Objective The aim of this study was to investigate the relationship between juxtapapillary duodenal diverticula (JDDs)and stenosing papillo odditis,and the diagnosis and treatment for this clinical entity.Methods Patients underwent upper gastrointestinal radiography,ERCP, and radionuclide scan. 18 cases were treated with operation,8 cases underwent sphincteroplasty,3 with combined diverticulo sphincteroplasty, 3 with choledochoduodenostomy or choledochojejunostomy,1 with gastrojejunostomy,1 case with diverticulectomy.Results Sphincteroplasty effects a good result for coexistant JDDs and stenosing papilloodditis. There were no recurrence and complication after the combined diverticulo sphincteroplasty. Conclusion There was a causal relation between JDDs and stenosing papillo odditis. Effective treatment was achieved by combining sphincteroplasty with diverticulo sphincteroplasty.

Objective To study the effect of thoracoscopic sympathectomy and/or chemical lumbar sympa- thectomy performed on patients with Raynaud disease. Methods Five patients, 1 male,4 females, aged from 30 to 65(mean 45. 3 ). Raynaud phenomenon appeared only on both hands in one patient, only on feet with a toe gangrene in another one , the other 3 cases on all limbs. Thoracoscopic symathectomy was performed for those whose hands were af- fected and chemical lumbar sympathectomy(12-3 ) was pererformed for those whose feet were affected. Results All patients were followed up from 12 to 48 months(mean 24 months). All experinced improvement with hands warm and satisfactory results after thoracoscopic sympathectomy. However, the original symptoms reccurred in two patients after postoperatire six months. All 4 patients performed chemical lumbar sympathectomy experienced improved symptoms with feet warm and satisfactory results and the symptoms did not recur up to now. The sympathectomy showed different results for hands and for feet. Conclusions Thoracoscopic sympathectomy for hands affected by Raynaud disease has efficiency temporarily, but is not satisfactory. The chemical lumbar sympathectomy for the feet affected by Raynaud disease has dramatically disappearence of symptoms and the results are very good

0.05). Conclusions The upstream lesions of biliary tract must be dealt with thoroughly in the treatment of hepatolithiasis. EST should not be the first choice for hepatolithiasis preparatory to determining whether or not lesions like stricture are present in intrahepatic ducts.

Objective To summarize the experience of endoscopic thyroidectomy for hyperthyroidism.Methods Endoscopic total or subtotal thyroidectomy was performed through anterior chest wall approach in 7 patients with primary or secondary hyperthyroidism.Results The operation was successfully performed in all the 7 patients.The operation time was 130~260 min(mean,168 min),and the intraoperative blood loss was 10~200 ml(mean,70 ml).No recurrent laryngeal nerve or superior laryngeal nerve injuries,or postoperative hemorrhage,or conversions to open surgery were encountered.The postoperative recovery was uneventful.Short-term follow-up observations demonstrated satisfactory cosmetic results and no recurrence.Hypothyroidism occurred in 2 patients and thyroid functions restored to normal levels in 1 of them 2 months after operation.Conclusions Endoscopic thyroidectomy is a safe and effective procedure for hyperthyroidism.Apart from conventional pre-operative preparation,CT examination is also necessary for identifying the measurements of thyroid glands and determining the proportion and location of residual glands.

Objective To investigate the feasibility and significance of laparoscopic choledocholithotomy with T-tube drainage. Methods A total of 60 cases of common bile duct stones complicated with gallbladder stones were treated with laparoscopic cholecystectomy and common bile duct exploration with T-tube drainage. Results The operation was performed successfully in all the cases,without conversions to open surgery.Bile leakage occurred in 2 cases and was cured with conservative treatment.Residual stones were found in 6 cases and a postoperative choledochoscopy was required.The operative time was 90~180 min(mean,110 min),the blood loss was 10~50 ml(mean,20 ml).Follow-up checkups in 53 cases(88.3%) for 2~33 months(mean,13.2 months) revealed no abdominal pain,fever,or jaundice.Conclusions Laparoscopic cholecystectomy and common bile duct exploration for the treatment of common bile duct stones complicated with gallbladder stones is feasible and minimally invasive.

