Objective To summarize the experience of l ap aroscopic pyloromyotomy for the treatment of infantile hypertrophic pyloric sten osis (IHPS). Methods Laparoscopic pyloromyotomy was employed i n 50 cases of IHPS from April 2001 to April 2004. The patients aged 12~90 days ( mean, 35 days). Three 3-mm-diameter trocars were introduced into the abdominal c avity via the left, right and upper abdominal wall, respectively. A non-traumati c grasping forceps was inserted through the left trocar to manipulate the gastri c wall near the pylorus. Through the right trocar, a retractable pyloromyotomy s calpel, a stripper and a dissecting forceps were in turn utilized to complete py loromyotomy. Results The operation was completed under laparos cope in 48 cases, while a conversion to open surgery was needed in 2 cases (1 c ase of prepyloric membrane and 1 case of pyloric mucosal injury, which were cure d by open repair). The operative time was 15~45 min (mean, 25 min). The nasogast ric tube was removed and oral feeding with milk was attempted 6 hours after the operation. The patients were discharged at 3~5 postoperative days. Follow-up for 3~6 months (mean, 4.5 months) in 42 cases showed that the patients were normall y developed. Conclusions Laparoscopic pyloromyotomy can be wel l performed in the presence of experience in open surgery, technical skills in l aparoscopy, effective anesthesia and proper surgical instruments.

Objective To investigate the feasibility of L-[1- 13 C]phenylalanine breath test to assess liver function and determine the effective parameters of the test for quantitative assessment of liver function in adult. Methods Twelve healthy volunteers served as control group, and 26 liver cirrhotic patients with hepatitis B were divided into three groups, 10 patients in Child-Pugh classification A, 8 in B and 8 in C, An oral dose of 100 mg of nonradiative tracer L-[1- 13 C]phenylalanine were administered to all the subjects. Breath samples were taken before and different intervals within 360 min after administration. 13 CO_2 enrichment was measured by isotope ratio mass spectrometer. Results After the oral administration of L-[1- 13 C] phenylalanine, 13 C excretion reached a peak within 10-30 min. The parameters of 13 CO_2 excretion rate at 30 min ( 13 CO_2ER_ 30 ) , 13 C cumulative excretion of 60 min ( 13 C_ cum60 ), 75 min( 13 C_ cum75 ), 90 min( 13 C_ cum90 ) and 13 CO_2 half excretion time ( t _ 1/2 ) were shown sensitive, which could differentiate significantly the groups( P

Objective To summarize the value of laparoscopic operation using an ultrasonic scalpel for the radical treatment of Hischsprung’s disease (HD) in infants and children. Methods Laparoscopic operation was performed in 20 infants and children with HD under general anesthesia from February 2003 to January 2006. The CO_2 pressure of pneumoperitoneum was set at 10~12 mm Hg. By way of three abdominal ports, the diseased colon and rectum were mobilized by dissecting the supplying vessels and severing the peritoneal reflection in the pelvic floor. The modified Soave pull-through procedure was employed to incise and mobilize the rectal mucosa at 0.5 cm above the dentate line. The lateral ligament of rectum was severed and the intraabdominal cavity was reached through the peritoneal reflection. The diseased colon was pulled through the anus passing the level of the transition zone for resection. Then coloanal anastomosis was made between the proximal colon and the cutting edge of the anal canal above the dentate line. Results All the procedures were completed smoothly. The operation time was 120~210 min (mean, 132 min). The length of resected colon was 20~55 cm (mean, 35 cm). The intraoperative blood loss was 5~20 ml (mean, 14 ml), with no need of blood transfusion. Enterocolitis happened in 2 cases postoperatively. Follow-up observations in the 20 cases for 3~36 months (mean, 12.5 months) found no complications. The patients had 1~2 times of fecal discharge per day during follow-up. Conclusions Laparoscopic pull-through procedure using an ultrasonic surgical scalpel has advantages of minimal invasion, little hemorrhage, simple performance, quick recovery, and low complication rate.

Objective To investigate the feasibility of two-port laparoscopy-assisted resection of the Meckel’s diverticulum in children. Methods Resection of the Meckel’s diverticulum was performed under a laparoscope in 13 children in our hospital from July 2002 to March 2006. Two 5-mm trocars were introduced at the infraumbilical ring and the right lower abdomen, respectively. When the Meckel’s diverticulum was found, the incision was prolonged to 2 cm long along the inferior border of the umbilicus, the diverticulum was removed externally and the intestine was anastomosed. Results The operation was completed successfully without conversion to open surgery. The mean operation time was 50 min (range, 40-70). The intestinal function of the patients recovered 24 hours after the operation, and then liquid food was given at 3 days postoperatively, and the patients was discharged from hospital within 5-7 days after the operation. The patients were followed up for 6-48 months (mean, 13), during which no one had recurrence, intestinal adhesion, or intestinal obstruction. Conclusions Two-port laparoscopy-assisted resection of Meckel’s diverticulum is safe and feasible for children. The recovery time and hospital stay are short after the procedure.

OBJECTIVE To investigate the susceptible factors and the methods of prevention and treatment of nosocomial deep fungal infection in intensive care unit(ICU).METHODS The clinical information of 798 patients in ICU was investigated from Jul 2005 to Jun 2007.The risk factors,species,drug-resistance and the methods of prevention of fungal infection were analyzed.RESULTS Fungal infections were found in 137 cases(17.2%).The lower respiratory tract accounted for 72.3% in 137 cases with fungal infection.A total of 180 strains of fungi were isolated,Candida albicans,C.tropicalis and C.glabrata accounted for 43.3%,25.6% and 23.3%.The resistance characteristics to fluconazole,itraconazole,5-fluorocytosine and amphotericin B were relatively weak.The factors related to nosocomial fungal infection were the severity of the underlying disease,long-term use of antibiotics and glucocorticoid and invasive procedure.CONCLUSIONS Proper use of antibiotics and immuno-depressor,reduction of unnecessary operation and early diagnosis are the keys in prevention of systemic fungal infection.

