Yi Guan Jian decoction is a traditional Chinese medicine formula noted in Wei Yu-huang's Xu Ming Yi Lei An (Supplement to the Classified Medical Records of Famous Physicians). Acne vulgaris and chronic pelvic inflammation could be successfully treated by the decoction following the principle of formula corresponding to syndromes. The identical characteristics of constitution are found among the patients treated by the decoction, known as the "Yi Guan Jian constitution". It indicates that patients can be treated according to the constitutional characteristics.

Objective Transcatheter thrombolysis is an important method for early recanalization of acute superior mesenteric venous thrombosis (SMVT), which is conducted mainly through percutaneous transhepatic , transjugular intrahepatic, or superior mesen-teric artery approach .This study is to assess the feasibility , effectiveness and safety of catheter-directed thrombolysis via the superior mesenteric vein and artery for acute SMVT . Methods We retrospectively reviewed 8 cases of acute extensive SMVT treated by tran-scatheter thrombolysis via superior mesenteric vein and artery in our institute .We collected and analyzed the general information , case history, etiology, risk factors, imaging characteristics, treatment procedures, complications, and follow-up data of the patients summa-rized the experience in the treatment of acute extensive SMVT by catheter-directed thrombolysis . Results Technical success was a-chieved with substantial symptoms improvement after thrombolytic therapy in all the cases .The local urokinase infusion via the superior mesenteric artery and vein was performed for (6.13 ±0.83) and (12 ±2.51) d.Four patients required delayed localized bowel resection of (1.63 ±0.48) m, with satisfactory recovery after intensive care and organ function support .Contrast-enhanced CT scan and portogra-phy demonstrated complete thrombus resolution in all the patients before discharged after a hospital stay of (19.25 ±4.89) d.Minor bleeding at the puncture site occurred in 2 cases and sepsis developed in another 2 postoperatively .No recurrence and complications were ob-served during the follow-up of (12.13 ±0.99) mo. Conclusion For acute extensive SMVT , catheter-directed thrombolytic therapy via superior mesenteric vein and artery can accelerate thrombus resolution , stimulate collateral vessel development , reverse extensive intestinal is-chemia, avert bowel resection , localize infarcted bowel segment to pre-vent short bowel syndrome , and effectively speed up the recovery and significantly increase the survival rate of the patients .

Objective To determine the effect of different surgical modalities on hemodynamics,systemic major organ injury and survival rate following superior mesenteric artery (SMA) injury in an attempt to search a modality that conforms to principles of damage control surgery (DCS).Methods SMA was exposed in 30 domestic hybrid pigs,leaving the blood flow blocked using non-invasive vessel forceps.The animals were divided into control group,primary anastomosis group (anastomosis group) and temporary intravascular shunt (TIVS) group according to random number table.TIVS group was further divided into three subgroups:shunting for 6 hours group (TIVS-6 h group),9 hours group (TIVS-9 h group) and 12 hours group (TIVS-12 h group).At each time point,the angiography was performed for evaluation of shunt patency; hemodynamic parameters were detected,terminal ileum and SMA samples were harvested for pathological analysis.Results All groups suffered extreme physiological conditions including hypothermia,severe acidosis,hypotension,low cardiac output and low oxygen supply.Less requirement of resuscitation fluid,faster restoration of SMA blood flow,earlier clearance of lactate,milder intestinal ischemia-reperfusion injury and higher survival rate were observed in TIVS-6 h and TIVS-9 h groups,compared with anastomosis group.Patency rate in TIVS-6 h,9 h and 12 h groups was 100％,50％ and 0％ respectively.Pathologic outcome of intestine revealed diffuse intestinal necrosis in TIVS-12 h group and reversible intestinal ischemia-reperfusion injury in TIVS-6 h and 9 h groups.Conclusion For SMA injury in severe hemodynamic disarrangement and jeopardized condition,TIVS shortens intestinal ischemia time,maintains systemic hemodynamic stability,relieves intestinal injury,improves early survival rate and keeps long-term intestine patency when compared with primary vascular anastomosis.

Objectives: To investigate the effect of growth hormone on liver protein synthesis in patients with portal hypertension following TIPS. Methods: Ten patients with liver cirrhosis and portal hypertension were injected with rhGH (8 U/day) for 7days after TIPS. The serum levels of Alb, PA and FN were detected before and days 3 and 7 after TIPS and use of rhGH. Plasma insulin like growth factor 1 (IGF 1) was also measured by immunoradiological method. Results: As compared with the day before TIPS and rhGH, the levels of IGF 1, Alb , PA and FN were significantly increased on the 7th day after TIPS and rhGH treatment( P

Objective: To evaluate the effectiveness of bowel nutritional rehabilitation therapy in patients with gut dysfunction caused by acute mesenteric artery occlusion. Methods: Two patients with acute mesenteric artery occlusion received management of revascularization by operative and nonoperative approach. Viability dusky bowel was leaved in one patient. Second look laparotomy was performed to access the viability of the bowel in another patient. The patients remained gut dysfunction and received bowel nutritional rehabilitation therapy early after operation. Results: The gut function of the patients recovered and had normal diet after bowel nutritional rehabilitation therapy. Conclusions: The gut dysfunction caused by acute mesenteric artery occlusion should be treated with bowel nutritional rehabilitation early.

