Objective To explore the causes and surgical management of acute gangrenous cholecvstitis(AGC)after endoscopic sphincterotomy(EST).Methods Clinical and pathological data of 1066 patients who underwent EST from June 2003 to January 2007 were analyzed retrospectively.ResultsAGC was complicated in 16 patients(16/1066,1.5%),who underwent emergency operations and no death occurred.During the follow-up period of 4 to 36 months,no infection or obstruction was found.Conclusion Difficuitv in EST manipulation and biliary obstrucion might play a leading role in AGC after EST,and early surgical intervention is effective.

Inhalation injury seriously threatens the survival and quality of life in burn and trauma patients. So far there is no breakthrough in the treatment of inhalation injury. A significant advance has been witnessed in the experimental study of the use of stem cells in the treatment of lung injury in recent years. In this paper, according to the results of our study in the systemic transplantation of bone marrow mesenchymal stem cells for the treatment of inhalation injury, the effect of mesenchymal stem cells on anti-inflammatory process and repair of lung tissues in inhalation injury, and its possible mechanisms are reviewed.
Humans ; Lung ; Lung Injury ; blood ; surgery ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stromal Cells ; Quality of Life ; Smoke Inhalation Injury ; blood ; surgery ; Treatment Outcome ; Tumor Necrosis Factor-alpha ; blood

Objective To evaluate the clinical application of immediate breast reconstruction with the pedicle transverse rectus abdominus myocutaneons(TRAM)flap.Methods Ten breast cancer patients underwent immediate breast reconstruction with the pedicle TRAM flap after mastectomy,among which 4 cases used single pediele TRAM and 6 cases used bipedical TRAM.Polypropypene mesh were applied on all cases of patients to repair the abdominal defect. Results All the breast reconstructions were successful.Complications included grafting flap infection in one case and skin necrosis on partial abdominal skin flap in one case.The reconstructed breasts had a very good shape in 8 cases,and good in 2 cases.No local recurrence and distant metastasis occurred in the patients during the follow-up time ranging from 3 to 15 months. Conclutions Immediate breast reconstruction with the pedicle TRAM flap is an ideal breast reconstruction method for those patients undergoing mastectomy not only because it reconstructs the defective breast but for its cosmetic effect on the abdominal wall.

Objective To establish the hyperinsulinemic-euglycemic clamp(HEC) technique in conscious rats, and to explore the effect of acute infusion of lipid on glucose infusion rate (GIR) in rats. Methods Ten SD rats were random-ly divided into two groups, 5 rats for each group. The right jugular vein and left carotid artery were catheterized and under-went a HEC with infusion of lipid (intralipid group) for 6 hours, and with continuing infusion of 5%glucose (control group). The plasma levels of free fatty acid(FFA) and GIR were measured by HEC method. Results The level of FFA concentration increased by 17.6-fold, and GIR was reduced by 27%in the intralipid group compared to those of control group (P＜0.001). Conclusion The rat model of HEC has been successfully established by intravenous intralipid infusion, which can be con-firmed by HEC technique.

Objective To sum up and discern the high risk factors of iatrogenic duodenl injuries and to evaluate the value of the treatment according to the new trauma scaling,so as to to facilitate and guide clinical research.Methods 21 patients with iatrogenic duodenal trauma hospitalized and From Jan.1985 to Oct.2005,in our hospital were collected and retrospectively reviewed,the duodenum organ iatrogenic injury scale was classified and developed depending on the clinical finding and referring to the injury scale by the American Association for the Surgery of Trauma(A.A.S.T.)in 1990.Results The iatrogenic duodenal injuries result from various surgery and endoscopic procedures,most from a sequelae to pertinent biliary operation and(or)iatrogenic technical errors of instrumention.High risk factors responsible for the iatrogenic injuries include inflammatory conglutination,biliary systems anomalies or anatomic variations,duodenal Vater's papilla with neoplasma or diverticulum,surgeohs with less experience or over self-confidence or some procedures with violence and specific correctable errors,and so on.According to the new grading scheme,the duodenal injuries of the 21 cases were classified as follows:grade I-5 cases,grade II-6 cases,grade III-5 cases,grade IV-3 cases,and grade V-2 cases.Among the patients,3 cases were treated by drainage.2 cases underwent simple repair.8 cases were treated with repair and drainage.8 cases underwent enterorrhaphy and drainage.Conclusions Knowledge about causal factors of such iatrogenic processes can play a crucial role in their prevention,correct diagnosis,and management.Having the iatrogenic duodenal scaling done well,appears to be an accurate and practical way to select an optimum and flexible treatment and improve the patients's prognosis.

