Objective To study the causes of conversions to open surgery during laparoscopic cholecystectomy (LC). Methods The study was based on a retrospective review of 156 cases of conversions to laparotomy out of 12672 cases of LC from December 1991 to October 2001 in this hospital. Results Ninety-two (58.97%) cases of conversions were due to complicated clinical condition and preoperative misdiagnosis, 47 (30.13%) cases of conversions due to technological complications, and 17 (10 90%) cases underwent delayed laparotomy. The total conversion rate was 1.23% and the rate of bile duct injuries was 0.2% (26/12672). Conclusions Inadequate preparation, deficiency of experience, complicated clinical situation, and anatomical variation of bile ducts are the leading causes to conversions.

Objective To discuss clinical effects of combined use of duodenoscopy and laparoscopy in the treatment of acute billiary pancreatitis (ABP), and to establish a systematic protocol of minimally invasive treatment for ABP. Methods According to the patients’ biliary tract conditions, severity of disease and treatment methods, a total of 696 patients with ABP were given laparoscopic cholecystectomy (LC) alone, or endoscopic retrograde cholangiopancreatography (ERCP) and LC, or ERCP and laparoscopic common bile duct exploration (LCBDE), or ERCP and endoscopic sphincterotomy (EST), or individualized treatment for severe acute pancreatitis (SAP). Clinical effects were observed. Results Among the 696 patients, 330 patients (47.4%) received EST and biliary stones were successfully removed under endoscope in 267 patients (38.4%). ERCP, LC and LCBDE were conducted in 411 (59.1%), 513 (73.7%) and 85 (12.2%) patients, respectively, and successfully accomplished in 409 (99.5%), 511 (99.6%) and 82 (96.5%) patients, respectively. Out of 36 patients with SAP, 34 patients survived (94.4%). The total cure rate was 99.7% (694/696). Conclusions Combined use of duodenoscopy and laparoscopy is significantly effective for acute billiary pancreatitis and benefits the improvement and standardization of the protocol of minimally invasive treatment for acute billiary pancreatitis.

Objective To investigate the qualitative diagnosis of salivary gland mass with contrastenhanced ultrasound(CEUS).Methods The CEUS manifestations in 78 cases with salivary gland mass were observed after intravenous bolus injection with contrast agent SonoVue and confirmed by histology.Results Among 78 salivary gland masses,there were 29 cases with pleomorphic adenomas (37.2％),19with Warthin's tumors (24.4 ％),7 with basal cell adenomas (8.9 ％),and 11 with the other benign masses (14.1％),12 with malignant tumors (15.4％).The intensity of contrast-enhanced masses,whether the enhanced mass margin was clear,whether the peripheral enhancement rim was complete and whether the mass was enlarged were the diagnostic criteria to differentiate the benign and malignant tumors.The accuracy,the sensitivity,specificity,positive predictive value and negative predictive value were 87.2％,95.2％,56.3％,89.4％,75.0％ respectively,and the results also displayed positive likelihood ratio and negative likelihood ratio were 2.178,0.085 respectively.Although they presented with the highest incidence among benign tumors,their CEUS manifestations showed remarkable statistical differences when the pleomorphic adenoma was compared with Warthin' s tumor and basal cell adenoma respectively in enhancement intensity(P ＜0.01) while there were no statistical differences between Warthin's tumors and basal cell adenomas (P ＞0.05).Conclusions CEUS manifestations of salivary gland mass were helpful to the differential diagnosis of various salivary gland tumors.

Objectives This study was designed to explore the function of ATP binding cassette transporter 1 ( ABCA1) and ApolipoproteinA-I (ApoA-I) in cholesterol reverse transportation ( RCT) , the influence of lovastatin and rosiglitazone on the concentration of cholesterol ( CHO) in THP-1 ( human monocytic leukemia cell line) derived foam cells.Methods LDL from healthy volunteers was obtained by density-gradient ultracentrifugation and was oxidized by incubation with Cu2+ and ox-LDL was identified.Macrophages were induced from THP-1 cell by phorbol ester (PMA).Models of foam cells were built by incubating macrophages with oxLDL.The effect of lovastatin and rosiglitazone on ABCA1 protein expression in THP-1 cell line derived macrophage were detected by western blot Foam cells were divided into 9 groups: control, ApoA-I, lovastatin, rosiglitazone lovastatin + ApoA-I, rosiglitazone + ApoA-I, ABCA1 monoclonal antibody pretreatment + ApoA-I, ABCA1 monoclonal antibody pretreatment + lovastatin + ApoA-I, ABCA1 monoclonal antibody pretreatment + rosiglitazone + ApoA-I.The concentration of intracellular CHO in each group was detected by using cholesterol kit Results As compared with control group, there are no big differences of CHO concentration within the cell of group lovastatin, rosiglitazone, and each ABCA1 monoclonal antibody pretreatment group (P >0.05), but the CHO concentration within the cells of group ApoA-I, lovastatin + ApoA-I, rosiglitazone + ApoA-I decreased obviously as compared with the control (P <0.05), and CHO concentration in group rosiglitazone + ApoA-I have a further decrease than the former two groups ( P < 0.05 ).Conclusions CHO concentration can be descreased in foam cells by cooperation of ABCA1 and ApoA-I mediate cholesterol efflux.Rosiglitazone can enhance this procedure in THP-1 macrophages derived foam cells which means that they can promote ABCA1 mediated cholesterol reverse transportation through improve ABCA1 protein expression.

