Objective To observe the clinical results of laparoscopic cholecystectomy(LC) combined with endoscopic Oddi sphincterotomy(EST) in treating cholecystolithiasis and choledocholithiasis.Methods The preoperative and postoperative clinical data of 20 cases that received LC & EST combined therapy for cholecystolithiasis and choledocholithiasis were analyzed retrospectively.Results The success rate was 95.0% ,with all the calculi removed completely;no complications occurred.The average hositpal stay was 7.5 days.Conclusions Combined LC & EST procedure is a safe and effective method to treat patients suffering from cholecystolithiasis and choledocholithiasis.

Objective To study effect of Radix Angelica Sinensis (RAS) on Alzhemier's Disease (AD)-like lesions in rats with chronic cerebral hypoperfusion (CCH).Methods rats were randomly divided into sham group,bilateral vascular occlusion (model group),low RAS dose treatment group and high RAS dose treatment group.Cognitive function was assessed by Morris Water Maze and Object Recognition Test.Aβ was detected by ELISA while brain-derived neurotrophic factor (BDNF)、β secretory enzyme 1 (BACE1)、phosphorylated Tau and phosphorylation of Akt/ GSK3β was detected by Western blot.Results There were shorter target quadrant exploration time (TQET),lower priority index (PI) 、phosphorylated Akt/GSK3β expression、BDNF and high-er Aβ1 40 、Aβ1-42 、p-Tau and BACE1 in model group than insham group (P＜0.05,P＜0.01).Low and high RAS dose treatment lengthened TQET,improved PI、phosphorylated Akt/GSK3β expression and BDNF while decreased Aβ1-40 、Aβ1-42 、p-Tau and BACE1 compared with model group.BDNF was higher after high dose RAS treatment than model group (P＜0.01).Conclusion RAS inhibits AD-like lesions in rats with CCH by downregulating the Akt/GSK3β pathway and BACE1 activity,thus improving the cognitive impairment.

Objective To evaluate the diagnosis and surgical treatment of adult congenital choledochal cyst(ACCC). Methods Clinical data of 345 ACCC cases from 1974 to 2007 were analyzed retrospectively. Results There were only 110 patients (31.9%) with typical triad (abdominal pain, palpable mass and jaundice). B-ultrasound, CT, ERCP, PTC and MRCP were methods for diagnosis. Cancer arising from choledochal cysts was found in 19 cases who had undergone internal drainage and its incidence of cholangiocarcinoma is much higher than in the general population. All cases underwent surgical treatment, in which total excision of choledochal cyst and Roux-en-Y hepaticojejunostomy was main operation, 337 cases recovered well and 8 (2. 3%) died. C..ondusions Accurate diagnosis of ACCC was difficult depending on clinical symptoms only. B-ultrasound was the choice of atraumatic diagnosis. All patients with an established diagnosis of ACCC should undergo exploratory laparotomy. Total excision of eholedochal cyst and Roux-en-Y hepaticojejunostomy is most effective treatment for ACCC.

Objective To investigate the prevalence and transmission mechanisms of plasmid-mediated blaoxa-23 resistance genes in Acinetobacter baumannii.Methods One hundred and one Acinetobacter baumannii were collected from Obstetrics and Gynecology Hospital of Fudan University and Renji Hospital Shanghai Jiaotong University School of Medicine.Antibiotic susceptibility of carbapenems were determined by standard agar dilution method.Molecular typing of Carbapenem-resistant Acinetobacter baumannii (CRAB) was performed by MLST.blaoxa-23、blaoxa-24、blaoxa-51、blaoxa-58、blaIMP-1、blaVIM-1/2 and blaAmp-C were analyzed by PCR.The analysis of blaoxa-23 transposons for carbapenems resistant A.baumannii isolates was also performed by PCR.Plasmid was analyzed by gel electrophoresis.Conjugation experiments were performed to determine the transferability of blaoxa-23.Results The antibiotic susceptibility tests showed the resistant rates to carbapenems were extremely high , and the ones of imipenem and meropenem were 64.4%and 69.3%.Fifty-six (53%) isolates were carbapenems-resistant A.baumannii.Main clone ST208 includes 28 isolates(50%) in CRAB.A total of the CRAB isolates harbored blaoxa-23 and blaoxa-51 (100%), 44 for blaIMP-1(78.6%) and 54 for blaAmp-C(96.4%), while blaoxa-24, blaoxa-58 and blaVIM-1/2 was undetected.Two previously identified transposons ( Tn2006 and Tn2008 ) was found in the isolates.Plasmid gel electrophoresis results showed that the isolates carried 2-4 plasmids and blaoxa-23 were transferable by plasmids.Conclusions There is high carbapenems resistance of A.baumannii infections.ST208 was the most prevalent molecular type.The mainly drug-resistant genes of A.baumannii are blaoxa-23.Based on the findings, blaoxa-23 is plasmid mediated, suggesting that it may transfer by plasmids carrying Tn 2008 transposon, thus induced isolates resistant to carbapenemase.

