Objective To evaluate the clinical applications and surgical methods of combined laparoscopic common bile duct (CBD) exploration with choledochoscopy. Methods From 2006 to 2009,clinical data of 42 patients with choledocholithiasis undergoing laparoscopic common bile duct exploration were retrospectively analyzed. We applied a step-by-step electric coagulating incision technique on the CBD,the step-by-step suturing technique, and the step-by-step clamping technique with alligator forceps, and soft tube irrigating technique with suctioning by selecting the proper exploration route, improving the common bile duct incision technique and calculus removing techniques. Results Procedures were successful in all the cases. There was no conversions to open surgery, no postoperative bleeding and no operative mortality. The mean operating time was 120 minutes (ranging, 90 to 150 minutes) with minimal intraoperative blood loss ( ranging, 20 to 40 ml). Ductal stone clearance was successful in 41 out of 42 patients ( 93% ). The largest number of the common bile duct stones was 16. With the diameter of stones larger than 15 mm in 18 cases in which the biggest was 30 mm. Bile leak developed in 1 patient, retained stones found in 3 patients,including intrahepatic cholelithiasis in one case. As a result, 38 out of 42 patients underwent common bile duct exploration. 35 patients were placed on T-tubes. Four patients underwent cystic duct exploration in which 3 had primary suture of the cystic duct and 1 had drainage. There was no infection and stenosis of biliary tract in the 42 followed-up cases. Conclusions Laparoscopic common bile duct exploration with stone extraction can be performed with high efficiency, minimal morbidity and without mortality. Improving the way of operation and selecting suitable exploration can result in better clinical outcomes.

OBJECTIVETo identify the genetic alterations in nonsyndromic cleft lip and palate (NSCLP).

METHODSComparative genomic hybridization was applied to investigate the genomic imbalance (the gain or loss of genetic material) in 7 cases of NSCLP.

RESULTSIt showed that the loss of chromosome DNA copies happened in chromosome 6, 7, 10, 13, 14, 16, 20, 22 and the gain of chromosome DNA copies happened in chromosome 5, 15, 18, 19. Conclusions 13q had a high frequency (71.4%) of chromosome loss.

CONCLUSIONSAbnormal chromosome DNA copies happen in all the patients with NSCLP. Most of the patients have chromosome DNA copies loss. It suggests that loss of inhibitory gene may be related to the NSCLP. The related inhibitory gene may locate in 13q.

Adolescent ; Adult ; Child ; Child, Preschool ; China ; ethnology ; Cleft Lip ; genetics ; Cleft Palate ; genetics ; Comparative Genomic Hybridization ; DNA ; Genetic Variation ; Genotype ; Humans ; Infant ; Mutation ; Phenotype ; Young Adult

OBJECTIVETo study the association of TGF-alpha gene Taq I polymorphism and nonsyndromic cleft lip with or without cleft palate (NSCL/P) in Chinese.

METHODS107 patients with NSCL/P and 136 healthy controls were examined for TGF-alpha/Taq I genotypes. TGF-alpha/Taq I typing was carried out by digesting the locus specific polymerase chain reaction amplified products with alleles specific Taq I restriction enzyme (PCR-RELP).

RESULTSThe C2 allele frequency of TGF-alpha/Taq I in patients with NSCL/P (16%) was significantly higher than that in healthy controls (8%). The C2 genotype frequency of TGF-alpha/Taq I in NSCL/P patients with positive family history (12.5%) was significantly higher than that in healthy controls.

CONCLUSIONThese findings demonstrate the role of TGF-alpha as a gene of major effects in the development of nonsyndromic cleft lip with or without cleft palate clefts in human. These findings suggest that a family history of clefting may correlate with the TGF-alpha Taq I rare variation.

Adolescent ; Adult ; Child ; Child, Preschool ; China ; Cleft Lip ; genetics ; Cleft Palate ; genetics ; DNA ; genetics ; metabolism ; Female ; Gene Frequency ; Genotype ; Humans ; Infant ; Male ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length ; Taq Polymerase ; metabolism ; Transforming Growth Factor alpha ; genetics

Objective To investigate the intervention effects ofYinao Jieyu Prescription on the behaviors and damages in hippocampal CA1 area of the rats with post-stroke depression (PSD).Methods Totally 168 SPF male SD rats were randomly divided into normal group, sham-operation group, stroke group, PSD group, Western medicine group and TCM group. There were 24 rats in the normal group and sham-operation group, and 30 rats in the other groups. Rats in the normal group received no intervention. Rats in the sham-operation group received no suture. Rats in the stroke group were given middle cerebral artery occlusion operation and normally fed after operation. Rats in the PSD group, Western medicinal group and TCM group were made into PSD models by chronic immobilization stress for one week and individual battery to the end. At the inception of modeling, Western medicine group received fluoxetine hydrochloride for gavage; TCM group receivedYinao Jieyu Prescription for gavage; other groups received distilled water for gavage, once a day. At the end of week 2, 4, and 8, the morphology of the hippocampal CA1 area in each rat was observed by microscope after HE stained.Results Except for the week 2, at the same time point, the behavior scores of the rats in the TCM group were higher than those in the PSD group. At the same time point, the CA1 region of the hippocampus in the TCM group was more complete than the PSD group, and the cells were arranged neatly and in normal morphology.ConclusionYinao JieyuPrescription can improve the symptoms of PSD rats, and has protective effects on hippocampal CA1 area.

