Objective To explore the diagnosis and treatment of acute biliary pancreatitis (ABP) and when to operate. Methods 126 cases of ABP from Jan. 2005 to Dec. 2009 in our hospital were analyzed retrospectively. Results The cases number of the mild non-obstructive type, mild obstructive type, severe non-obstructive type, and severe obstructive type was 54, 33, 15, 24 respectively. 43 patients underwent early operation, 80 patients underwent postponed operation and three patients died preoperatively as a consequence of fulminat severe pancreatitis. 117 cases ( 92.86% ) were cured and 9 cases ( 7. 14% ) with severe acute pancreatitis died. Conclusion ABP should be treated according to its type. The key to reduce the complications and increase the cure rate is to determine the proper operation time according to the condition of individual patient.

Objective To explore and analyse the causes of reoperation after biliary duct operation, so as to decrease the reoperation rate of biliary tract. Methods Clinical data of 71 patients who underwent reoperation of biliary duct diseases in our hospital between January 2005 to September 2010 were analysed,and the causes of biliary duct reoperation were summarized and analysed. Results The main cause of reoperation was recurrent or retained bile stone (76.1%,54/71), noncalculous stenosis of biliary tract ( 15.5 %, 11/71 ),biliary tract obstruction due to tumor (4.2%,3/71), and other factors (4.2%,3/71).Conclusion Recurrent or retained bile duct stone were the main cause for biliary reoperation, but noncalculous stenosis of biliary tract and biliary tract obstruction due to tumor could not be ignored. The initial rational operative method, approporiate operation time and the thoroughness of operation are the key factors to decrease bile duct reoperations.

Objective To explore the etiological factors,clinical characteristic and diagnosis of nonacute biliary pancreatitis (NABP) and acute biliary pancreatitis (ABP).Methods The Clinical data of 152 patients with NABP and 206 patients with ABP from January 2004 to December 2014 in the Hepatobiliary Surgery Department of Jinshan Branch of the Sixth People's Hospital of Shanghai were analyzed retrospectively.Results There were no statistically significant differences in terms of the Ranson score,blood amylase and C reactive protein (CRP) between two groups (P ＞ 0.05).The incidences rate of hepatic insufficiency,renal insufficiency and encephalopathy were 35.5％ (54/152),25.6％ (39/152) and 8.5％ (13/152) in the NABP group,and 25.7％(53/206),12.1％(25/206) and 3.3％(7/206) in the ABP group,with significant difference between the two groups (x2 =4.01,10.89,4.41;P ＜ 0.05).Conclusion The key to reduce the complications and improve the cure rate is to make clear the etiology of NABP and ABP and to take active and effective treatment for the cause of the disease.

Objective To investigate precipitants of epileptic seizure, and to explore the correlation between various precipitants and relationship between precipitants and clinical features of epilepsy.Methods Data were collected from 154 patients attending a tertiary-care epilepsy clinic of Nanjing Brain Hospital between April 2015 and April 2016.The patients with epilepsy were older than 16 years, had a clinical history of one year or more, and one seizure at least a year and one seizure at least in the latest three months.An enclosed questionnaire was combined with open interview to identify and characterize seizure precipitants and clinical characteristics of patients.Patients were asked respectively whether there were some precipitants three months before and during last three months.Correlation between seizure precipitants and relationship between precipitants and clinical characteristics, such as age, gender, course, seizure frequency and so on, were calculated.Results A total of 125 (81.2%) participants reported at least one precipitant.Common precipitants (in descending order) were as follows: emotional stress (56.0%), sleep disorder (38.4%), fatigue (27.2%), missed medication (20.0%).There were one to six different precipitants for one patient, and 60.8% of patients had two or more precipitants.There was a correlation between emotional stress and sleep disorders as well as fatigue (χ2=4.665, 8.668;P<0.05).Patients with idiopathic epilepsy were more sensitive to sleep disorders.There was no relationship between total precipitants and clinical features such as age, gender, age of onset, duration, type of seizure, seizure frequency, number of drug taking and so on.Conclusions Seizure precipitants were found widespread.The most common precipitants were found to be emotional stress, sleep disorders, fatigue and missed medication.There existed a correlation between emotional stress and sleep disorders as well as fatigue.There was no connection between total precipitants and patient′s demographic characteristics as well as clinical features.However, the type of seizure precipitants was different in patients with different demographic and clinical characteristics.

