Objective To study the technique and to evaluate the clinical value of stent implantation by butt joint of percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangio-pancreatography (ERCP) for the treatment of obstructive jaundice. Methods 24 patients with obstructive jaundice were treated by butt joint of PTBD and ERCP after the ERCP failure, and the clinical results were evaluated. Results A total of 24 cases with obstructive jaundice were successfully operated by butt joint of PTBD and ERCP. In PTBD, 10 cases were punctured from right side, and 14 cases were from left side. PTBD, ERCP and butt joint were done simultaneously in 16 cases, and separately in 8 cases. The total serum bilirubin decreased by 47.07 in 4 days, and the direct bilirubin decreased by 45.43. Infection of biliary tract was the main complication. Conclusion Stent implantation by butt joint of PTBD and ERCP for the treatment of obstructive jaundice may be chosen to treat the patients who failed in ERCP alone.

Objective To observe the characteristics of glycemic excursion and to evaluate the therapeutic effects on blood glucose in new dignosed type 2 diabetes mellitus after being given continuous subcutaneous insulin infusion(CS Ⅱ).Methods Thirty-eight new dignosed type 2 diabetes mellitus patients were randomly divided into group CS Ⅱ(n=18) and group many-times subcutaneous insulin infusion(MS Ⅱ,n=20).The blood glucose lasted for three days were monitored by continuous glucose monitoring system(CGMS).Results The abnormal glucose metabolism in two groups were markedly released after two weeks treatment,the mean blood glycemic(MBG),mean amphtude of glycemic excursions(MAGE),means of daily differences(MODD) and the percentage of blood glucose beyond 7.8 mmol/L and 11.1 mmol/L after therapy were all significantly decreased compared with those of before therapy (P＜0.001);the average levels of blood glucose before and after diet were decreased obviously as well(P＜0.05,P＜0.01).All index in group CS Ⅱ were lower than that of group MS Ⅱ (P＜0.01,P＜0.001).Conclusion Continuous glucose monitoring system can assess the changes characteristics of blood glucose effectively,continuous subcutaneous insulin infusion was an effective means of controlling blood glucose.

Retrospective analysis of 761 case-times successive color Doppler sonography for 518 renal transplant patients was carried out.six parameters of sonography were used to compare, the CsA-NT hemodynamic changes among the patients with normal function, rejected and hy-dronephrotic kidney.It revealed that during rejection of the rendl srafts, besides an elevation of resistance index(RI)and a decrease of D/S ratio, the velocity and volume of renal blood flow were also slowed down and decreased respectively.After combating rejection, the renal function recovered to normal gradually, and RI dropped below 0.75 subsequently.Otherwise R1 would be persistently elevated, which indicated an irreversible rejection.The diagnosis of acute rejection was given at RI≥0.83, with the sensitivity rate being 82.70%and specificity being 80.10%.It was suggested that RI is a relatively sensitive and relialble parameter for the diagnosis of rejection.In combination with the clinical manifestations RI is of great important clinical value for the early diagnosis and treatment of acute rejection.

Objective To improve the level of the diagnosis and treatment of gastric ectopic pancreas. Methods We reviewed the data of endoscopic ultrasonography(EUS) examination of gastric submucosal mass from 2000 to 2004 and analyze the EUS features of gastric ectopic pancreas. Results Among 241 cases of gastric submucosal mass, 105 cases were diagnosed as benign stromal tumors, 23 as malignant stromal tumors, 48 as lipomas,45 as ectopic pancreas and 20 as cysts. The EUS features of gastric ectopic pancreas included submucosal lesions (39 cases), clear boundary (37cases),hy-perechoic heterogenous internal echo(42 cases), hypoechoic(3 cases), echoless in the center of the lesions (32 cases). After resection,26 cases confirmed by pathology had no complications. Conclusion EUS examination is helpful to confirm the diagnosis'of gastric ectopic pancreas. Resection under endoscopiy is a an effective measure of treatment.

