Objective To investigate the clinical relevance of hepatic artery variation during the procedure of duodenopancreatectomy. Methods Data of 100 patients who underwent duodenopancreatectomy were retrospectively reviewed, and the anatomy of hepatic artery variation was evaluated, then the types of variation and specific intra-operative managements were recorded. Results Through pre-operative celiac artery and superior mesenteric artery DSA and duodenohepatic ligament skeletonization during operation, 16 cases were found to have hepatic artery variation, and 14 (14%) patients had alternative hepatic artery, among them there were 10 cases of alternative right hepatic artery (10%) , 8 cases originated from superior mesenteric artery, 2 cases originated from gastroduodenal artery. 4(4%) patients had alternative left hepatic artery, 3 of them originated from left gastric artery, 1 originated from right hepatic artery. The diameter of variant artery was 0.3 -0.6 cm with a mean of 0. 47 cm. All the variant arteries were reserved in operation. 1 patient had a variant hepatic artery located in the posterior of hepatoduodenal ligament parallel with portal vein, and the diameter of this variant artery was 0. 4 cm, the variant artery was reserved. 1 patient had a variant hepatic artery towards right hepatic lobe which originated from the direction of pancreatic head, and the diameter of this variant artery was 0.2 cm, the artery was dissected 1 h after artery occlusion. Conclusions Whether variant blood vessel need to be reserved shall be judged according to blood vessel diameter, the changes of liver in the course of variant artery occlusion and suggestions from blood vessel surgeon.

Objective To investigate the feasibility and safety of spleen-preserving distal pancreatetomy outside abdominal cavity. Methods We used the method of spleen-preserving distal pancreatetomy outside abdominal cavity for 6 patients of benign diseases of distal pancreas who were admitted in Gulou Hospital from December 2005 to December 2008. Results All patients underwent the operation successfully. The mean operation time was 180 minutes, the blood loss was 100～300 ml with a mean of 200ml. No patients needed blood transfusion. The mean post-operative hospital stay time was (14±5 ) days. One patient developed pancreatic fistula and was cured with non-operative management, there was no other complications. All patients were followed up from 3 to 24 months, and the results were excellent. Conclusions Spleen-preserving distal pancreatetomy outside abdominal cavity is safe and feasible, which may avoid the unnecessary splenectomy.

Objective To explore clinical efficacy and safety of intraoperative localization of occult insu -linoma by using step-by-step occlusion of the pancreas .Methods 22 cases of occult insulinoma patients admit-ted from Mar.2003 to May 2013 were given intraoperative localization by adopting the technology of step -by-step occlusion of the pancreas .Results All the 22 patients were successfully completed the segmental resection of pancreas.The average operation time was(120 ±50)min, and the average intraoperative blood loss was (100 ± 80)ml.No blood transfusion was needed.Blood glucose rose rapidly when insulinoma was located within the scope of occlusion, blood glucose remained unchanged when insulinoma was beyond the scope of occlusion ,and blood glucose dropped swiftly when insulinoma was on the point of occlusion .Two patients had postoperative short-term pancreatic fistula and they were cured by conservative treatment .No other complications occurred .The average hospitalization time was(12 ±5)d.The result was good during the followed up of 8 to 24 months.Con-clusion The technique of step-by-step occlusion of the pancreas for localization of occult insulinoma is effective supplement for conventional methods , worthy of promotion .

ObjectiveTo investigate the application of CT inspection during the recovery period to cerebral infarct patients. Methods53 recurrence cases were taken out from random 100 cases of first reexamination CT films and analyzed while comparing the cases′ recurrence times,contents and the relationship between recurrence times and the original deceases.ResultsThere was no close connection between the rate of cerebral infarct recurrence and recurrence times(P>0.05).But cerebral infarct recurrence mainly appeared within the first year and the recurrence time caused by the presence of hypertension was shorter than the time caused by diabetes(P<0.05).92% cerebral infarct recurrence were cavity cerebral infarct recurrence and 11% were silent brain infarction.Conclusions It is significant for the patients to take CT reexamination within the first recovery year and also important for the no symptom patients.

