Objective To study the therapeutic effect of EUS-guided rendezvous (EUS-RV) when ERCP failed in patients with malignant obstructive jaundice. Methods 12 cases of malignant obstructive jaundice patients were underwent EUS-RV after unsuccessful ERCP. The operation success rate, liver function recovery 1 week and 1 month after operation, complication rates, hospital stay and patient survival were observed. Results All 12 patients were successfully operated and placed stents by endoscopic ultrasound puncture following by ERCP: 8 patients by the stomach, 4 patients by duodenum, the operation success rate was 100.00%; There were significant difference between the liver function recovery of preoperative and postoperative one week or postoperative one week and postoperative one month (P < 0.05). 1 bleeding occurred and were improved after conservative treatment, the complications rate was 8.33%; the hospital stay was (20.68 ± 5.76) d; the average survival time of patients was 224 d. Conclusion EUS-guided rendezvous may be the alternative treatment due to the diminutive trauma and good effect when ERCP failed in patients with malignant obstructive jaundice.

Adult ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Lead ; blood ; Lead Poisoning ; blood ; epidemiology ; Middle Aged

Prostatic artery of 12 elder and 9 younger cadavers were isolated and transected.Vascular inner diameter and thickness of vascular wall of these cross sections were observed microscopically.Atherosclerotic plaque could be seen in the prostatic artery of 12 elders.And there were the thickening of tunica intima and the narrowing of inner diameter.The inner diameter of elderly prostatic artery was (452 ± 97) μm,the thickness of their tunica intima (228 ± 82) μm and inner diameter/thickness 3.14 ± 0.68.Tunica intima of 9 younger prostatic arteries were glabrate.The inner diameter of younger prostatic artery was (864 ± 17)μm,the thickness of their tunica intima (57 ± 4)μm and inner diameter/thickness 15.52 ± 0.18.Statistically significant differences existed between elder and younger cadavers in the above 3 parameters.As compared with younger counterpart,prostatic artery of elders was more stenotic and its tunica intima tended to he thicker.

Objective To observe the different expression of somatomedin-receptor in cell membrane of prostate epithelial cells at anoxic or normoxic condition.Methods Human prostate epithelial cells line RWPE-1 were cultured in vitro.At 4,8,12,24,48 h after cells had been seeded,the gene and protein expression of epidermal growth factor receptor (EGFR),fibroblast growth factor receptor (FGFR),transforming growth factor β1 receptor (TGF- β 1R),insulin-like growth factor-1 receptor (IGF-1 R) and vascular endothelial growth factor receptor (VEGFR) in prostate epithelial cells were tested by RT-PCR and immunohistochem-istry methods,respectively.Results The expression of mRNA and protein of EGFR,FGFR,IGF-1R,TGF- β1R,VEGFR were significantly increased in anoxic and normoxic prostate epithelial cells (P ＜ 0.01 ).At different time point,the expression of mRNA and protein of EGFR,FGFR,IGF-1R,TGF- β1R,VEGFR significantly higher in anoxic than those in normoxic prostate epithelial cells (P＜ 0.01 )besides 4 h EGFR mRNA,12 h EGFR protein,4 h IGF-1R mRNA,4 and 8 h IGF-1R protein,4 and 8 h TGF-β 1R mRNA,4 and 8 h TGF-β 1R protein,4 h VEGFR mRNA (P ＞ 0.05).Conclusion Anoxic prostate epithelial cell can up-regulate the expression of somatomedin-receptor.

