ObjectiveTo study the feasibility,safety and effect of laparoscopic splenectomy and selective pericardial devascularization in the treatment of portal hypertension.MethodsThis study included 7 patients diagnosed as posthepatitie cirrhosis and portal hypertension with a history of up GI bleeding receiving laparoscopic splenectomy and selective pericardial devascularization.ResultsThe operation was successful in all 7 patients without conversion to laparotomy.There were no postoperative severe complications.The average operation time was 4.2 h,mean blood loss was 430 ml.All patients recovered well,and were followed-up for 0.5 ～ 2.0 years,and there was no rebleeding in this period.ConclusionsLaparoscopic selective pericardial devascularization is feasible,safe,minimally invasive.The short to mid term result was satisfactory.

Objective To investigate the clinical features,treatment and prognosis of paraneoplastic pemphigus (PNP).Methods A retrospective study was performed on 11 patients with PNP hospitalized in the Department of Dermatology,Ruijin Hospital.Clinical characteristics of these patients were analyzed.Results Of the 11 patients,10 had oral or labial erosions or ulcers,and 6 had obstructive bronchiolitis.Computed tomography (CT)showed solitary internal tumors in all the patients after appearance of skin lesions,and 8 of them were diagnosed with Castleman's disease.All the patients had been treated with corticosteroids before operation,but achieved no obvious improvement.After 2-7 months of postoperative treatment with low-dose prednisone and thalidomide,both cutaneous and mucosal lesions healed with the relief of pulmonary symptoms in 5 patients.Conclusions Oral erosions or ulcers appear to be the most common initial manifestation of PNP with Castleman's disease as the most frequent accompanying tumor.Early detection and timely resection of tumors are keys to successful treatment of PNP,and postoperative treatment with glucocorticoids and thalidomide proves to be effective for PNP.

The early clinical symptoms of newborns with acute bilirubin encephalopathy are absent or slight.In addition ,this diseaes is no specificity.So ne wborns with acute bil rubin encephalopaht y is easy to miss ni d iagnosis.If the best treatmetn opportunity of this disease is delayed,it can affect the long-term prog-nosis and survival.Neuros-pecfi ic nlo ase,cranial magnetic resonance imga ing,electroencpe halogram,amlp i-tude integrated electroencephalogram and rb ainstem auditory evoked potential can judge the position and in-tensity of brain injury from the different angle and level,which can provide important basis for the early diag-nosis and intervention of acute bilirubin encephalopathy.

OBJECTIVE To investigate and know the site distribution,susceptible factors and antibiotic resistant condition in hospital-acquired infection by Enterococcus so as to provide reference for clinical preventive control and for reasonable uses of medicine.METHODS Sixty five Enterococcus strains isolated from different infection specimens in the hospital from 2001 to 2005 were analyzed,and examined their sensitivity to medicines.RESULTS Among 65 Enterococcus strains there were 36 strains of Enterococcus faecalis and 29 strains of E.faecium.The first three susceptible site diseases were alimentary,circulatory and injury.The site distributions were urinary tract,lower respiratory tract and surgical incisions.Related aggressive operations included urethra intubation,tracheal intubation,and surgery.Except for vancomycin and teicoplanin,E.faecalis was sensitive to ampicillin,high-level streptomycin,levofloxacin and nitrofurantoin,and E.faecium had antibacterial activity to chloramphenicol and tetracycline.There were 2 vancomycin-resistant Enterococcus(VRE) cases detected.CONCLUSIONS It is the easiest to examine and find Enterococcus in urine and the prevalence rate is high after related aggressive operations.The isolation rate of E.faecium is high and it has strong antibiotic resistance.Vancomycin is still the most sensitive medicine to Enterococcus.

