Objective To discuss the technique and clinical value of laparoscopic splenectomy (LS) without using Endo-GIA combined with pericardial devascularization for the treatment of cirrhotic portal hypertension. Methods From March 2005 to October 2006, 23 patients with cirrhotic portal hypertension-induced lower esophageal varices were treated with LS combined with pericardial devascularization. In 18 of the cases, the spleen was resected by disconnection of the secondary splenic pedicle without using endo-GIA. During the operation, the splenic vessels were separated and disconnected by using absorbable clip or ligation respectively. And then the lesser omentum was cut using ultrasonic knife, and the pericardial varices devascularization was performed using the absorbable clips or ultrasonic knife. Finally, the spleen was placed into a bag, broken into small pieces, and removed from an enlarged trocar hole. Results The operation was completed successfully in the 18 cases. The mean operation time was 255 min (range,180-320 min). The mean intraoperative blood loss was 450 ml (range, 200-1600 ml). After the operation, 2 patients developed plural effusion, 1 had subphrenic abscess, and 2 had mild ascites. The subphrenic abscess was cure by ultrasonography-guided puncture. The mean hospitalization was 7.5 days (range 6 to 17 days). No mortality occurred. All the patients were followed up for an averge of 16.4 months (range 5 to 24 months). No patient died after the operation. The mean hospital stay was 7.5 days (6-17 days). The cases were followed up for 5-24 months (mean, 16.4 months). One patient developed rebleeding 20 months after the operation, and was cured by injecting sclerosing agent under a gastroscope. The other 17 cases had no hemorrhage after the operation.Conclusions It is a low-cost and superior method to disconnect the secondary splenic pedicle without using endo-GIA in LS combined with pericardial devascularization for the treatment of cirrhotic portal hypertension.

Griscelli syndrome type Ⅱ (GS2) is a rare disease, and patients with GS2 are susceptible to secondary haemophagocytic lymphohistiocytosis (HLH). GS2 accompanied by secondary HLH has a dangerous clinical course, high mortality, and a high miss-diagnosis rate.In this paper, the pathogenesis and prognosis of a case confirmed as GS2 with secondary HLH by gene screening were reported, so as to improve diagnosis and treatment of this disease.The patient had clinical manifestations of silver hair and eye lashes, recurrent pulmonary infection, contiuning high fever, significantly increased ferroprotein levels and decreased fibrinogen levels.Besides, RAB27A gene homozygous mutations were found in the patient, originating from her parents (p.P126Qf3*3 frameshift mutation). This finding confirmed the diagnosis of GS2.The patient underwent transplantation of marrow stem cells from her father since the father-daughter HLA was 7/10.The follow-up results showed that the patient was still alive and healthy 2 years after transplantation.

The uncertainty of prognosis for chronic diseases is a persistent problem in the medical community.Mechanical attribution such as questioning disease （stubbornness）， equipment （medical and nursing level）， and patients （low compliance）， it is believed that there is a bias in analyzing the deep causes of low compliance on prognosis after breakthrough progress in the treatment of this type of diseases.Taking hepatitis B patients from the perspective of hermeneutics as an example， this paper clarified the reasons for the non-identity of doctor-patient cognition on the problem of doctor-patient communication in health education.Meanwhile， it was found that there is a pre-structure of heterogeneous experience in the ontology of understanding between doctors and patients， which presents inherent limitations， openness， generativity， and external micro power penetration in their history of dialogue logic.Finally， epistemologically， this paper clarified the essence such as the history of identity effect was pointed by the reconstruction of heterogeneous “meaning ideals” of doctors and patients， the understanding of certainty and elimination of subjectivity was guided by meaning ideals under the fusion of horizons， as well as good personalized prognostic behavioral literacy was led by cultivations of embodied practice.

Objective: The clinical application of free perforator flaps in aesthetic repairing of the wounds of electric injuries in forearms and palms. Methods: 20 cases of skin tissue defects of electric injuries in forearms and palms were collected in this group, including 18 male patients and 2 female patients ranged from 20 to 50 years. The size of the skin defects are from 7 cm×5 cm to 18 cm×8 cm. 20 cases of forearms and palms with electric injuries, all of which were repaired by the transplantation of free musculocutaneous perforator monoflaps with anastomosis of interregional blood vessels. 10 cases of wounds in forearms were treated with lateral femoral circumflex artery perforator flaps with sensate nerves. The other 10 cases of wounds in palms were treated with medial plantar artery perforator flap with sensate nerves, with a flap area of 8 cm× 6cm to 20 cm×9 cm. In the donor area, 10 cases were closed with aesthetic suture and 10 cases were repaired with skin grafts. Results: All flaps survived in 20 cases. Artery crisis was found in 1 case on the second day after surgery, and this flap with anastomosis of blood vessels also survived after surgical exploration without delay. The shapes and functions of palms and forearms were observed basically restored from a aesthetic point of view from a follow-up of 3 months to 36 months. Most touch, pain and warm senses were restored in cases with sensate nerves. And a two-point discrimination was 9—11 mm. A satisfactory functional recovery was achieved. The donor sites were found well-healed without any obvious scars or functional disorders. Conclusions Because of the advantages of hidden donor sites, reliable blood supply, closed texture and good abrasion-resistance, the multiple perforator sublobe flaps with sensate nerves could be adopted, and after thinning could be used as the free flaps to repair the wounds. These have predicted that this method is one of the desirable methods of aesthetic repairing and functional reconstruction of subunits skin tissue defects in palms and forearms.