Objective To summarize our experience in the management of extensive small bowel necrosis from acute superior mesenteric arterial (SMA) embolism. MethodsSeven cases with extensive small bowel necrosis from acute SMA embolism were treated from 1991 to 1999. Results In this group small bowel of 28～ 30 cm and 70～90 cm were remained respectively in 3 and 4 cases after surgery. Two patients died of septic shock while the other 5 developed short or ultra short bowel syndrome and were finally cured by means of combined intravenous nutrition and oral feeding. 5 patients were followed up for 18～36 months, all are in good health. Conclusions Timely diagnosis and prompt operation are important to elevated survival rate. SMA embolectomy helps in preserving living intestine. For patients with short or ultra short bowel syndrome, comprehensive measures of intravenous nutrition and stepwise oral feeding in combination can quickly restore digestive and absorptive function of the residual intestine.

OBJECTIVE:To study the efficacy of Urokinase vs.Low Molecular Weight Heparin in the treatment of acute pulmonary thromboembolism.METHODS:A total of 35 patients with acute pulmonary thromboembolism who had no past history of heart and lung diseases were enrolled and randomly assigned to two groups following ultrasonography and pulmonary ventilation/perfusion scanning:15 were given thrombolysis therapy with urokinase,and 20 given anticoagulation therapy with low molecular weight heparin.Symptoms,arterial blood gas analysis,electrocardiogram,echocardiogram were compared in two groups before and after treatment.RESULTS:The patients receiving thrombolysis therapy had better improvement in symptoms,arterial blood gas index,echocardiogram and the pulmonary ventilation/perfusion scanning than in those receiving anticoagulation therapy(P

Objective To examine outcomes of superficial vein stripping for vein varicosis caused by combination of superficial and deep venous reflux and the effect on deep vein reflux. Methods From January 2004 to December 2006, twenty patients (22 lower extremities) with combined superficial and deep venous reflux were enrolled for evaluation, patients with superficial venous reflux alone worked as controls.All patients underwent superficial vein stripping and followed up for 2 years. Venous clinic severity score (VCSS) and color duplex ultrasound test were used to evaluate the change of clinic symptoms and valve reflux of deep veins. Results Preoperative VCSS of superficial and deep vein reflux group and superficial vein reflux group was 7.1 ± 2. 9 and 6. 6 ± 2. 0 respectively (P = 0. 44). At two years after operation the VCSS was 2. 3 ± 1.2 and 1.8 ± 0. 8 respectively without significant statistic differences, whereas comparing postoperative VCSS with individual preoperative parameters there was a significant decrease (P <0. 01). In combined superficial and deep vein group, deep venous reflux reduced in 7 limbs, progressed in 4 limbs, no change in 12 limbs. While in superficial reflux alone group, deep venous reflux occurred in 4 limbs.Conclusions Superficial vein stripping effectively improves symptoms of great saphenous vein varicosis of lower extremity caused by combination of superficial and deep vein reflux without a significant effect on the stares of deep vein reflux.

Objective To investigate the treatment and prevention for postoperative complications of abdominal aortic aneurysm(AAA)in open surgery.Methods 329 AAA patients received open surgery from January 1991 to August 2009.The postoperative complications were analyzed retrospectively.Results 30 d mortality rate was 0.91%,the incidence of postoperative complications was 19.1%(63/329),including cardiac dysfunction in 21 cases,respiratory insufficiency in 15 cases,myocardial infarction in 6 cases,renal failure in 5 cases,arrhythmia in 6 cases,cerebral infarction in 2 cases,artery embolism of lower extremity in 2 cases,wound dehiscence in 2 cases,incisional hernia in 1 case,ecchymoma in 1 case and deep vein thrombosis in 2 cases.One patient died of acute myocardial infarction,one died of renal failure after 20 d dialysis,1 patient died of premature ventricualr contraction and fibrillation ventricular.Other patients recovered well. Conclusions Cardiac dysfunction and respiratory insufficiency are the main postoperative complications of AAA.Preoperative evaluation.careful intraoperative maneuvre and postoperative care ale the key to improve the treatment effectiveness.

