Objective To investigate the safety and efficacy of endoscopic duodenal papillary muscle small incision(EST)combined with duodenal papillary balloon dilation(EPBD)in the treatment of elderly patients with bile duct stones.Methods 100 elderly patients with bile duct stones were treated with endoscopic stone removal. Among them,55 patients were treated with SEST combined with EPBD(EPBD group),45 patients were treated with a single EST(EST group),the rate of stone removal,the occurrence rate of lithotripsy and the incidence of complications were compared between the two groups.Results The SEST +EPBD group at a time calculi clearance rate,postopera-tive hyperamylasemia,post pancreatitis,cholangitis were 98.2%,7.3% and 3.6%,1.8%,the EST group were 97.7%,6.7%,6.7%,3.6% and the difference between the two groups had no significant(all P >0.05).The SEST+EPBD group of gravel formation rate was 3.6%,lower than 13.3% in the EST group,the difference was statistically significant(χ2 =9.647,P <0.05).The SEST +EPBD group had no bleeding,bleeding in EST group incidence rate was 11.1%,the difference was statistically significant(χ2 =11.235,P <0.05);The recurrence rate of the SEST +EPBD group was 1.8%,which was lower than 11.1% in the EST group,the difference was statistically significant (χ2 =10.113,P <0.05 ).Conclusion EST combined with EPBD in the treatment of elderly common bile duct stones is safe and effective,which can significantly reduce the incidence of debris and bleeding,reduce the recurrence rate of common bile duct stones.

Child, Preschool ; Ear, External ; abnormalities ; Humans ; Male ; Nasopharynx ; abnormalities

Cartilage ; pathology ; Catheter Ablation ; adverse effects ; methods ; Female ; Humans ; Laryngeal Nerves ; Microwaves ; Middle Aged ; Necrosis ; Thyroid Gland ; surgery ; Trachea ; pathology ; Vocal Cord Paralysis ; etiology

Objective To evaluate the safety and feasibility of totally thoracoscopic anatomic pulmonary segmentectomy (TTAS) for the treatment of the peripheral stage ⅠA non small cell lung cancer(NSCLC).Methods The study involved 50 consecutive patients undergoing totally thoracoscopic anatomic segmentectomy (TTAS) from September 2010 to November 2012 in the First People's Hospital affiliatied to Nanjing Medical University.The diameter of the tumors were less than 2 cm [(mean diameter(1.35 ±0.48) cm].All lymph node sampling of N1 and N2 were neglive,All patients received symtematic lymph node dissection.The pulmonary vessels were individually ligated,and the bronchi were closed using an endoscopic stapler.The intersegmental plane was identified using the demarcation between the resected(inflated) and preserved(collapsed) lungs.Staplers were used for intersegmental dissection.Results The mean operative time and intraoperative bleeding were (191.5 ± 50.4) min and (49.2 ± 54.6) ml respectively.The chest tube drainage duration was (3 ± 1) days.The number of stapler cartridges used for intersegmental division was 3.9 ±0.8.The mean number of lymph nodes and nodal stations dissected were 12.6 ± 2.8 and 6.0 ± 1.5 respectively.No mortality and complications were observed 30 days after the surgery.Further,no local recurrence or metastases were observed during follow-up.Conclusion Totally thoracoscopic anatomic segmentectomy(TTAS) is a feasible and safe technique.With systematic lymph node dissection,TTAS can be a reasonable therapeutic option for stage ⅠA NSCLC.

Endoscopy ; methods ; Female ; Humans ; Meningocele ; surgery ; Middle Aged ; Pterygopalatine Fossa ; surgery

Objective To investigate the effects of 7 5% hypertonic saline (HS) on fluid balance after elective major abdominal surgery Methods Twenty two patients undergoing elective major abdominal surgery were assigned to receive either Ringer lactate solution followed by 4 ml/kg of 7 5% HS (study group, n =11) or Ringer lactate solution (control group, n =11) during the early postoperative period in ICU We compared fluid infusion volumes and urine outputs, fluid balance, and body weight change between the 2 groups Results Urine outputs in the operative day and the first postoperative day in study group were significantly more than in control group [(2?650?531)ml vs (2?046?572)ml, t =2 551?7, P

