Objective To analyze the clinical characteristics and therapeutic effects of cutaneous metastasis from cholangiocarcinoma. Methods From 2006 to 2009, clinical data of 6 patients found with cutaneous metastasis from cholangiocarcinoma were reported. Perineural and vascular invasion were all found in the primary cholangiocarcinoma in these 6 cases with cutaneous metastasis and results were compared with 60 cases of cholangiocarcinoma without cutaneous metastasis. Follow-up to the 6 patients with cutaneous metastases was conducted at an interval of three months. Results One patient with mixed hepatocellular and cholangiocellular carcinoma developed cutaneous metastatic tumor and the pathological diagnosis was cholangiocellular carcinoma. Three patients with hilar cholangiocarcinoma and two patients with distal cholangiocarcinoma presented cutaneous metastases. All six cases of the primary cancers and cutaneous metastases were diagnosed as moderately- poorly differentiated adenocarcinoma. And there was perineural and vascular invasion in the primary tumors. Perineural and vascular invasion of primary cancer was found in 17of 60 patients with cholangiocarcinoma and without cutaneous metastasis. The cutaneous metastasis was positively correlated to the perineural and vascular invasion in the primary tumor (χ2 = 12. 7288, P ＜0. 001 ). Two of 6 cases presenting solitary nodular cutaneous metastasis received skin tumor excision. These two patients survived 8 and 10 months respectively. Among four patients with multiple cutaneous metastases,two cases received chemotherapy and survived 3 and 6 months respectively, the other two cases refusing treatment survived 3 and 4 months respectively. Conclusions Cutaneous metastasis usually occurred at cholangiocarcinoma with lower differentation and perineural and vascular invasion in the primary tumor.Solitary nodular cutaneous metastasis could be excised, multiple cutaneous metastases had poor prognosis.

Objective To investigate the mechanism of PBEF in pulmonary vascular endothelial permeability increasing after car-diopulmonory bypass ,in order to provide the basis for a better lung protective measures during cardiopulmonary bypass .Methods Animal models were established ,group A :the rats were transfected with the lentiviral AD-PBEFshRNA ;group B :the rats were took 30 min deep hypothermic circulatory arrest ;group C :the rats were took 30 min deep hypothermic circulatory arrest ,then trans-fected with the lentiviral AD-PBEFshRNA ;control group :the rats were anesthetized and established CPB tube ,without CPB by-pass .Lung tissue was detected with Western blotting and ELISA .Results PBEF ,phosphorylation of P38MAPK ,ERK ,MLC ,VE-cadherin ,FAK in group C had significant difference with group A ,B and the control group(P<0 .05) .VEGF ,MMP2 ,MMP9 ,W/D in group C had significant difference with group A ,B and the control group(P<0 .05) .The pathological results showed that rat lung tissue of the control group was normal ,while in group C ,it had severe pathological damage ,the pathological damage degree in group A ,B reduced compared to group C .Conclusion PBEF can through MAPK/PI3K-Akt/VEGF signaling pathway ,increase pulmonary vascular endothelial permeability .

Objective To investigate the combined inhibition effect and the potential mechanism of rapamycin (mammalian target of rapamycin inhibitor) and PD98059 (mitogen-activated protein kinase/extracellular signal-regulated kinase kinase (MEK) inhibitor) on mouse colorectal cancer (CRC). Methods S-ICR mice were subcutaneously injected with 20 mg/kg of 1,2-dimethylhydrazine dihydrochloride in the nape for 20 weeks to induce CRC. From the 16th week, the mice were treated with alone or combined injection with 0.25 mg/kg rapamycin and 2.5 mg/kg PD98059. The drugs were administered for 8 weeks. Subsequently, the animals were sacrificed and dissected, the tumor sizes were measured, and the tumors were harvested for pathological assay. Furthermore, the phosphorylation of mTOR, p70S6K, and 4E-BPl proteins was detected by using immunohistoehemistry. Results The mice treated with rapamycin (44. 44 %) or PD 98059 (either alone (38.89%) or combination treatment (6.67%) were significantly less likely to develop cancer compared with mice receiving none of them (77.78%, P<0. 05). The average size of tumors was (6.15±2. 192), (8.85±3. 983), (2.917±0. 191), (16.36±6.855) mm3 respectively (P<0.05).The anti-cancer effect of the combination treatment was substantially significant. The proteins of phospho-mTOR, phospho-p70s6K and phospho-4E-BPl were significantly down-regulated after treatments (all P values < ,0.05). Conclusions Combined treatment was more effective than single-drug treatments of rapamycin or PD98059 alone for the prevention and treatment of mouse CRC. The mTOR signal pathway might be involved in the inhibitory mechanism.