ObjectiveTo investigate the clinical features of the abnormal chromosome karyotypes in twin pregnancies complicated with fetal malformations. Methods Totally 181 twin pregnancies (362 fetuses) in which one or two fetuses had abnormalities diagnosed by ultrasound were referred to the First Affiliated Hospital of Sun Yat-Sen University from January, 2000 to September, 2010. They were divided into different groups according to ( 1 ) maternal age: the cases with maternal age ≥35 were divided into advanced pregnancy group ( 105 fetuses) , and those with maternal age ＜35 were divided into young pregnancy group (203 fetuses) ; ( 2 ) conceived method : those conceived by assisted reproductive technology were divided into assisted reproductive group (81 fetuses), and the natural conception pregnancies were divided into natural conception group (227 fetuses) ; ( 3 ) chorionicity: the monochorionic twin (MCT) pregnancies were divided into MCT group( 123 fetuses), and the dichorionic twin (DCT) pregnancies were divided into DCT group( 185 fetuses); (4) structural abnormalities: 205 fetuses with structural abnormalities were divided into the abnormal fetal group, and 103 fetuses without structural abnormalities were divided into the normal fetal group. All fetuses were examined by the ultrasound and chromosomes were examined in 308 fetuses. Results( 1 ) The karyotype of fetuses: among 181 twin pregnancies, 23 cases had chromosomal abnormalities in 1 or 2 fetuses ( 12. 7％ ,23/181 ), and chromosomes were exarmined in both fetuses in 20 of 23 cases. Twenty-six of 308 fetuses were found with abnormal chromosomes ( 8.4％, 26/308 ) , and the aneuploid was the most common type of abnormal karyotypes ( 53.8％ , 14/26 ). Twenty-one of 205 fetuses with malformations were found with abnormal karyotypes (10. 2％, 21/205 ). (2) Seven of 123 fetuses in MCT group were with abnormal karyotypes (5.7％, 7/123), and 19 of 185 fetuses in DCT group were with abnormal karyotypes ( 10. 3％, 19/185 ). There was no statistical difference of abnormal chromosome incidence between the two groups. There were 14 fetuses with aneuploid in DCT group ( 7.6％, 14/185 ) ;but there was no fetus with aneuploid in MCT group. There was statistical difference between these two groups. In two cases of DCT group, only one fetus with malformation received chromosome examination because another fetus was dead, and the karyotypes were trisomy 21 and trisomy 18 respectively. Both fetuses of the rest 17 cases received chromosome examination, and the chromosomes of both fetuses in each pregnancy were different. Fifteen of 19 fetuses with abnormal chromosomes in DCT group were complicated with structural abnormalities, and 7 fetuses of 4 twin pregnancies in MCT group were with chromosomal abnormalities. (3) The comparison of the abnormal karyotype incidence between the advanced pregnancy group and young pregnancy group: the abnormal karyotype incidence of the advanced pregnancy group was 7. 6％ (8/105), and that was 8.9％ (18/203) in young pregnancy group. There was no statistical difference between the two groups ( P ＞ 0. 05 ). Six of 105 fetuses in advanced pregnancy group were aneuploids (5. 7％, 6/105), and 8 of 203 fetuses in young pregnancy group were aneuploids (3.9％, 8/203). The aneuploid incidence in advanced pregnancy group was significantly higher than that in young pregnancy group ( P ＜ 0. 05 ). (4) The comparison of the abnormal karyotype incidence between the assisted reproductive group and the natural conception group: 11 of 81 fetuses were with the abnormal karyotypes in assisted reproductive group ( 13. 6％, 11/81 ), and 15 of 227 fetuses were with the abnormal karyotypes in assisted reproductive group (6. 6％, 15/227). There was statistical difference between the two groups ( P ＜0. 05). There were 7 fetuses with the aneuploid in assisted reproductive group ( 8. 6％, 7/81 ) and 7 fetuses with the aneuploid in natural conception group ( 3. 1％, 7/227 ), which showed no statistical difference ( P ＞0. 05 ).(5) The comparison of the abnormal karyotype incidence between the abnormal fetal group and normal fetal group: 21 of 205 fetuses in abnormal fetal group were with abnormal karyotypes (10. 2％, 21/205), and 5 of 103 fetuses in normal fetal group were with abnormal karyotypes ( 4. 9％, 5/103 ) . There was no statistical difference (P ＞ 0. 05 ). 13 fetuses in abnormal fetal group were with the aneuploid (6. 3％, 1 3/205), and only one fetus in normal fetal group was aneuploid (1.0％, 1/103 ). There was statistical difference between the two groups ( P ＜ 0. 05 ). ConclusionsAneuploid is the most common abnormal karyotype in twin pregnancy complicated with fetal abnormalities, especially trisomy 21. Aneuploid mainly occurs in only one fetus of DCT, and chromosomal discordance is usually found in DCT. While in MCT, the twin fetuses with the same abnormal karyotype may have different pbenotypes. The results suggest that it is necessary to analyze both karyotypes of twins even if only one fetus is complicated with structural abnormalities.