Objective To evaluate the enhancement effect of SLC(secondary lymphoid tissue chemokine)gene mediated by a repli- cation deficient recombinant adenovirus(Ad)on human pancreatic cancer in vitro and vivo and to investigate the mechanism of action of SLC.Methods Human pancreatic carcinoma cell line ASPC-1 was infected with Ad-SLC and Ad-CFG,and compared with phosphate buffered saline(PBS).MTT(3,-[4,5-dimethyhhiazol-2-yl]-2,5-diphenyhetrazolium bromide)assay was used to estimate the proliferation of ASPC-1 cells;tube formation assay and choriallantoic membrane assay were used to evaluate angiogenesis in vivo and in vitro.Xenografted nude mice with pancreatic cancer were established to observe in vivo tumour growth suppression.Microvessel density re- vealed by CD34 immunohistochemical staining was measured and TIL in tumor region was also evaluated.Results Growth and tube forma- tion of ASPC-1 cells infected with Ad-SLC were suppressed significantly compared with cells infected with Ad-CFG or ceils treated with PBS.Neovascularisation in the Ad-SLC group was less than that in the PBS and Ad-CFG groups,based on chorioallantoic mem- brane results.Volumes of pancreatic tumours in the Ad-SLC group were significantly smaller than those in the PBS and Ad-CFG groups at the end of the treatment period.Microvessel density in the Ad-SLC group was significantly lower than that in the Ad-CFG and PBS groups and TILs in tumor region in the Ad-SLC group was significantly risen much more than that in the Ad-CFG and PBS groups when the mice transferd the same number of TILs from spleen of health mice.Conclusions The SLC gene mediated by adenovirus is efficient for gene therapy for pancreatic carcinoma.Suppression of SLC on proliferation of vascular endothelium cells,attracting TIL to tumor region and angiogenesis may account for its effect.

Objective To observe the influence of Baicalin and Octreotide on lung injury of rat with severe acute pancreatitis(SAP) and discuss the therapeutic effect and mechanism of the two medicines on SAP.Methods The improved Aho(?)method was adopted to pre- pare SAP rat models via retrograde injection of 3.5% sodium taurocholate to the pancreatic duct.The 135 SAP rat models after being pre- pared were randomly divided into the model group,Baicalin treatment group and Octreotide treatment group with 45 rats in each group;an- other 45 were selected to be the sham operation group which only received abdomen opening surgery.The above - mentioned groups were then randomly divided into 3h,6h and 12h groups with 15 rats in each group.Observed respectively at 3h,6h and 12h after operation,the mortalities of all rat groups followed by batch execution of rats,and then observed the gross pathological and pathological changes of lung. The tissue microarrays technology was applied to prepare the lung tissue microarrays sections.The changes in Bax and bcl-2 protein ex- pression levels of lung tissue of each group were observed via immunohistochemical staining and meanwhile the TUNEL method was applied to observe the lung cell category and apoptotic index changes of lung tissue in each group.Results The 12h survival of model group was 66,67% while those of Baicalin treatment group and Octreotide treatment groups were both 100%,indicating a marked difference(P＜0.05).Comparison of lung pathological score disclosed:The model group and Baicalin treatment group obviously exceeded the sham oper- ation group at various time points(P＜0.01);at 6h and 12h the Baicalin treatment group was obviously less than the model group(P＜0.05)and the Oetreotide treatment group less than the model group(P＜0.01).Comparison of Bax protein of lung in each group dis- closed:The Baicalin treatment group and Octreotide treatment group obviously exceeded the sham operation group and model group at 3h (P＜0.05),meanwhile the Baicalin treatment group obviously exceeded the Octreotide treatment group(P＜0.01).Changes of lung bcl -2 protein expression level of all groups disclosed:The model group and Baicalin treatment group obviously exceeding the sham operation group(P＜0.01)as well as the Octreotide treatment group(P＜0.05)at different time points,the Baicalin treatment group was obviously less than the model group at 6h(P＜0.05).The peak of apoptosis occurred to the Baicalin treatment group at 6h,but statistics showed no obvious difference among all groups at different time points(P＞0.05).Conclusions(1)Both Baicalin and Octreotide have protecting effect on SAP lung injury and their therapeutic mechanism is possibly related to apoptosis.The application of tissue microarrays in SAP pathological examination can save manpower and material resources,cut down the experimental cost and improve the experimental efficien- cy,thus worth popularizing.

