Objective To summarize the diagnostic and therapeutic experience on chronic pancreatitis characterized by a pancreatic mass. Methods The clinical data of 28 cases of chronic pancreatitis with mass undergoing surgical operations were retrospectively analyzed in our hospital from June1999 to June 2009. Results Among the 28 cases, 19 were diagnosed as carcinoma, 9 cases were diagnosed as chronic pancreatitis respectively before operation. Needle aspiration biopsy and/or postoperative pathology identified chronic pancreatitis in all cases. The symptom included abdominal pain (22 cases),jaundice (15 cases), and obstruction of duodenum (4 cases). Pancreaticoduodenectomy was performed in 17 cases, choledochojejunostomy performed in 3 cases, pancreatojejunostomy performed in 1 case.Duodenum-preserving resection was performed in 4 cases, and resection of body and tail of the pancreas were performed in 3 cases. There was no operative death. Postoperative complications included pancreatic leakage (2 cases), severe gastroplegia (2 cases) and stress peptic ulcer with massive bleeding ( 1 case). All patients got follow-up ranging from 6 months to 5 years. Recurrence of abdominal pain developed in 7 cases after 2 years. Canceration of pancreatic mass was found respectively in 8 months, 1 year after operation in one each cases. Conclusion Preoperative differential diagnosis of chronic pancreas and pancreatic tumor was difficult. Although needle aspiration biopsy is the effective method for diagnosis, there may be still a possibility of missed diagnosis/misdiagnosis.

Objective To retrospectively analyze the effect of corticosteroids therapy for inflammatory bowel disease (IBD) at 1-month and 1-year. Methods Those who was diagnosed as Crohn's disease (CD, n=55) or ulcerative colitis (UC, n= 154) from 1998 to 2006 were investigated. The effect of corticosteroids was evaluated after one month and 1-year. The prognostic factors were calculated using Logistic regression analysis. Results The patients who received eortieosteroids therapy were 21 (38.2%) with CD and 20 (13.0%) with UC (2 cases withdrawn). In one month followe-up, the complete and partial remissions were found in 15 (71.4%) and 3 (14.3%) patients with CD, respectively, while there were 15 (83.3%) and 3 (16.7%) in patients UC, respectively. Only 3 (14.3%) patients with CD was no response. In one year follow up, 11 out of 21 (52.4%) patients with CD had prolonged response to corticosteroids, 6 (28.6%) were corticosteroid dependence, and 4 (19%) required surgery; whereas 11 out of 18 (61.1%) patients with UC had prolonged response, 3 (16.7%) were corticosteroid dependence, and 4 (22.2%) required surgery. Logistic regression analysis showed that serum albumin level was associated with efficacy of corticosteroids after one year (P= 0.027, OR: 1.320,95% CI: 1.032~1. 690). Conclusion The IBD patients who has response to initiating corticosteroids therapy will get shor-term remission. Its prognosis is related with serum albumin level.

ObjectiveTo investigate the effect of milk and milk products on morphological structure and epidermal growth factor (EGF) of non-steroidal anti-inflammatory drugs (NSAIDs) induced small intestinal damage in animals.Methods Eighty male SD rats were randomly divided into 5 groups:control group,diclofenac group,diclofenac with 10% low fat milk group,diclofenac with 10% colostrum group and diclofenac with yoghurt group.The animals with milk or colostrum or yoghurt were fed for 5 days before the administration of diclofenac with 15 mg/kg by gavage,once.Then they were observed the scores of anatomical lesion and the scores of tissue damage of mucous membrane and the height of villous at the 24th and 48th hour after making the models.Observation of the change of ultrastructural organization of mucous membrane was carried out with transmission and scanning electron microscope and immunohistocbemistry of EGF.Results The scores of anatomical lesion and tissue damage of mucous membrane of the colostrum group were lower than those of the diclofenac group ( P ＜ 0.05 ).The heights of the pile on small intestine of the24th and 48th hour of the colostrum group were (145.7 ± 16.5) μm and (139.2 ± 19.0) μm,respectively.They were higher than those of the diclofenac group[( 119.2 ± 19.2 ) μm and ( 105.4 ± 18.4 )μm,P ＜ 0.05].However there was no difference of the scores and the height among diclofenac group,milk group and yoghurt group.TEM and SEM of tissues showed that the cytoplasmic membrane and other cellular components of villous epithelial cells were well preserved in colostrum group,and the microvilli in the milk group and yoghurt group were ablated more obviously.The positive area of EGF of small intestine [(6170.5 ± 1483.9) μm2]were higher 48 h after administration of diclofenac compared with the diclofenac group ( P ＜ 0.05 ).The expression of EGF in milk and yoghurt group were no significant statistical difference with the diclofenac group.ConclusionBovine colostrum may have a beneficial effect in prevention of NSAIDs induced small intestinal injuries and preserve mechanical barrier of small intestinal mucosa which is probably relative to EGF.