BACKGROUND:Islet and islet cel transplantation for the treatment of diabetes has achieved effect, but the research is limited dut to the shortage of islet and immune rejection. OBJECTIVE:To observe the effect of transplantation of islet-like cells that in vitro differentiated from bone marrow mesenchymal stem cells on the treatment of diabetes in rats. METHODS:The rat bone marrow mesenchymal stem cells were induced with basic fibroblast growth factors and hepatocyte growth factors, and then received immunocytochemistry staining to detect the induction. The Sprague Dawley rats received intraperitoneal injection of streptozotocin to establish the diabetes models. After modeling, the rats were randomly divided into control group and experimental group (transplanted with induced islet-like cells). The experimental group was transplanted with the induced islet-like cells through renal capsule, and the control group was transplanted with normal saline in the same dose. The blood glucose and body mass of the diabetes rats were observed after transplantation. RESULTS AND CONCLUSION:The bone marrow mesenchymal stem cells could differentiate into islet-like cells after in vitro induced with basic fibroblast growth factors and hepatocyte growth factors. There was no significant change in blood glucose of the control group after transplantation (P>0.05), and the blood glucose of the rats in the experimental group was significantly decreased compared with the control group (P<0.05). The bone marrow mesenchymal stem cells can differentiate into islet-like cells after in vitro induced with the induction system containing basic fibroblast growth factors and hepatocyte growth factors, and the islet-like cells have a certain ability of insulin secretion. The transplantation of induced islet-like cells after transplanted into the diabetes rats through renal capsule can decrease the blood glucose level of the rats.

Objective To set up an administrative system of altitude knowledge data so as to raise up the retrieval efficiency of altitude knowledge for the scientific research in hospital.Methods ACCESS 2003 was used to create the administrative system.Results Altitude literature resources could be retrieved rapidly.Conclusion The administrative system of altitude knowledge data is simple in structure,easy to operate,fast in rate and convenient to retrieve.Good result is obtained in practice.[Chinese Medical Equipment Journal,2008,29(2):62-63]

Objective To explore the relationship between the histological alterations of Oddi sphincter lesions and clinical manifestations. MethodsFrom October 1995 to May 2003, biopsies of Oddi sphincter were undertaken during transduodenal sphincteroplasty (TSP) in 32 cases. Specimens were stained with Van Gieson Mason staining. ResultsThirty one out of 32 specimens were found with histological alterations in Oddi sphincter including diffuse fibrosis in 87 1% (27/31) , adenomyosis in 2 cases and chronic inflammatory infiltration in 2 cases. Impacted stone in the terminal common bile duct, benign papillary stenosis and visible postpancreatitis parenchymal changes were all found accompanying severe fibrosis of Oddi sphincter. ConclusionIn patients with impacted stones in the ampulla, intracholedochal sludge with recurrent cholangitis, and relapsing pancreatitis, endoscopic sphincterotomy is recommended.

Objective To analyze the etiologies,clinical characteristics and prognostic factors of patients with acute renal failure(ARF)admitted to the hospital at high altitude.Method This retrospective study included clinical data of patients with acute renal failure in the General Hospital of Tibet Military Command from May 2001 to April,2006.Results There were 85 male patients and 63 female patients with mean age(42.4?18.1)years old.Among 148 patients with acquired ARF,52.7% was iatrogenic or nosoeomal origin, demonstrating a trend of increasing.The ARF included pre-renal(n=48,32.4%),renal parenchymal(n= 90,60.8%)and post-renal(n=10,6.8%)in origin.Acute high altitude sickness(n=20)was the major causes of pre-renal ARF.Renal parenchymal ARF could be classified into glomerular vascular lesions(n=24), acute tubular necrosis(n=53),acute interstitial nephritides(n=12),and contusion of unitesticle(n=1).of 90 cases of renal parenchymal ARF,39 patients(43.3%)were induced by medicines.Lithiasis was the major causes of post-renal ARF.The mortality of ARF in our study was 42.6%.The mortality of patients contracted ARF in hospital was much higher than that of patients community ARF in community(55.1 vs 23.6%;P=0.01). There was no significant differences of the mortality between the patients with and without dialysis treatment. Univariate analysis showed that prognosis was correlated with age,the presence of hematuria and oliguria or anuria Hb,and the number of organ system failures.The logistic regression showed that age,Hb and the number of organ system dysfunction were the predictors of mortality.Conlusions The major causes of ARF at high altitude were acute high altitude sickness and the use of medicines with nephrotoxicity.The morbility and mortality of nosocomisl ARF increased significantly.Prevention of MODS is a key management to decrease mortality in severe ARF.