Objective To investigate the changes in serum hyaluronic acid level at different periods of experimental piggyback liver transplantation and its significance. Methods Fifteen pairs of healthy pigs of both sexes weighing (28.3 + 5.0)kg undergoing liver transplantation were studied. The donor pigs were slightly smaller than the recipient pigs. The recipient pigs were premedicated with intramuscular ketamine 8mg kg-1 and atropine 0.02mg-kg-1 .Anesthesia was induced with propofol 2mg-kg-1 , fentanyl 0.002mg-kg-1 and vecuronium 0.1mg-kg-1 iv. After tracheal intubation the animals were mechanically ventilated. CVP line was placed via internal jugular vein. Carotid artery was cannulated for continuous BP monitoring. Anesthesia was maintained with iv propofol, fentanyl and vecuronium. Circulatory stability was maintained by infusion of crystalloid, colloid, plasma and whole blood of pig. Blood samples were taken from peripheral vein before operation (T0), pre-anhepatic phase (T1), anhepatic phase (T2) and neohepatic phase (T3) for determination of serum hyaluronic acid concentration by radioimmunoassay. At the same time liver function tests, ALT, AST, y-GT were also examined. Results The average time of liver transplantation was (343+74) min. SBP decreased by (23.51+5.87 ) mm Hg and DBF by (11.35+7.81) mm Hg after induction of anesthesia. Serurn hyaluronic acid level was 267ug-L-1 before operation (T0) and rose to 1743ug-L-1 at T1 , and 9530ug-L-1 at T2 (P

Objective To explore the diagnosis and treatment of gastroparasis syndrome after abdominal operation. Methods Clinical data of 25 cases with gastroparasis syndrome after abdominal operation from Jan 1995 to June 2006 were analysed retrospectively. Results Gastrectomy and nongastrectomy amounted to 16 and 9 cases( portal-azygous vein disconnection in 4 cases, panceaticoduodenectomy in 1 case, partial small intestinectomy and adhesions lysis in 1 case, radical excision of colon carcinoma in 2 cases, choledocholithotomy in 1 case). Gastroparasis syndrome characterized by upper abdominal distension, nausea, vomiting after clipping the pipe or large quantity of gastric drainage after operations. Gastrointestinal series and gastroscopy confirmed functional delayed gastric emptying. All cases recoverd through non-operative therapy including fasting, continuous gastrointestinal decompression, total parenteral nutrition or enteral nutrition, adn administration of gastro-intestinal dynamic medicine. Conclusions Gastroparasis syndrome is the common complication after abdomianl operation, gastrointestinal series, gastroscopy are main diagnostic methods, conservative medication obtains good effect.