Objective:To discuss the relationship between defunctionign stoma in low anterior resection for rectal carcinoma and the incidence of anastomotic leakage.Methods:Totally 270 patients who received low anterior resection for rectal carcinoma(with the distance between anastomosis and anal edge being 6 cm or less)from Jan.2005 to Oct.2006 were included in the present study.Defunctioning stoma was performed in 113(41.9%)patients considered with high risk of anastomotic leakage.The clinicopathological data were used to construct database.SPSS 10.0 software was used to analyze the incidences of anastomosis leakage in patients with and without receiving defunctioning stoma.Results:There were 20(7.4%)leakages in the 270 cases.The symptoms included abdominal pain(37%),increase of pulse(53%),fever(47%),leukocytosis(53%),pelvic fluid properties change(68%),anal discharge of bloody fluid(26%)and others(10%).The average age of patients with leakage was 57.8 years.No death was caused by anastomotic leakage.Four(3.5%)leakages happened in defunctioning stoma group,and 16(10.2%)leakages happened in non-stoma group(P=0.04).Eighteen(75%)of the 24 patients with preoperative radiotherapy history received defunctioning stoma and none of them had leakage.Two of the 6 cases who had preoperative radiotherapy history receiving no defunctioning stoma had anastomotic leakages;the fisher exact probability test showed P=0.054.The leakage rate was 4.9%(7 cases)in 142 cases who had received protective measures during low anterior resection and the rate was 10.2%(13 cases)in the rest 128 cases who had not received any protective measures(P=0.10).Leakages subsided with conservative treatment in the 4 patients with stoma,but 8 patients without stoma had severe symptoms and required surgical intervention;one developed peritonitis.The average fasting periods were significantly different between the 2 groups(P

Objective To discuss the application values of image reconstructive technique in 16-slice helical CT scanning. Methods 32 cervical spinal cord lesion images which have processed in MPR, MIP and VR were reviewed to discover the best image reconstructive form. Results By grading, reconstruction score of MPR, MIP and VR was 4.75, 1.75 and 4.5, MPR and VR in top. Conclusion 16-slice CT scanning with MPR and VR image reconstructive of cervical spinal cord can be satisfied the clinical demands.

Objective To investigate the clinical characteristics and surgical management of adult presacral tumors.Methods The clinical data of 24 patients with adult presacral tumors from 2007 to 2012 were retrospectively analysed.All patients were diagnosed by digital rectal examination and imaging examination before operation.Seventeen patients with via sacrococcygeal approach,4 patients with via abdominal approach,and 3 patients with via combined abdominal and sacrococcygeal approach.Results The incision of 22 patients primary healing.There were 2 patients with postoperative incision infections,after dressing change cure.No patients died during perioperative period.Twenty patients were followed up for 3-17 months,1 patient with via abdominal approach recurrenced,and was healed after a second surgical resection.Conclusions Digital rectal examination and imaging examination are the main methods for diagnosis of adult presacral tumors.Most adult presacral tumors can be resected through sacrococcygeal route.

Objective:To study the effect of ischemic postconditioning(I-postC)on the lung injury following ischemia-reperfusion(I/R)of skeletal muscle in the hind limbs of rats.Methods:The rat model of hind limbs I/R injury was established by subrenal abdominal aorta cross-clamping for 4 hours.Forty-eight rats were divided into 3 groups:I/R group,IPC and I-postC group.Each group received 4 hours of ischemia and then 12 or 24 hours of reperfusion respectively.The tissue morphology,wet-to-dry weight(W/D)ratio,malondialdehyde(MDA)and myeloperoxidase(MPO) of lung tissue were compared.The expression of ICAM-1 mRNA in lung was also studied by RT-PCR or in situ hybridization.The protein product was detected by Western blot.Results:In IPC and I-postC groups,all parameters decreased significantly compared with I/R ischemia group(P

Objective To summarize our experience in treating abdominal aorta saddle embolism(ASE).Methods The clinical data of 21 cases of abdominal ASE were treated with Fogarty catheter and other(methods) during January 2000 to July 2006 were retrospectively assessed.Results After the blood flow was restored by operation,4 died in the postoperative early stage because of sudden cardiac asystole due to(hyperkalemia);in the late stage,6 died of multiple organ dysfunction syndrome socondary from acute renal(failure)(ARF).Eleven patients were cured.Of them,bilateral lower extremites were salvaged in 5 patients;and 6 patients received amputation.Ten patients were followed up,and the blood supply of the salvaged legs was good.Conclusions Early diagnosis and embotism removal are the key points to decrease the mortality and amputation rate of ASE.The intra-operative and post-operative prevention and management of(hyperkalemia) and ARF are important for reduction of mortality.