Inflammatory bowel disease (IBD) is a group of chronic and non-specific intestinal inflammatory diseases of undetermined origin,which including ulcerative colitis (UC) and crohn's disease (CD).Interleukin(IL) is a kind of cytokines,and plays an vital role in growth,differentiation,immune response of immune cell.With a intensive study in the pathogenesis of IBD in the world,parts of IL were found and confirmed to be a important role in the progression of IBD,and will become a new hot spot in the research of the diagnosis and treatment of IBD.

Acute myeloid leukemia (AML) is a group of heterogeneous diseases with diverse genetic abnormalities,variable responsiveness to therapy and prognosis.In recent years,a lot of information has become available regarding chromosome and gene mutations that occur in AML and their influence on prognosis.Improvements in the understanding of molecular biology of AML are critical for accurate diagnosis.risk stratification,monitoring of minimal residual disease and provides opportunities to develop targeted therapies and improve the clinical outcome.This article reviewed chromosome abnormalities and characteristic gene mutations,and discussed their clinical signiflcances and presented new drugs in clinical trials presented in the 55th ASH annual meeting.

Although globally recommended standardized stratification treatment of acute myeloid leukemia (AML) effectively improves its therapeutic effects and prognosis,due to unknown personalized differences of tumorous biology,most of the patients eventually develop to therapy failure,relapse,and even death.Additionally,a number of patients are naturally resistant to current used combined chemotherapy and with extremely poor prognosis,This review presents definitions of refractory and relapsed AML,then describes their pathogenetic mechanism and lastly summarizes three aspects of therapeutic principle,clinical drugs and hematopoietic stem cell transplantation (HSCT).To review advances in relapsed and refractory AML diagnosis and treatment will be helpful to master disease characteristics and to guide clinical treatment.

The transcranial doppler ultrasonography (TCD) is a non-invasive detection methods of evaluating intracranial artery.Since the 1980s,TCD has been extensively used in various fields of clinical work.Because of its simple operation,good repeatability,and the continuous bedside observation of patients,TCD is especially suitable for severe patients.Increased intracranial pressure is one of the important reasons for the deadly disease in children,it can make the cerebral blood flow perfusion decreased,causing serious consequences,such as brain dysfunction,so intracranial pressure monitoring has important clinical significance.TCD as a noninvasive monitoring tool,can monitor the patients with increased intracranial pressure dynamically,according to the blood flow velocity,the related parameters and the wave of cerebral hemodynamics,so as to achieve the purpose of monitoring intracranial pressure change.This article focused on the TCD application progress in several common children's diseases of increased intracranial pressure.

Due to the fact that early full term newborn has no specific clinical signs,early diagnosis of hypoxic-ischemic brain damage is difficult. Timely intervention will affect the longterm prognosis in patients with the treatment and survival. Amplitude integrated electroencephalography( aEEG) is a noninvasive monitoring and evaluation of brain function,simple and effective method,which can provide exact basis for full term newborn with hypoxic ischemic brain damage in early diagnosis and prediction of prognosis.

Objective Effects of intra articular injection of 153 Sm citrate HA on antigen induced arthritis were investigated to provide the theoretical fundation for its clinical application.Methods Rabbit arthritis was induced by subcutaneous injection of ovalbumin at weeks 2 and 4,and by intra articular injection of it at week 6.The dosage of 1 85?10 7 Bq or 3 7?10 7 Bq of 153 Sm citrate HA was injected separately into a side of knee joint.The severity of arthritis was determined by joint swelling,skin surface temperature,macroscopic and histologic changes in joints when the rabbits were killed at week 9 after establishment of model.Results Both dosages of 153 Sm have an initial pro inflammatory effects during one week after injection,and then resulted in reduction of joint diameter and skin surface temperature. 153 Sm (3 7?10 7 Bq) showed a more alleviation than 153 Sm (1 85?10 7 Bq) in respect of macroscopic and histologic changes.Conclusion Synovectomy with 153 Sm citrate HA is effective for treatment of chronic arthritis with dependence on the doses and deserves further study.