Objective To explore etiological factors, clinical characteristic and diagnosis of acute recurrent pancreatitis (ARP). Methods Clinical data of 68 patients with ARP from Jan. 2003 to Dec. 2009 were reviewed retrospectively. Results Among 532 acute pancreatitis (AP) cases, 68 were diagnosed as ARP ( 12.8% ). The majority of ARP patients were male, amounting 76.5% of the total. The average age of ARP patients was 45.6 years. Cholelithiasis, hyperlipemia and alcohol were the most frequent factors causing ARP. Among the 68 ARP cases, 58 cases were mild (85.3%) and 10 cases were severe ( 14. 7% ). 54 cases underwent surgery or endoscopic treatment (79.4%) while 14 cases underwent non-operative treatment (20.6%). As a result, 66 cases were cured or improved and 2 cases with severe ARP died. Conclusion The key to reduce recurrent rate of ARP is to find out the causes of recurrence and then treat the diseases accordingly.

Objective To investigate the causes of repeated operations in patients with biliary diseases.Methods The clinical data of 265 patients who received repeated operations at the Jinshan Branch of Shanghai Sixth People's Hospital from January 2005 to June 2011 were retrospectively analyzed.The causes of repeated operations were analyzed. The first reoperation aimed at removing the calculi completely,repairing the injured biliary ducts and managing malignant tumors. The primary surgical procesures of the first reoperation included choledochotomy + T tube drainage,choledochotomy + Roux-en-Y choledochojejunostomy,endoscopic retrograde cholangiopancreatography + endoscopic sphincterotomy,choledochotomy + hepatectomy + T tube drainage or Rouxen-Y choledochojejunostomy,choledochotomy + biliary-endo-drainage,end-to-end anastomosis of bile duct + T tube drainage,radical or palliative resection of tumor,endoscopic biliary stent drainage or exploratory laparotomy.The second and multiple reoperations aimed at reconstructing the passage for biliary drainage. All data were analyzed using the chi-square test.Results A total of 69.8％ (120/172) of patients who had recurrent or retained calculi received first reoperation,which was significantly higher than 31.2％ ( 29/93 ) of those who received second or multiple reoperations (x2 =36.51,P ＜ 0.05 ).A total of 58.1％ (54/93) of patients who had benign stenosis of bilioenteric anastomosis received multiple reoperations,which was significantly higher than 4.1％ (7/172) than those who received first reoperation (x2 ＝ 99.32,P ＜ 0.05 ).Of the 265 patients,46 had complications.The incidence of complications of patients who receive first reoperation was 10.5％ ( 18/172),which was significantly lower than 30.1％ (28/93) of patients who received second or multiple reoperations ( x2 =13.61,P ＜ 0.05 ).Six patients died of hemorrhagic shock or multiple organ syndrome dysfunction postoperatively.The mortality rates for patients who received first reoperation and second or multiple reoperations were 1.7％(3/172) and 3.2％ (3/93),respectively,with no significant difference ( x2 ＝ 0.59,P ＞ 0.05 ).Conclusions The causes for reoperation of biliary disease are muhifactorial.Full assessment of the status of biliary diseases and ample preperation preoperatively,careful operation and precise and rational selection of operative procedures are keys to decrease the reoperative rates and perioperative complications.