Objective To study on the effectiveness and reliability of endoscopic varicose vein ligation (EVL) combined with hand-assisted laparoscopic splenectomy (HLS) in portal hypertensive patients. Methods Retrospectively 15 cases of EVL combined with HLS were reviewed from June 2001 to October 2004. These patients with severe esophageal varicose and hypersplenism were adapted to perform endoscopic varicose vein ligation, then 1 -2 weeks after the varicose became milder or disappeared, hand-assisted laparoscopic splenectomy was conducted. Results The number of preoperative ligation was 2. 2 times in average. Esophageal varicose was completely disappeared in 11 and mild in 4. There were no postoperative complications, conversion and death in Hand-assisted laparoscopic splenectomy. The average postoperative count of platelets were (38-67) ? 106/L preoperatively raised to (89-310) ? 106/L postoperatively. In the follow up period (average 17. 6 months) , no varicose vein bleeding happened. Conclusions EVL combined with HLS is not only minimal invasive, but also a secure and effective measure for portal hypertension.

Objective To evaluate the effects of pyruvate Ringer' s solution on erythrocyte deformation function in the patients undergoing cardiopulmonary bypass (CPB) in vitro.Methods Thirteen patients of both sexes,aged 25-64 yr,of ASA physical status Ⅱ or Ⅲ (NAHY Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement under CPB were enrolled in the study.At 10 and 60 min of CPB (T1,2) and 60 min after termination of CPB (T3),blood samples 18 ml were drawn from the radial artery and each patient's blood sample was equally divided into 6 parts (3 ml per part).The blood samples were divided into 3 groups (n =13 each):control group (group C),lactated Ringer's solution group (group R),and pyruvate Ringer's solution group (group P).In C,R and P groups,normal saline 1 ml,lactated Ringer's solution 1 ml,and pyruvate Ringer's solution 1 ml were added,respectively,and then the erythrocytes were incubated for 60 min at 37 ℃.At 30 and 60 min of incubation,the erythrocyte rigidity index (ERI) and erythrocyte deformation index (EDI) were detected.Results Compared with C and R groups,the ERI was significantly decreased at 30 and 60 min of incubation at T1,the EDI was decreased at 30 min of incubation at T1,2,and no significant change was found in ERI at T2,3 or in EDI at T3 in group P.There was no significant difference in ERI and EDI at different time points of incubation within groups.Conclusion Pyruvate Ringer's solution can enhance erythrocyte deformation function in the patients undergoing CPB.

OBJECTIVE: To investigate the correlation between the polymorphism of genotype of site-1296 in alpha2A-AR receptor gene and the susceptibility of vestibular function. METHOD: Ninety-four blood samples were collected from pilot cadets, consisting of susceptible and tolerance groups to vestibular function. Genomic DNA was isolated, and the coding region of alpha2A-AR receptor gene was amplified by polymerase chain reaction (PCR). The PCR products were analyzed by gene sequencing. Gene frequency was calculated, and, the coincidence between the polymorphism of alpha2A-AR receptor gene in the groups and Hardy-Weinberg balance was evaluated. The allele frequency of the two groups was compared by Chi square test. RESULT: G/C polymorphism was existed in Site-1296 of alpha2A-AR gene regulation zone, including GG, GC, CC. The express of GG Genotype in susceptible group exceeded that of the other group. There were significance differences in both genotype constituent ratio and alleles frequency of the two groups. CONCLUSION The polymorphism of genotype of site-1296 in alpha2A-AR receptor gene is possibly correlated with the susceptibility to vestibular function.
Adult ; Alleles ; Gene Frequency ; Genotype ; Humans ; Male ; Polymorphism, Single Nucleotide ; Receptors, Adrenergic, alpha-2 ; genetics ; Vestibular Function Tests ; Vestibule, Labyrinth ; physiology ; Young Adult

