Objective To study the diagnosis and therapy of recurrent cholelithiasis caused by peripapillary duodenal diverticulum.Methods The clinical data of 40 patients with repeated formation of bile duct stones caused by peripapillary duodenal diverticulum were retrospectively reviewed,and the data on surgical treatment were analyzed.Results All the patients underwent duodenal diverticulum operation and subtotal gastrectomy (Billroth Ⅱ).Twenty-one patients in addition underwent R-Y cholangiojejunostomy,14 patients and 5 patients underwent choledochotomy with T-tube drainage and duodenotomy with Oddi sphincterotomy,respectively.In forty patients,three patients presented temporarily biliary fistula,two patients lost touch,three-eighty fully recover from an illness in three years.Conclusion Recurrence of bile duct stones caused by peripapillary diverticulum may be cured by duodenal diverticulum operation combined with bile duct surgery,which is a feasible and efficacious treatment.

Objective To examire the effects of hydroxyethyl starch (HES 200/0.5 6%) on lung capillary permeability in endotoxemic rats.Methods Forty-two male Wistar rats weighing 250-300 g were randomly divided into 7 groups with 6 animals in each group: group 1 served as control; group 2 received lipopolysaecharide (LPS) 6mg?kg-1 intraperitoneally (i.p.); in group 3-6 1 min after LPS 6 mg?kg-1 i.p. HES 3.75 ml?kg-1 (group 3), 7.5 ml? kg-1 (group4), 15 ml? kg-1 (group 5) or 30 ml?kg-1 (group 6) was infused i. v. at a rate of 0.2 ml ? min-1 ; group 7 received only HES 30 ml ? kg . The animals were anesthetized with urethane. Right external jugular vein was cannulated for continuous intravenous infusion. Animals were sacrificed at 2 h and 4 h after LPS challenge respectively. Lung capillary permeability, lung wet/dry weight ratio and lung PMN accumulation were measured at 4 h after LPS challenge and nuclear factor Kappa B (NF-?B) activation in the lungs at2 h after LPS challenge.Results HES 3.75 ml?kg-1 and 7.5 ml ? kg-1 significantly reduced LPS-induced increase in lung capillary permeability, lung wet/dry weight ratio and lung PMN accumulation ( P

Different preparations of Hydroxyethyl starch (HES) each have unique molecular weight, degree of substitution and manner of substitution, which are responsible for their intravascular volume expansion and half-life. HES solutions have notable effects on ameliorating hemodynamic and hemorrheological parameters, as well as unique capacity to prevent and reduce capillary leak. Compared with other colloid solutions, HES is more effective, safe and economical. It is an ideal volume expander.

Objective To explore the diagnosis and treatment of iatrogenic bile duct injury during choledochocystectomy. Methods Clinical data of 24 cases of iatrogenic bile duct injury were analyzed retrospectively from 2005 to 2009. Results Eight patients underwent early repair of bile duct within 4 days after the injury. 14 patients with later recognized bile duct injury underwent selective operations, and two patients were discharged after their jaundice were relieved without any surgical treatment. Supporting T tubes were left in place in 22 patients for 8 to 14 months after operations, without any biliary obstruction found after one year and six months to five year follow-up. Conclusions Early bile duct injury within 4 days was easily treated, but later bile duct injury should have selective operation. The patients with jaundice could be diagnosed with PTCD and ERCP to observe the bile duct injury. During operation membrane-to-membrane wide hepatojejunostomy helps prevent later anastomotic stenosis. The left in drainage tube in anastomotic stoma for more than 8 months improves success rate in the process of injuried bile duct repair.

