The Tear Film Break-Up Time(BUT) in the diagnosis of the dry eye syndrome was widely used, but its results were variable according to the methods of measuring BUTs. Especially, the method of Fluorescein administration and concentration had a great influence on BUT. The purpose of this study was to standardize the method used in measurement of BUT, particularly fluorescein solution concentration. We measured BUT in seven groups of different fluorescein solution concentration and total subjects were 464 persons. The results were as follows; 1. The mean BUT was 14.24 +/- 2.04 seconds in 0.12% Fluorescein solution, 11.73 +/- 2.11 seconds in 0.25% solution, 11.34 +/- 3.00 seconds in 0.5% solution, 10.3 +/- 3.50 seconds in 1% solution, 9.59 +/- 2.74 seconds in 2% solution, 7.56 +/- 1.84 seconds in 5% solution and 5.55 +/- 1.20 seconds in 8% solution. 2. The more Fluorescein concentration was, the shorter BUT became and there were statistically significant decrease in 0.25%, 0.5% and 2% Fluorescein solution.
Diagnosis ; Dry Eye Syndromes ; Fluorescein* ; Humans ; Tears*

BACKGROUNDThe technique of intersphincteric resection of tumors combined with coloanal anastomosis has been used to avoid permanent colostomy for patients with a rectal cancer located < 5 cm from the anal verge. This study aimed at assessing the preservation of continence function of the residual rectum and the clinical prognosis of patients with lower rectal cancer after intersphincteric resection using a prolapsing technique.

METHODSThis study included patients with the following inclusion criteria: (1) pathological evidence of rectal cancer and the tumors within distal margins located 5 cm or less from the anus by preoperative endoscopic examination; (2) no evidence by MRI of infiltration of either the external sphincter, puborectalis or the levator muscle; (3) the patients are eligible for intersphincteric resection and lower coloanal anastomosis with a preoperative biopsy showing the tumors with well-to-moderate differentiation. From January 2000 to June 2004, 23 patients with low rectal cancer were included in this study. We used the standard abdominoperineal approach to perform radical resection of tumors with excision of the mesorectum and total or part of the internal sphincters. The patients were followed for assessment of the function of the residual rectum and of cancer recurrence after the operations.

RESULTSThe median tumor distance from the anal margin was 4.5 (range 3.5 - 5.0) cm and the mean distal surgical margin 1.6 (range 1.0 - 2.0) cm. Cancer was classified into Stage I (30.4%), Stage II (47.8%), and Stage III (21.7%) according to the TNM classification. Two patients developed anastomotic fistula after the surgical resection and 2 patients (8.7%) developed later stages of anastomotic stricture at the site of coloanal anastomosis. The median follow-up period was 31.5 months (range 12 - 54) and 2 patients (8.7%) developed local recurrence. Three deaths were associated with distal organ metastasis. Twenty patients (87.0%) have maintained competence to control solid or liquid stool and the capacity of flatus continence after the surgery. Among these patients, 2 patients were able to control solid stool and occasionally lose continence of liquid stool. And only 1 patient (4.4%) has retained partial rectum function with good continence of solid stool but not liquid after the operations. Average times of defecation per day of 3, 6, 12, 24 and 36 months after the surgery were 13.1, 4.7, 3.1, 2.9, and 3.2 times/day. Anal manometer measurements showed a decrease of pressure during the resting time after intersphincteric resection and this change remained during the period of follow-up. The maximum squeeze pressure was improved after an initial decrease after the surgery.

CONCLUSIONSMore residual rectum function after the surgery may be preserved by intersphincteric resection of low rectum cancer. At the same time this technique is safe with few postoperative complication and low tumor recurrence after the surgery.

Digestive System Surgical Procedures ; methods ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Prognosis ; Rectal Neoplasms ; mortality ; pathology ; physiopathology ; surgery ; Rectum ; pathology

OBJECTIVETo investigate the clinical characteristics and prognosis factors of primary resectable high-risk gastrointestinal stromal tumors (GIST).