Objective To investigate the intrauterine growth characteristics of twins and birthweight discordant twins (discordant twins ).MethodsTotal of 1010 twin pregnancies (2020 fetuses) with complete delivery records from the Department of Obstetrics and Gynecology,the First and Third Affiliated Hospital of SUN Yat-sen University between January 1,2000 and July 31,2010 were studied retrospectively.One handred and ninteen cases (238 fetuses) with intrapair birthweight difference ≥25％ were determined as the discordant twins group,and the other 891 cases (1782 fetuses) with intrapair birthweight difference ＜ 25％ were identified as the concordant twins group.The singleton control group included 4042 singleton pregnancies in the same period.Results ( 1 ) Comparison of clinical data between the twins groups:the birthweight of larger-twin,smaller-twin and intrapair birthweight difference in the discordant twins group and the concordant twins group were ( 2090± 827 ) g,( 1392 ± 592 ) g,( 33.9 ±9.3 ) ％,and ( 2408 ± 543 ) g,( 2191 ± 505 ) g,( 8.9 ± 6.5 ) ％,respectively,with significant differences (P＜0.01).The incidence of discordant twins was 11.78％ (119/1010).Compared with the concordant twins group,the discordant twins group bad higher proportion of monochorionic twins,and higher prevalence of pregnancy complications such as late miscarriage,abnormal umbilical insertion,twin-twin transfusion syndrome and hypertensive disorders in pregnancy ( P ＜ 0.05 ).( 2 ) The characteristics of twin birthweight distribution:① In all the 2020 twins,80.05％ (1617/2020) fetuses had birthweight below the 50th percentile of the singleton control group,while 23.71％ (479/2020) feeuses got birthweight below the 10th percentile of the singleton control group.② After 19th gestational week,the 50th and 90th percentile of all twins' birthweight were lower than those of singletons.After 38th gestational week,the birthweight of singletons kept increasing and reached its peak at 41 th week,while the birthweight of twins reached its peak at 38th week,followed by a decline at 39 weeks,which was even lower than the 10th percentile of the singleton control group.③ The distribution of birthweight of larger- and smaller-twin in the discordant twins group:65 (54.6％,65/119) larger-twins and one (0.8％,1/119) smaller-twin had birthweight above the 50th percentile of all twins,while 5 (4.2％,5/119) larger-twins and 97 ( 81.5％,97/119 ) smaller-twins got birthweight below the 10th percentile of all twins.Conclusions ( 1 ) The patterns of birthweight curves for each gestational week are different between twins and singletons.In order to evaluate the growth of twins, birthweight reference for twins shoull be employed.( 2 ) According to the reference of twins birthweight,the most discordant twins are complicated with fetal growth restriction at least in one twin.

Objective To analyze the molecular genetic basis of novel allele HLA-B * 9534 and establish the allele group specific primer PCR method. Methods Genomic DNA was extracted from whole blood by commercial DNA extraction kit. The HLA-B exons 1 to 8 coding sequences of the proband were am-plified by PCR and the amplification product was purified with double enzymes digestion and both strands of exons 2, 3 and 4 were sequenced. The exon 2-4 amplification of the HLA-B * 9534 was performed with al-lele group specific primers PCR and the PCR product was directly sequenced for exon 2 to 4. Results The proband has two HLA-B alleles. The result was assigned for HLA-B * 1518 and B * 4601 combination with a mismatch in 593A/G heterozygote by DNA sequencing of exon 2 to 4 with loci primers. After separating the two alleles of the proband with allele group specific primers polymerase chain reaction method, HLA-B * 4601 and HLA-B * 9534 alleles were identified after sequencing. The HLA-B * 9534 is identical to HLA-B * 1518 except for one nucleotide substitutions in exon 3 at position 593 A→G, this results in amino acid substitution at cedon 174 from Asn to Ser. The sequences of the novel allele have been submitted to GenBank (EU046491) and the allele has been officially nominated by the WHO Nomenclature Committee. Conclusion Identification of a novel HLA-B * 9534 allele and allele group specific primer PCR for HLA-B * 9534 was re-liable.

