Objective To report one stage treatment of chronic tibial defection in children. Methods 19 children with chronic tibial defection were treated in our department when their infection was at the stage of latency. First their focuses of infection were cleared away. Next a piece of fibula with vessel pedicles whose length was equal to that of the tibial defect was taken as the support to restore the length of the tibia. Then the external fixators were applied and a mixture of antibiotic and Lebone powder was used to fill the defect. Results In 15 cases the incision healed at one stage, slight infection occurred in 4 cases whose incisions healed after treatment of 3 to 4 weeks. Follow-ups of 0.5 to 1.5 years showed that no infection occurred again, bone defects healed well and limb function was satisfactory. Conclusion To treat chronic tibial defection in children at one stage, combined therapy should be applied. Grafting of fibula with vessel pedicles and Lebone under external fixators is a good one, because it can shorten the treatment time at no cost of satisfactory effects.

Objective The clinical features of elderly patients with severe acute pancreatitis (SAP) were atypical and these patients were often misdiagnosed as having paralytic ileus. The clinical presentations of elderly patients with SAP whose first diagnosis as paralytic ileus were analyzed. Methods 18 patients of elderly SAP who were misdiagnosed as having paralytic ileus were included and the clinical data were compared with 58 elderly patients with SAP. Results Among the misdiagnosis group, the first symptom onset were fleus, abdominal distension, vomiting, constipation, abdominal pain, diarrhea for 5, 4, 3, 3, 2, 1 case, respectively. Among SAP group, the first symptoms onset were 2, 31, 9, 3, 11, 2 cases, respectively. For misdiagnosis group, 13 cases were correctly diagnosed by CT scan, 3 cases by ultrasound and 2 cases by serum amylase test. For SAP group, 32, 15, 11 cases were diagnosed by CT scan, ultrasound and serum amylase, respectively (P < 0.05). 4 and 13 patients died in misdiagnosis and SAP group, respectively; among these 13 patients, 10 were female and 3 were male. Conclusions The elderly patients with paralytic ileus should consider the possibility of SAP, and CT scan was valuable for correct diagnosis.

Objective To evaluate the diagnosis value of spiral CT in leiomyosarcoma of abdomen.Methods Both plain and enhanced CT fingdings in 12 cases with pathologic-proved leiomyosarcoma of abdomen were respectively analyzed.Results In all of 12 cases,1 case occurred in colon,1 case in rectum,1 case in small intestine,5 cases in mesentery,4 cases in retroperitoneum,CT positioning accuracy rate was 91.7 ％ (11/12).The volume was comparatively large,the average diameter was 6 cm.The density were uneven,nodosity or lamellar necrosis were found.Delay enhacement were occurred in lower density part in most part of cases (9/12).Conclusion The localization of spiral CT is comparatively accurate to the leiomyosarcoma of abdomen,some characteristics are found in CT image,but the final diagnosis depends on immunohistochemistry.

Objective To evaluate the efficacy of living donor liver transplantation in the treatment of infants with end-stage liver diseases. Methods The clinical data of 33 infants who received living donor liver transplantation at the Renji Hospital of Shanghai Jiaotong University from October 2006 to September 2009 were retrospectively analyzed. The median age of the infants was 10.9 months, and the mean body weight was 8.2 kg.All of the grafts were left lateral lobes. Tacrolimus (or cyclosporine A) + steroid or tacrolimus (or cyclosporine A)+ steroid + mycophenolate mofeti] were applied to the infants to suppress the immune reaction. Operative techniques, perioperative management and results of follow-up were analyzed. Results The mean operation time,blood loss and blood transfusion of the donors were (384±108)minutes, (183±35) ml and O, and the three indexes of the recipients were (500± 103) minutes, (296±163) ml and (292 ± 159) ml , respectively. The cold preservation time of the grafts was (64 ±23)minutes, the mean weight of the grafts was (249 ±52)g, and the mean graft to recipient weight ratio was 2.1% ± 0.4%. All donors recovered smoothly and no complication occurred. Of the recipients, three were complicated with hepatic artery thrombosis, two with portal vein thrombosis,nine with biliary complications, 11 with infection, two with acute rejection and five infants died perioperatively.The one-year cumulative survival rate of the infants was 85% (28/33). Conclusions Infants with end-stage liver diseases could be treated by living donor liver transplantation. The development of surgical techniques and perioperative managements improves the success rate of operation and the long-term survival rate.