Objective To evaluate the safety and efficacy of ultrosonography-guided two-stage ERCP for management of emergent pancreatobiliary diseases during pregnancy.Methods The clinical data of 32 consecutive pregnant women with suspected emergent pancreatobiliary diseases,who were treated with two-stage ultrasonography-guided ERCP from January 2005 to May 2010,were analyzed retrospectively.All patients were treated with ERCP in two stages. In stage Ⅰ,all the patients underwent ultrasonographyguided biliary cannulation,sphincterotomy with small incision and plastic stent placement during pregnancy.In stage Ⅱ,routine ERCP was performed in two weeks after delivery.The success rate of first ERCP,relief of clinical manifestation,improvement of lab indices,maternal and fetal complications were evaluated.Results All patients presented with fever,biliary colic and jaundice.Abdominal ultrasonography or magnetic resonance cholagiopancreatography (MRCP) revealed dilated common bile duct (CBD) in all patients,with CBD stones in 24 and acute cholangitis in 8.Bile duct cannulation and stent placement were successful in all patients.All patients markedly improved after first ERCP,with laboratory indices significantly improved at 1week after the procedure ( P ＜ 0.01 ).In stage Ⅱ,CBD stones were retrieved in 24 patients under ERCP,including 2 cases of mechanical lithotripsy.Bile duct stenosis was found in 3 patients and plastic stents were replaced.Biliary bleeding occurred in 1 case,mild acute pancreatitis in another,with a complication rate at 6.25％.Patients and babies were followed up for 12 months and found to be healthy.Conclusion Twostage ultrosonography-guided ERCP is safe and effective for pregnant patients with emergent pancreatobiliary diseases,which might be regarded as the first choice for such patients to avoid radiation.

Objective To investigate the litholytic effect of stirring by plastic stem inside biliary tract in large common bile duct (CBD) stone. Methods Forty-five patients with large CBD stones were included in this study (8 with the distal bile duct stricture and 5 with too-small Vater's papilla).Plastic stent of 8.5Fr was inserted into the CBD under the guidance of guide wire in all the 45 patients. Results In 10 of the 45 patients, ERCP showed that there was no stone in CBD 3 months later after stent placement. In 22 cases, repeated ERCP revealed that the stone had become smaller to the extent of more than a half or became stone fragments that were easily extracted by baskets or balloon dilation. Thirteen patients continued to have large stone at the second time ERCP treatment, and a new stent was replaced and follow-up performed by B mode ultrasonography of abdominal region per month. Further endoscopic treatment was performed immediately when the stone became small enough. The percentage of 95.6% (43/45) of large CBD stone were eventually cleared after endoscopic treatment for an average of 2.4 times. There were no severe complications related to ERCP or stent placement. Conclusion Placement of plastic biliary stent is a convenient and effective measure for the treatment of large CBD stones. It is especially appropriate for aged patients of CBD stone of high risk.

Objective To explore the strategies for diagnosis and treatment of anomalous junction of pancreaticobiliary duct (AJPBD) complicated by acute pancreatitis. Methods The clinical dataof 22 patients with abnormal pancreaticobiliary junction were analyzed retrospectively. Results The incidence of acute pancreatitis in this series was 31.8 % (7/22), thereinto, 5 cases(71.4%) in C-Ptype (the common bile duct joining the pancreatic duct) and 2(28.6%) in P-C type (the pancreatic duct joining the common bile duct). Seven patients underwent ERCP+ EST+ ENBD. Two patients with common bile duct stones were treated with stone basket and cholecystectomy was performed in two cases with gallstone. All patients were successfully treated. The follow-up for l year showed that there was no recurrence of pancreatitis. Conclusion Acute pancreatitis usually occurs in patients with AJPBD, especially in C-P type or with gallbladder stone or common bile duct stone. ERCP+EST+ENBD and prophylactic cholecystectomy are effective to prevent and treat acute pancreatitis.

OBJECTIVETo investigate the causes and the prophylactic measures for the complications following correction of mandibular angle prominence.

METHODSFrom 1996 to 2001, a total of 203 patients with mandibular angle prominence underwent mandibular angle osteotomy.

RESULTSOf them, 9 patients had postoperative complications, which included bleeding, hematoma, infection, mental nerve injury, labia scar, asymmetry, and steep mandibular angle.

CONCLUSIONThe correction of mandibular angle prominence should be designed and performed precisely. Care must be taken to avoid severe complications like condyle fracture.

