Objective To assess the effectiveness of carotid endarterectomy(CEA) in the surgical treatment of stenosis of carotid artery.Methods From December 2003 to June 2006,28 patients of carotid arteriosclerotic stenosis received CEA and vascular repair or plasty(VP).Before and after operation,the hemodynamic parameters including inner diameter of internal carotid canal,blood flow rate,blood flow and blood flow rate of middle cerebral artery of 28 patients were measured by color Doppler flow imaging(CDFI) and transcranial Doppler(TCD).Results The inner diameter of internal carotid canal in all patients recovered to normal range.Blood flow rate and blood flow after operation were improved.No postoperative complications occurred,and no aneurysms formed.Conclusion CEA is one of the effective ways to manage carotid stenosis and angioplasty can improve the long-term efficiency.

Objective To establish mice models of Kawasaki disease by Lcatobacillus casei cell wall extract(LCWE) ,in order to provide experimental materials for follow-up study .Methods LCWE group was given LCWE 0 .1 mL per mouse(containing 200 mg LCWE) via abdominal intramuscular injection .PBS group was given 0 .1 mL PBS per mouse .Orbital blood samples were collected respectively at the 1st ,3rd and 28th day after administration .The heart ,lung ,liver ,kidney ,spleen and other organs tissue samples were collected for pathological section ,HE staining .The histopathological changes were investigated ,and the routine blood test was proceeded .Results The WBC of LCWE group showed a trend of rising at the 1st ,3rd and 28th day after administration .PLT and MPV of LCWE group increased at the 3rd day after administration ,which returned to normal levels at the 28th day after adminis-tration .The pathological section showed the blood vessel walls of heart tissue enlargement ,surrounded and infiltrated by inflamma-tory cells infiltration ,the atheromatous plaque in blood vessels occasionally .Conclusion The study established mice model of Ka-wasaki disease successfully .

Objective To investigate clinical and pathological characteristics of insulin-induced localized lipoatrophy and treatment.Methods We retrospectively analyzed clinical manifestation, skin biopsy pathology, treatment regimen and follow-up of 6 diabetic patients with insulin-induced localized lipoatrophy in Peking Union Medical College Hospital from January, 2010 to March, 2016, with systemic review of related literatures.Results Among 6 cases with insulin-induced localized lipoatrophy, 5 patients were with insulin allergy.5 patients were with positive insulin-autoimmune antibody, which was similar to the ratio reported in the systematic review (18 out of 19).Insulin-induced lipoatrophy could be caused by various types of preparations of insulin and insulin analogs.Subcutaneous biopsy, performed on the atrophied area, revealed the decrease of the number and volume of adipocytes and tissue fibrosis, probably accompanied with lymphocytes, eosinophils or mast cells infiltration.Lipoatrophy could sometimes be relieved by changing injection sites, types of insulin preparations or drug-delivery way, sometimes by application of systemic/local glucocorticoid or local cromolyn sodium.Conclusions Insulin-induced localized lipoatrophy is a rare adverse reaction of insulin preparations.It might be related to immune response of local tissue and heterogeneous pathological manifestations.The lipoatrophy might be improved by changing injection sites, changing the type of insulin preparations or drug-delivery way, and with possibility to carry out targeted immunosuppressive therapy according to the biopsy pathology in the future.

Objective: To analyze the causes of preoperative miscarriage of pancreatic serous cystadenoma (SCN) and find the ways to improve it. Methods: Clinical data of 425 pancreatic cystic neoplasm patients who underwent surgical resection from January 2006 to December 2016 in Department of Pancreatic Surgery in Huashan Hospital were retrospectively analyzed.Excel database was created which covered 128 fields of 7 fields: general information of patients, preoperative blood biochemical indexes, tumor markers, surgical related data, postoperative complications, imaging findings and pathology.One hundred and sixty-one cases of SCN were analyzed in depth, mainly in three aspects: surgical benefit, preoperative imaging diagnostic value and interference factors in preoperative judgement.The classification data were analyzed by χ² test and the quantitative data were analyzed by t test.The Logistic regression model was used for multiple factor analysis. Results: Of the 425 PCN cases surgically removed, 161 cases (37.9%) were SCN, the incidence of operative complications was 40.4%(65/161), the hospitalization days was (20.7±12.1)days and the medical cost was (75 267±37 866) yuan.Only 3 of 161 cases of SCN were accurately diagnosed by preoperative imaging methods, 61 cases were diagnosed as "cystic lesions of pancreas" (37.9%) and 52 cases were diagnosed as "pancreatic cystadenoma" (32.3%). SCN was misdiagnosed as MCN(32.3%) and IPMN(28%) before operation.25.5% of them were diagnosed as SCN before operation, but still underwent radical operation.The rate of preoperative imaging diagnosis for identifying SCN was 62.8%.The lack of preoperative endoscopy and the lack of understanding of the image characteristics and biological behavior of SCN were the most important factors affecting the accuracy of preoperative judgment.Statistics found that gender, age, CA125 and tumor location can be used as independent factors contribute to the clinical identification(χ²=8.995, P=0.003; χ²=10.019, P=0.007; t=3.157, P=0.002; χ²=6.790, P=0.009). Logistic analysis showed that women, older than 60 years old, the tumors located in the pancreatic body and tail were the independent factors of SCN classification and diagnosis (OR=0.481, 0.376, 0.577, 0.666, 95% CI: 0.305-0.759, 0.199-0.710, 0.361-0.924, 0.433-1.024, P=0.002, 0.003, 0.022, 0.064). Conclusions SCN has more benign biological behavior.Although surgical excision is acceptable for clinical safety, the corresponding benefit is very limited.It is possible to improve the rationality of SCN clinical operation decisions to some extent by performing endoscopic examination, imaging doctors to improve the SCN feature recognition and surgeons to enhance the awareness of SCN.

BACKGROUNDAnaphylactic reactions during anesthesia and operation are common and life threatening. Follow-up investigation is necessary for avoiding potential re-exposure of the patients to the offending drugs. The purpose of this study was to assess cellular allergen stimulation test (CAST) as a diagnostic instrument in immunoglobulin E (IgE)- and non-IgE-mediated anaphylactic reactions.

METHODSThis study included 25 patients who developed perioperative anaphylactic reactions and 10 subjects that tolerated anesthetics and other drugs during perioperative period from September 2009 to October 2013 in Peking Union Medical College Hospital. We performed skin tests and flow cytometric analysis of basophil activation-based CAST in all subjects.

RESULTSOf the 25 patients, 17 had IgE-mediated anaphylactic reactions (causative agent identified by skin tests) and 8 had non-IgE-mediated anaphylactic reactions (negative skin tests). CAST showed a sensitivity of 42.9%, specificity of 90%, and negative predictive value of 80.6% for neuromuscular blocking agents.

CONCLUSIONSCAST may be useful for the diagnosis of anaphylactic reactions during perioperative period. Our findings call for further investigation to increase the sensitivity of the test.

Adult ; Allergens ; immunology ; Anaphylaxis ; diagnosis ; Drug Hypersensitivity ; Female ; Humans ; Male ; Middle Aged ; Perioperative Period ; Skin Tests ; methods ; Young Adult