Objective To evaluate the impact of pancreatic duct hanging and continuous suturing maneuver in end-to-side pancreaticojejunostomy on the incidence of pancreatic fistula after pancreaticoduodenectomy (PD),and to study the feasibility,safety and efficacy.Method 165 patients who underwent pancreaticoduodenectomy were randomly selected and the incidences of pancreatic fistula for the different types of pancreaticojejunostomy were analyzed.Results The overall rate of pancreatic fistula was 13.9％ (23/165).The incidences of pancreatic fistula after pancreatic duct hanging and continuous suturing maneuver in end-to-side anastomosis (3.1％,2/65,group C) was significantly lower than the traditional intussusception anastomosis (23.1％,12/52,group A,P＜0.05) and the mucosa mucosa anastomosis (18.8％,9/48,group B).There was no significant difference between the traditional intussusception anastomosis and the mucosa mucosa anastomosis (P＞0.05).In group C,the average operative time,intraoperative blood loss,and postoperative drainage was obviously superior to the A and B group (P＜0.05).There was no significant difference between the A and B group (P＞0.05).The other complications showed no significant differences among the three groups (P＞0.05).Conclusion Pancreatic-duct hanging and continuous suturing maneuver in end-to-side anastomosis significantly reduced the rate of pancreatic fistula after pancreaticoduedenectomy.It was feasible,safe,convenient to use and should be popularized.

Objective To investigate laparoscopic-guided selective portal vein ligation in the two-stage hepatectomy for patients with primary hepatocellular carcinoma (HCC).Methods Twenty-three patients with HCC who were not suitable for one-stage hepatectomy were admitted to the Sichuan Provincial People's Hospital from March 2009 to February 2012.Their clinical data were retrospectively analyzed.Laparoscopic-guided selective portal vein ligation was firstly performed,dynamic changes of hepatic volume and predicted volume of liver to be resected were detected by computed tomography.Two-stage open hepatectomy was performed after assessment of resectability of HCC.All data were analyzed using the analysis of variance or q test.Results Laparoscopic-guided selective portal vein ligation was successfully performed on 22 patients (2 patients received concomitant cholecystectomy because the right branch of portal vein was difficult to expose),1 patient was converted to open surgery because of hemorrhage during portal vein separation.Three patients with multiple lesions received transcatheter arterial chemoembolization at 1 week after selective portal vein ligation.Dull pain in the hepatic region,low fever,nausea and vomiting were observed in the 23 patients,while no severe complications including peritoneal hemorrhage,bile leakage,hepatapostema was observed.The levels of aspartate aminotransferase,alanine aminotransferase and total bilirubin were back to normal at 1 week after the surgery.The right liver volume at postoperative week 3 was (590 ± 154)cm3,which was significantly smaller than (698 ± 135)cm3 before surgery.Compared with right liver volume at postoperative week 1,2,3,the right liver volume before operation was significantly smaller (F=15.62,P ＜0.05).The left hepatic volume at postoperative week 3 was (408 ± 149)cm3,which was significantly bigger than (331 ± 68)cm3 before operation.The left liver volume before operation was significantly different from those at postoperative week 1,2,3 (F =17.48,P ＜ 0.05).The predicted ratio of liver to be resected was 60％ ± 18％ at postoperative week 3,which was significantly smaller than 67％ ± 15％ before operation (F =12.35,P ＜ 0.05).Two patients with insufficient hyperplasia of offside liver,2 patients with intrahepatic metastasis at postoperative week 3,2 patients were lost to follow up and 3 patients gave up hepatectomy,14 patients received hepatectomy at 2-4 weeks after laparoscopic-guided selective portal vein ligation.The resection rate was 60.9％ (14/23).There were 2 patients received extended right hepatectomy,8 received right hepatectomy,4 received non-anatomical hepatectomy.All the 14 patients recovered well,and no hepatic failure,severe peritoneal effusion and infection was observed.Conclusion Laparoscopic-guided selective portal vein ligation is easy to perform,and it extends the indication of hepatectomy,increases the safety of two-stage hepatectomy.