Objective To explore selective criteria of sphincter preservation operation(SPO) for middle to low third rectal cancer,and analyze clinicopathologic parameters resulting in the selective criteria.Methods Two hundred and seventy-nine cases of middle to low third rectal cancer who accepted operative treatment from 1996 to 2004 were analyzed retrospectively.One hundred and eighty-seven rectal tumours were located in 5-10 cm from anus,92 rectal tumours in below 5 cm from anus.Among them 127 cases were treated by abdominal-perineal resection(APR),and 152 cases were treated by SPO in which there were 130 Dixon operations,12 Bacon operations,and 10 Parks operations.Clinicopathologic parameters and survival rate in APR and SPO groups were compared statistically.Results Gender,age,size,tumor types,site of tumor,degree of differentiation,infiltrated circumference of intestine,and lymph node metastasis,depth of invasion and Dukes stages were not significantly different between APR and SPO groups.SPO performed rate was 54.48% in all.SPO was performed in 48 lower third rectal cancer cases(52.17%,48/92).Regional recurrence rate was 6.81%(19/279).Middle survival time was((65.00?6.87))months and 5-year survival rate was 63.51% in SPO group.Middle survival time was((52.23?5.63)) months and 5-year survival rate was 52.50% in APR group.Chi-Suqare was 18.14 by Log-rank test(P=0.054 1).Conclusion There is no statistically difference in survival rate between APR and SPO groups.

Objective To evaluate the diagnosis and surgical treatment of primary retroperitoneal extraadrenal pheochromocytoma(PREAP). Methods Clinical data of 17 cases with PREAP from 1976 to 2006 were analyzed retrospectively. Results It was not difficult for the diagnosis of PREAP based on the primary symptoms, including paroxysmal hypertension or persistent hypertension. PREAP is usually deep, large and invading on adjacent organs. B-uhrasound was used for preliminary screening. CT and MRI with high soft tissue resolution and multi directional imaging are of great value for correct diagnosis and determination of exact extent of the tumor in diagnosis of PREAP. 24 h urinary VMA output imcreased in 12 cases (92. 3%) and urinary catecholamine level was up to 526. 1 μg- Precise location of PREAP by 123I-MIBG is superior to that by 131I-MIBG. The diagnosis was tentative in 4 cases and definite in 13 cases. Complete tumor resection was achieved in 15 cases, among them 2 cases died on table due to inadequate preparation before surgery in 1970's. In the remaining 2 cases with huge tumors partial resection, silver clips were put in during operation to locate the extent of the tumors for further management after operation. Conclusions Locating and qualitative diagnosis before operation are valuable and once the patients are diagnosed as PREAP, they should receive exploratory laparotomy after an adequate preparation.