Objective:To summarize the experiences of the surgical treatment of tumors in the posterior part of the third ventricle and pineal region. Methods: Twenty-seven patients with tumors in this region treated microsurgically from 1990 to 2000 were analyzed. The surgical indications, approaches, and operative key points were discussed. The prognostic factors were also analyzed. Results:Tumors were removed totally in 11 patients, removed subtotally in 7 and removed partially in 5. Biopsy and ventriculo-peritoneal shunt was performed in 4 patients. Of 17 patients in follow-up, 13 patients survived longer than 5 years. Conclusions: Most tumors in the posterior part of the third ventricle and pineal region can be surgically removed.Sufficient specimen obtained in the operation can confirm pathologic property of the tumor,guiding next chemotherapy and radiotherapy.

Objective To compare the clinical efficacy between continuous and intermittent androgen deprivation in high risk prostate cancer.Methods Sixty-four patients with high risk prostate cancer were treated from January 2008 to April 2009,36 cases who accepted goserelin and bicalutamide were taken as intermittent hormonal therapy (intermittent treatment group),while 28 cases who accepted bilateral orchiectomy in addition to flutamide were regarded as continuous hormonal therapy (continuous treatment group).The comparison of tumor specific mortality,time of prostate specific antigen (PSA) to nadir,tine to PSA recurrence,serum testerone and quality of life score were assessed between the two groups.Results In continuous treatment group and intermittent treatment group,follow-up period was (26.4 ± 10.3) and (28.1 ± 8.7) months,the time of PSA to nadir was (3.8 ± 2.1 ) and (4.0 ± 3.6) months,the time to PSA recurrence was (20.1 ± 12.3) and (24.5 ± 14.6) months,respectively.There was no significant difference between the two groups.At the time of 18,24 and 30 months after therapy,serum testerone was 0.85,0.88,0.89 μg/L in continuous treatment group,while 1.21,1.36,1.48 μg/L in intermittent treatment group,respectively (P ＜ 0.05 ).Similarly,quality of life score was 38.7,40.5,39.8 scores in continuous treatment group,while 49.2,51.4,52.3 scores in intermittent treatment group at the time of 12,18 and 30 months after therapy,respectively (P ＜ 0.05 ).Conclusions Clinical efficacy could not been found between continuous and intermittent endocrinic therapy of prostate cancer.During intermittent,quality of life seems to be better and increases in accordance with serum testerone recurrence at given time.

Objective To investigate the value of radiofrequency catheter ablation(RFCA) on idiopathic ventricular tachycardia(IVT) in children.Methods The treatment efficiency of 35 patients accepting RFCA from March 2000 to February 2006 was analyzed,which was divided into control group and study group,randomly.The target site of IVT was localized by routine mapping in control group,and study group was localized by routine mapping combining doppler tissue imaging(DTI) on the basic treatment.Results Numbers of discharge,X-ray exposure time in study group were shorter than that in control group.There were no significance of radiofrequency energy,achievement rates and relapse rates between two groups.Conclusions RFCA is a safe and effective method on IVT.Children are localized combined with DTI shall decrease numbers of discharge and X-ray exposure time.

Objective To study effects of early non-invasive ventilation (NIV) application in treating elderly patients with acute left ventricular failure induced respiratory failure. Method Totally 32 elderly patients with acute left ventrieular failure induced respiratory failure, admitted from August 1997 to February 2007, received NIV treatment, and were retrospectively studied. There were 22 male and 10 female, aged (81.5?8.6) yearsdd. The changes of rahs, respiration rate, heart rate, arterial blood gas, cardiac function before and after NIV application were compared. According to the application time of NIV, 32 patients were divided into two groups: group A (early NIV application group, n=17) and group B (non-early NIV application group, n= 15). The time to improve the symptoms, the application time of NIV, cure rates, tracheal intubation rates and mortality were compared between the two groups. Results Thirty of the 32 patients survived, cardiac function was improved from New York classⅣtoⅠ～Ⅱ, respiratory rate, heart rate and blood pressure significantly decreased, PaO_2 and SaO_2 significantly increased and PaCO_2 significantly decreased. The tracheal intubation was performed in 4 patients. The time needed to improve the symptoms and the application time of NIV were significantly different between group A and group B (P