Objective To investigate the expression of heat shock protein(HSP)70 and HSP90 in patients with atrophic gastritis(AG)or gastric cancer(GC)and its significance.Methods One hundred and forty-one patients including 35 with superficial gastritis(CSG),66 with AG(miner in 21,medium in 30 and severe in 15)and 40 with GC were enrolled with mean age of 47.8,56.1 or 59.4 years,respectively.H.pylori positive patients were 12 with CSG and 28 with AG.The quantity analysis of HSP90 and HSP70 were detected by immunohistochemistry,whereas their mRNA and protein expressions were measured by Western bolt and real-time PCR,respectively.Results The mRNA expression of HSP70 was significantly higher in CSG(1.31±0.80)and AG(1.41±0.80)than that in GC(1.18±0.70,P＜0.05),but was significantly lower in miner(1.32±0.70)and medium(1.34±0.60)AG than that in severe AG(2.20±0.80,P＜0.05).The mRNA expression of HSP90 was kept on increasing in order of CSG(1.27±0.60),AG(1.53±0.80)and GC(1.84±0.70); or in order of miner(1.33±0.60),medium(1.47±0.90)and severe(2.75±0.70)(P＜0.05).The patients infected with H.pylori had higher expression of HSP90 compared with those without H. pylori infection (P＜0.05). Conclusion The synchronous increase of HSP90 and HSP70 indicates the aggravation of AG. When HSP90 is up-regulated and HSP70 is down-regulatied, it may predict the occurrence of cancer.

Aim To evaluate the reversal effect of 2-deoxy-D-glucose ( 2-DG ) on multidrug resistance ( MDR) by observing the uptake change of 99m Tc-MIBI in HNE-1/DDP cells, and to explore its mechanism. Methods The uptake of 99m Tc-MIBI in HNE-1/DDP cells under different concentrations of 2-DG was detec-ted by γ-counter, and the clearance rates of 99m Tc-MI-BI in HNE-1 cells and HNE-1/DDP cells after treated with 2-DG (10 mmol·L-1 ) were compared. The con-tent of ATP in HNE-1/DDP cells was detected after treated with 2-DG. P-glycoprotein ( P-gp ) and multi-drug resistance-associated proteins ( MRP ) expression were measured by Western blot. Apoptotic HNE-1/DDP cells treated with DDP alone or combined with 2-DG (10 mmol·L-1 ) were detected by propidium io-dide ( PI ) staining. Results The clearance rate of 99m Tc-MIBI in HNE-1/DDP cells was 54. 8%, which was significantly higher than that ( - 41. 3%) in HNE-1 cells (P<0. 01). The clearance rate of 99mTc-MIBI in HNE-1/DDP cells was -203. 7% after treat-ment with 2-DG ( 10 mmol · L-1 ) , which could be significantly reduced compared with the control group ( P<0. 01 ) . The level of ATP was 55 . 69% compared with the negative control group and the expression of P-gp and MRP protein decreased dramatically in HNE-1/DDP. With the combination of 2-DG and DDP, the ap-optotic rate of HNE-1/DDP cells reached 49 . 4%which was significantly higher than DDP treated group (22. 5%) . Conclusion Multidrug resistance and the reversal effect of 2-DG on multidrug resistance could be evaluated effectively by detecting the uptake change of 99m Tc-MIBI in HNE-1/DDP cells. The mechanism may be related with the inhibition of ATP level and the re-duced expression of P-gp and MRP protein in cancer cells.

Matrix metalloproteinase-9 (MMP-9) can promote the invasion and metastasis of breast cancer through various mechanisms.The expressions of MMP-9 in the patients with breast cancer are correlated with the prognosis.The higher expression of MMP-9 indicates poorer prognosis.It is suggested that the level change of MMP-9 pre and post treatment can be used as a reference standard for judging the prognosis and clinical effect.

Objective To evaluate the relationship between ambulatory arterial stiffness index (AASI) and intracranial and extracranial arterial stenosis in 146 patients with ischemic cerebrovascular disease. Methods Degree of intracranial and extracranial arterial stenosis in 146 patients with ischemic cerebrovascular disease was assessed by CT angiography (CTA). Then all patients were divided into 4 groups according to the numbers of branches with stenosis: no stenosis group, 1 branch group, 2 branches group, and 3 and more than 3 branches group. Dynamic blood pressure was monitored to calculate the AASI. Results There was no significant difference of AASI among the extracranial arterial stenosis groups (P=0.614). AASI was positively correlated with the degree of intracranial artery stenosis (r=0.743, P<0.05), and with 3 and more intracranial artery branches stenosis (r=0.797, P<0.05). Conclusion AASI is closely correlated with the degree and numbers of branches of intracranial artery stenosis.

Objective To improve the recognition and reduce the misdiagnosis of bipartite patella by analyzing and summarizing the imaging features.Methods X-ray,CT and MR images of 1 7 cases of bipartite patella were collected,imaging features were ana-lyzed and summarized.Results X-ray revealed the smooth interface of the main and accessory patella fragments with sclerotic mar-gins,the cleft was slightly wide but not sharp.CT showed the bone sclerosis of interface was mostly smooth,rough and vesicular interface could also be found in a few patients,low density soft tissue could be found in separation zone.MRI could detect the intact but thinned cartilage covering the main and accessory patella fragments,fibrous like tissues could be found in separation zone with MRI.Conclusion Imaging findings of bipartite patella are characteristic,these features are helpful in the diagnosis and differential di-agnosis of bipartite patella.