OBJECTIVETo observe the effects of the external application of Qiyu oil gauze (QYOG) for promoting post-operational healing in patients with anal fistula and to explore its mechanism of action so as to provide a beneficial scientific basis for its wide use.

METHODSSixty patients with anal fistula scheduled to receive simple low anal fistulectomy were equally assigned, according to the sequence of hospitalization, to the tested group and the control group, and their wounds were classified according to longitudinal diameter into three grades (Grade I with a diameter below 2 cm; Grade II, 2-5 cm; and Grade III, over 5 cm). After the operation was completed and the operational wound was sterilized with benzalkonium bromide, the wound substratum was packed with QYOG in the test group and with vaseline gauze in the control group. The packing gauze was changed every day till the wound was healed. The healing time of the patients was observed, and the number of capillaries and positive cell percentages of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and epidermal growth factor (EGF) in wound granulation tissues were counted on the 5th day after the operation.

RESULTSThe wound healing time was 17.80+/-5.46 days in the test group, which was significantly shorter than that in the control group (21.90+/-6.32 days, P<0.01). The number of capillaries and positive cell percentages of VEGF and bFGF in wound granulation tissues on the 5th day in the tested group were higher than those in the control group (P<0.01), though the difference in EGF between the two groups was insignificant (P>0.05).

CONCLUSIONQYOG could shorten the wound healing time after anal fistulectomy, which suggests that it participates in the stimulation of wound granulation tissues to produce VEGF and bFGF, and thus promotes capillary genesis and improves blood circulation in wounds so as to promote wound healing.

Administration, Topical ; Adult ; Bandages ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Granulation Tissue ; drug effects ; Humans ; Male ; Middle Aged ; Plant Oils ; administration & dosage ; Postoperative Care ; methods ; Rectal Fistula ; drug therapy ; rehabilitation ; surgery ; Time Factors ; Treatment Outcome ; Wound Healing ; drug effects ; physiology

To determine the relevance between MDCT features and anatomic-pathological basis of lymphoid neoplasm in cervico-thoracic junctional region, we performed a retrospective analysis of 69 patients with lymphoid neoplasm (lymphoma: 41 patients; metastatic tumor: 28 patients) involving the cervico-thoracic junctional region for MDCT features and distribution of lesions. The relevance between MDCT features and the anatomic-pathological basis in this region were evaluated. Among all the 41 patients with lymphoma, 29 with NHL (70.7%), 12 with HD (29.3%). The lymphomatous lymphadenopathy mainly located in superficial lateral cervix (51.2%, 21/41) ,deep jugular chain (65.9%, 27/41), supraclavicular fossa (75.6%, 31/41), paratrachea space in anterior mediastinum (46.3%, 19/41), around aortic arch (56.1%, 23/41), aortopulmonary window (53.7%, 22/41), upper anterior mediastinum (41.5%, 17/41), subcarinal space (26.8%, 11/41) and paraesophageal space (17.1%, 7/41). 28 patients had metastatic lymphoid tumor. The primary tumor were nasopharynx tumor (5 patients), thyroid cancer (7 patients), lung cancer (10 patients), and esophageal cancer (6 patients). Most metastasis took stage by stage in the way of lymphatic return, but a minority of cases migrated jumpily. The main metastatic sites were: beside jugular chain (82.1%), supraclavicular fossa (75%), paratracheal in anterior mediastinum (60.7%), upper anterior mediastinum (64.3%), beside aortic arch (35.7%), aortopulmonary window (39.2%), and paraesophageal space (28.6%). So lymphoid neoplasms in cervico-thoracic junctional region were involving both lower cervix and upper thorax simultaneously. The MDCT features and main distribution of lesions correlated with the anatomic-pathological characteristics in this region.
Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; diagnostic imaging ; Lymphoma ; diagnostic imaging ; Male ; Middle Aged ; Multidetector Computed Tomography ; Neck ; Thorax ; Young Adult