Medical professionalism is an important part of competencies which physicians are acquired to own.Team of physician's competency model construction and education revolution project concluded the current situation and theoretical cognition of physician's professionalism of experts from medical education and administration organizations in China according to the results of the first round of Delphi.Meanwhile,suggestions for the further improvement of physician's professionalism were pro

Objective To make a comparative assessment on both the therapeutic effects and side effects between percutaenous lauromacrogol injection therapy(PLIT) and percutaenous ethanol injection therapy(PEIT) for simple hepatic or renal cyst.Methods In group A,55 patients with simple hepatic or renal cysts underwent ultrasound-guided aspiration and successive PLIT.The intra-operative side effects were investigated and the therapeutic effects assessment by using ultrasonography was conducted 3 months after the treatment.In group B,60 patients with simple hepatic or renal cysts had received ultrasound-guided aspiration and PEIT sometime before.The intra-operative side effects and therapeutic effects on the thirdmonth ultrasonography were independently reviewed according to their case records.Results In group A,3 patients(5.5 ％) expressed slight discomfort but not pain while receiving lauromacrogol injection.Follow-up ultrasound examination at the end of third month demonstrated the cysts in 43 patients completely regressed,while cysts in rest 12 patients shrank over 50 ％ in size,showing the overall response rate(ORR) and completely cure rate(CCR) were 100％ (55/55) and 78.2％ (43/55) for PLIT respectively.In group B,12 patients(20％) suffered from slight to moderate irritating pain or drunk performance.The third-month ultrasound examination disclosed that cysts in 47 patients completely vanished,and cysts in the other 13patients shrank more than a half,indicating the ORR and CCR were 100％ (60/60) and 78.3 ％ (47/60) for PEIT respectively.Conclusions Although their therapeutic efficacy are perfectly similar,PLIT is much more superior to PEIT in term of less and minor side effects.

Objective To investigate the abnormal region of gray matter and distribution in patients with Parkinson’s disease (PD),and explore the brain structural changes closely related to mild cognitive impairment(MCI).Methods 20 cases of PD-MCI, 1 7 cases of PD-nMCI and 20 normal controls (NC)were examined by 3D-T1 WI brain volume sequence.The data of three groups were analyzed using voxel-based morphometry(VBM)based on SPM8 to generate gray matter map.Results Compared to NC,decreased gray matter volume in PD-nMCI was observed in the right temporal lobe,including the middle temporal gyrus,inferior temporal gyrus,and right fusiform gyrus,uncus and left superior temporal gyrus.Compared to PD-nMCI,decreased gray matter volume in PD-MCI was observed in the bilateral midfrontal gyrus,inferior frontal gyrus,left precentral gyrus,right midtemporal gyrus,superior temporal gyrus,bilateral insular,and right cuneus,lingual gyrus,posterior cingutate.Conclusion Decreased gray volume in PD-nMCI is mainly located in the right temporal lobe and right uncus.With occurrence of MCI,abnormal brain regions are gradually extended.Gray matter atrophy in the bilateral midfrontal gyrus,inferior frontal gyrus,and left precentral gyrus are related to the MCI.

Objective To explore the value of brain CT scanning for distinguishing tumor-like inflammatory demyelinating diseases (TIDD) from glioma or primary central nervous system lymphoma.Methods The brain CT features in 20 patients with TIDD(10 female,10 male;mean age (35.6±14.0)years;range,6-51 years)and 32 gliomas(16 female,16 male;mean age(42.0±19.8)years;range,12-75 years)and 6 lymphomas(3 female,3 male;mean age(53.8±11.8)years;range,32-68 years)were retrospectively reviewed and compared between brain tumors and TIDD.Results (1)Among the 38 primary brain tumors,there were 19 cases(50%,14 gliomas,5 lymphomas)with hyperdense lesions,10 cases(26.3%,9 gliomas,1 lymphomas)with isodense lesions,and 9 glionms (23.7%)with hypodense lesions.In contrast,the brain unenhanced CT manifestation of 20 TIDD all showed with hypodense lesions.(2)On unenhanced CT the lesions of 6 lymphomas all were hyperdense or isodense,like 90% of 20 high grade gliomas(WHO grade Ⅲ and Ⅳ),but this rate for grade Ⅱ was only 41.7%.(3)According to the shape of hyperdense lesions of the 19 primary brain tumors with,7 cages(6 gliomas,1 lymphomas)manifested with asymmetric hyperdense small-patches,4 cases(1 gliomas,3 lymphomas)with symmetric hyperdense large-patches,4 cases(3 gliomas,1 lymphomas)with diffused hyperdensed lesions,and 4 cases(4 gliomas)with ring-shaped hyperdensed lesions.Furthermore,4 primary brain tumors(4 lymphomas)underwent CT enhanced scanning and all the cases showed strong enhancement(3 cases with hyperdense lesions and 1 with isodense lesions on unenhanced CT),but only 3 cases of 7 TIDD showed mild enhancement in contrast.(4)By Spearman's relevant analysis,hyperdense and isodense on unenhanced CT was proved to have significant positive correlation between the grade of gliomas(r=0.435,P=0.013).Therefore,the frequency of hyperdense and isodense lesions in lymphomas and WHO grade Ⅲ and Ⅳ astrocytoma was higher in contrast with low grade astrocytoma.Conclusions Brain CT as a simple,economical and practical examination method has significant meaning for differentiating TIDD from glioma or PCNSL and could be used as an adjuvant method for MRI and magnetic resonance spectroscopy.Patients with hyperdense or isodense on unenhanced CT or strong enhancement could be excluded from TIDD.