Objective To study the etiological factors,clinical characteristics and diagnosis of acute pancreatitis (AP).Methods The clinical data of 217 patients with AP treated from January 2005to December 2010 in our hospital were studied retrospectively.Results The majority of patients were male (60.4％).The average age was 52.5 years.Cholelithiasiss,hyperlipidemia and trauma were the most frequent etiologic causes of AP.There were 164 patients with mild (75.6％) and 53 patients with severe (24.4％) AP.151 patients underwent surgical or endoscopical treatment (69.6 ％) while 66 patients underwent non-operative treatment (30.4 ％).14 of 53 patients with severe AP died.Conclusions AP should be treated according to the cause and the type.The key to reduce complications and increase cure rate is to find the cause of AP and then treat the underlying disease.

Objective To investigate the distribution of biliary bacteriology and their sensitivity to antibiotics in patients with biliary tract infection in Jinshan area in recent 3 years.Methods Bile specimens collected from 367 patients with cholelithiasis between June 2006 and June 2009 were cultured and tested for drug sensitivity to aerobic bacteria.The results were statistically analyzed.Results One hundred and fifty-six bacterial strains were found in 142 (38.7%) bile specimens including gram negative strains (97,62.2%),gram positive strains (51,32.7% ),and fungal strains (8,5.1%).Enterococcus (17.9%) was major pathogen and follwed by Escherichia coli (12.8%),staphylococcus (11.5%),Klebsiella pneumoniae (8.3%),Pseudomonas aeruginosa (7.7%).Whereas the mixed infection was found in 26 (18.3%) specimens.The positive rate of bacterial infection was 53.1% in patients over 60 years of age (X2=8.36,P<0.01 ) and 47.1% in patients with acute biliary infection(X2=4.68,P<0.05).The drug susceptibility revealed that gram negative strains had low resistance to Meropenem (7.5 %),and followed by Imipenem (8.8 %),Cefoperazone +Sulbactam (19.7%),Amikacin (21.9%) and Tazobactam+Piperacillin (TZP,25.3%),but they were highly resistant to Ampicillin,Quinolones and some third generation of Cephalosporins (>50% ).In gram positive strains,none was resistant to Vancomycin,11.3% to fosfomycin and 11.6% to chloromycetin.They were highly resistant to Penicillins,Ampicillin and Cefazollin (>40%).ConclusionsEnterococcus,Escherichia coli,Sstaphylococcus and Klebsiella pneumoniae are commonly seen pathogens in biliary tract infection in Jinshan area.Use of Sulperazone or TZP plus Amikacin and metronidazole is recommended.Imipenem and Vancomycins may be second choice in treatment of severe biliary infection and refractory infection.

Objective To investigate the correlation and expression of PTEN, matrix metalloproteinase-9 (MMP-9),and vascular endothelial growth factor-C(VEGF-C)in colorectal cancer.Methods The expression of PTEN, MMP-9 and VEGF-C in 102 cases of colorectal cancer tissues and 30 cases of normal colorectal tissues was detected using immunohistochemical SP method.Their correlations with cliniopathologic features were analyzed. Results The positive expression of PTEN in colorectal cancer was significantly lower than that in the controls (54.9%vs 100%, P<0.01).Both MMP-9 and VEGF-C were over expressed compared with the controls(83.3%vs 21.7%and 69.6%vs 16.7%respectively, P<0.01).The expression of PTEN was negatively correlated with that of MMP-9 and VEGF-C, and the expression of MMP-9 was positively correlated with that of VEGF-C ( P<0.05).The expressions of the three proteins in colorectal cancer tissues were not associated with age, gender, or tumor size.There were significant associations between the expression of these proteins and lymph node metastasis, distant metastasis, differentiation, and TNM staging(P<0.05).The 1, 3 and 5-year survival rates of the patients with positive PTEN were significantly higher than those of the patients with negative PTEN(P<0.05).The 1, 3 and 5-year survival rates of the patients with positive MMP-9 and VEGF-C were significantly lower than those of the patients with negative MMP-9 and VEGF-C( P<0.05) .Conclusions The decrease in the expression of PTEN and increase in MMP-9 and VEGF-C are closely correlated to the development of colorectal cancer.Their expressions may be favorable markers and useful prognostic indicators in the patients with colorectal cancer.