Objective To study the etiology,diagnosis and treatment of xanthogranulomatous cholecystitis (XGC).Methods Clinical data of 78 cases with xanthogranulomatous cholecystitis (confirmed by postoperative pathology) from January 1985 to December 2012 were reviewed retrospectively.Results All 78 cases underwent ultrasonography,50 cases did CT scan.Preoperative diagnosis included chronic calculous cholecystitis in 60 cases,gallbladder carcinoma with cholelithiasis in 8 cases,gallbladder space-occupying lesions in 10 cases.Among those 68 cases of tentative gallstone disease,67 cases were with gallbladder neck incarcerated stones.Surgery were performed in all 78 cases including cholecystectomy in 48 cases,partial cholecystectomy or subtotal resection in 13 eases,cholecystectomy with partial hepatic wedge resection in 12 cases.Intraoperatively 5 cases were misdiagnosed as the carcinoma of the gallbladder and underwent partial liver resection along with cholecystectomy.17 cases underwent choledocholithotomy.2 cases suffered from hepatic duct injury and received Roux-en-Y hepatojejunal anastomosis.Conclusions XGC is a special type of chronic cholecystitis,and accompanied by yellow granuloma formation.Preoperative diagnosis of XGC is often difficult,the definite diagnosis depends on intraoperative fiozen and postoperative paraffin pathology.

Objective To investigate the diagnosi s and management of inflammatory abdominal mass after appendectomy. Methods Clinical data of 42 patients wit h inflammatory abdominal mass developing after appendectomy from 1972 to 2004 we re retrospectively analyzed. Results There were two kinds of mass: on abdominal wall (26 cases) and that within the abdominal cavity (16 cases). Diagnosis was established on clinical fi ndings and the barium enema examination. Correct preoperative diagnosis was achi eved in 30 cases, with 12 cases (28.6%) misdiagnosed. Laparotomy was performed in 29 cases. Postoperative pathology revealed inflammatory mass. All the 42 case s recovered from the illness. Conclusions Post-appendectomy abdominal mass is infrequent complication. T he clinical course is most often self-limited. However, laparotomy is indicated in patients when conservative therapy fails or there is a fear of malignancy or tuberculosis.

Objective To summarize our experience in the diagnosis and treatment of thyroid Hurthle cell neoplasms. Methods Clinical data of thyroid Hurthle cell neoplasm patients admitted from 1972 to 2003 were analyzed retrospectively. Results The main symptoms were thyroid solitary node or mass (37 cases) and multiple nodule (9 cases). 4 cases had cervical lymph node metastasis. With BUS、CT、ECT and FNAC,only 10 cases were diagnosed as HCNs preoperatively, 36 cases were misdiagnosed as nodular benign single or multiple node. Twenty-eight cases were diagnosed by FNAC and quick freezing pathology. Benign HCNs was treated by isolateral thyroidectomy and malignant HCNs by additional contralateral subtotal thyroidectomy. Eighteen cases were diagnosed by postoperative paraffin pathology, and retrival second operation was performed according to the benignity or malignancy of the thyroid lesion. All cases were followed-up for 2 to 10 years and doing well without recurrence. Conclusions We should realize thyroid Hurthle cell neoplasms fully, if HCNs is suspected intraoperatively, quick freezing pathology is helpful. With appropriate therapy, the prognosis is satisfactory.

Objective To summarize the diagnosis and surgical treatment of hepatic focal nodular hyperplasia (FNH). Methods The clinical data of 63 patients with FNH proved by pathology were analyzed retrospectively. Results The disease mainly affected young to middle aged, 50 cases (79. 4% )were of 31-50 years old. Male and female ratio was 2.94: 1. Fifty-six patients (89%) were asymptomatic, 3 cases were HBsAg positive (4.8%). Liver function was basically normal (92. 1%),5 cases (7.9%) were with elevated level of total bilirubin and rGT. AFP, CEA and CA19-9 was all negative. FNH occured as a single node in 95.2% cases, ranging from 1.5 cm to 17 cm in diameter ( average 4. 5 cm). Of these patients, 25 lesions were present in the left lobe, 29 in the right lobe, 6 in the mid lobe, and 3 in the caudate lobe. A big central artery was found in 2 cases (3. 2% ) as found by color Doppler ultrasound. CT scan showed transient immediate enhancement in 96. 8% (61/63) of patients, with central scar in 6 cases. MRI demonstrated early vigorous enhancement in 93. 7% (59/63) of patients, with central scar in 5 cases. All patients underwent surgical resection; including local resection in 34 cases;segmentectomy or hepatectomy in 13 cases; hemihepatectomy in 13 cases. There was no postoperative mortality and major complications. Conclusions FNH is a kind of hepatic benign disease and characteristic of high preoperative misdiagnosis rate (25. 4% ).