For patients with malignant pancreatic cancer combined with vascular invasion,radical pancreaticoduodenectomy with vascular resection and anastomosis is the treatment of choice.Because this procedure is difficult to manage and with high risks,it is a great challenge to surgeons.A 50-year old patient with pancreatic head cancer whose portal vein and superior mesenteric vein were involved received radical pancreaticoduodenectomy in the Second Affiliated Hospital of Harbin Medical University.In the surgery,the tumor and its surrounding tissues were dissected,and then the portal vein and splenic vein were reconstructed.The patient was discharged at the 10th day after the surgery with favorable prognosis.

Objective To explore the clinical features and perioperative treatment effects of colorectal cancer in elderly patients.Methods Retrospective analysis of clinical data especially focusing on perioperative treatment from 104 elderly patients with coloreetal cancer were performed.Results A total of 99 patients (95.2%) were cured or improved at discharge.Perioperative pulmonary infection occurred in 13 cases (12.5%), of whom 6 cases (5.8%) suffered from respiratory failure.Lower extremity deep venous thrombosis occurred in 3 cases (2.9%), incision infection in 6 cases (5.8%), wound dehiscence in 2 cases (1.9%), intestinal fistula in 1 case (1.0%) and gastroparesis in 1 case (1.0%).About 5 cases (4.8%) died from multiple organ failure.Conclusions Old age is not a contraindication in surgical treatment for colorectal cancer.Paying attention to accurate and timely treatment in perioperative peroid can reduce postoperative complications and improve patients' quality of life.

This paper analyzes the characteristics of medical equipment's preventive maintenance, and it expounds the objective and methods of introducing risk management to medical equipment's preventive maintenance,what's more,the problem of establishment object and cycle of preventive maintenance was solved scientifically.
Equipment and Supplies, Hospital ; Maintenance ; Risk Assessment

Objective To investigate the clinical phenotype and genotype in three probands with antithmmbin(AT)deficiency and their families,and to identify the molecular mechanism of AT deficiency.Methods Chromogenic substrate method and immunoturbidimetry assay was used to detect the plasma levels of AT:A and AT:Ag,respectively.Genomic DNA was extracted from the peripheral blood.All 7 exons and the flanking sequences were amplified by PCR.and the abnormal mutant genes were analyzed by direct sequencing.Western blot was used to detect the AT levels and thrombin generation tests were used to detect coagulation status.Results The plasma levels of AT:A and AT:Ag of the three probands declined by 50%.G7386C(Trp225Cys)mutation in exon 4,C2591G(Ser36stop)in exon 2 and C9819T(Arg359stop)in exon 5 were characterized in the three prebands and they could result in W(Trp)225C(Cys)missense mutation,S(Set)36X(stop)nonsense mutation and R(Arg)359X(stop)nonsense mutation respectively,The testing results of phenotype and genotype from some of their family members showed consistent with results from the probands.Western blot results indicated that the Icyels of PC:Ag were lower compared with the normal pooled plasma.The hypercoagulative status was present in the probands using thrombin generation tests.Conclusions Type Ⅰ hereditary AT deficiency was found in these three families.The 3 heterozygous mutations.W225C,S36X and R359X are genetic defects of hereditary AT deficiency.W225C and S36X have not been described before.