Among 2625 patients with type 2 diabetes,body mass index,systolic blood pressure,HbA1C,triglyceride,ApoB,serum uric acid,highly-sensitive C reactive protein,tumor necrosis factor α levels,and common carotid artery intima-media thickness in hypertriglyceridemic-waist ( HTWC ) phenotype group were higher than those in non-HTWC group,while high-density lipoprotein cholesterol and ApoA1 levels were lower( all P＜0.05 ).HTWC phenotype was an independent risk factor for atherosclerosis of carotid artery in patients with type 2 diabetes mellitus (OR 1.45,95％CI 1.07-1.96).

ObjectiveTo evaluate the various methods of choledochoplasty in the repair of major bile duct defects in Mirizzi syndrome.MethodsThis is a retrospective study on 3 patient with Mirizzi syndrome with a large bile duct defect.These defects were repaired by using a vascular gastric pedicle patch in our department from July 2008 to November 2011.The authors searched the domestic medical literature on surgical repair for Mirizzi syndrome in the past ten years.The patients were treated by various surgical methods,and they were analyzed according to the Csendes Classification.ResultsThere were no surgical complications in our three patients.There was one patient with a Csendes type Ⅲ,while the remaining 2 patients were with Csendes type Ⅳ.At a median follow- up of 2.5 years,no patient developed signs of chronic cholangitis.In the medical literature,there were 93 patients who were with Csendes type Ⅰ ; and 58 patients were treated by cholecystectomy only,while 35 patients were treated by partial cholecystectomy plus mucosal ablation.Of the 40 patients with type Ⅱ,29 patients were treated by direct fistula repair,9 patients by pedicle gallbladder flap and 2 patients by pedicle round ligament.Of the 20 patients with type Ⅲ,9 patients were treated by pedicle gallbladder flap.1 patient by pedicle round ligament,3 patients by pedicle gastric flap and 7 patients by Rouxen- Y hepaticojejunostomy.For the 5 patients with type Ⅳ,they were treated by Roux-en- Y hepaticojejunostomy.Of these 159 patients,postoperative complications included biliary fistula (n=1 ),upper gastrointestinal bleeding (n=1),and biliary stricture (n=1).All the remaining patients were cured.ConclusionIn patients with Mirizzi Syndrome,the choice of treatment depends on the size of the fistula.For patient with a major tissue defect in the common hepatic duct,a pedicle vascular gastric flap is a good treatment.

Objective To assess the effectiveness and safety of non-insufflation intra-abdominal compression as a prehospital hemostatic technique in treatment of liver injury.Methods Twenty-nine male Wistar rats were enrolled and randomly assigned into four experimental groups:IAP0 group ( n =8 ),IAP5 group (n =8),IAP10 group (n =8) and IAP15 group (n =5).Then,the anticoagulated rat models of severe liver injury were established with different intra-abdominal pressures ( 0,5,10 and 15 mm Hg) by using a non-expansible insufflated gas bag.Once the mean artery pressure (MAP) was less than 95 mm Hg,Lactated Ringer' s solution was infused through the right jugular vein at speed of 3.3 ml · min-1 · kg-1 until MAP reached 100 mm Hg.Thirty minutes later,the animals were killed by intravenous injection of 0.2 ml saturated potassium chloride solution to measure the intraperitoneal total blood loss,liver weight,volume of infused solution and MAP.Results No death was observed in IAP0,lAP5 and IAP10 groups and four rats (4/5) died at 10-15 minutes following exposure to the 15 mm Hg intra-abdominal pressure in IAP15 group.Total blood loss was reduced to ( 54.20 ±11.30)ml/kg in IAP0 group,(43.98 ±9.2) ml/kg in IAP5 group,(32.49 ±7.40) ml/kg in IAP10group and (25.77 ± 14.16) ml/kg in IAP15group ( P ＜0.01 ).The infused volume of resuscitation solution was (31.06 ± 3.14) ml in IAP10 group,which was higher than (24.94 ±6.67) ml in IAP0 group,(23.06 ± 7.98) ml in IAP5 group and (16.50 ±7.27) ml in IAP15 group (P ＜0.05).Liver weight was ( 11.18 ± 1.45) g in IAP5 group,( 12.13 ± 0.96) g in IAP10 group and ( 11.41 ± 1.20) g in IAP15 group,which was significantly higher than (10.03 ±0.58) g in IAP0 group (P＜0.05).The MAP was (64.81 ± 19.65) mm Hg in IAP5 group and (65.80 ± 15.36) mm Hg in IAP10 group ( insignificant difference between groups,P ＞ 0.05 ),which was higher than (41.22 ± 10.00) mm Hg in IAP0 group and (44.50 ±28.60) mm Hg in IAP15 group (P ＜0.05).Conclusions Non-pneumatic intra-abdominal compression can effectively control bleeding in rat models of severe liver injury,while the adverse effect of intra-abdominal hypertension should be avoided.

