Objective To study how to reduce the complication rate of laparoscopic cholecystectomy (LC) for acute cholecystitis. Methods A retrospective analysis was made on clinical data of 158 cases of acute cholecystitis treated by LC from September 2001 to December 2003. Results Operations were accomplished laparoscopically in 151 cases, while conversions to open surgery were required in 7 cases (1 case of Mirizzi’s syndrome, 2 cases of gallbladder carcinoma, 1 case of cholecystoduodenal fistula, 2 cases of "ice-like" adhesions in the Calot triangle, and 1 case of common bile duct stones). Open re-exploration was performed in 1 case because of biliary leakage. Intraoperative cholangiography (IOC) was successfully conducted in 10 cases, 3 of which were found common bile duct stones. Out of the 3 cases, 2 cases underwent an intraoperative endoscopic sphincterotomy and 1 received a conversion to open choledochotomy with T-tube drainage. Conclusions When utilizing LC for acute cholecystitis, the rate of conversion and the incidence of complication may be reduced as long as the patients were properly selected, the principles of safety were abided by, and the intraoperative cholangiography was performed routinely.

Objective To evaluate the incidence of postoperative epididymitis by laparoscopic cluster ligation and laparoscopic internal spermatic vein high ligation in the treatment of varicocele. Methods Forty-four cases of bilateral varicocele were retrospectively analyzed , who had undergone laparoscopic spermatic vein ligation. The 22 cases were treated with laparoscopic cluster ligation, and the other 22 cases with laparoscopic internal spermatic vein high ligation. The effects and the reasons of two kinds of surgical procedures on postoperative epididymitis were investigated. Results A total of seven patients were affected with postoperative epididymitis. The incidence of laparoscopic cluster ligation was 27.27%. The incidence of laparoscopic internal spermatic vein high ligation was 4.55%. All cases were affected within 4 weeks after surgery. Conclusion It is important to reserve the spermatic artery for decreasing the incidence of postoperative epididymitis.

Objective To improve self-management of diabetics with role lack.Methods A total of 121 diabetics with role lack were enrolled and received mass education and individual counseling.Serum levels of glucose and lipid profiles and body mass index (BMI) were assessed and compared before and after intervention by using paired t test.Results Knowledge on diabetes ( 79.37 ± 12.45 vs 31.69 ± 9.36,t =2.860,P ＜ 0.05) and self-management skills ( 9.21 ± 2.85 vs 4.43 ± 1.72,t =2.812,P ＜ 0.05 ) were significantly improved after receiving health education,although fasting plasma glucose [ ( 6.3 ± 1.8 ) vs (8.1 ±2.1) mmol/L,t =2.736,P ＜0.05],2-h postprandial blood glucose [(8.1 ±3.7) vs (12.8 ±4.1)mmol/L,t =3.549,P ＜ 0.05 ],glycosylated hemoglobin Alc [ (6.4 ± 2.5 ) ％ vs (7.1 ± 2.7 ) ％,t =2.603,P ＜ 0.05 ],total cholesterol [ ( 5.2 ± 2.3 ) vs ( 6.3 ± 2.4 ) mmol/L,t =2.036,P ＜ 0.05 ],triglyceride [(1.7±0.7) vs (2.4±0.8) mmol/L,t=2.368,P＜0.05] and BMI [(25.6±6.2) vs (27.3±6.5)kg/m2,t =2.546,P ＜ 0.05 ] were largely decreased.Conclusion Health education could improve selfmanagement and cure of diabetic patient with role lack.

Objective To investigate the expression of monocyte chemoattractant protein-1(MCP-1)and CCR2 in peripheral blood and pleural fluid of tuberculous pleurisy patients.Methods Flow cytometry was used to detect the expression of CCR2 in the peripheral blood mononuclear cell and pleural fluid cell of tuberculous pleurisy patients;ELISA was used to detect the content of MCP-1 in serum and pleural fluid.Results MCP-1 in surem and pleural fluid and CCR2 in the peripheral blood mononuclear cell and pleural fluid cell of tuberculous pleurisy patients was significantly higher than that of the healthy normal controls[MCP-1:(340.8±220.8)and(9.0±3.8)ng/L,P＜0.01;CCR2(18.2±10.1)%and(6.9±3.5)%,P＜0.05];Both MCP-1 and CCR2 were detected in pleural fluid and both of them were positivley correlated(r=0.227,P＜0.05).Conclusion The expression of MCP-1 and CCR2 in peripheral blood of tuberculous pleurisy patient are significantly elevated which are significance molecule participating in the pathogenesis of tuberculous pleurisy.