Objective To investigate the effects of prescription of nourishing blood and stretching of stoke (PNBSS) on the levels of TXB2 and 6-Keto-PGF1αin serum of patients with acute ischemic cerebrovascular disease (AICD);To discuss its action mechanism in AICD treatment. Methods Ninety patients with AICD were randomly divided into trial group and control group, 45 cases in each group. The control group received western routine treatment, while the trail group received the western routine treatment plus PNBSS, one dose per day, for one week. Rating scale of neurologic deficit was employed to evaluate treatment effectiveness. Venous blood was collected before the treatment and on the 3rd and 7th days of treatment. Levels of TXB2 and 6-Keto-PGF1αin serum were detected respectively. Results The score of neurologic deficit of post-treatment in two groups apparently decreased compared with baseline (P<0.01), and score of neurologic deficit in trial group on 7th day was lower than that of control group (P<0.05). The total effective rate in trial group was 93.3%, which was apparently higher than that of control group (84.4%). The level of TXB2 in serum and ratio of TXB2/6-Keto-PGF1α (T/P) in two groups on 3rd and 7th days remarkably decreased compared with baseline (P<0.01), while the level of 6-Keto-PGF1α in two groups on 3rd and 7th days was higher than that of baseline (P<0.01). Meanwhile, the level of TXB2 and ratio of T/P in two groups on 7th day were apparently lower than that of 3rd day (P<0.01), and the level of 6-Keto-PGF1αon 7th day was higher than that of 3rd day (P<0.01). The level of TXB2 in serum and ratio of T/P on 3rd and 7th days in trial group were apparently lower than that of control group (P<0.01, P<0.05), while the level of 6-Keto-PGF1α on 3rd and 7th days in trial group was apparently higher than that of control group (P<0.01, P<0.05). Conclusion One of the mechanisms of PNBSS for AICD appears to inhibit overavtivity of thrombocyte, and regulate the misadjustment of ratio of T/P.

OBJECTIVEInvestigate the association between GNB3C825T gene polymorphism and pediatric vasovagal syncope.

METHODSyncope group consisted of 54 cases of unexplained syncope in children, including 18 males and 36 females, at the age of 11.8 years; control group consisted of 54 healthy children over the same period, of whom 20 were male and 34 female, at the age of 11.2 years. The patients underwent head-up tilt test (HUTT). According to HUTT test results, HUTT-positive group and HUTT-negative group were further classified. For cases in HUTT-positive group, based on the changes in blood pressure and in heart rate during HUTT, vasodepressor, mixed and cardioinhibitory patterns were studied. DNA was extracted from peripheral blood in all the patients. A pair of primers was designed flanking 825 polymorphic loci. Products were recovered by using polymerase chain reaction (PCR). GNB3C825T polymorphism was detected by using gene-side GNB3C825T sequencing. Allele distribution between the various groups were studied.

RESULTAmong fifty-four children with syncope, HUTT was positive in 30 cases, including vasodepressor pattern in 15 cases (50.0%), mixed pattern in 9 cases (30.0%) and cardioinhibitory pattern in 6 cases (20.0%). Whereas the subjects in control group had negative HUTT response. GNB3C825T allele C in the control and syncope groups was 81.5% and 65.7%, respectively. GNB3C825T allele T in the control and syncope groups was 18.5% and 34.3%, respectively (χ(2) = 6.888, P < 0.05). GNB3C825T allele C in HUTT-positive and negative groups was 61.7% and 81.3%, respectively. And GNB3C825T allele T in HUTT-positive and negative groups was 38.3% and 18.7%, respectively (χ(2) = 4.905, P < 0.05). GNB3C825T allele frequency did not show statistically significant difference among the 3 hemodynamic patterns of VVS (χ(2) = 0.658, P > 0.05).

CONCLUSIONStudy on GNB3C825T allele frequency in children with vasovagal syncope is of significant value for a better understanding of the pathophysiology of VVS and provide a molecular biologic basis for its mechanisms.

Adolescent ; Alleles ; Case-Control Studies ; Child ; Female ; Gene Frequency ; Heterotrimeric GTP-Binding Proteins ; genetics ; Humans ; Male ; Polymorphism, Genetic ; Syncope, Vasovagal ; genetics ; Tilt-Table Test