Objective:To study the effects of Somatostatin-14 and-8 on portal hemodynamics and plasma levels of the insulin-like growth factor(IGF-1),nitric oxide(NO),endothelin-1(ET-1) and glucagon(GLU) in patients with portal hypertension after transjugular intrahepatic portosystemic shunt(TIPS). Methods:Fourteen portal hypertension patients underwent TIPS,their portal pressures directly measured by the intravenous catheter placed in the portal vein,the hemodynamic changes observed and the plasma levels of IGF-1,NO,ET-1 and GLU determined before and 8 and 24 hours after the infusion of Somatostatin-14 or-8 according to a cross-over design.Results:The average decrease in portal pressure after the intravenous infusion of Somatostatin-14 and-8 was(9.4?1.0) cmH2O and(5.0?1.0) cmH2O,respectively(P0.05) 8 and 24 hours after the infusion.Conclusion:Both Somatostatin-14 and-8 can significantly reduce portal pressure,although the former is more potent than the latter.The underlying mechanism may involve their inhibition of the secretion of GLU,IGF-1 and other hormones as well as their reduction of hepatic metabolism and portal inflow.

Objectives The purpose of this study was to compare the effect of somatostatin and octreotide on portal vein pressure in portal hypertensive patients.KG*2MethodsWT5”BZ Portal pressure in 12 patients with portal hypertension after TIPS was measured directly by means of a cathater placed in portal vein after infusion of somatostatin (6 mg/24h) or octreotide(0 6 mg/h). The drugs was infused intravenously and alternatively in each individual patient on day 1 or day 3 after TIPS. Portal pressure was assessed at baseline and at 1、2、4、6、8、12、24、30、36 hours after infusion of each drug.KG*2ResultsKG1The average decrease of portal pressure was 9 4?1 0 cm H 2 O and 5 0?1 0 cm H 2 O respectively after the intravenous infusion of somatostatin or octreotide( P

The blood level of tumor necrosis factor (TNF) was measured by the method of TNF cytotoxic activity in 20 patients with abdominal infection, 10 patients with gastrointestinal cancer and 30 normal subjects. The results showed that the blood level of TNF in patients with abdominal infection was significantly higher than that in normal subjects and in patients with gastrointestinal cancer. The blood level of TNF in serious abdominal infection was remarkably higher than that in moderate abdominal infection. The blood level of TNF in both group of patients was obviously declined after the infection had been controled. The blood level of TNF in the patients died from abdominal infection was constant during treatment. Therefore, the blood level of TNF is an important index of abdominal infection and has important clinical value in evaluating the seriousness of abdominal infection and predicting the development of infectious disease.

Objective To study the effects of ePTFE-covered stents versus bare stents on portal hemodynamics in portal hypertensive patients receiving TIPS. Methods Sixty patients with portal hypertension underwent TIPS with 8 mm diameter bare stents and ePTFE-covered stent from April 2007 to April 2009. The clinical outcomes were observed after TIPS, and the hemodynamics of potal vein system were studied before and after TIPS and during the follow up using direct portography and color Doppler ultrasound technique. Results TIPS procedures were successful in all patients without major complications. The follow-up of patients with bare stents were (8 ± 4) months and follow-up of ePTFEcovered stents group were (6 ± 4) months. Immediately after the TIPS the portosystemic pressure gradient of the two groups decreased by 60% and 58%, respectively(t =0.79, P >0.05). During the follow-up,portosystemic pressure gradient of bare stents group increased gradually, while that in ePTFE-covered stents group maintained low portosystemic pressure gradient (13.2 ± 1.2) mm Hg vs. (9. 5 ± 2. 9) mm Hg, P =0. 015. The blood velocity and volume of venous return of potal vein system were significantly higher in ePTFE-covered stents group than in bare stents group during the follow-up using color Doppler ultrasound method. The blood velocity and volume of the shunts were significantly higher in covered stents group than in bare stents group after 1 year, (125 ±20) cm/s vs. (88 ±13) cm/s, and (1816 ±380) ml/min vs.(1074 ±239) ml/min, respectively P<0. 01. Conclusions In TIPS patients with ePTFE-covered stents high blood velocity and low portosystemic pressure gradient sustained in contrast with those using bare stents.

OBJECTIVESTo investigate intestinal permeability in patients with portal hypertension and to search for a relationship with portal pressure.

METHODSTwenty patients with portal hypertension were divided two groups (A, B), 10 patients per group. In group A patients were treated with combined TIPS and modified Sugiura. In group B, patients were treated with modified Sugiura only. Intestinal permeability was assessed before operation, two weeks after TIPS, and two weeks after modified Sugiura, and 20 healthy control subjects were also assessed.

RESULTSIntestinal permeability was significantly higher in patients with portal hypertension than in healthy controls (0.132 +/- 0.110 vs. 0.032 +/- 0.018, P < 0.01). In group A, portal pressure and intestinal permeability decreased two weeks after TIPS (P < 0.05) and no obvious change was noted two weeks after modified Sugiura; but they were significantly lower than those before TIPS (P < 0.05). In group B intestinal permeability was not different before and after operation. Intestinal permeability in group A was not different from that in group B before treatment, but significantly lower after modified Sugiura (P < 0.05). Portal pressure was significantly correlated with intestinal permeability (r = 0.627, P < 0.01).

CONCLUSIONSThis study shows that combined TIPS and modified Sugiura can lower portal pressure and intestinal permeability, and enhance the therapeutic efficacy on portal hypertension.

Female ; Humans ; Hypertension, Portal ; physiopathology ; surgery ; Intestines ; physiopathology ; Male ; Middle Aged ; Permeability ; Portal Pressure ; physiology ; Portasystemic Shunt, Surgical