ObjectiveTo probe the feasibility and therapeutic effect of the lateral thigh perforator flap for repairing soft tissue defects in extremity limbs.MethodsDissected six fresh Chinese adult lower limbs specimens which were injected with red latex via arterial cannula. Obseved the number, distribution,course, category of the flaps'perforators and measured their length of pedicle, external diameter on the specimens.Combinafing the results of the anatomy study,thirteen lateral thigh perforator flaps,whose size were 3.0 cm × 3.0 cm - 19.0 cm× 8.0 cm, were applyied to repair different defect, in which 1 was pedieled flap and 12 were free flaps.Two of them applied vessel anastomosis in series with anterlateral thigh perforator flap. The axis was from the fibulae capitulum to greater trochanter of femur.ResultsAll 13 flaps surived com-pletely.In 3-6 months follow-up,all flaps were with thin and good appearance,and they were characterized by soft texture and good colour.No chimatlon and ulcer appeared in any flap.There were no effect of motor function in donor site because of muscle conglutination and scar contracture. There were plainness figure in donor site where skin- grafing was used, and only linearity scar remained where sewed directly.ConclusionThe lateral thigh flap had provided with thin and pleasing appearance, soft texture and minor morbidity in donor site and correspondingly easy dissection. It was feasiblely to repair middling to little skin and soft tissue defect in extremity limbs as a free flap, and to repair skin and soft tissue defect in knee and popliteal space as a pedicel flap.It could apply vessel anastomosis in series with anterlateral thigh perforator flap for repairing large defect.

Objective To explore new methods of innervating the anterolateral thigh flap(ALTF) for repairing widespreadly traumatic soft tissue defects in heel and report their initial results of clinical application. Methods Twenty-five consecutive ALTFs were transplanted in 25 patients for repairing widespreadly traumatic soft tissue defects in heel from October 2005 to October 2010. Three ways were used in this series for sensory reconstruction of ALTFs,which based on the primary researches of the anatomic and histomorphological characteristics of lateral femoral cutaneous nerve (LFCN),medial calcaneal nerve (MCN) and lateral calcaneal nerve (LCN). The first way which was of suture between reshaped LFCN and MCN or LCN was used in 16 cases, the second way which was of perineurial suture combined with epineurial suture was used in 6 cases,and the small-gap-suture way was used in the remaining cases.The section of LFCN 5-7 cm below the anterior superior iliae spine and the initial segment of MCN or LCN were selected as anastomotic position. Postoperative follow-up parameters include pain sensation, touch sensation, thermal sensibility and static two-point discrimination. Results All flaps survived,and the wounds were primary intention.Twentyfive cases followed up 9-36 months (18 months on average).All flaps restored protective sensation,and the rate of good sensory recovery was 60％. All patients restored weighing and walking, and no ulceration happened. Conclusion Satisfactory sensory function restoration can be obtained by paying attention to the distribution and variety of LFCNs, selecting suitable cutaneous nerves and rational coaptated position as well as suitable suturation means which based on the anatomic and histomorphologieal characteristics of LFCN,MCN and LCN when repairing widespread soft tissue defects in heel.

Objective To investigate the effect of repairing soft tissue defects in the middle and distal phalanx with the reverse dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artery. Methods Twenty-five fingers with soft tissue defects in the middle and distal phalanx were repaired by the reverse dorsal metacarpal and digital fasciocutaneous flaps based on the dorsal cutaneous branches of the proper digital artery from June 2007 to June 2009. Their pivot points were located at the midpoint or distal segment of proximal phalanx. Results Among 25 flaps, 24 survived completely, but cuticular layer in the distal part of one flap was partially necrotic. Twenty flaps were followed up from 12 to 18 months after operation. All flaps were characterized by rich blood supply, cold-resistance, suitable thickness, soft texture and good colour, except that 6 flaps required a secondary operation because of their fat and clumsy pedicel. There was no adhesion of extensor tendon and contraction of interdigital web in the donor sites. Two-point discriminations of anastomosing cutaneous nerve ranged from 6 mm to 10 mm in 5 of the 20 flaps, and 8 mm to 14 mm in the other 15 flaps. Conclusion The dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artery is an ideal option for repairing soft tissue defects of middle and distal phalanx because of its advantages of easy and secure dissection, reliable blood supply, longer arch of rotation, being closer to the raw surface of finger, less injury to the donor site, good appearance, avoidance of sacrificing major arteries ,and high probability of reconstructing flap sensation by anastomosing cutaneous nerve.