In hippocampus, numerous studies have shown that N-methyl-D-aspartate (NMDA) receptors are essential for the initiation of long-term potentiation (LTP), whereas the expression of LTP is primarily mediated by the phosphorylation of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors and the increased insertion of postsynaptic AMPA receptors. However, in recent years there is also evidence that NMDA receptor channels contribute to the expression of LTP under physiological conditions. It was examined whether NMDA receptor channels contributed to the expression of LTP of C-fiber evoked field potentials in rat spinal dorsal horn by intravenous or spinal application of NMDA receptor antagonists after the establishment of LTP. It was found that MK 801 (a non-competitive NMDA receptor antagonist) at dose of 0.1 mg/kg (iv) had no effect on the spinal LTP and at the dose of 0.5 mg/kg depressed the LTP significantly. However, the inhibitory effect of MK 801 at higher dose (1.0 mg/kg)was not different from that produced by the dose of 0.5 mg/kg. The similar inhibitory effect on spinal LTP was also observed, when MK 801 was applied locally at the recording segments of spinal cord. To confirm the above results, a competitive NMDA receptor antagonist AP V was tested. Spinal application of AP V at a concentration of 100 μmol/L produced a stronger depression than at 50 μmol/L. When the concentration of AP V increased to 200 μmol/L, no further depression was observed. These results indicate that NMDA receptor channels are involved in the expression of LTP of C-fiber evoked field potentials in the rat spinal dorsal horn.

SUMMARY To summarize the experience of managing substernal goiter by totally endoscopic procedure and evaluate the curative effect , we analysed eight patients diagnosed as substernal goiter type Ⅰ and treated with totally endoscopic technique via central routing approach during March 2011 to June 2013 in Beijing Shijitan Hospital retrospectively .The feasibility , safety and curative effect of this surgical tech-nique were estimated .All the cases were successfully operated with the totally endoscopic procedure , and the pathological result showed that 6 were goiter and the other 2 were minimal papillary carcinoma .None of the patients suffered from any complication , and the median follow up time was 6 months ( 1 -28 months) .The totally endoscopic technique is a feasible , safe and cosmic one for managing substernal goiter type Ⅰ.

Objective To sunmarize the clinical experience of emergency laparoscopic choledocholithotomy plus T-tube drainage for acute calculous cholangitis.Methods We retrospectively analyzed the clinical data of 98 cases with acute calculous cholangitis undergoing emergency laparoscopic choledocholithotomy between Mar 2007 to Jul 2011 at our hospital.Results In this study,93 cases with definite diagnosis of acute calculous cholangitis underwent at their acute stage totally laparoscopic choledocholithotomy and T-tube drainage,2 cases received laparoscopic transeystic common bile duct exploration and 3 cases were treated with primary closure of the common bile duct following laparoscopic common bile duct exploration and intra-bile duct stent.All procedures were successful without conversion to open surgery.The average of the operative time and the hospital stay was 96 minutes and 12 days respectively.The major complications included residual stones in 8 cases,bile leakage in 4 cases and intraperitoneal bleeding in I case.All were cured by conservative therapy.Conclusions For most patients of acute calculous cholangitis,emergency T-tube drainage after laparoscopic chuledocholithotomy is safe and effective.

Objective To introduce a surgical technique for the cases with the papilla of Vater located in the diverticula. Methods When diverticula was opened, there was a cuff shape edge left in the bottom, which reduced tensility of oversew, and the probability of postoperative leakage was reduced. Fistula Oddi sphincteroplasty was adopted oversewwing when it was splitted,and the length of each time was not more than 3mm,and the total length was not more than 2cm. ResultsNone of 11 cases died in postoperation, 3 of them occured biliary fistula,duodenal fistula,and pancreatic fistula, the rate of fistula was 27.27%. They were all followed-up, and the result was satisfactory.ConclusionAlthough the operation technique is ifficult,and there are many complications,it is a good technique.

Objective To investigate the technical difficulties and the avoidance of complications in delayed laparoscopic cholecystectomy (LC) for acute cholecystitis (AC).MethodsThe results of LC carried out on 133 consecutive patients with AC between February 2004 and August 2008 were retrospectively studied.The outcomes were compared between patients who received LC for AC within 72 hours (the early group) and those after 72 hours (the delayed group).There were 34 patients in the early group and 99 in the delayed group.During LC,Calot's triangle was carefully dissected,and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identified.Retrograde cholecystectomy in 2 patients was used when the Calot's triangle was poorly identified.Laparoscopic subtotal cholecystectomy was carried out in 4 patients whose inflammation or fibrosis precluded dissection of the Calot's triangle.ResultsThere was no conversion to open cholecystectomy,biliary tract injury,biliary leak,or any other intraoperative or postoperative complications.There was no 30day readmission in the 2 groups.Patients who received delayed LC had a significantly longer operation time [(44.1±5.32) vs (66.4±3.05)rnin,P＜0.01].There was no significant difference in wound infection rates in the 2 groups (1/34 2.94 ％ vs 2/99 2.02 ％,P＞0.05).ConclusionsDelayed LC was as feasible and safe as early LC in the treatment of AC.Delayed LC was technically more demanding than early LC.