METHODSThe clinicopathological and follow-up data of 45 patients with primary resectable high-risk gastrointestinal stromal tumors between January 2002 and November 2010 were retrospectively reviewed.

RESULTSForty-five patients included 18 males and 27 females with a median age of 48 years (range, 28-77 years). Of 45 tumors, 19 (42.2%) located in the stomach, 9 (20.0%) in the small intestine, 7 (15.6%) in the rectum, 4 (8.9%) in the mesentery, and 6 (13.3%) in the retroperitoneum. All the patients received surgical resection and 35 (77.8%) underwent complete resection, 10 (22.2%) underwent resection of ruptured tumors (before or during operation), 33 (73.3%) underwent R0 resection, 5 (11.1%) underwent R1 resection, and 7 (15.6%) underwent R2 resection. All the patients received targeted therapy of imatinib after surgery. The median duration of imatinib was 24 (10-99) months. The main side effect was noticed in all the patients, mainly including edema in 39 (86.7%) patients and leukopenia in 27 (60.0%) patients. The relapse rate was 37.8% (17/45). The 1-, 3-, and 5-year survival rates were 100%, 86.7% and 74.4%, respectively. Univariate and multivariate analysis revealed that the degree of resection was independently associated with the prognosis of high-risk GIST patients.

CONCLUSIONSSurgery is effective treatment for the GIST. Efforts to obtain R0 resection are important to improve the efficacy of primary resectable high-risk GIST.

Adult ; Aged ; Female ; Follow-Up Studies ; Gastrointestinal Neoplasms ; surgery ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

Catastrophic failure of a zirconia head with Hylamer acetabular component and early failure due to the phase transformation of zirconia ceramic head after total hip arthroplasty have been indebted issues. We report two cases who had failure of the zirconia ceramic head with polyethylene articulations shortly after total hip arthroplasty. Revision retrieval studies were performed subsequently.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Ceramics* ; Head* ; Polyethylene*

BACKGROUNDWhen compared with conventional abdominoperineal resection (APR), extralevator abdominoperineal excision (ELAPE) has been demonstrated to reduce the risk of local recurrence for the treatment of locally advanced low rectal cancer. Combined with the laparoscopic technique, laparoscopic ELAPE (LELAPE) has the potential to reduce invasion and hasten postoperative recovery. In this study, we aim to investigate the advantages of LELAPE in comparison with conventional APR.

METHODSFrom October 2010 to February 2013, 23 patients with low rectal cancer (T 3-4 N 0-2 M 0 ) underwent LELAPE; while during the same period, 25 patients were treated with conventional APR. The patient characteristics, intraoperative data, postoperative complications, and follow-up results were retrospectively compared and analyzed.

RESULTSThe basic patient characteristics were similar; but the total operative time for the LELAPE was longer than that of the conventional APR group (P = 0.014). However, the operative time for the perineal portion was comparable between the two groups (P = 0.328). The LELAPE group had less intraoperative blood loss (P = 0.022), a lower bowel perforation rate (P = 0.023), and a positive circumferential margin (P = 0.028). Moreover, the patients, who received the LELAPE, had a lower postoperative Visual Analog Scale, quicker recovery of bowel function (P = 0.001), and a shorter hospital stay (P = 0.047). However, patients in the LELAPE group suffered more chronic perineal pain (P = 0.002), which may be related to the coccygectomy (P = 0.033). Although the metastasis rate and mortality rate were similar between the two groups, the local recurrence rate of the LELAPE group was statistically improved (P = 0.047).

CONCLUSIONSWhen compared with conventional APR, LELAPE has the potential to reduce the risk of local recurrence, and decreases operative invasion for the treatment of locally advanced low rectal cancer.

Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; surgery ; Postoperative Complications ; Rectal Neoplasms ; surgery ; Rectum ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome

Common variable immunodeficiency (CVID) is a heterogeneous group of primary immune deficiencies in adults characterized by hypogammaglobulinemia, recurrent bacterial infections, and a higher incidence of autoimmune diseases. More than 25% of CVID patients also have autoimmune diseases such as autoimmune hemolytic anemia, immune thrombocytopenic purpura, rheumatoid arthritis, and systemic lupus erythematosus. However, the pathogenesis of autoimmunity in CVID remains obscure. We report a 56-year-old woman with CVID and Sjogren's syndrome. In addition to a long history of recurrent upper respiratory infections, acute gastroenteritis, and cellulitis, she has also suffered from persistent xerostomia and xerophthalmia for the past 10 years. Serologic studies revealed hypogammaglobulinemia (low levels of IgG, IgA, and IgM in serum) and the presence of anti-Ro antibodies, and salivary scintigraphy indicated salivary gland involvement. These findings led to a diagnosis of CVID and Sjogren's syndrome, which was treated by monthly intravenous immunoglobulin therapy.
Adult ; Agammaglobulinemia ; Anemia, Hemolytic, Autoimmune ; Antibodies ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Autoimmunity ; Bacterial Infections ; Cellulitis ; Common Variable Immunodeficiency* ; Diagnosis ; Female ; Gastroenteritis ; Humans ; Immunization, Passive ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Incidence ; Lupus Erythematosus, Systemic ; Middle Aged ; Purpura, Thrombocytopenic, Idiopathic ; Radionuclide Imaging ; Respiratory Tract Infections ; Salivary Glands ; Sjogren's Syndrome* ; Xerophthalmia ; Xerostomia

Pregnancy related stroke is rare and poorly understood. A 28-year-old pregnant woman at 20 weeks of gestation presented with sudden headache and left homonymous hemianopsia. MRI revealed acute right posterior cerebral artery territory infarction. Laboratory data revealed combined protein C and S deficiencies. Coagulation profiles returned to normal 6 months after the delivery. Although stroke can occur either with protein C or S deficiency, acute cerebral infarction associated with combined protein C and S deficiencies during gestation is very rare.
Adult ; Cerebral Infarction ; Female ; Headache ; Hemianopsia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Posterior Cerebral Artery ; Pregnancy* ; Pregnant Women ; Protein C* ; Protein S ; Stroke*

OBJECTIVETo evaluate the effect of titrated target-controlled infusion with propofol and remifentanil on anesthetics consumption and anesthesia depth in patients undergoing elective laparoscopic colorectal surgery.

METHODSSixty ASA I-III patients for elective laparoscopic colorectal surgery were enrolled. Titrated target-controlled infusion (TCI) with propofol and remifentanil was performed. Plasma concentration of the drugs was administered by titrated method to maintain bispectral index (BIS) in the range of 40-60 with systolic blood pressure (SBP) fluctuation within 20% of the basic value. BIS, SBP, plasma concentration of propofol and remifentanil were recorded at different time points. Awareness during operation was inquired postoperatively.

RESULTSDuring the entire anesthesia period, the blood pressure was stable and BIS was maintained less than 60. There was no awareness during operation. The plasma concentrations (95% confidence interval) for TCI of propofol and remifentanil were 2.55-2.65 mg/L and 4.09-4.26 μg/L respectively when existing surgical stimulation during anesthesia, and the plasma target concentration of propofol was lower than the recommended dosages.

CONCLUSIONTitrated target-controlled infusions with propofol and remifentanil for elective laparoscopic colorectal surgery can maintain proper anesthesia depth and reduce the drug consumption.

Adult ; Aged ; Aged, 80 and over ; Anesthesia, Intravenous ; methods ; Anesthetics, Intravenous ; administration & dosage ; Blood Pressure ; drug effects ; Colorectal Surgery ; Electroencephalography ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Piperidines ; administration & dosage ; Propofol ; administration & dosage

BACKGROUNDIschaemic reperfusion injury (IRI) is inevitable during major liver surgery. Ischaemic preconditioning (IPC) has been proven an effective intervention against hepatic IRI. Recently, it was demonstrated that ischaemic postconditioning (IPO) provided effective cardioprotection on IRI. We evaluated the protective effects of IPO on warm/cold IRI in rat liver by a comparison with IPC and assessed the role of apoptosis in the process.

