Objectives:The time of Carotid intervention for recently symptomatic,severe carotid stenosis which cause a transient ischemic attack or minor stroke is still a controversial issue.Early studies showed that carotid endarterectomy (CEA) caused a high risk if performed within days follow an acute ischemic stroke.However,The National Stroke Strategy posted by UK Department of Health advocated that this situation should be regarded as an emergency procedure,and carotid intervention should ideally be performed within 48 hours.We designed this study to discuss the effect of urgent CEA on operative risk and benefit.Methods: we analyze 12 urgent CEA with primary closure performed during 1996 to 1998.All 12 patients were underwent CEA within 2 weeks,and 2 of them within 2 days.Operative risks and overall benefit from surgery were discussed in relation to the time from the last symptomatic event to CEA.Results: 2 urgent CEA performed in 2 days are recovery uneventful.1 of 12 patients,who underwent urgent CEA within 2 weeks,occurred restenosis after 3 months follow up.No 30-day perioperative recurrent TIA,stroke and death.Conclusions:CEA performed within 2 weeks is feasible and reliable procedure in preventing recurrent TIA and stroke after presenting manifestations.The future aim is to perform CEA within 48 hours after TIA or stroke symptoms.

Objective:In order to study mechanism of hematogenous metastasis of rectum cancer.Methods:8 specimens of human rectum cancer and 6 specimens of rectum in normal human were examined.The immunohistochemical SP method was employed in study of the expression of ICAM1,CEA and CD31 in the peritumoral rectum tissues and lymphy nodes.Results:The intercellular role in the adhesion molecule-1(ICAM-1)and carcinoma embryonic antigen(CEA) were expressed on the vascular endothelial cells of peritumoral rectum tissues and peritumoral lymph nodes in the rectum cancer.CD31 are expressed on the vascular endothelial cells of rectum tissues from normal human with the same intensity of cancer peritumoral rectum tissues.Conclusion:This study showed that ICAM-1 and CEA seemed to play a stable role in the adhesion effect between cancer cells and endothelial cells.It is not clear whether CD31 plays a role in the interaction between cancer cells and endothelial cells.

Objective:To investigate the reasonable approach and surgical indication for acute necrotizing pancreatitis(ANP)by analyzing the factors that affecting the mortality of ANP.Methods:One hundred and twelve patients with ANP were retrospectively divided into two groups-the dead and the survivors.Some parameters were analyzed statistically to reveal what's the reason for death.Results:The average age,sex ratio and onset of illness were similar between two groups.And the ratio of early shock,early adult respiratory distress syndrome (ARDS),high temperature,leukocytosis and high blood glucose between two groups were also similar between two groups(P＞0.05,respectively).The important factors that affecting the mortality were:①severity of pancreatic necrosis,②improper surgical approach,③incorrect surgical indication.Conclusion:The patiets with mild or moderate ANP should mainly receive conservative treatment for 48～72 hours.The early shock and ARDS should be redressed before surgical intervention.If the operation is unavoidable,the swelling pancreas should be dissected fully,which will provide sufficient drainage after operation,and duodenostomy should be performed during operation.

Objective:To investigate the number of CD+68 cells in hepatocellular carcinoma (HCC),paraneoplastic tissues,cirrhosis tissues and normal liver tissues and their clinical significance.Methods:Surgical specimens from 60 cases of HCC,62 cases of cirrhosis and 23 cases of normal liver were investigated by immunohistochemical staining of CD+68with streptavidin-horseradish peroxidase detective system.Results:(1)The order of the mean number of CD+68cells in the tissues from the highest to the lowest was:paraneoplastic,cirrhosis,normal liver and HCC tissues(P〈0.01);(2)The number of CD+68cells in the tissues decreased successively with the decrease of HCC differentiation (P〈0.05);(3)There was no relationship between the number of CD+68cells in HCC and its clinical TNM stage;(4)The number of CD+68cells in the cases with metastasis within 15 months was significantly lower than that without metastasis (P〈0.05).Conclusion:The number of CD+68cells might be an important marker to estimate the immune status and a useful factor to predict the prognosis of HCC patients.