Objective To evaluate surgical therapy for ruptured aortoiliac artery. Method Between Apr 1984 and Dec 2003, 23 patients of ruptured aortoiliac artery were admitted with ruptured aortoiliac artery aneurysm in 18 cases and traumatic artery rupture in 5 patients. Two patients were treated with direct vascular repair and 21 patients underwent prosthetic grafts replacement. Result Four cases died perioperatively including 2 patients dying of acute renal failure, one of upper gastrointestinal heamorrhage caused by stress ulcer at 48 h after operation, and one of respiratory failure in 72 h. Conclusion Based on the etiology emergency operations should be performed on patients of ruptured aortoiliac artery by repairing or prosthetic grafts replacement.

Objective To investigate the clinical prognostic value of neutrophils to lymphocyte ratio(NLR)in patients with ST-segment elevation myocardial infarction(STIMI)who underwent percutaneous coronary intervention(PCI). Meth?ods A total of 326 patients with acute ST segment elevation myocardial infarction were enrolled. According to the neutro?phils to lymphocyte ratio, patients were divided into group T1(≤3.46), group T2(3.47-6.75)and group T3(>6.75). Basic clinical data,laboratory indexes,coronary angiography results, TIMI grading and left ventricular ejection fraction(LVEF) were collected in all groups. Incidence of adverse events in hospital such as acute heart failure, thrombosis, ventricular tachy?cardia and ventricular fibrillation, atrial fibrillation, atrioventricular block and cardiogenic shock, were recorded. Major ad?verse cardiac events(MACE), death of all causes, non-fatal MI, ischemic stroke and readmission due to heart failure at the 6-month follow-up were also noted. Results The incidence of heart failure, atrial fibrillation, ventricular tachycardia/ven?tricular fibrillation and cardiogenic shock was higher in group T3 than those in the other two groups(P < 0.05).The inci?dence of multivessel coronary artery disease was significantly higher in group T3 than that in group T1 (54.1% vs 37.0%, P<0.05). The percentage of TIMI grade 3 in post-operative infracted artery was significantly lower than that in group T1 (83.5%vs 94.4%). Left ventricular ejection fraction was significantly lower in group T3 than that of group T1 during hospital?ization (0.48 ± 0.10 vs 0.52 ± 0.10). There was no significant difference in the incidences of death, non-fatal MI, ischemic stroke at 6 month follow up. But the rate of readmission due to heart failure was significantly higher in group T3 than that in the group T1(P<0.05). Conclusion Neutrophils to lymphocyte ratio may be a useful marker to predict the prognosis of pa?tients with heart failure due to acute myocardial infarction.

OBJECTIVE:To observe the efficacy and safety of doxofylline combined with ceftazidime in the treatment of elder-ly patients with chronic emphysema. METHODS:Data of 78 elderly patients with ceftazidime was collected and divided into single drug group(31 cases)and combined medication group(47 cases)according to different treatment methods. All patients adopted flu-id infusion,oxygen inhalation and nutrition support. Based on it,single drug group received 0.05 g Doxofylline injection,once ev-ery 12 h. Combined medication group additionally received 1.0 g Ceftazidime for injection,once every 12 h. If the symptoms were out of control,20 mg prednisone was given,twice a day. The courses of 2 groups were 10 d. Total efficacy,pulmonary functions [maximum mid-expiratory flow(MMEF),1s forced expiratory volume percent predicted(FEV1%),peak expiratory flow(PEF)] before and after treatment,American Concise Health Survey Questionnaire(SF-36 scale)(QLS)and the incidence of adverse reac-tions in 2 groups were observed. RESULTS:The total effective rate in combined medication group was significantly higher than sin-gle drug group,the difference was statistically significant (P<0.05). Before treatment,there was no significant difference in MMEF,FEV1%,PEF and QLS scores between 2 groups(P>0.05). After treatment,MMEF,FEV1%,PEF and QLS scores in 2 groups were significantly higher than before,and combined medication group MMEF,FEV1%、PEF were higher than single drug group,the difference was statistically significant (P<0.05),but there was no significant difference QLS scores in 2 groups(P>0.05). And there was no significant difference in the incidence of adverse reactions in 2 groups (P>0.05). CONCLUSIONS:Based on conventional treatment,doxofylline combined with ceftazidime shows better efficacy than doxofylline alone in the treat-ment of elderly patients with chronic emphysema,it can improve pulmonary functions,with better safety.