Objective In order to study the effect of ? 1,4 GalT Ⅰ on proliferation of Schwann cells, The changes in cell proliferation were checked after Schwann cells transfected with sense or antisense ? 1,4 GalT Ⅰ plasmids. Methods Methods of counting numbers of proliferating cell and measuring [ 3H] thymidine incorporation by liquid scintillation were used to study the proliferation of purified Schwann cells which transfected with ? 1,4 GalT Ⅰ plasmids. Cell cycles of those transfected cells were determined by fluorescence activated cell sorting. Results After Schwann cells transfected with sense ? 1,4 GalT Ⅰ plasmids, the proliferation of those cells was restrained, and the number at G 1/G 0 phase of those cells increased while the number at S phase decreased. Schwann cells transfected with antisense ? 1,4 GalT Ⅰ plasmid showed opposite changes.Conclusion ? 1,4 GalT Ⅰ may play an important role in regulating the proliferation of Schwann cells in peripheral nerve.\;[

Objective To compare the metabolic characteristics, dosages and blood concentrations of tacrolimus (Tac) in patients subject to cadaveric liver transplantation (CLT) vs living-donor partial liver transplantation (LDLT) in order to investigate the usage of Tac in patients undergoing LDLT. Methods The clinical data of 85 patients undergoing liver transplantation from April 2007 to September 2009 were analyzed retrospectively. Thirty-four underwent LDLT (group A)and the remaining 51 underwent CLT (group B). Results The time to reach therapeutic window was shorter in group A (3. 4 ± 1.0 days) than in group B (4. 5 ± 2. 0 days, P = 0. 002). The Tac dosage in group A was significantly less than in group B during the first 28 days post-transplantation. However,the Tac dosage approached gradually and tended to be consistent after 28 days. On the postoperative day7, 14, 21 and 28 days, the Tac dosage in group A was 72.74 ％, 82.26 ％, 83.92 ％ and 88. 87 ％ of that in group B respectively. Correlation analysis revealed that graft-recipient body weight ratio (GR/WR) was significantly correlated with the Tac dosage on the day 7 (mg·day-1 · kg-1) (r =0. 728, P＜0. 01) and Tac concentration/dosage ratio (ng/ml)/(mg/kg) (r = - 0. 644, P＜0. 01 ).Conclusion The early Tac dosages in patients subject to LDLT were correlated significantly with the volume of graft. The early Tac dosages in patients undergoing LDLT were about 70 ％ of those in patients undergoing cadaveric liver transplantation. Moreover, with the regeneration of the liver, they tended to be consistent after 28 days.

Objective To investigate the clinical efficacy of RevoLix 2 μm continuous wave laser treatment on bladder neck contracture after benign prostatic hyperplasia operation. Methods A total of 21 cases were enrolled in current research and they all accepted 2 μm continuous wave laser treatment of bladder neck contracture after benign prostatic hyperplasia operation in the 252th Hospital of the Chinese People's Liberation Army. The clinical efficacy was recorded. Results The operation of the 2 μm continuous wave laser vaporesections were successfully performed on 21 cases. The maximum urine flow rate was increased from(6. 86 ± 1. 97)ml/ s to(16. 31 ± 1. 61)ml/ s,and the difference was significant(t = 15. 49,P < 0. 01). After 3 to 23 months(median 14 months)follow-up,20 cases were cured and 1 case was combined with bladder residual urine 110 ml. Conclusion The therapy of 2 μm continuous wave laser is a superior micro-invasive surgery method for patients with Bladder neck contracture,which shows little blood loss,high level safety,convenient operation and infrequent complications.

