Objective To focus on the causes and management of complications after laparoscopic cholecystctomy (LC). Methods A retrospective analysis of clinical records of 13 278 patients undergoing LC in this hospital from March 1991 to July 2003 was made. Results Complications occurred in 110 patients (0.83%), involving 19 cases of bile duct injuries (0.14%), 37 cases of bile leakage (0.28%), 31 cases of residual calculi in common bile duct (0.23%), 4 cases of intraabdominal hemorrhage (0.03%), 5 cases of gastrointestinal injury (0.04%), 3 cases of intraabdominal abscess (0.02%), 6 cases of incisional infection or hernia (0.05%) and 5 cases of serious subcutaneous emphysema (0.04%), respectively. Five patients died (0.04%). Conclusions The major complications after LC include bile duct injury, bile leakage and residual calculus. Most of complications are preventable and curable.

Objective To explore the effect of ulinastatin trypin inhibitor on inhibiting pancreatic secretion and preventing and curing pancreatic fistula in patients underwent pancreatodudenectomy.Methods 45 cases underwent pancreatodudenectomy were not given ulinastatin as control group postoperatively,32 patients underwent pancreatodudenectomy were intravenously driped by ulinastatin 100,000u solution in physiologic saline,every 12 hours (Bid) for 5～8days.Child's pancreatodudenectomy was adopted in all the cases. Results Pancreatic secretion at postoperative 120h in ulinastatin group (138 26?114 74)ml/d were significantly lower than those of control group (248 56?106 75)ml/d (P

Objective To summarize the experience in prevention and treatment of bile duct injury during laparoscopic cholecysteclomy(LC). Methods Retrospective analysis on the clinical data of 31 cases of LC was carried out. Of them, 27 underwent one stage operative repair and 4 underwent palliative external drainage of the bile duct first. Results 16 cases succeeded and 11 failed in the one stage operative repairing.There were 15 cases underwent 2～4 operations in this series,and the re-operation rate was 48.4%. 29 patients was cured while 2 died. Conclusions During LC, the operative rule should always be strictly observed, and the key to preventing bile duct injury is to avoid clipping, cutting and coagulation blindly.

Objective To observe the effect of kidney-tonifying herbal medicine (KTHM) on the changes of female rat genital system induced by Tripterygium wilfordii Hook(TWH).Methods Thirty female rats with normal oestrus cycle were randomly divided into 3 groups: control group,TWH group and TWH+KTHM group. The changes of genital system in all rats were examined after 90-day feeding. Results Compared with the TWH group,oestrus cycle was normal, estrogen and progestogen level and the weight of reproductive organs increased, the ovary was big,follicle grew well with more corpus luteum and good blood supplying, endometrium was thick with hyperplastic uterine gland,and vaginal epithelium became thick and cornificated in TWH+KTHM group. Conclusion Kidney-tonifying herbal medicine can antagonize the toxic and side effects of Tripterygium Wilfordii on the genital system of female rat.

Objective To evaluate the therapeutic effect of combination of sandostatin and growth hormone (GH) in the treatment of severe acute pancreatitis (SAP ). Methods Sixty patients with SAP were divided randomly into 3 groups:(1)Sandostatin treatment(ST) group (n=15);(2)combination of sandostatin with GH treatment(CT) group (n=30) ;(3)control group (n=15). The changes in serum IL-1, IL-6,TNF-? and albumin levels after treatment, and the incidence of complications, the duration of hospital stay and cost were compared among the 3 groups. Results The complications, mortality, duration of hospital stay in the CT group were significantly shorter than those in ST group and control group (all P

Objective To discuss the clinical value of combined antegrade and retrograde technique of laparoscopic cholecystectomy in prevention of bile duct injury.Methods Clinical data of 613 patients who underwent laparoscopic cholecystectomy with combined antegrade and retrograde technique from March 1991 to June 2006 were analyzed retrospectively.Results Cholecystolithiasis with atrophy of gallbladder was found in 121 cases,acute and subacute cholecystitis in 432 cases,cholecystolithiasis with chronic cholecystitis in 42 cases and polyps of cholecyst in 18 cases.Nine cases were converted to laparotomy(5 cases of cholecystolithiasis with atrophy of gallbladder and 4 cases of subacute cholecystitis).The average operation time was 43.5 minutes.Bile leakage occured in only 1 case after operation and fully recovered after 3 days of drainage,and all the other cases had smooth recovery with no bile duct injuries or serious complications such as haemorrhage,infection or death.The mean hospitalization time after operation was 5.5 days.Conclusions The application of combined antegrade and retrograde technique can increase the success rate of laparoscopic cholecystectomy,and reduce the incidence of injuries of bile duct,especially in those patients with inadequate exposure or anatomical variation of Calot′s triangle.

Objective To investigate the risk factors leading to complications in patients undergoing laparoscopic cholecystectomy (LC). Methods Clinical data of 11?974 patients undergoing LC from Mar. 1991 to June 2003 were collected and analyzed retrospectively. Fifteen clinical factors were recruited for the study in relation to surgical complications. Data were analyzed by ?2 test and Logistic regression. Results The overall operative complication rate was 1.896%. The procedure was shifted to open surgery in 2.389% of all cases, Logistic regression analysis revealed that Calot triangle adhesion, stage, expertise of the team, gallbladder wall thickness, gallbladder and vicinity adhesion were important risk factors for complications. Conclusion LC complications can be prevented by good training, strictly following protocol, and timely shifting to open surgery.

