Objective To explore the application value and clinical efficacy of one half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced in pancreaticoduodenectomy.Methods The retrospective cross-sectional study was conducted.The clinical data of 17 patients with pancreatic neoplasms and ampullar neoplasms who underwent pancreaticoduodenectomy at the Second Affiliated Hospital of Harbin Medical University from May to September 2015 were collected.One half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced method was applied to the digestive tract reconstruction after pancreaticoduodenectomy in the 17 patients.Observation indicators included:(1)surgical situations:surgical procedures,operation time,time of pancreaticojejunostomy,volume of intraoperative blood loss,tumor sizes,(2) postoperative situations:recovery time of gastrointestinal function,postoperative complications,duration of postoperative hospital stay,(3) postoperative pathological examinations,(4) follow-up.Patients were followed up by outpatient examinations including color Doppler ultrasound or abdominal computed tomography (CT) and telephone interview detecting abdominal pain or distention and general situations (diet,sleep) up to October 2015.Measurement data were represented as average (range).Results (1) Surgical situations:all the 17 patients underwent successful operations without perioperative death,including 16 undergoing radical pancreaticoduodenectomy and 1 undergoing pancreaticoduodenectomy and left liver resection.The average operation time,average pancreaticojejunostomy time,average volume of intraoperative blood loss and average tumor size were 276 minutes (range,230-440 minutes),12 minutes (range,9-16 minutes),310 mL (range,200-950 mL) and 3.25 cm2(range,1.92-5.60 cm2),respectively.(2) Postoperative situations:the average recovery time of gastrointestinal function was 3 days (range,1-7 days).Three patients had postoperative complications,including 1 patient with pancreatic fistula (Grade A) and 2 patients with delayed gastric emptying,and all of them had been healed after symptomatic and supportive treatments.The results of T-tube cholangiography or CT before hospital discharge showed that there was no leakage around the anastomoses.The average duration of postoperative hospital stay was 10 days(range,6-20 days).(3) The postoperative pathological examinations showed 5 patients of pancreatic ductal adenocarcinomas,4 of common bile duct ampulla area adenocarcinomas,3 of duodenal papillary adenocarcinomas,3 of pancreatic intraductal papillary mucinous neoplasms and 2 of duodenal ampullary adenocarcinomas.(4) Followup:all the 17 patients were followed up for 1-4 months and the abdominal color Doppler ultrasound or CT showed that there was no evidence of tumor recurrence or leakage around anastomoses.Conclusion One half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced is safe and feasible,and it can reduce the rate of pancreatic fistula successfully.

Hepatocellular carcinoma (HCC) combined with inferior vena cava (IVC) tumor thrombosis is regarded unresectable.Most of the patients received non-surgical treatment or gave up treatment,and the prognosis of these patients is poor.As the development of surgical treatment,the success rate of surgical treatment for HCC combined with IVC tumor thrombosis is increasing yearly.In May of 2012,one patient with HCC combined with IVC tumor thrombosis received hepatic Ⅴ,Ⅶ and Ⅷ segmentectomy + tumor thrombosis removal from the IVC at the Second Affiliated Hospital of Harbin Medical University.Preoperative computed tomography showed space-occupying lesions in the segments Ⅴ,Ⅶ and Ⅷ,and the IVC was filled with tumor thrombi.The volume of the left liver was 489 cm3,which was under the limit for survival.In order to preserve the remnant liver,right hepatectomy with reservation of hepatic segment Ⅵ,and the tumor thrombi in the IVC were removed with total hepatic vascular exclusion.The patient was recovered with no tumor recurrence or metastasis at postoperative month 18.

One case of renal infarction due to trauma in a 26 years old male patient, which was treated with partial nephrectomy, was presented with the brief review of literature.
Adult ; Humans ; Infarction* ; Male ; Nephrectomy

The medical curriculum is designed to provide a core of scientific knowledge and technical skills that ultimately enables a student to care for primary patients. In addition to specific knowledge, the school offers an environment in which students have the opportunity to acquire the habits of study, the sound attitud, and the sense of responsibility for patients that characterize the true physician. To achive these purposes, the clerkship of medical student is very important. We investigated current problems in clinical clerkship of Chonnam University Medical School, and the problems were as follow: (1) relatively short period of clinical training especially in main subjects, (2) lack of presonnels in charge of clinical training, (3) lack of objective test, (4) lack of clinical training in primary care hospital, (5) lack of opportunity of self learning. The methods to improve clinical training were to promote interests in clinical education of staffs, to prolong the duration of clinical clerkship, to select and educate the personnel in charge of clinical education, to do the objective tests, to do the elective tests, to do the elective course, to use of integrated course and problem oriented education, and to let the student care the patients under supervision.
Clinical Clerkship ; Curriculum ; Education ; Education, Medical ; Humans ; Jeollanam-do ; Learning ; Linear Energy Transfer ; Organization and Administration ; Primary Health Care ; Schools, Medical ; Students, Medical*