Objective To observe the effect of magnetic stimulation of sacral roots on detrusor overactivity and urge incontinence after spinal cord disease.Methods 15 cases with detrusor overactivity and urge incontinence after spinal cord disease were treated with magnetic stimulation of sacral roots for 10 d.Voiding diary,quality of life scale and urodynamic investigation were applied to evaluate the effect.Results The mean frequency of voiding in 24 h after treatment decreased,urine volume increased,frequency of incontinence decreased and the quality of life score improved.Urge incontinence improved in 85.7% cases.The results of urodynamic investigation showed bladder capacity at first desire to void and maximum cystometric capacity significantly increased after stimulation,while the detrusor pressure at storage decreased.Conclusion Magnetic stimulation of sacral roots can improve urinary frequency and urge incontinence of patients with detrusor overactivity after spinal cord disease by inhibiting detrusor overactivity,increasing cystometric capacity.Magnetic stimulation of sacral roots may be an alternative promising rehabilitation technique.

Objective To observe the outcomes of living donor liver transplantation (LDLT) for children with biliary atresia (BA) and to summarize the clinical experiences. Methods Forty-four BA patients (26 boys and 18 girls) underwent LDLT between October 2006 and December 2010. Mean (SD) and median (range) age at operation was (12.1 ± 9.0) months and 9 (6-60) months,respectively. The 44 donors were lineal relatives to the consorted recipients. Their mean (SD) and median (range) age at operation was (32. 7 ± 8. 0) months and 31 (20～54) years, respectively. All donor graft types were the left lateral segments with compatible ABO blood groups. Clinical data,including pre-operative evaluations, surgical technique, postoperative management and outcomes in all donors and recipients were retrospectively analyzed. Results All donors were followed up for (17. 5 ± 13. 3) months. No donor mortality was encountered, with a minimal morbidity and no long-term sequelae. Nine out of 44 recipients died. Three patients died of portal vein thrombosis (PVT), one of hepatic artery thrombosis (HAT), two of biliary complications, one of surgical site infections, one of abdominal bleeding and one of pulmonary infection. The overall 1-year and 2-year cumulative survival rate in recipients was 81. 2% and 76. 1 %, respectively. No re-transplantation was done. Postoperative complications included PVT, HAT, biliary leakage and refluxing cholangitis, pulmonary infections,surgical site infections and acute rejection. Conclusion LDLT has been the effective treatment for pediatric recipients with BA and provides favorable prognosis. To improve prognosis of recipients, the key points are pre-operative evaluations, surgical technique, and postoperative management

Objective To characterize the clinical course of biliary complications after right lobe living donor liver transplantation (RL-LDLT) and to identify the independent risk factors for biliary strictures.Methods 105 consecutive RL-LDLT recipients operated from April 2007 to April 2010 were followed up. The clinical and operative data were reviewed. The biliary complications and independent risk factors of biliary stricture were studied.Results The median follow-up duration was 49.5 months ranging from 562 to 1675 days.A total of 40 patients (38.1 ％) experienced 11 bile leak episodes (10.4％ ) and 37 (35.2％) biliary stricture episodes after transplantation.Bile leaks occurred at a median time of 9 days ranging from 4 to 54 days after transplantation.For biliary strictures,the occurring time was delayed and scattered wide with a median of 7.6 months ranging from 12 to 790 days after transplantation. Moreover, the biliary stricture incidence in the first year after transplantation was significantly higher than later.The independent risk factors for biliary strictures were CMV infection,bile leaks and bile duct size (≤3 mm).Conclusion The independent risk factors for biliary strictures after RL-LDLT were CMV infection,bile leaks and bile duct size (≤3mm).In order to avoid biliary complications,careful preoperative evaluations are necessary. The dissection of bile ducts should be meticulous to protect its blood supply.CMV infection should be prevented after transplantation.Close surveillance of biliary complications should be given to RL-LDLT recipients during the first year after transplantation.