Cicatrix ; Facial Nerve Injuries ; etiology ; Female ; Hematoma ; etiology ; Humans ; Male ; Mandible ; surgery ; Osteotomy ; adverse effects ; Postoperative Complications ; Surgery, Plastic ; adverse effects ; Treatment Outcome

OBJECTIVETo evaluate the prognostic value of surgical operation-related factors in patients with hepatocellular carcinoma (HCC).

METHODSThe clinical data of 234 patients after hepatic resection (214 men and 20 women) were retrospectively studied. Univariate and multivariate COX regression analyses were performed for surgical operation-related prognostic factors including age, gender, intraoperative blood loss, iatrogenic tumour rupture, transfusion, operation duration, hepatectomy extent, Pringle manoeuvre, with or without devarscularization, and complications (e.g. postoperative ascites, biliary leakage, incision infection, and pleural effusion). Kaplan-Meier and log-rank tests were used to compare survival rates. Kendall's tau bivariate analyses were used to examine the correlations of these surgical operation-related factors.

RESULTSUnivariate COX regression analysis revealed that iatrogenic blood loss (chi2 = 19.721, P < 0.001), transfusion (chi2 = 7.769, P = 0.005), tumour rupture (chi2 = 6.401, P = 0.011), operation duration (chi2 = 4.793, P = 0.029), and postoperative ascites (chi2 = 4.452, P = 0.035) were statistically significant predictors in patients with HCC after hepatic resection. Multivariate COX regression analysis revealed that pathological factors, such as blood loss (RR: 2.138, 95% CI: 1.556-2.939), tumour rupture (RR: 2.260, 95% CI: 1.182-4.321), and postoperative ascites (RR: 1.648, 95% CI: 1.088-2.469), independently influenced the HCC prognosis. Blood loss correlated with transfusion (Kendall's tau = 0.416, P < 0.001). There was no correlation between hepatectomy extent and blood loss (Kendall's tau = 0.057, P = 0.383), while transfusion closely correlated with the hepatectomy extent (Kendall's tau = 0.185, P = 0.004). The postoperative ascites closely correlated with Child classification (Kendall's tau = 0.151, P = 0.024).

CONCLUSIONSThe long-term survival of patients with HCC after hepatectomy may be improved by avoiding blood loss and iatrogenic tumour rupture. The indications of blood transfusion may not be strictly obeyed in some severe cases. Child class B and C cirrhotic patients may experience postoperative ascites and a worse prognosis, and therefore may be candidates for liver transplantation.

Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; mortality ; pathology ; surgery ; Child ; Female ; Hepatectomy ; adverse effects ; Humans ; Intraoperative Complications ; Liver Neoplasms ; mortality ; pathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the possibility of using distraction osteogenesis to repair skull defect.

METHODS17 goats with one year age were chosen randomly. The animals were divided to 3 groups. Group A includes 7 goats, a 3.0 cm x 2.2 cm rectangle skull defect is created on both sides of parietal area. Group B includes 5 goats, a 2.2 cm x 2.2 cm square skull defect was created on right side of parietal area. Group C includes 5 goats, a 3 cm x 1 cm rectangle skull defect was created on both sides of parietal area. Accordingly, different size of transport discs were created on right side of skull and the distraction apparatus is implanted. 3-D CT was done to measure the skull defect on group A. Biomechanical test was done on group B. Process of bone formation illustrated by histological stain, scan and transparent electric microscope was observed on group C.

RESULTSGroup A measured by 3-D CT showed that skull defect of experimental side have been repaired by distraction osteogenesis. There was definitely difference between experimental and control side (P < 0.01). Group B measured by biomechanical test showed no definitely difference between experimental and normal side (maximum load P = 0.235 > 0.05, rigidity P = 0.213 > 0.05). Group C showed that the process of bone formation was typical intramembranous.

CONCLUSIONSThe evidence showed that skull defect of goat can be repaired by distraction osteogenesis.

Animals ; Goats ; Osteogenesis, Distraction ; Skull ; pathology ; surgery