Objeetive:To study the expression of cell adhesion molecules on the lymphatic endothelial cells In the rectum cancer and peritumoral lymph nodes as well as their relationship with the diffusion of cancer cellS. Methods: In this Study the immunhistochemistry method was employed to observe the expression of CEA, ICAM-1 and CD31 on rectum cancer lymphatic endo-thelial cells. Results :The results demonstrated that CEA and lCAM-1 were highly expressed on the lynphatio endothelial cells in the peritumoral rectum tissues and lymph nodes. It was, howev-er,negative in normal lymphatic endothelial cells. CD31 was expressed on both lymphatic endothe-Ilal cells in the periturmral rectum tissues and lymph nodes and vessel endothelial cells of the normal human. Conelusion: The study suggests that there are relationships between the dis-semination of cancer cells and excession of CEA, lCAM-1 and CD31 in lymphatic endothelial cells.The CAE and ICAM-1 seem to induce stable adhesion between oancer cells and endothelial cells.

Objective: Gallbladder polyps are frequently discovered in the past decade. Ifthe polyps are oenign,without concomitant stone and the gallbladder has a good function, it is not an absolutely indication for cholecystectomy. For this reason percutaneous endoscopio polypectomy of the gallbladden polyps were developed and applied. Methods: Among those who underwent peroutaneous endosoopic polypectomy of the gallbladder, 85 patients with gallblaeder polyps were studied. Under the epidural anesthesia, cholecystoscope was introduced into the gallbladder. The polyps were coagulated by self-made miorowave ceagulator and then resected for histopathelogical evaluation. The preserved gallbladders were followed up to evaluate the effioacy of this minimally invasive therapy. Results: All precedures were eventful with mean operation time of 1h to 1. 5h. Sixty seven patients were followed-up for a mean of 5.5 yeah (2～9 years) and showed all patients to be symptom free and in 64 cases the gallbladder function was found to be well preserved without recurrence of polyps and occurrenca of gallstones on ultraSound. Conclusion: The procedure reposed is a reliable, simple,effective and minimally invasive technique to remove gallbledder polyps and to preserve gallbladder function for the patients who have the benign gallbladder polyps.

Objective:TO explore the effectiveness of splenic tissue autotransplantation in restoring host defense. Methods: Rabbits were divided into three groups,Sham Operation(SO), Splenic Autotransplantation(SA)and Total Splenectomy(TS), and dynamic changes in histology and immunology were observed for over 24 weeks. Results: Histologic study shows that the white pulps were poorly developed and central arterioles disappeared in the regenerated splenic tissue. The weight of regenerated spleens recovered six months later in SA was 11% of that in SO, and was significantly reduced comparing with the implanted weight( P ＜0.05). Tere were no significant difference in the number of T lymphocytes and the levels of serum lysozyme among the three groups. A poor antibody response by the rabbits of SA and TS as compared to those of SO was noted after the primary intravenous administration with sheep red blood cells. After the challenge with type 3 pneumococci intravenously, pneumococcal clearance from bloodstream in SA did not differ significantly from that in TS,but was marKedly delayed compared with that in SO(P＜0.01). Conclusion: The results indicate that the low quantity and poor quality of the regenerated spleens may contribute to the inferior immunoprotective ability of 1/3 splenic autotransplantation. Therefore, it implies that the regenerated spleens can not fully compensate the original one in im-munology, especially, host resistance to infection.

Objective: TO verify through animal experiment the validity of chemical cholecystectomy . Methods: The experimental objects seven healthy juvenile pigs,hardener was infused into the gallbladder,after infusion the samples were collected by pathoiogical examination , according to the different duration under anesthestize. Reslts:The mucous destructive and digestive process remained with one week, the inflammatory reacton in two weeks,the chronic inflatoy reaction compained a a great deal of granu lation tissue and scar formation occurred in 4th-8th week,10 weeks latter,the inflmmatory reaction reduced ,and scar tissue formed. Conclusion: Chemical cholecystectomy is safe and reliable in clinical.

