The incidence ot bile duct cancer at hepatic hilum has a tendency to increase in recent years. This paper is to report 60 cases during a 10-year-period from 1975 to -1985. The cancer at the hepatic hilum (60 cases) made up 73% of all extrahepatic bile duct cancers(82 cases),and accounted for 1.65% of 3626 biliary operations done at the same period. The clinical manifestations of the patients could be categorized into three types, the presenting symptoms were obstructive jaundice in 29 cases, of which 25 had been misdiagnosed as infectious hepatitis; the symptoms of acute cholangitis were found in 12 cases; and in 14 cases, various symptoms and signs of biliary diseases had been found for a long time before the diagnosis was established as cancer. In the remaining 5 cases, miscellaneous manifestaions were revealed. The patients were examined with B-US(19 cases), ERCP(10 cases) and PTC(39 cases). The final diagnosis was established according to the findings of PTC and / or ERCP, surgical exploration, or histopathological examination.Surgery was performed on 56 cases. Only 6 out of the 56 received radical resection of the cancer with hemi-hepatectomy; palliative internal drainage of the bile duct was done on 15 cases, external drainage on 23 cases, and other palliative measures on 12 cases. The average survival time after operation was 24.5 months iu 6 cases with radical resection, 8.7 months in 48 cases with palliative measures, and only 5 months in 4 cases without surgical intervention. Ear- ly diagnosis is imperative if successful therapy is expected. It is suggested that a patient over 40 years of age, suffering from "infectious hepatitis" or obstructive jaundice, be watched out for the possibility of hilum cancer, and appropriate examinations such as B-US,CT,ERCP or PTC be carried out. It is emphasized that PTC plays an important role izi the diagnosis of hilum cancer. In severe cases, the intrahepatic bile ducts could be examined with PTC of the two sides at oae time. Exploratory laparotomy should be performed on suspected cases.

Vascular disconnection around the gastroesophageal junction in 100 patients with portal hypertension and gastroesophageal varices resulted in such complications as ascites,peritoneal infection,recurrent gastrointestinal bleeding,gastric perforation,ischemic gastric necrosis,hepatic failure,multiple organ failure,etc in 41 patients (with a operative morbility of 41%).9 cases out of the 41 died because of peritoneal sepsis,massive bleeding and hepatic or multiple organ failure.Multiple organ failure was the most common cause of death.Grade III liver function and improper perioperative management were the associated factors responsible for the operative complications and death in these patients.

Internal drainage of the biliary tract such as choledocho-duodenostomy or Roux-en-y choledocho-jejunostomy is a common operation for the treatment of primary choledocholithiasis and biliary stricture. Though these operations can creat a good drainage, serious reflux cholangitis is frequently resulted. In order to prevent this tiresome complication, the authors have designed a new operative procedure: a loop of jejunum is isolated and an artificial papilla is made on its distal end, then its proximal end is joined to the bile duct and its distal end with the artificial papilla is inserted into the duodenum and the two parts are sutured up.This paper is to report this operative method in detail and our experience with 11 cases. After operation, no reflux of the intestinal content into the interposed jejunal loop was found and barium meal could demonstrate reflux of the contrast medium only in one case out of the 11. Ten cases were followed up from 4 to 18 months and excellent results were observed. It proves that this operative procedure can prevent the reflux of chyme into the biliary tract.Interposed jejunal loop with an artificial papilla is more physiological than Roux-en-y choledochojejunostomy since bile can flow through the interposed jejunum loop into duodenum to mix with the pancreatic fluid and the chyme, which is helpful to better digestion.

Objective To study the mechanism of cytotoxic T lympocytes in the acute rejection of xenogenic liver transplantation(XLT). Methods Hamster to rat orthotopic liver transplantation model was performed with three cuff method. In XLT,lymphocytes including CD8 and CD4 subsets were observed by histology and immunohistochemistry; the expression of perforin and Fas- L was observed by immunohistochemistry; and apoptotic cells of XLT were observed in situ end-labelling of fragmented DNA. Results In the XLT, T cell infiltration firstly ocurred on the 2nd day posttansplantation and located at the portal triads; the infiltrating lymphocytes proliferated increased with time and reached the peak on the 5th to 6th days.Perforin and Fas-ligand were expressed on the 4th day after XLT, and peaked on the 5th to 6th day,and the expression of perforing was still higher than the expression of Fas-ligand. Conclusions T lymphocyte participates in the acute rejection of XLT through the expression of perforin and Fas-ligand, which leads to apoptosis or necrosis of hepatocytes.

To study the significance of the expression of splice variants of CD44 (CD44v) in tu-m0r-adjacent tissue of the patients with primary liver cancer(PLC). Methods: To research into the signifi-cance of the expression of CD44v mRNA in tumor-adjacent tissue of 30 patients with PLC by RT-PCR andfollow-up. Results: In the patients that the expression of CD44v mRNA of tumor-adjacent tissue washigher than those of tumor tissue(group I ), clinical pathological indexes were higher than in the patientsthat the expression of CD44v mRNA was higher than the tumor tissue(group I ). The recurrent rate ofgroup I was higher than that of group n (P

In order to clarify the limitative factors in the management of severe acute pancreatitis (SAP) especially the problems of the complicated multiple organ failure (MOF),70 cases of SAP,of which 17 were complicated with MOF,admitted to our hospital in the past 16 years were reviewed.The overall mortality rate of the series was 20.0% (14/70),and the death of 12 cases out of the 14 was associated with MOF (85.7%) and that of the other 2 with single organ failure (14.3%).MOF occurred in 17 cases with a mortality rate of 70.0%.Two patterns of MOF manifestations identified:A rapid single-phase of MOF was found in 7 cases.It developed rather early after the onset of SAP and was associated with severe pancreatic necrosis and early shock.And a delayed two-phaseof MOF was seen in 10 cases.It developed progressively with a lagging interval and from the pancre-atic necrosis and subsequent infection.The clinical manifestations of MOF were characterized by a severe and systemic inflammatory response.It is believed that the systemic inflammatory response trigged by the septic material released from the pancreatic necrotic focus seems to be the pathological channel to link SAP with MOF.

Objective To carry out a taxonomic identification of a strain of claviform bacteria iso-lated from prostatic fluid of a patient who suffered from chronic prostatitis, and to approach its phylogenic and biologic position. Methods We undertaked an initial identification by phenotypic characters such as morphologecal, physiological and biochemical characteristics to ascertain its phylogeny by chemical composi-tion analysis of cell wall and 16S rRNA gene sequencing and alignment. Results A club-shaped gram posi-tive rod bacillus was isolated in pure culture state. Its biochemical reactions were not active. The diamino-acid of cell wall was meso-diaminopimelic acid (meso-DAP) and it had wall chemotype Ⅳ ( contained arabi-nose, galactose and maltose ). Sequence searches of the GenBank database revealed that this strain had a highest level of 16S rDNA sequence similarity (99.4%) to C. tuberculostearicurn strain ATCC35692 with only 8 nucleotides difference. Conclusion On the basis of phenotypic and phylngenetie analysis, it is rea-sonable to assign this strain to the species C. tuberculostearicum, and this is the first isolation of C. tubercu-lostearicum from prostatic fluid home and abroad.