Objective To summarize the experience of multidisciplinary consultation for prenatal fetal deformity, and to explore the mode suitable for China. Methods The Obstetrics and Gynecology Hospital of Fudan University and Children's Hospital of Fudan University established a joint multidisciplinary consultation center, including obstetrics, pediatrics, pediatric surgery, ultrasound and other departments. A total of 3 378 pregnant women visited the consultation center from July 31, 2003 to August 1, 2013. After consultation, treatment was divided into three classes:pregnancy termination, pregnancy continuation and perinatal treatment. Follow-up was made through correspondence and telephone communication. Retrospective analysis on reasons for consultation, fetal structural abnormalities of the classification system, chronological order of abnormalities, gestational weeks of diagnosis, maternal-related factors, treatment and prognosis was performed. Results (1) Reasons for consultation:Among 3 378 women undertaking prenatal multidisciplinary consultation, 3 243 (96.00%) were due to fetal factors, and 135 (4.00%) were due to maternal factors. (2) Classification of fetal structural abnormalities:Among the 3 243 cases undertaking consultation with fetal factors, fetal abnormality was found in 80.85%(2 622/3 243). The most common were neurological abnormalities(23.19%, 608/2 622), followed by urinary tract malformation (20.25%, 531/2 622) and cardiovascular malformation (15.48%, 406/2 622). These were followed by digestive system malformation, limb deformities and space-occupying lesions. There were 156 cases of multiple malformations. (3) Average gestational weeks for diagnosis of fetal deformity:The 2 622 cases of fetal deformity were diagnosed at a mean (26.7± 2.1) of gestational weeks (21.1–30.4 weeks). Urinary tract malformations were detected at (24.0±0.7) weeks, whereas digestive system malformations were detected at (28.3±2.6) weeks. (4) Induced labor:Induced labor cases accounted for 35.66% (935/2 622), among which, 92 cases were fetal intrauterine death and 843 cases were active choice. The several highest induced labor rates resulted from multiple malformations (75.64%, 118/156), abdominal wall defects (62.22%, 28/45), diaphragmatic hernia (61.54%, 24/39), cleft lip and palate (55.32%, 26/47) and cardiovascular malformations (49.51%, 201/406). For nervous system (27.80%, 169/608), urinary tract (25.80%, 137/531) and digestive system malformations (26.94%, 66/245), induced labor rates were <30%. For abdominal lesions (14.04%, 25/178) and sacrococcygeal teratoma (13.64%, 3/22), induced labor rates were<15%. (5) Continuation of pregnancy in 1 687 cases:Cesarean section was conducted in 1 046(61.94%). Neonatal death occurred in 117(6.94%).(6) Perinatal treatment:Twenty-one cases were treated during pregnancy, including thirteen cases with fetal ascites and hydrothorax treated by drainage, five cases with fetal anemia treated by intrauterine transfusion and three cases with fetal tachycardia treated by digoxin. Ten cases were treated by ex-utero intrapartum treatment. After birth, 297 newborns immediately underwent neonatal surgery. Among these, 259 cases underwent radical surgery, eleven palliative surgery, and sixteen elective surgery after follow-up. Conclusions Prenatal multidisciplinary consultation can make comprehensive multidisciplinary assessment of fetal prognosis and improve the diagnosis and treatment of structural malformations.

Objective To assess the characteristic of normal tension glaucoma (NTG) patients with mild cogni?tive impairment (MCI). Methods This study included twenty-six cases of normal tension glaucoma patients who were diagnosed at ophthalmology department of Peking University Third Hospital. All the participants were examined by us?ing the scales of Montreal Cognitive Assessment (MoCA), mini-mental state examination(MMSE), clinical dementia rat?ing (CDR), activities of daily living (ADL), Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), Pitts?burgh Sleep Quality Index (PSQI) and polysomnography (PSG). The patients were then divided into Group with MCI (16 cases) and Group without MCI (19 cases). Results There was no difference between the two groups in gender, age, edu?cation, depression, anxiety and body mass index (BMI) (P>0.05), but significant difference in MoCA scores (P<0.05). The incidence rate of sleep disorder of PSQI in was 28.6%(10/35 patients) of total NTG patients, 43.8%(7/16 patients) in Group with MCI, and 15.8% (3/19 patients) in Group without MCI, respectively. The PSQI score was higher in Group with MCI than in Group without MCI (P<0.05). Sleep efficiency was higher in Group without MCI than in Group with MCI (P<0.05), but no difference was found between the two groups in six other indexes of PSQI (P>0.05). The in?cidence rate of sleep structure disorder of PSG in all the NTG patients was 85.7%(30/35 patients), 87.5%(14/16 pa?tients) in Group with MCI, and 84.2%(16/19 patients) in Group without MCI. Sleep time of NREM-N3 was significant?ly shorter in Group with MCI than in Group without MCI (P<0.05), but no difference was found between those groups in total sleep time, sleep efficiency, sleep latency and REM time (P>0.05). Conclusion NTG patients with mild cogni?tive impairment are more prone to sleep disorders, especially sleep structure disturbance and short NREM-N3 time may affect cognitive function.