OBJECTIVE: To explore the reasons of poor sensation recovery after anterolateral thigh flap (ALTF) transplantation and to improve the design and sensation reconstruction of ALTF. METHODS: Lower limbs from 21 adult cadavers were chosen, and the lateral femoral cutaneous nerves (LFCN) were dissected. Their courses, shape, distribution and anatomic variation were observed, the distance from original sites of LFCN's posterior and anterior branches to the anterior superior iliac spine (ASIS) were measured, and the external diameter of their main trunks,after piercing out from the inferior margin of inguinal ligament or sending out their posterior branches and their anterior branches, were measured. RESULTS: The plane which the posterior branches sent out from the LFCN located at 4.8 (0~16.9) cm below the ASIS. The plane which the anterior branches sent out from the LFCN located at 14.2 (6.7~24.1) cm below the ASIS. There were 6 branches of the LFCN, namely ordinary three branches (9/21), high-level posterior branch (5/21), posterior branch absent (3/21), anterior branch absent (1/21), tiny branch, (2/21) and LFCN absent (1/21). The section of the LFCN was oblate, the external diameter of the LFCN,s main trunk after piercing out from the inferior margin of inguinal ligament or sending out its posterior branch and its anterior branch was 2.68 (1.18-4.52) mm, 2.18 (0.80-4.10) mm and 1.63 (0.44-2.60) mm, respectively. CONCLUSION Poor sensation recovery after ALTF transplantation is due to anatomic variation of the posterior branch of the LFCN. The sensory recovery of ALTF may be improved if the 2/3 low to median part of the anterolateral thigh and the main trunk of the LFCN or its plane before sending out the anterior branch is chosen for anastomosis.
Cadaver ; Female ; Humans ; Ilium ; anatomy & histology ; Inguinal Canal ; anatomy & histology ; Male ; Skin ; innervation ; Surgical Flaps ; innervation ; Thigh ; innervation

Objective To evaluate the efficiency and safety of genipin collagen crosslinking (G-CXL) on rabbit corneas in vivo.Methods Forty healthy New Zealand white rabbits were randomly divided into 0.20％ G-CXL,0.25％ G-CXL,standard UVA-CXL and normal control group.And the right eyes were treated in different grouping.No procedures were performed in the normal control group.The corneal curvature (Km) and central corneal thickness (CCT) of right eyes were evaluated before,7 days and 14 days after crosslinking treatment.Cornea strips were harvested from the right eyes and tensile strain measurements were performed 7 days and 14 days after crosslinking treatment.The structure of corneal stroma was observed under light microscope (LM) and transmission electron microscope (TEM).Results No statistically significant differences in Km were observed among different groups or different timepoints (Fgroup =0.301,P=0.825;Ftime =1.287,P=0.284).Significant difference in CCTs was noticed among different time pionts (Ftime =3.786,P =0.029).Compared with preoperative,the CCTs of all the groups were significantly increased 7 days after crosslinking (all at P＜0.05).No significant difference in CCT was found among the groups (Fgroup =0.557,P=0.646).Seven days after crosslinking treatment,the Young's modulus at 10％ strain was (1 1.96±5.74),(21.24±6.77),(18.76±3.34) and (11.56±4.37) MPa in 0.20％ G-CXL group,0.25％ G-CXL group,UVA-CXL group and normal control group,respectively;the stress at 10％ strain was (0.68 ±0.24),(1.20 ± 0.25),(1.0l ± 0.30) and (0.69 ± 0.26) MPa,respectively;the Young's modulus and stress in 0.25％ G-CXL group was significantly increased when compared with those in 0.20％ G-CXL and normal control group (both at P＜0.05).No significant difference in Young's modulus and stress was observed between 0.25％ G-CXL group and UVA-CXL group (all at P＞0.05).Forteen days after crosslinking treatment,Young's modulus at 10％strain was (16.65±3.19),(19.12±2.39),(22.83 ±4.38) and (12.70±2.72)MPa in 0.20％ G-CXL group,0.25％ G-CXL group,UVA-CXL group and normal control group,respectively;stress at 10％ strain was (0.83 ±0.12),(0.97±0.04),(1.23±0.30) and (0.65±0.20) MPa,respectively;the Young's modulus and stress in UVA-CXL group was significantly increased,when compared with 0.20％ G-CXL group and normal control group (all at P＜0.05).Statistical significance of stress was observed between 0.25％ G-CXL group and UVA-CXL group (P =0.046).There is no significant difference in Young's modulus between 0.25％ G-CXL and UVA-CXL group (P =0.090).LM showed the reduction of keratocytes existed in superficial stroma of 0.20％ and 0.25 ％ G-CXL groups,while the reduction of keratocyte was found in anterior and intermediate stroma of UVA-CXL group.In 0.20％ and 0.25％ G-CXL groups,the ultrastructure of keratocytes was normal except vacuole in some keratocytes.Keratocytes apoptosis was noticed in UVA-CXL group and keratocytes was normal in deep stroma under TEM.Conclusions 0.25％ has a similar biomechanics effect when compared to UVA-CXL.Moreover,histological observation proves a better safety of G-CXL in comparison of UVA-CXL.