous signal in 60.0% after bolus injection. MR imaging demonstrated early vigorous enhancement (64.3%), homogenous signal (57.1%) and having central scar (35.7%) in the lesion. The demonstration of a central scar in the lesion was very helpful for the diagnosis of FNH. MRI was more helpful for the diagnosis of FNH using liver specific contrast agents: superparamagnetic iron oxide(SPIO). All patients underwent focus resection (18 cases) or segmentectomy (2 cases), except one having no treatment. Conclusion FNH shows some typical clinical and imaging features. We could increase the rate of correct diagnosis by comprehensively analyzing the clinical and imaging materials. It is very important and necessary to determine a definite diagnosis of FNH, hepatic adenoma (HA) and primary liver cancer (PLC) preoperatively, because the HA and PLC must be surgically resected, FNH can only be followed up.

Objective To study the expression of survivin protein in primary hepatocellular carcinoma(PHC) and its relationship to the proliferation of the tumor cells and prognosis of PHC. Methods The expression of survivin protein and the proliferation of tumor cells marked by proliferating cell nuclear antigen (PCNA) in 48 cases of PHC were determined by immunohistochemical method. Results The survivin protein was expressed in 31 of 48 cases of PHC (64.6%). The expression of PCNA was significantly higher in hepatocellular carcinoma (HCC) with positive survivin expression than in HCC with negative survivin expression. The patients with positive survivin expression had the worse prognosis than those with negative survivin expression. Conclusion The expression of survivin may play an important role in the proliferation of PHC cells and closely associate with the prognosis of PHC, and probably become the prognostic factor and an important target of therapy.

Objective To explore the application of extracorporeal veno venous bypass in orthotopic liver transplantation in pigs and to compare hemodynamic changes during operation of two different bypass ways. Methods Twenty five porcine orthotopic liver transplantations were performed and extracorporeal veno venous bypass was established during anhepatic phase through a catheter in portal vein (group A, n =16) or in splenic vein (group B, n =9).Hemodynamic changes were monitored continuously.Results Fourteen recipients survived two days after operation (14/16) in group A while all survived in group B (9/9).Transient hemodynamic disturbance (MAP and CVP decreased,and HR increased) was monitored at both the beginning and the end of anhepatic stage in group A,while these parameters kept stable in group B ( P

Objective To investigate the cause of stoma recurrence after anterior resection of rectal cancer and discover the methods of prevention and treatment.Methods A total 91 patients with stoma recurrence after anterior resection of rectal cancer (or Dixon) were analysed retrospectively between 1985 and 1996. Fourty seven patients experienced re radical resection (Miles), 27 cases palliative resection, and 11 cases only exploration. Thirty two cases had been followed up for 5 years and obtained 1,3,5 year survival rate for re radical radical resection (Miles). Diagnosis and treatment of stomal recurrence after Dixon were evaluated. Results One, three and five year survival rate of re radical resection (Miles) was 93%,77%,45% respectively.Conclusion To amplify blindly the adaptation of Dixon is to raise the rate of stoma recurrence. Digital rectal examination and fiberopic colonoscopy (and biopsy) are very essential methods for the diagnosis of stoma recurrence, and we strive to do re radical resection (Miles) for the patients with stoma recurrence after Dixon's operation.

Objective To study the expression and significance of proliferating cell nuclear antigen (PCNA) and argyrophilia nucleolar organizer regions (AgNORs) in colorectal carcinoma (CRC) and carcinoma adjacent mucosa (CAM).Methods The expression of PCNA in 48 cases of colorectal carcinoma tissue, CAM and 10 cases of normal mucosa was detected by immunohistochemistry techniques. AgNORs was determined with argyrophilia stain. Results The PCNA labeling index (PCNA LI) and AgNORs count in CRC were higher than that in CAM and normal mucosa( P

Objective To investigate the anatomical mark of attachment edge in mesorectal tail and the effect of its morphologic distribution in performing total mesorectal excision (TME). Methods The gross specimens of 220 consecutive patients with the middle lower rectal cancer were collected by a group of surgeons.Patients were divided into two groups.①Group in saving sphincter. Ⅰa group, low anterior resection (LAR): 81 patients with lesions between 5 and 6 cm from the anal verge underwent LAR ; Ⅰb group, anterior resection (AR): 68 patients with lesions between 7 and 8 cm from the anal verge underwent AR.②Group in resecting sphincter. Abdominoperineal resection (APR): 71 patients with lesions between anal verge and 5 cm from the anal verge underwent APR. Results ①The circular edge of mesorectal tail is attached on rectal wall of 1 cm above anal hiatus of levators,which level parallels the lower margin of lower rectal cancer.In order to reset distal rectal wall of 2 and 3 cm,undergoing LAR must avoid injuring rectal wall when dissecting muscular vessel of rectum continue along the levators fascia to the anal hiatus.②The attachment morphology of mesorectal tail is a circular flake and not circular linear in shape. There are a little of fat tissue between posterior rectal wall and mesorectal tail,the length of its longitudinal attachment is (1.269?0.171) cm (81 cases in LAR group and 71 cases in APR gourp).Because the distal resective margin of rectum undergoing AR just locate in area of flake attachment of mesorectum, removing mesorectum around rectal wall must avoid injuring the rectal wall. Conclusion The mesorectal tail is a circular flake and attaches on rectal wall of 1.0 cm above anal hiatus of levatorani.Undergoing LAR or AR must avoid to injure rectal wall,which may result in leakage of anastomosis when removing mesorectal tissuce around distal rectal wall.

Objective To study the function of selectin in the pathogenesis and advancement of acute pancreatitis(AP), so as to guide further investigation and clinical treatment. Methods Correlative articles in recent years were reviewed. Results Selectins act as an indicator of the activation of endothelium. Their expression changes markedly during AP and is closely related to cytokines, oxygen free radicals and complements. Conclusion Selectin is a component which is engaged in the pathology of AP, the level of selectin is useful in guiding clinical observation and treatment.