Objective To study the diagnosis and treatment of choledocholithiasis in patients with low left and right posterior hepatic duct confluence.Methods Clinical data of 12 patients suffering from cholelithiasis with a low confluence of the left and right posterior hepatic ducts admitted between January 2000 to June 2013 were retrospectively analyzed.Results Of the 12 cases,the left and right posterior hepatic ducts joined between 2 cm below hilus hepatis and the superior border of the duodenum in 8 cases,below the superior border of the duodenum in 4 cases.Seven cases had a low confluence of the right and left hepatic ducts,and 5 cases had right posterior duct low confluence.As for bile duct stricture:the opening stricture at the junction of the right and left hepatic ducts were found in 4 cases,the opening stricture in the right hepatic ducts were found in 3 cases,the opening stricture of the left hepatic duct were found in 2 cases.There were left and right bile duct stones in 7 cases,right intrahepatic bile duct stones in 3 cases,left intrahepatic bile duct stones in 2 cases.Cystic duct joined the right hepatic duct in 5 cases,left hepatic duct in 2 cases.Seven cases with a low confluence of the right and left hepatic ducts were with double T tube drainage; five of low right hepatic duct confluence were treated by T tube drainage.The right posterior branch of hepatic ducts were injured in four cases and right hepatic duct was injured in one.Conclusions Low confluence of left and right posterior hepatic ducts often leads to misdiagnosis during surgery of cholelithiasis.Magnetic resonance cholangio-pancreatography or endoscopic retrograde cholangiopancreatography was helpful before cholecystectomy to avoid iatrogenic injury of biliary tract.

Pancreatic enzyme replacement therapy is given to manage pancreatic exocrine insufficiency (PEI) in cystic fibrosis (CF) and following pancreatectomy, total gastrectomy or chronic pancreatitis. The article reviews on aspects of pancreatic enzyme replacement therapy containing the assement of pancreatic exocrine function, the pathogenesis of exocrine pancreatic insufficiency, pancreatic enzyme preparations and their efficiency, dosing of pancreatic enzymes, enteral nutrition and pancreatic enzyme replacement, the modulation of pancreatic exocrine and adverse reactions to pancreatic enzyme.

China ; Dyslipidemias ; prevention & control ; Guidelines as Topic ; Humans

Objective: The aim of this study is to investigate the clinical factors in association with venous thromboembolism (VTE) in patients with lung cancer, and to provide evidence for prevention and therapy of VTE. Methods: Clinical information of 2 053 patients with lung cancer definitely diagnosed by cytology or pathology between July 2008 and June 2010 was retrospectively analyzed. VTE wasconfirmed by chest spiral computed tomography (CT), pulmonary arteriography and colorful Dopplerultrasound. The clinical factors including age, gender, pathological type, operation, clinical stage,body mass index, co-morbidity and platelet count as well as D -dimer, interleukin-1 (IL-1) and tumornecrosis factor (TNF) were considered as the potential VTE-related factors. Results: Of 2 053 patients,89 (4.34%) were confirmed with VTE. The incidence rates of VTE in patients with adenocarcinoma andnon-adenocarcinoma were 5.65% (58/1 027) and 3.02% (31/1 026), respectively, and the difference wasstatistically significant (P £?0.003). The incidence rate of VTE in stage I-III A lung cancer patients was significantly lower than that in stage IIIB-IV lung cancer patients [1.48% (10/677) vs 5.74% (79/1 376); P<0.001]. In patients with stage I-IIIA undergoing surgical operation or not, the incidence rates of VTE were 1.55% (10/645) and 0% (0/32), respectively (P=0.044). Significant difference of incidence rate of VTE was also found between the patients with and without co-morbidity [6.73% (56/832) vs 2.70% (33/ 1 221); P<0.001]. The incidence rates of VTE in patients with normal levels of platelet count, D -dimer,IL-1 and TNF were 3.72%, 0.31%, 2.44% and 3.27%, respectively; whereas, the incidence rates in patients with increased levels of these measurements were 6.26%, 19.91%, 10.26% and 7.74%, respectively; the differences between two groups were all significant (P<0.05). Logistic multivariant regression analysisrevealed that the clinical factors of adenocarcinoma, operation, co-morbidy and high levels of D-dimer,IL-1 and TNF in blood were associated with increased risk of VTE (P<0.05). Conclusion: Adenocarcinomais the most common pathological type in lung cancer patients with VTE. The risk factors of VTE include operation, co-morbidity and high levels of D -dimer, IL-1 and TNF in blood. Copyright© 2011 by TUMOR.

Objective To evaluate the role of serum homocysteine (HCY) in diabetes mellitus(DM ) complicating proliferative diabetic retinopathy (PDR) .Methods 174 patients with DM were selected and divided into PDR ,non‐PDR(NPDR) and non‐dia‐betic retinopathy (NDR) groups .The serum HCY level was detected .Results Serum HCY levels in the PDR ,NPDR and NDR groups were (18 .20 ± 5 .60) ,(14 .40 ± 6 .70) and ,(12 .10 ± 6 .80)μmol/L respectively ,which was highest in the PDR group (P<0 .05) .Conclusion HCY could result in PDR generation possibly by injuring the retinal blood vessels .