Objective To explore the surgical methods for the treatment of the total anomalous pulmonary venous connection (TAPVC) and choices to prevent related complications.Methods We analyzed retrospectively the clinical data of 24 cases with TAPVC admitted to our hospital from Jan 2006 to Dec 2011,including 15 male and 9 females with the age range of 50 d-14 years.There were 10 cases younger than six months,accounting for 41.7％ (10/24).The average body weight was (9.30 ± 3.96) kg.There were 8 cases 33.3％ (8/24) had a body weight of below 10.00 kg.Among the patients,16 cases (66.7％,16/24) were supracardic type,6 (25.0％) were cardiac type,and 2 (8.30％) were intracardiac type.For the treatment of the upracardiac type,5 cases were treated through the right atrium and interatrial septum incision path;Eleven cases were through the left atrial anastomosis.For the treatment of the cardiac type,the right atrial incision was used for coronary vein antrum isolation,and the patch was carefully packaged to separate the coronary sinus openings into the left atrial side.For the 2 cases of the intracardiac type,heart was slightly lift towards the right,and the venous anastomosis was performed for the left atrial posterior wall and the summary vein,and the vertical vein was then ligated.Results No surgery-related death occurred.Reoperation was performed for 1 patient occurred pulmonary edema due to pulmonary venous obstruction induced two days post-surgery.Condition was improved after the extension of left atrial side as the patient was found to have anastomotic stenosis.Postoperative arrhythmia were observed in 7 cases (29.2％,7/24),including 3 nodal arrhythmia (12.5％,3/24) and 4 (16.7％,4/24) atrial arrhythmia.Patients were followed up for 4-24 months.All children during the follow-up period were in good condition.They had significantly improved activity tolerance compared with pre-surgery.Chest X-ray showed clear markings free of congestion.Conclusion Appropriate surgical approach and routes could help improve the success rate of surgery treatment of TAPVC and reduce postoperative complications,thus achieving good therapeutic effect.

To examine AZT resistance of HIV-1 isolates from AZT treated or untreated Korean, several biological characteristics such as syncytium formation, HIV-1 reverse transcriptase activity and the p24 antigen production in MT-2 cells infected with 4 HRT_1 isolates were determined. As controls, we tested HIV-1 HTLV-IIIB and pre-drug isolate as AZT susceptible strains, in addition to HIV-1 RTMC/MT-2 and post-drug isolate as AZT resistant strains. When the inoculum size of HIV-1 was 300 TCID50well and 100 TCID50/well, the AZT susceptibility of AZT untreated HIV-1 isolates 8806 and 9571 were similar to that of HIV-1 HTLV-IIIB and AZT-susceptible HIV-1 strains. When we evaluated AZT resistance of isolates HRs-1 8812 and 9113 treated with AZT for 36 months by observation of syncytium formation, HIV-1 8812 showed resistance simillar to that of HIV-1 RTMC/MT-2 strain forming syncytium up to AZT 1microgram/ml, and HIV-1 9113 showed resistance identical with that of AZT-resistant HIV-1 strain which formed syncytium up to AZT 10 microgram/ml. Especially, when we evaluated AZT resistance by HIV-1 reverse transcriptase activty and the p24 antigen production, HIV-1 isolates 8812 and 9113 showed much higher resistance (>10 - 200 fold) compared with HN-1 RTMC/MT-2 and AZT-resistant HIV-1 strain.
Giant Cells ; HIV-1* ; Korea* ; Population Characteristics ; RNA-Directed DNA Polymerase ; Zidovudine*

