Background: s/Aims: Pancreaticoduodenectomy (PD) is the only radical treatment for periampullary malignancies. Superior mesenteric artery (SMA) first approach combined with total meso-pancreas (MP) excision was conducted to improve the oncological results.There has not been any previous research of a technique that combines the SMA first approach and total MP excision with a detailed description of the MP macroscopical shape. Methods: We prospectively assessed 77 patients with periampullary malignancies between October 2020 and March 2022 (18 months). All patients had undergone PD with SMA first approach combined total MP excision. The perioperative indications, clinical data, intra-operative index, R0 resection rate of postoperative pathological specimens (especially mesopancreatic margin), postoperative complications, and follow-up results were evaluated. Results: The median operative time was 289.6 min (178−540 min), the median intraoperative blood loss was 209 mL (30−1,600 mL).Microscopically, there were 19 (24.7%) cases with metastatic MP, and five cases (6.5%) with R1-resection of the MP. The number of lymph nodes (LNs) harvested and metastatic LNs were 27.2 (maximum was 74) and 1.8 (maximum was 16), respectively. Some (46.8%) patients had pancreatic fistula, but mostly in grade A, with 7 patients (9.1%) who required re-operations. Some 18.2% of cases developed postoperative refractory diarrhea. The rate of in-hospital mortality was 1.3%. Conclusions The PD with SMA first approach combined TMpE for periampullary malignancies was effective in achieving superior oncological statistics (rate of MP R0-resection and number of total resected LNs) with non-inferior short-term outcomes. It is necessary to evaluate survival outcomes with long-term follow-up.

Background: s/Aims: Parenchymal-sparing anatomical hepatectomy (Ps–AH) based on portal ramification of the right anterior section (RAS) is a new technique to avoid unnecessarily transecting too much liver parenchyma, especially in cases of major anatomical hepatectomy. Methods: We prospectively assessed 26 patients with primary hepatic malignancies having undergone major Ps–AH based on portal ramification of the RAS from August 2018 to August 2022 (48 months). The perioperative indications, clinical data, intra-operative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated. Results: Among the 26 patients analyzed, there was just one case that had intrahepatic cholangiocarcinoma The preoperative level of α– Fetoprotein was 25.2 ng/mL. All cases (100%) had Child–Pugh A liver function preoperatively. The ventral/dorsal RAS was preserved in 19 and 7 patients, respectively. The mean surgical margin was 6.2 mm. The mean surgical time was 228.5 minutes, while the mean blood loss was 255 mL. In pathology, 5 cases (19.2%) had microvascular invasion, and in the group of HCC patients, 92% of all cases had moderate or poor tumor differentiation. Six cases (23.1%) of postoperative complications were graded over III according to the Clavien–Dindo system, including in three patients resistant ascites or intra-abdominal abscess that required intervention. Conclusions Parenchymal-sparing anatomical hepatectomy based on portal ramification of the RAS to achieve R0-resection was safe and effective, with favorable short-term outcomes. This technique can be used widely in clinical practice.

In Bach Mai Hospital from May 1998 to June 2002, 23 children aged 10-15 (15 girls and 8 boys) with malformation of brain vessel were diagnosed definitely. Most of under 11-year-old children have swelling vessel, 30.4% of above 11-year-old children have AVM malformation - 52.1%. The main manifestations of brain vessel malformation are hemorrhage of brain lobe 65.2%, subarachroid hemorrhage 39.1%, brain ischemia 30.4%, epilepxy or epileptic conditions 21.7%, head pain of migraine type 17.4%. Unilateral palsy of III nerve is specific sign for diagnosis of swelling of prosterior communicating artery with a rate of 8.7%. Dysphasia is temporary, while the visual dysfunction is more persistent
Child ; Pupil Disorders ; Nervous System Malformations

At the Department of Neurology, Bach Mai Hospital, 11 cases of cerebral infarction were studied in the first 6 months of the year 2002. All 11 patients underwent CT scanning, blood examination, EEG, X-ray examination of heart and lung. Results showed that cerebral infarction can be diagnosed definitely, especially it can be differentiated with cerebral haemorrhage, etc … to develop a possibility of intensive and effective management of cerebral infarction. CT radiography permits an efficacy monitoring of the treatment processus
Cerebral Infarction ; Brain Infarction ; Brain Diseases