Objective To introduce the method and to evaluate the therapeutic effect of collagenase chemonucleolysis for treatment of cervical disc herniation.Methods 92 patients with cervical herniated discs were selected from January 2002 to December 2004.The procedure was guided by DSA and the puncture was defined from C_(6~7) or C_7-T_1 extradural cavity.Collagenase(1200~2400 u) was injcted in the herniated extradural cavity through the micrcatheter.Results The procedure of 88 cases was successful.80 cases were followed up from 6 to 12 months.The effect showed that 70 cases(87.5%) were excellent or good.No serious complication occurred.Conclusion The method of collagenase chemonucleolysis for treating cervical disc herniation is safe and effective,it can be used in clinic.

Objective To investigate the cell morphology and immune phenotypic characteristics in Uygur and Han patients with myelodysplastic syndrome (MDS) in Xinjiang Uygur Autonomous Region.Methods Bone marrow smears of 67 cases diagnosed as MDS were systematicly observed and recorded,flow cytometry (FCM) was used to test the immunophenotyping.Results There were abnormal hematopoiesis in different extent in granulocyte series,erythron series and megakaryocytic series of all patients.Occurence of pathological hematopoietic performance in Uygur patients with MDS was similar to that in Han,granulocyte series [52 cases (77.6 ％)] ＞megakaryocytic series [44 cases (65.7 ％)] ＞ erythrocyte series [36 cases (53.7 ％)],the differences in two groups were not significant (x2 values 1.02,0.30,0.02,respectively,all P ＞ 0.05).The changes type of pathological hematopoietic performance in two groups were similar,single garden nuclear megakaryocyte [36 cases (53.7 ％)],false Pelger nuclear anomaly granulocyte [36 cases (53.7 ％)],erythroid gigantic young cell change [33 cases (49.3 ％)],granulocyte cell particles reduced or absent [27 cases (40.3 ％)] etc.The result of FCM showed that along with the progressive change of RA/RAS to RAEB/RAEB-t,the expression ratios of mature CD15 were decreased,while the expression ratios of early stage CD117 and CD34 were raised gradually (x2 values 6.23,12.06,8.95,7.37,8.95,8.08,respectively,all P ＜ 0.05),the differences in two groups were not significant (x2 values 0.715,0.024,0.146,respectively,all P ＞ 0.05).Meanwhile,Uygur patients with MDS has great expression of CD56 and Han had HLA-DR,there were significantly differences in two groups (x2 values 3.91 and 3.90,respectively,both P ＜ 0.05).Conclusion Occurence of pathological hematopoietic performance in Uygur patients with MDS are similar to that in Han.Most MDSs has two or more levels of pathological hematopoietic performance.The differences of immunophenotype characteristics in two groups are partially significant and test of immunophenotype are helpful in the diagnosis,classification,prognosis of MDS.

Objective:To explore the diagnostic value of treadmill exercise test (TET)and its Duke score in menopa-usal female patients with coronary heart disease (CHD).Methods:A total of 102 menopausal female patients re-ceived TET and coronary angiography (CAG)examination.With CAG as control,accuracy indexes etc.of TET combined Duke score diagnosing coronary artery disease in these patients were compared and analyzed.Results:Compared with single application of TET or Duke score,there were significant rise in specificity (27.12% vs. 30.50% vs.44.44%),positive predictive value (47.56% vs.46.75% vs.54.55%),negative predictive value (80%vs.72% vs.90.91%)and accuracy (53.92% vs.52.94% vs.64.94%)diagnosing CHD by TET combined Duke score both positive and negative,P <0.05 all;but there was no significant difference in sensitivity,P >0.05 both. There was no significant difference in CHD diagnosis between single use of TET and Duke score,P >0.05 all.Con-clusion:False positive rate of treadmill exercise test is higher in menopausal women.Treadmill exercise test com-bined Duke score is helpful to improve specificity,positive predictive value,negative predictive value and accuracy of the test.

Objective To study the qualitative analysis and quantitative analysis of flavonoids and other ingredients in leaves of Lonicera hypoglauca miq,and to optimize the reflux extraction condition for total flavonoids from leaves of lonicera hypoglauca miq. Methods Preliminary test was used for qualitative analysis. UV-spectrophotometry was used to determinate content of total flavonoids. By orthogonal design,the extraction rate of flavonoids was determined in different factors of ethanol reflux extracting. Results Leaves of lonicera hypoglauca miq contained alkaloids and flavonoids.The optimum conditions of ethanol reflux extracting total flavonoids are 12 times 50% ethanol,and refluence for 1.0h at water bath for two times.According to validate experiment,the average total flavonoids content was 16.6% in leaves of lonicera hypoglauca miq,with RSD=1.52%(n=3). Conclusion Flavonoids are in higher level in leaves of Lonicera hypoglauca miq. There are some chemical similarity in leaves of lonicera hypoglauca miq and leaves of flos lonicerae.

[Objective] To investigate the effects of Qianggu capsule plus alendronate on postmenopausal osteoporosis.[Methods]By random number generating method,120 patients were randomly divided into a treatment group with Qianggu capsule plus alendronate,control group A only with Qianggu capsule,and control group B only with alendronate.The pain of the patient before treatment,3 m and 6 m after treatment was assessed.At the same time,the bone mineral density (BMD) before and 6 months after treatment was recorded.[Results] There was significant difference before and after 3 m in the score of pain in three groups,but the difference in treatment group was higher than other two control groups.After 6 m,all the scores of pain in 3 groups had changed significantly compared to the ones before treatment,but the scores of pain in treatment group were lower than 2 control groups.The BMD of both vertebral and ward in treatment group after 6 months treatment was higher than before.[Conclusions]Qianggu capsule plus alendronate has definite therapeutic effects on postmenopausal osteoporosis.