Charcot Spinal Arthropathy (CSA) is a rare and progressive serious degenerative spinal disease. The clinical manifestations of CSA are concealed and atypical, which could lead to missed misdiagnosis, disease prognosis, and a huge burden on patients. However, there is no systematic review of CSA in China. The causes of CSA are mainly divided into spinal cord injury and non-injury neuropathy. The risk factors for CSA caused by spinal cord injury include long-segment fixation, scoliosis, laminectomy, overload spinal exercise and obesity. CSA usually occurs in the lower thoracic or lumbar spine. The symptoms of CSA include spinal deformity, unbalanced sitting posture and local pain. The CSA can be diagnosed after excluding non-specific chronic inflammation in histology and other inflammatory diseases or tumor based on the following items, damage to proprioception, pain and temperature perception, bone destruction, absorption and new bone formation on imaging. Conservative treatment can be considered for patients with CSA who have good stability without infections, stable nerve function, skin fistulas, balanced sitting posture, and autonomic dysfunction. Surgery is recommended for patients with symptoms lasting for more than 6 months with spinal instability, skin fistulas or complicated infections. Before surgery, it is recommended to evaluate the heterotopic ossification or rigidity of both hip joints. During operation, more attention should be paid to the adequate removal of necrotic tissue and inflammatory tissue in the lesion and sufficient bone grafting. Spinal fusion is recommended at the sacrum or pelvis. Postoperative complications include failure of internal fixation, new Charcot joint formation, difficulty in wound healing and infection. The authors emphasize that the overall thoracolumbar spine should be followed up for patients with spinal cord injury and paraplegia for the long-term. The typical symptoms of CSA are helpful for early diagnosis and selection of appropriate interventions.

Objective To understand the distribution of infectious pathogens and antibiotics resistance from children patients with dacryocystitis .Methods Lacrimal secretion specimens of the outpatients with dacryocystitis were identified for bacteria using automatic instrument VITEK2 and API systems .Antibiotics sensitivity tests were detected by using VITEK 2 instrument and K‐B method .Results There were 800 strains of pathogenic bacteria isolated from eye secretions .Gram positive bacteria were 502 strains ,accounting for 62 .75% ,mainly of which were Streptococcus pneumoniae ,Streptococcus viridans and Staphylococcus au‐reus .Gram negative bacteria were 295 strains ,accounting for 36 .88% ,mainly of which were Klebsiella pneumoniae and Pseudo‐monas aeruginosa .There were 3 strains of Candida albicans ,accounting for 0 .37% .Streptococcus pneumonia and Streptococcus viridans were highly resistant to tobramycin ,erythromycin and clindamycin .At the same time ,Staphylococcus aureus resistant rate to penicillin was 99 .3% .The resistant rate of Klebsiella pneumoniae to ampicillin was 98 .6% ,but susceptible to the third generation cephalosporins and tobramycin ,and completely susceptible to imipenem .Most of children patients with dacryocystitis were from 1 month to 1 year old .Conclusion Children patients with dacryocystitis were mainly distributed in infants .Antibiotic resistant rate of pathogenic bacteria might be high .

OBJECTIVETo observe the preventive effects of multi-glycoside of Tripterygium wilfordii (GTW) on glomerular lesions in experimental diabetic nephropathy (DN).

METHODThe DN model of rats was established with streptozotocin (STZ) and intervened with GTW. In the same time, normal, benazepril, and vehicle control groups were set up. After 8 weeks of oral treatment with GTW (50 mg x kg(-1) BW), benazepril (6 mg x kg(-1) BW), and vehicle (physiological saline), the changes of body weight, urine albumin (UA1b), blood glucose (BG), serum creatinine (Scr), blood urea nitrogen (BUN) and glomerular morphology were examined. In addition, the level of protein expression of alpha-smooth muscle actin (alpha-SMA) and collagen type I in glomeruli was determined by immunofluorescence.

RESULTBoth GTW and benazepril reduced UA1b. GTW ameliorated glomerular injury, such as mesangial cell proliferation, alpha-SMA and collagen type I over-expression, in DN model. Compared with benazepril, beneficial effects of GTW on glomerulusclerosis were more significant (total cell number: GTW group 54.44 +/- 2.41, benazepril group microg/67.83 +/- 4.41, P < 0.05; alpha-SMA score: GTW group 1.98 +/- 0.52, benazepril group 2.27 +/- 0.46, P < 0.05; collagen type I score: GTW group 2.11 +/- 0.37, benazepril group 2.88 +/- 0.58, P < 0.05).

CONCLUSIONPreventive effects of GTW on glomerular lesion in DN model are related to decreasing UA1b and ameliorating glomerulusclerosis.

Animals ; Diabetic Nephropathies ; drug therapy ; metabolism ; prevention & control ; Disease Models, Animal ; Glycosides ; administration & dosage ; Humans ; Kidney Glomerulus ; drug effects ; injuries ; metabolism ; Male ; Plant Extracts ; administration & dosage ; Random Allocation ; Rats ; Tripterygium ; chemistry