Objective To investigate the effective route and proper method in transfecting gene into liver graft mediated by adeno-associated virus vector.Methods Three routes including hepatic artery,portal vein and hepatic artery+portal vein,and 3 methods,i.e.routine,circulation and clamping were employed for infusion.The best infusion route and method of gene transfection into liver graft were determined by observing the color change of liver and detecting liver function and transfoetion rate of liver cells.The safety of these methods was evaluated.Results In all the infusion procedures,the color of the liver grafts turned from red to white,no apparent color differenee of the livers and no enlargement nor mottling were observed under surgical microscope.The liver color was back to normal immediately after blood flow was restored.No significantly statistical differences of the ALT values were observed among all the groups(F=0.343,1.265,0.055,P＞0.05).Adeno-associated virus vectors coding for the enhanced green fluorescence protein(AAV2-EGFP)were successfully transfected into liver cells by the 3 infusion routes 1 week later,and the difierences of transfection rates via the 3 routes had no statistical significance(F=0.080,0.091,0.045,P＞0.05).The transfoction rate of AAV2-EGFP was the highest at any time points when using the clamping method,and then followed by circulation method and routine method,with statistical differenee(F=3.880,2.976,5.129,P＜0.05).The transfection rates of AAV2-EGFP were increased progressively and peaked at the 6th week,and then they were decreased gradually.Conclusions Infusion via hepatic artery is the effective route for gene transfection and clamping the vessels can elevate the transfection rate of AAV2-EGFP.All procedures were performed without detectable liver injury.The transfection of gene into liver graft mediated by adeno-associated virus vector is a slow and persistent process.

Objective To investigate the features of familiar facial palsy,ophthalmoplegia and dysphagia characterized by autosomal dominant inheritance in a family and to discuss the classification and pathogenesis of the disease.Methods Clinical,electrophysiological,pathological examinations were performed and blood samples were obtained from 5 patients and 26 family members.PCR protocol was used to identify a certain gene. Results In the 5 patients receiving physical examination,all had ptosis,external ophthalmoplegia,facial paralysis,dyphagia,hoarseness,decreased pharyngeal reflex;4 had amyotrophy of muscle of tongue,temporal nuscle,masseter and muscles of distal lower limbs;3 had proximal limb asthenia and distal limbs amyotrophy.Compared to those of oculopharyngeal muscular dystrophy(OPMD)with similar symptoms and signs,both electrophysiological manifestation and pathological findings of the family members supported the diagnosis of muscular dystrophy,but the(GCG)6(GCA)3GCG in the first exon of PABPN1 mutated neither in normal family members nor in patients.Conclusions This family presents clinical manifestations somewhat resembling to those of OPMD and distinctive to other disorders,but has a totally different genetic background from OPMD.It may be a new subtype of muscular dystrophy.

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Pancreatic ductal carcinoma accounts for 85％-90％ in pancreatic cancer, followed by the pancreatic cellendocrine tumors and pancreatic acinar cell carcinoma.In addition, mesenchymal cell carcinoma of pancreas is rare, and a mixed pancreatic cancer from 3 cells carcinoma is extremely rare.And pancreatic cancer always assume hypovascular tumor,spontaneous rupture of pancreatic cancer is rarely reported.A patient with a mixed duct-acinar-islet cell tumor of pancreas was admitted to the Second Affiliated Hospital of Harbin Medical University in June 2014, and underwent emergent operation of intraabdominal bleeding due to spontaneous rupture of tumor.The follow-up was done up to January 20, 2015.The patient died of intraabdominal widespread implantation metastasis of pancreatic cancer.A mixed duct-acinar-islet cell tumor of pancreas is extremely rare and easy to metastasis and diffusion of tumor with a rapid disease progression and a poor prognosis of patient,while operation is the key to terminate deterioration of the condition, and is the last line of defense to save lives.

Hepatolenticular degeneration was one of the rare several genetic metabolic diseases in clinic that could be cured by liver transplantation method, developing slowly and being irreversible. Metabolic disorders of copper lead to abnormal copper accumulation in various of tissues and organs. So that, the disease′s clinical manifestations were lacking in specificity and many patients missed the best opportunity of drug treatment. With the maturity of technologies and innovation of theory of liver transplantation, there were more and more methods that will be applied to personalized treatment. In this paper, a review of the research progress in the treatment of hepatolenticular degeneration with liver transplantation was made with reference to the relevant literature at home and abroad.

For patients with malignant pancreatic cancer combined with vascular invasion,radical pancreaticoduodenectomy with vascular resection and anastomosis is the treatment of choice.Because this procedure is difficult to manage and with high risks,it is a great challenge to surgeons.A 50-year old patient with pancreatic head cancer whose portal vein and superior mesenteric vein were involved received radical pancreaticoduodenectomy in the Second Affiliated Hospital of Harbin Medical University.In the surgery,the tumor and its surrounding tissues were dissected,and then the portal vein and splenic vein were reconstructed.The patient was discharged at the 10th day after the surgery with favorable prognosis.