The study carried on 30 patients diagnosed reversible ischemic neurologic deficit (RIND) at Bach Mai Hospital Nervous deparment from 2000 January. Result: The indicende of male was higher than female (67% vs 33%). 70% were 45 to 59 years of age. Two major reasons were internal carotid artery stenosis 60%, heart diseases e.g mitral stenosis and insufficiency, artrial fibrillation 27%, the cause of unknown 13%. The clinical symptoms of RIND were: hemiplegia 100%, hemisensory loss, dysphasia or aphasia. RIND can make cerebral infarction, so need to detect early and treat timely to advoid stroke and cerebral infarction
Brain Ischemia ; Neurologic Manifestations ; Ischemia

23 patients with diagnosed malformation of cerebral artery treated at Bach Mai Hospital from May 2000 to April 2002, were admitted because of complications of subarachnoid, or epileptic state, or of localized signs of nerves such as unilateral paralysis of III nerve. All patients were undergone basic examination such as angiography, uremia, glucemia, electroencelograme. 16/23 patients undergone CT scan, 19/23 encephalomyelo puncture, 100% encephaloarterigraphy and 16/23 operation. Internal therapy in acute stage is very important, contibuting to the results of an operation
Cerebral Arteries ; Arteriovenous Malformations ; Patients ; diagnosis ; Therapeutics

37 patients (20 male, 17 female) treated in Bach Mai Hospital from May 2000 to March 2002 with definite diagnosis of ventricle hemorrhage. All they were undergone a CT scanning for detecting the blood in brain ventricle by various level and various images. In 19/37 patients by puncture encephalomyelo liquid was examined, in 1 patient there is an artery - venous communicans determined by arrterioangiography. Initial symptoms such as headache, nausea/vomit, conciousness disturbance, hemi-paralytis, seizure, fever, urine retention, uncontrolled urination, eyelid collapsure, dizziness and perspiration. An early diagnosis and proper treatment can decrease the mortality and the disability
Hemorrhage ; Patients ; Cerebral Ventricles ; diagnosis

60 subjects with brain lacunar infarction and 60 with other brain (no lacunar) infarction aged 20-67 were investigated in Bach Mai Hospital from Jan 2001 to Jun 2002. The proportion of brain lacunar infarction vs other brain infarction was 38% in the same duration. 5 main syndromes of lacunar infarction were 98%, other syndromes 2%. There is no difference in age and gender of both groups. Risk of complications of brain lacunar infarction raised by 8,9 times in comparing with high blood pressure, 6,5 times with smoking, 2,3 times with diabetes
Cerebral Infarction ; Brain Infarction ; Brain ; diagnosis ; risk factors

A study on 60 patients with the cerebral lacunar infarction, ages of 20-85 and 60 patients with cerebral infarction (control), ages of 20 -87 has shown that the syndromes of cerebral lacunar infarction comprised hemiplegia type of merely moving, speaking disorder hemiplegia type of combination of sense and moving, merely sense accident and other lacunar syndromes. The risk factors of diseases were hypertension, diabetes and smoking.
Cerebral Infarction ; Brain Infarction ; diagnosis

Hemorrhage occurs within 48 hours after accident onset. In fact, there was not any case in which the hemorrhage occurred before 6 hours. 4 week serial and continuous CT scanner imaging showed that hemorrhagic cerebral infarction occurred within 24 hours in 10%, within 7 days in 39% and within 14 days in 54%. In this study, hemorrhagic cerebral infarction occurred within 1 to 3 days in 40%, 4 to 10 days in 50% and 11 to 30 days in 3%. These results are limited because the serial and continuous CT scanner imaging is less to be performed. All of 30 patients have bleeding from middle cerebral artery. CT scanner imaging showed that hemorrhagic infarction occurred in 24 out of 30 patients (80%) and parenchymal hematoma occurred in 6 patients (20%)
Ischemia ; Hemorrhage ; diagnosis ; Cerebrovascular Accident