OBJECTIVE:To establish a method for simultaneous determination of 6 residual organic solvents in aprepitant raw material as methanol,ethanol,acetone,isopropyl alcohol,methyl tert-butyl ether and tetrahydrofuran.METHODS:Headspace capillary gas chromatography was adopted.The determination was performed on DB-624 capillary column using temperature programming.The temperature of injector port was 180 ℃,and flame ionization detector was used with temperature of 260 ℃.Nitrogen was used as carrier gas with flow rate 3.0 mL/min.The spilt ratio was 5 ∶ 1,and head-space injection volume was 1.0 mL.The head-space equilibrium temperature was set at 80 ℃,and equilibrium time was 40 min.RESULTS:The linear ranges of methanol,ethanol,acetone,isopropyl alcohol,methyl tert-butyl ether,tetrahydrofuran were 6.052-605.232 μ g/mL (r=0.999 9),9.987-998.718 μg/mL(r=0.999 9),9.998-999.768 μg/mL(r=0.999 8),9.986-998.634 μg/mL(r=0.999 9),9.991-999.090 μg/mL (r=0.999 7),1.461-146.133 μg/mL(r=0.999 5),respectively.The limits of quantitation were 1.782 1,2.079 0,0.749 8,1.777 8,0.223 1,0.607 0 μg/mL;the limits of detection were 0.594 0,0.693 0,0.249 9,0.592 6,0.074 4,0.202 3 μg/mL,respectively.RSD of precision test was lower than 2.0％.Only acetone and isopropyl alcohol were detected in stability test and reproducibility tests,RSD＜2.0％.Their recoveries were 99.34-100.75％ (RSD=0.52％,n=9),98.20％-100.24％ (RSD=0.69％,n=9),98.07％-100.07％ (RSD=0.84％,n=9),99.86％-101.32％ (RSD=0.58％,n=9),97.87％-104.02％ (RSD=2.13％,n=9),98.26 ％-100.58 ％ (RSD =0.75 ％,n =9),respectively.CONCLUSIONS:The established method is simple,accurate and reproducible,and can be used for simultaneous determination of 6 residual organic solvents in aprepitant raw material.

Objective In order to explore the safety , feasibility of early enteral nutrition for children of 1～36 months old undergoing nongastrointestinal postoperative received general anaesthesia. Methods 93 children of 1 ～ 36 months old received operation were divided into the experimental group (52 cases)and control group(41 cases), A kind of postopertion early enteral nutrion of diet method was conducted in the experimental group,while the traditional enteral nutrion of diet method was used in the control group. The time of drinking and eating, the postoperative discomfortable condition of children and patriarchal anxiety were compared between the groups. Results There were no significant differences about the postoperative vomiting and mis-inhalation between the two groups , the time of drinking and eating in experimental group [ (44.45 ± 27. 57 ),(57.75 ± 31.69 ) min ] was shorter than that of control group [ (218.12 ± 25.83), (225.00 ± 24.89) min ],the postoperative discomfortable condition of children and patriarchal anxiety in control group were significantlysevere than those in experiment group, P < 0. 01. Conclusions The early enteral nutrion of diet method forchildren is safty and feasibility , which can improve the comfort of children , but not increase the postoperativevomiting and mis-inhalation.

OBJECTIVETo promote the diagnostic accuracy of salivary Warthin's tumor by summarizing the ultrasonographic features of salivary Warthin's tumor.

METHODSSixty-nine lesions (58 patients with salivary Warthin's tumor) were retrospectively studied by ultrasonography and confirmed by histopathology.

RESULTSThe ultrasonographic manifestations of salivary Warthin's tumor demonstrated in three patterns.Type I: Solid mass(34 lesions, 49.3%), the mass was solid, grid-shaped echo inside. The mass was pathologically composed of such various tissues as epithelial cells, lymphatic organization, fibrous tissue which were compactly and evenly arranged, and little mucous formed the cyst cavity in which there projected epithelial papilla. Type II: Cystic-solid mixed mass(30 lesions, 43.5%), there was no flake-like echo, cystic-solid boundary was clear. Histopathological study revealed glandular epithelium made up irregular catheter and cyst cavity with yellowish mucous, glue-frozen-like stuff or brown colloidal substances. Type III: Cystic mass (5 lesions, 7.2%), the mass manifested separated cystic echo crumbs. The histopathological study showed salivary Warthin's tumor with infarctions and infections. The coincidence of ultrasound and histopathology diagnose was 79.7%.

CONCLUSIONThe ultrasonographic features of salivary Warthin's tumor are mainly based on the organization of histopathological study. The grasp of various ultrasonographic imagings and pathological changes is beneficial for increasing the accuracy rate of diagnosis higher.