To determine the multidetector computed tomography (MDCT) features as well as the anatomic-pathological basis in thyroid diseases involving the upper mediastinum, we performed a retrospective analysis of 49 patients who had thyroid diseases involving the upper mediastinum. In the study, 22 cases were nodular goiter, 13 cases were thyroid adenoma, and 14 cases were thyroid cancer. The relevance between MDCT appearances and their diffusing route of common thyroid diseases as well as the anatomic-pathological features in this region were evaluated. It was found that the lesions located in the upper anterior mediastinum, the upper posterior mediastinum, and both sides were 67.3% (33/49), 14.3% (7/49), 18.4% (9/49), respectively. Different diseases had their distinct MDCT features nodular goiter mainly showed localized and multiple nodules or tumor bulk (77.3%), thyroid adenoma mainly showed solitary tumor bulk (92.3%), and thyroid cancer mainly demonstrated solitary tumor bulk (57.1%), respectively. Among the 49 cases, 9 cases had cervical and/or mediastinal metastases in lymph nodes. The thyroid diseases involving the upper mediastinum most commonly occurred in the upper anterior mediastinum. The MDCT features and distribution of diffusing thyroid lesions in cervico-thoracic junctional region closely correlated with the anatomic-pathological characteristics in this region.
Goiter, Nodular ; diagnostic imaging ; pathology ; Humans ; Mediastinal Neoplasms ; diagnostic imaging ; pathology ; secondary ; Mediastinum ; diagnostic imaging ; pathology ; Multidetector Computed Tomography ; Thyroid Neoplasms ; diagnostic imaging ; pathology

Adolescent ; Child ; Child, Preschool ; Colonoscopes ; Colorectal Neoplasms ; prevention & control ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; etiology ; therapy ; Humans ; Infant ; Intestinal Polyps ; complications ; Male

The purpose of this study was to evaluate the prothesis and vascular features of Debakey III aortic dissection by DSCT angiography after endovascular graft exclusion. We performed a retrospective analysis of 39 Debakey III aortic dissection patients who underwent DSCT angiography after endovascular graft exclusion. After the operations in this study, all the 39 patients had no stent fracture and migration, 15 among all the 39 had endoleaks (type I 12 patients, type II 2 patients, 1 patient had no reason), 17 had large amount of thrombosis in false lumen, and 1 had false lumen outside the stent absorbed completely. While before the operations, 15 patients had abnormal renal perfusion pre-operation, and 9 of them had recovered after the operations. And the nearer located to the initial exclusive place, the more obviously the aortic remodeling occurred. In conclusion, DSCT angiography can accurately evaluate the prosthesis and anatomic-pathologic features of Debakey III aortic dissection after endovascular graft exclusion.
Adult ; Aged ; Aneurysm, Dissecting ; diagnostic imaging ; surgery ; Angiography ; methods ; Aorta, Thoracic ; diagnostic imaging ; surgery ; Aortic Aneurysm ; diagnostic imaging ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Tomography, X-Ray Computed

Objective To investigate the feasibility of determining the breast cancer extension with diffusion-weighted imaging(DWI)and the apparent diffusion coefficient(ADC).Methods Fifty-nine lesions(57 patients)were studied by using DWI and ADC measurement before surgical excision.The cancer extension was investigated on ADC maps with different b values(b=500 and 1000 s?mm~(-2))according to the threshold values discussed before.The lesion extension on dynamic enhanced images and on DWI was used for comparison.The tumor extension was determined by calculating two lines.Line one:the maximum diameter of lesion.Line two:perpendicular line crossing the midpoint of line one.All measurement was compared with the pathologic specimen.Results(1)There were 48 invasive ductal carcinomas,6 ductal carcinomas in situ with small invasive foci,3 mucinous carcinomas,and 2 medullary carcinomas.(2)The low ADC value on ADC maps at b=500 and 1000 s?mm~(-2)was described as cancer extension.The measurement results were compared to pathologic figures and the pattern of correlation was categorized into 3 groups:Group 1,the area of low ADC values was almost the same as the pathological tumor extension; Group 2(overdiagnosis),the area of low ADC values was wider and more than 20% larger than the area of tumor extension;Group 3(false negative),no area of low ADC value was observed.There were no significant difference between DWI with b of 500 and b of 1000 s?mm~(-2)(X~2=0.160,P=0.689;X~2= 0.172,P=0.679)in Groups 1 and Group 3.There were 2 lesions in Group 2,which were consistent in DWI with b of 500 and b of 1000 s?mm~(-2).There were 14 misdiagnosed lesions,including overdiagnosis in 2 lesions and false negative in 12 lesions.Eight lesions measured at DWI with b of 500 and b of 1000 s? mm~(-2)were not consistent.Five lesions were diagnosed correctly at DWI with b of 500 s?mm~(-2),three of them were duetal carcinomas in situ with small invasive foci.(3)The extension of lesion on dynamic enhanced imaging was measured at 4 minutes after enhancement,and was compared with the extension measured at the same slice on DWI map.Pathologic figures were regarded as the gold standard.The extension of 47 lesions(80%)on enhanced images accorded with DWI.The abnormal area on DWI,which was consistent with pathologic figures,was wider than the area on enhanced images in 8 lesions.Of them,3 lesions were mucinous carcinomas and 5 lesions were grade 3 invasive ductal carcinomas.Conclusion DWI and ADC value have the potential in evaluating the cancer extension.The accuracy of extension measured on DWI map was better than that on dynamic enhanced images for some kinds of breast cancers.