BACKGROUND: It has been recognized for many years that myocardial infarction is almost invariably associated with significant narrowing of one or more coronary arteries. However, the widespread use of selective coronary angiography has resulted in an increasing number of reports of patients with proved infarction and patent coronary arteries. The purpose of this study was to analyze whether any clinical features distinguishes patients with these findings from those having coronary arterial lesions. METHODS: The clinical association of myocardial infarction with no significant stenosis of major coronary artery on cineangiogram was analysed retrospectively. The findings on the 13 patients in this group was compared with those of myocardial infartion with significant coronary artery stenosis. RESULTS: There were no significant differences in risk factors, hemodynamic findings of cardiac catheterization and the site of infarction between both groups. However, the patients with no significant stenosis of coronary artery had fewer complications during hospitalization and lesser ST segment change during exercise test before discharge. CONCLUSION: It could be concluded that the acute myocardial infarction with no significant stenosis of coronary arteries would have the better prognosis. The mechanism of the acute myocardial infarction with no significant stenosis of coronary arteries might be studied in the aspect of the coronary artery spasm and the alternation of function of endothelial cell.
Cardiac Catheterization ; Cardiac Catheters ; Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis* ; Coronary Vessels* ; Endothelial Cells ; Exercise Test ; Hemodynamics ; Hospitalization ; Humans ; Infarction ; Myocardial Infarction* ; Prognosis ; Retrospective Studies ; Risk Factors ; Spasm

No abstract available.
Incontinentia Pigmenti*

A case of malignant melanoma occures in the palpebral conjuntiva is presented. A 60 years old female had dark brownish. strowbery-like peduncleated mass in her right upper conjuntiva. The tumor mass was excised radically and confirmed as malignant melanoma histopathologically and she received cobalt 60 irradiation. No recurrence was seen for 4 months since the excision of the mass.
Cobalt ; Female ; Humans ; Melanoma* ; Middle Aged ; Recurrence

OBJECTIVETo study the influence of Suspension Pancreatic-Duct-Jejunum End-to-Side Continuous Suture Anastomosis (SPDJCS) on the incidence of pancreatic fistula after pancreaticoduodenectomy, and to analyze its applicability, safety, and efficacies.

METHODSA prospective controlled trial was conducted with 165 cases receiving pancreaticoduodenectomy in the Department of Hepatopancreatobiliary Surgery from January 2010 to May 2012. The patients were divided into Group A (end-to-end/end-to-side invaginated anastomosis, n=52), Group B (end-to-side mucosal anastomosis, n=48), and Group C (SPDJCS, n=65). The preoperative data, intraoperative data, and operative outcomes (incidence of pancreatic fistula, operation time, intraoperative blood loss, peritoneal drainage, peritoneal hemorrhage, peritoneal abscess, delayed gastric emptying, pulmonary infection, postoperative infection, blood transfusion, and perioperative mortality) were compared among the 3 groups.

RESULTSThe total incidence of pancreatic fistula was 13.9% (23/165) in all the 165 patients. The incidence in Group A and Group B was 23.1% (12/52) and 18.8% (9/48), both higher than that in Group C [3.1% (2/65), both P<0.05]. Group C showed significantly better outcomes than group A and B in terms of the operation time (5.5±1.2 hours vs. 6.1±1.1 hours, 5.5±1.2 hours vs. 6.3±1.5 hours), volume of blood loss (412.0±205.0 mL vs. 525.0±217.0 mL, 412.0±205.0 mL vs. 514.0±217.0 mL), and postoperative drainage amount of plasma tubes (175.0±65.0 mL vs. 275.0±80.0 mL, 175.0±65.0 mL vs. 255.0±75.0 mL) (all P<0.05), while Group A and Group B displayed no difference in these aspects (P>0.05). As complications other than pancreatic fistula were concerned, the three groups were not different from each other (P>0.05).

CONCLUSIONSSPDJCS may have the effect of reducing the incidence of pancreatic fistula after pancreaticoduodenectomy. It could be safe, practical and convenient technique of anastomosis for pancreaticojejunostomy.

Adult ; Aged ; Anastomosis, Surgical ; methods ; Female ; Humans ; Jejunum ; surgery ; Male ; Middle Aged ; Pancreatic Ducts ; surgery ; Pancreaticoduodenectomy ; adverse effects ; methods ; Prospective Studies ; Suture Techniques