Objective To analyze the abnormal region of gray matter and its distribution characteristics in Parkinson's disease (PD) patients with mild cognitive impairment (PD-MCI),and to investigate the structural brain changes which closely related to mild cognitive impairment.Methods 27 PD patients were examined by T1WI three-dimensional brain volume (3D-fast spoiled gradient echo,3D-FSPGR) sequence,and were divided into 2 groups:PD patients with mild cognitive impairment group (PD-MCI group,n＝15) and PD patients without mild cognitive impairment (PD-nMCI group,n=12).Gray matter map in the two groups were analyzed by using voxel based morphometry (VBM) based on SPM5.Results There were significant differences in MMSE and MoCA scores between the two groups (P＜0.01 or 0.05).Compared with PD-nMCI group,gray matter volumes in PD-MCI group were decreased in bilateral mid frontal gyrus,left precentral gyrus,right mid-temporal gyrus,left superior temporal gyrus,transverse temporal gyrus,bilateral lingual gyrus,right cuneus,bilateral insular and right posterior cingutate gyrus.Conclusions Gray matter atrophy in bilateral mid-frontal gyrus,insular and left precentral gyrus is closely related to the mild cognitive impairment in PD patients.

[Abstract ] Objective Stenosis is a common complication of Crohn′s disease (CD), different treatments for different cau-ses.The article aimed to investigate bowel stenosis by the application of MRI diffusion-weighted imaging(DWI) and explore its value of identifying CD. Methods From Jan 2014 to Jun 2014, 31 patients with histologically proven CD (18 males and 13 females;mean age:38.90 ±13.65 years) were recruited in this approved retrospective study .All patients underwent conventional 3.0T MRI and DWI sequences .According to the most serious stenosis part identified by MRI , DWI sequence examination was added and the apparent diffusion coefficient (ADC) of the lesion was measured.All patients would undergo colonoscopy in 24 hours.According to the endo-scopic manifestations and pathological results , the patients were divided into inflammatory group (n=21) and fibrotic group (n=10). We observed the difference of ADC between two groups and worked out the cutoff points . Results In the inflammatory group , the ADC value andthe mean ADC value of stenosis bowel wall were (1.01 ±1.83) ×103 mm2/s and (1.40 ±0.23) ×103 mm2/s, whereas (0.53 ±1.03) ×103 mm2/s and (0.80 ±0.16) ×103 mm2/s in the fibrotic group(P<0.05).The area under receiver operating characteristic curve was 0.981 (95%confidence interval 0.943-1.000), taking 1.11 ×103mm2/s as the cutoff point.The sensitivity of low ADC values in detecting inflammatory bowels was 90.5%, and the specificity of high ADC values in excluding inflammatory bowels was 100%. Conclusion Different pathological components limit the movement of water molecular at different degrees , therefore quantitative parameters can be acquired by measuring ADCs , which contributes to the identification and diagnosis of CD secondary bowel stenosis.