Objective:To investigate gut barrier dysfunction and bacterial translocation (BT) in patients who underwent digestive tract reconstruction and to study the relationship between BT and acute systemic inflammatory state (SIRS). Method： Sixty patients who underwent selective digestive tract reconstruction were observed. Blood were collected before surgery and 1, 3, 5 days after surgery to detect plasma diamine oxidase(DAO) and bacterial DNA. PCR analysis was performed with β-Galactosidase gene of Eschenchia coli and 16SrRNA gene as target gene. The SIRS of all the patients were observed for 10 days. Result：All the PCR results before operation were negative, while there was positive in 14 patients after digestive tract reconstruction. There were 23 patients with SIRS after surgery, and 12 patients PCR result were positive among 23 patients with SIRS. 85.7% of the patients(12/14) with positive PCR result had SIRS, while 23.9% patients (11/46) with negative PCR result had SIRS (P<0.01).The positive PCR rate in SIRS was 52.2% (12/23), which was remarkably higher than that without SIRS(5.4%, 2/37, P<0.01).The levels of plasma DAO in patients with positive PCR result was significantly higher than those of the patients with negative PCR result (P<0.01). The levels of plasma DAO in patients with SIRS was significantly higher than those of patients without SIRS (P<0.01). Conclusion:The gut barrier dysfunction was closely related to BT, and BT was closely related to postoperative SIRS. PCR analysis can be used in early diagnosis of BT, the positive PCR result might be a useful early warning sign of postoperative SIRS.

Objective:To investigate the effects of n-3 fish oil fatty emulsion on fatty acid profile and lipid mediator,immune regulation mechanism and anti-inflammatory effect of inpatients underwent total gastrectomy.Methods:In a prospective,double-blind,and randomized controlled trial,60 patients underwent total gastrectomy were divided into two groups,therapy group and control group.The control group was given routine therapy while the therapy group was given routine therapy and fish oil.The day before the operation,1,4 and 8 days after the operation,The lipid metabolic Indices,including free fatty acids spectrum were detected;The inflammation indicator,including c-reactive protein(CRP) and interleukin(IL-1,lL-6),tumor necrosis factor alpha(TNF-α) were tested;The cellular immune function,including HLA-DR expression rate,the level of T cell subgroup were detected with flow cytometry.The clinical outcome indicators including APACHE Ⅱ score,postoperative infection and MODS incidence,postoperative hospitalization days,hospitalization mortality were observed.Results:There was no significant difference between Fish oil group and control group in age,sex and BMI,the serum levels of inflammatory cytokines,the HLA-DR expression rate,level of T cell subgroup,APACHE Ⅱ score,etc.(P＞0.05),so the two groups are comparable.Compared with control group,the n-6/n-3 PUFAs ratio drops,AA content decreased,but the content of EPA and DHA is increased,in fish oil group,decreased in fish oil group (P＜0.05);Compared with control group,serum concentration of CRP,IL-6 and TNF-α in patients of therapy group were significantly reduced,and clinical outcome improved.There was no difference in the expression of T cell subgroup between two groups.Conclusion:Application of n-3 fish oil fat emulsion,can lower the n-6/n-3 PUFAs ratio,reduce the AA content in serum,but the content of EPA and DHA is increased;N-3 fish oil fat emulsion can reduce serum after total gastrectomy,IL-1,IL-6,TNF-α inflammatory factor and the concentration of CRP,effectively reduce the inflammatory response in patients with;N-3 fish oil fat emulsion can improve the HLA-DR expression rate,reduce the immunosuppression,but had no significant effect on T cell subgroup level;N-3 fish oil fat emulsion to reduce the incidence of postoperative infection and MODS,improve patients with acute physiology,but had no significant effect on total days in hospital,mortality.