Objective To investigate the value of Doppler ultrasound in the eady diagnosis,monitoring and assessing of renal damage in neonatal asphyxia.Methods A total of 60 cases of neonates within 24 h were divided into severe asphyxia group (Apgar score 0-3),mild asphyxia group (Apgar score 4-7) and healthy control group (Apgar score 8-10) according to Apgar score at 1 min after born.Then the peak systolic velocity (PSV),end diastolic velocity (EDV) and resistance index (RI) of renal artery were obtained by Doppler ultrasound within 24 h,on day 3,day 7,and day 10.The level of serum cystain C (sCysC) was also recorded accordingly.Results Within 24 h,compared with healthy control group,the PSV and EDV in severe asphyxia group and mild asphyxia group decreased (all P＜0.05),while RI increased (all P＜0.05).The PSV in mild asphyxia group returned to normal in 3 days,EDV and RI returned to normal in 10 days,there were no statistically significant difference compared with healthy control group (all P＞0.05).The PSV,EDV and RI in severe asphyxia group were still significantly differences compared with healthy control group on day 10 (all P＜0.05).Within 24 h and on day 3,sCysC in the mild asphyxia group increased obviously compared with healthy control group (both P＜0.05).On day 7 and day 10,the differences of sCysC was not statistically significant between mild asphyxia group and healthy control group (both P＞0.05).Compared with healthy control group,the sCysC in severe asphyxia group increased significantly (all P＜0.05) on every time point.PSV and EDV were negatively correlated with sCysC,RI was positively correlated with sCysC.Conclusion Changes in renal function can be reflected soon by index of renal blood flow PSV,EDV and RI.

Objective To evaluate surgical therapies in patients with popliteal aneurysms (PA).Method The clinical data of 25 PA patients admitted from January 1988 to January 2012 were retrospectively analyzed.There were 21 men and 4 women,the mean age was (56 ± 16)years.There were 27 PA in these 25 patients,with bilateral PA in 2 cases.The main symptoms were pulsatile mass in the popliteal fossa,limb pain,acute or chronic distal limb ischemia and limb edema.Result In this series 23out of 25 PA cases recieved operations,17 of them were treated with aneurysmectomy and saphenous vein interposition or bypass grafting,4 of them were treated with aneurysmectomy and prosthetic grafts interposition,1 was treated with aneurism ligation and 1 underwent end-to-end anastomosis after aneurysm resection.There was no perioperative mortality.One patient recieved amputation for distal anastomotic thrombosis and severe limb ischemia.The mean follow-up time is (6.5 ± 0.5) years.After 4 years,a right subclavian artery aneurysm was found in a bilateral PA case and treated surgically.Conclusions Early elective surgical treatment is recommended for patients with PA because PA may go rupture or induce dital limb ischemia and these patients may have good outcome after surgical treatment.Long-term follow-up is warranted to detect the new aneurysm formation.

Objective: To investigate the temperature control methods for long-distance transportation of red blood cell suspensions in military affairs or emergence.Methods: We loaded blood transport cars with red blood cell suspensions to full capacity and kept the temperature by combined cooling methods.Results: The temperature in the container was kept between 2-6.2℃ during the 72 h transportation,even when the refrigeration system of the car was out of work.Conclusion: The required temperature for long-distance transportation of red blood cell suspensions could be attained by combined cooling methods in case of insecurity of transportation time and the effect of single cooling method.

ObjectiveTo investigate the expression and significance of p38 mitogen-activated protei n kinase (MAPK) in autogenous vein graft. Methods Autogenous vein graft model was established by transplanting the right jugular vein to infr arenal abdominal aorta in 80 Wistar rats. Ten vein graft samples were harvested 6 hours, 24 hours, 3 days, 7 days, 2 weeks, 4 weeks, 6 weeks and 8 weeks after s urgery,respectively. Reverse transcription-PCR and in situ hybridization,Wester n blot and immunohistochemistry methods were used to detect the expression of pr otein and phosphorylation protein of p38 and p38mRNA. ResultsThe expression of p38 mRNA increased 6 hours after surgery and reached the peak on the second week after surgery (59%?26%),and significantly higher than that on 4,6,8 weeks( P

Objective To investigate the expression and relationship of early growth response gene-1((Egr-1)),platelet-derived growth factor-B(PDGF-B) and tranforming growth factor(TGF-?_1) in autogenous vein graft in rats,and the role in vein graft intimal hyperplasia(IH).Methods Autogenous vein graft model was(established) in 90 wistar rats.The vein graft samples were harvested at 1,2,6,24 hours,and 3,7,14,28,42 days after surgery.Normal vein was used as control group.Egr-1、PDGF-B,TGF-?_1 mRNA was measured by reverse transcription-PCR and in situ hybridization.Western blotting and immunohistochemistry were used to detect the protein expression of Egr-1,PDGF-B and TGF-?_1. Results Expression of Egr-1,PDGF-B,TGF-?_1 mRNA and protein was not detected in normal vein.In grafting vein,expression level of Egr1mRNA reached a peak at 28days,and the positive rate of Egr-1mRNA was 45%?6%;(PDGF-BmRNA) reached a peak at 14days(48%?6%);a peak of TGF-?_1mRNA was 46%?9% reached at 7days;Egr-1 protein expression reached a peak at 28days, and the positive rate of Egr-1 protein was 40%?9%.PDGF-B protein reached a peak at 28days(45%?4%),TGF-?_1 protein reached a peak at 14days(41%?7%).Conclusions Intimal hyperplasia of vein graft is closely associated withexpression of Egr-1、PDGF-B and TGF-?_1;the activation and expression of PDGF-B and TGF-?_1 may be(modulated) by Egr-1,and they may contribute to increase expression of Egr-1 by feedback.