METHODSWarm IRI model (clamping hepatic pedicle for 30 minutes) and cold IRI model (orthotopic liver transplantation with 2 hours cold storage) were established. Each model consisted of 3 groups: (1) control group, normal warm/cold IRI; (2) IPC group, 5 minutes of ischaemia followed by 5 minutes of reperfusion twice prior to warm/cold IRI; (3) IPO group, 30 seconds of reperfusion followed by 30 seconds of reocclusion for three times after warm/cold ischaemia. The levels of serum transaminase, glucose, and gamma glutamyltransferase (GGT) in bile, histopathological examination, apoptotic activity of hepatocyte, and apoptosis related protein Fas, at 3 hours after operation were compared. Survival rates one week after intervention were also compared.

RESULTSIPO and IPC protected the functions of hepatocytes and biliary epithelial cells, inhibited the hepatocellular apoptosis by preventing expression of Fas gene, and elevated the one week survival rate compared with control group in both models (P < 0.05). IPO and IPC groups were comparable in levels of serum transaminase levels, glucose, and GGT in bile, Fas positive expression index, and one week survival. In cold ischaemic models, IPO had lower apoptotic index than IPC (P < 0.05).

CONCLUSIONCompared with ischaemic preconditioning, ischaemic postconditioning is associated with comparable protections of rat liver from warm or cold ischaemic reperfusion injury.

Animals ; Apoptosis ; Ischemic Preconditioning ; Liver ; blood supply ; pathology ; Male ; Rats ; Rats, Wistar ; Reperfusion Injury ; prevention & control ; Survival Rate ; fas Receptor ; genetics

BACKGROUNDWWOX and FHIT are two candidate tumor suppressor genes located in active fragile sites, the damage of which has been associated with the development of breast cancer. The association of the expression of these genes and the development of breast cancer has not been fully explored. We evaluated mRNA and protein expression of WWOX and FHIT in breast tissue with normal histological appearances, atypical ductal hyperplasia, ductal carcinoma in situ, and invasive cancer to see if a progressive decline in expression was present.

METHODSReverse transcription-polymerase chain reaction and Western blotting were used to evaluate the specimens for mRNA and protein expression, including 28 specimens with normal tissue, 28 specimens with atypical ductal hyperplasia, 33 specimens with ductal carcinoma in situ, and 51 specimens with invasive ductal carcinoma.

RESULTSCompared with in situ and invasive cancer specimens, both normal and atypical hyperplasia specimens had greater rates of detectable mRNA (WWOX rate ratio = 2.95, 95% CI 1.24 - 7.08; FHIT rate ratio = 4.58, 95% CI 1.82 - 11.81) and Western blotting detectable protein (WWOX rate ratio = 4.12, 95% CI 1.63 - 10.73; FHIT rate ratio = 3.76, 95% CI 1.44 - 10.06). For both proteins, differences between normal and atypical hyperplasia specimens and between in situ and invasive carcinoma specimens were explainable by chance (P > 0.05 for each analysis). Within each histological category, differences among fractions of specimens showed that FHIT and WWOX mRNA and protein expression were explainable by chance (P > 0.05 for each analysis).

CONCLUSIONExpression of FHIT and WWOX decreases along with breast tissue progress from a normal histological appearance to atypical ductal hyperplasia, in situ cancer, and the final invasive cancer.

Acid Anhydride Hydrolases ; analysis ; genetics ; Breast ; pathology ; Breast Neoplasms ; genetics ; Chromosome Fragile Sites ; Female ; Genes, Tumor Suppressor ; Humans ; Hyperplasia ; Neoplasm Proteins ; analysis ; genetics ; Oxidoreductases ; analysis ; genetics ; Tumor Suppressor Proteins ; analysis ; genetics ; WW Domain-Containing Oxidoreductase