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.

Objective To summarize experiences associated with hepatectomy of huge liver neoplasm.Methods Two hundred and sixty six consecutive cases of huge liver neoplasm undergoing hepatectomy from January 1987 to December 2005 at Chinese PLA General Hospital were analized retrospectively based on the clinical data.Results There were 174 males and 92 females with the average age of(44.8 ± 12.2)years(range 7-76 yrs).Among them,93 cases were with benign neoplasms.The maximum diameter of tumors was 30 cm and hemangioma accounted for 86.0%(80 cases).The other 173 cases were huge liver malignant neoplasms with the maximum diameter of 33 cm,hepatocellular carcinoma accounted for 73.4%(127 cases).The average diameter of all tumors was(14.7 ±4.0)cm(range 10.2-33.0 cm).HBsAg(+)was found in 40.49% of cases.Numbers of resected segments averaged(3.3 ±1.2)in benign cases and(3.1 ±1.2)in malignant ones without significant difference between the two groups(t=1.710,P=0.310).Postoperative complications occurred in 17.29% of cases and the hospital mortality was 0.75%.The postoperative 1-,3-and 5-year survival rates in patients with malignant liver tumors were 58.3%,39.7% and 27.5%,respectively.Conclusions Hepatectomy of huge liver benign and malignant neoplasms can be performed safely with low morbidity and mortality,provided that it is carried out with skillful surgical expertise and optimized perioperative management.

Benign biliary stricture is a challenging problem in hepatobiliary surgery. Benign biliary stricture is associated with major portal vein variation, which is not be found in literatures. A male patient with benign biliary stricture was admitted to the Chinese PLA General Hospital in March, 2010.The stricture was located in the hilar confluence with intrahepatic biliary dilation and hepatolithiasis. The result of computed tomography showed that the hilar biliary confluence was compressed by the left portal vein and right anterior portal vein. The patient was cured after receiving gallbladder interposition, choledocholithotomy and T tube drainage. We suggested that the benign hilar biliary stricture due to portal vein variation may be named as biliary nut-craker syndrome.

Objective To study the diagnosis and treatment of hepatocellular adenoma(HCA).Methods The preoperative imaging findings,pathologic specimens and surgical treatment of 18 patients with HCA who were admitted in our hospital from January 1990 to April 2007 were retrospectively analyzed.Results Most patients were male(male-to-female:11/7)and only 1 female patient had oral contraceptive history.Six patients presented with pain in the right upper quadrant.Contrast-enhanced CT and contrast-enhanced MRI both displayed that most lesions were characterized by homogeneous enhancement on arterial phase,except the lesions affected by irregular hemorrhage or fatty degeneration,and by washout on portal venous phase and delayed phase.All patients received resection.Hemorrhage in the lession was found in 10 patients and precancerous lesion in 2after operation.All patients were alive and well with no recurrence till December 2007.Conclusion The enhanced CT or MRI scanning for HCA has special features.Complete resection is the first choice for HCA.