AIM: To evaluate the effects of hyperthermic peritoneal chemiotherapy (HPC) on cardiovascular system. METHODS: Twenty-six patients whose age was 31 to 75 receiving gastric cancer radical resection followed by HPC were involved in this trial. All hemodynamic parameters were recorded during whole procedures. RESULTS: The blood temperature(T) increased significantly during HPC; cardiac index increased immediately when HPC began( P

Objective To analyze the screening results of yon Willebrand factor among patients before blood transfusion in Ruijin Hospital and discuss von Willebrand factor in ABO blood group and the relationship between age and gender,refine the classification of vWF antigen and activity by reference factors.Methods The von Willebrand factor among 247 cases of patients before blood transfusion in Ruijin Hospital with no clinical manifestations of abnormal blood clots and routine coagulation as laboratory tests for normal surgical patients.The vWF:Ag and vWF:Act were measured by immune turbidimetric method and ABO blood group was identified by blood type serology.Furthermore,the differences between A,B,O,AB different blood groups,sex and high (≥40 years) and low age group (＜40 years) were compared by statistical methods.Results The levels of vWF:Ag in different blood groups were as follows:A blood type:98.5-142.00,B blood type:97.90-160.30,O blood type:82.13-125.45,A B blood type:103.00-135.80.The levels of vWF:Act in different blood groups were as follows:A blood type:76-130.14,B blood type:78.06-144.3,O blood type:60.89-116.11,AB blood type:88.99-124.09.O blood type vWF:Ag and vWF:Act were lower significantly (P＜0.05) than non-O blood type,the difference was.Besides,young vWF:Ag and vWF:Act were lower significantly than in the elderly.There was no significant difference in vWF:Ag and vWF:Act levels between male and female groups.At last,the reference range of four groups of vWF activity (antigen) was obtained.Conclusion Plasma vWF antigen and activity levels were significantly affected by ABO blood type and age,and the refined reference range established for these influencing factors was beneficial for more detailed diagnosis of VWD and predicting vWF levels associated with bleeding and thrombosis risk.

Objective To analyze the phenotype and genotype of a Chinese family with inherited hypofibrinogenemia,and to investigate its molecular mechanism.Methods Peripheral blood was collected from seven people of this family and then plasma was separated.Activated partial thromboplastin time ( APTT),prothrombin time ( PT),thrombin time ( TT),reptilase time ( RT),the activities of antithrombin( AT∶ A ),protein C ( PC ∶ A ) and protein S ( PS ∶ A ) were tested.The activity and antigen of plasma fibrinogen were analyzed by Clauss method and immunoturbidimetry method,respectively.The fibrinogen peptide chain of the proband was semiquantitatively assessed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis(SDS-PAGE).Thrombin generation test was performed by calibrated automated thromhogram.The dynamic process of blood coagulation was evaluated by the thrombelastography (TEG).Genomic DNA was extracted from the peripheral blood.The sequences of all the exons and exon-intron boundaries of the three fibrinogen genes FGA,FGB and FGG were amplified by polymerase chain reaction ( PCR ) and analyzed by direct sequen(c)ing.Results The activity and the antigen levels of the proband' s plasma fibrinogen were reduced to 0.48 g/L and 0.68 g/L,respectively.TT prolonged to 29.2 s and RT prolonged to 75.8 s.The assays of SDS-PAGE showed no abnormal molecular weight of fibrinogen.Peak height of thrombin generation was reduced to 249.93 nmol/L and endogenous thrombin potential was reduced to 1007.0 nmol · L-1 · min.Hypocoagulability state of the whole blood was found by TEG test.The coagulation index was - 8.6.The proband was diagnosed as inherited hypofibrinogenemia by phenotype analysis.Two mutations (Gln143Pro and g.4642delC) were found in the proband's fibrinogen Aa-chain gene,Gln143Pro came from her mother and g.4642delC came form her father.Conclusion Compound Heterozygous Mutations (Gln143Pro and g.4642delC ) of fibrinogen Aa-chain causes the proband congenital hypofibrinogenemia.