To find the rule of alterations in AFP mRNA concentration in peripheral blood in patients with hepatocellular carcinoma(HCC) before and after the treatment with transhepatic arterial chemotherapy and embolization(TAE), 15 cases of the pateints with HCC were included in this survey. The AFP mRNA concentration in peripheral blood of the patients were investigated using compatitive RT PCR technique before and 1,2,3,4, 5,6,7, 14, 28 days after TAE. The results showed that AFP mRNA concentration on the third day after TAE was the highest. It declined to the level before treatment during one week.It suggested that AFP mRNA concentration changed with a rule, and following the rule, preventive measure to distant metastasis could be instituted in clinical work.

Objective To evaluate the efficacy and safety of thrombolysis treatment of mesenteric and portal venous thrombosis by TIPSS pathway. Methods Six patients with thrombosis of the PV and SMV were treated by transjugular intrahepatic portosystemic shunt (TIPSS) pathway. All 6 patients presented abdominal pain, distention, and anorexia etc. No clinical signs of peritonitis were seen. The diagnosis was established by Doppler ultrasound scan and contrast enhanced CT. Control PV-SMV venography was performed after access to the PV branch. As soon as the diagnosis was established the thrombus in the PV and SMV was aspirated and fragmented. After the majority of the clot was cleared away with restoration of blood flow in the main trunk, a 4-French catheter with multiple side-holes was passed into the SMV, and urokinase (UK) was continuously infused for 3 to 13 days. Anticoagulants were given for 6 months therefter. Results The majority of the thrombus in PV and SMV was cleared away resulting in flow restoration in all patients after the procedure. Clinical improvement was seen in 5 patients, characterized by progressive alleviation of abdominal pain, distention, and diarrhea. Prior to removal of the infusion catheter from the SMV, venography revealed a complete resolution of the thrombosis in 3 patients, and residual thrombus in the PV branches in 3 cases without showing clinical symptoms. Follow-up Doppler ultrasound scan performed during 4-36 months after the procedure confirmed patency of the PV and SMV. The symptoms did not recur. Conclusions Through the TIPSS pathway, catheter-directed thrombolysis is safe and effective in the treatment of PV and SMV thrombosis.

Objective To evaluate the safety and efficacy of endoscopic treatment in patients with primary hepatic carcinoma and gastroesophageal variceal hemorrhage. Methods Thirty cases of hepatic carcinoma with gastroesophageal variceal hemorrhage diagnosed with gastroscopy between January 2008 and June 2015 in Chinese PLA General Hospital and Hainan branch were included. Patients′ clinical data, complications and therapeutic effects of endoscopy were retrospectively analyzed. Results All patients underwent endoscopy successfully. No recurrent bleeding was found in any case after treatment. Eight cases of varicosis nearly disappeared. Six?month follow?up showed three cases of gastrointestinal bleeding, one case of death of bleeding, and no recurrence hemorrhage in 27 others. Conclusion Endoscopic treatment could safely and effectively control the primary liver cancer combined with gastroesophageal variceal hemorrhage, hence may provide opportunity for further treatment of liver cancer.

A total of 105 patients with ketosis-onset diabetes were divided into four groups (A+B-,A + B +,A - B -,A - B +) based on the results of islet-associated autoantibodies (A +,A - ) and β-cell function (B +,B - ).Nearly 94％ patients in the A -B + group and 1/10 patients in the A - B - group were non-insulin dependent.While in the A + B - and A + B + groups,the detection rates of subsequent non-insulin dependency were 20％ and 58％,respectively.Among the four groups,patients in the A - B + groups had a lower level of IL-6 and a higher level of TNF-α. Patients in the A + B - and A + B + groups had a higher level of IL-18.Our study indicates that patients with ketosis-onset diabetes may present different clinical characteristics. Evaluate the islet-associated autoantibodies and pancreatic β-cell function may be helpful to the clinical diagnostic and therapeutic strategies in diabetes.

ObjectiveTo investigate the clinical effect of endoscopic therapy for patients with esophagogastric variceal bleeding (EVB) after liver transplantation. MethodsA retrospective analysis was performed for the clinical data of 8 patients who experienced EVB after liver transplantation and underwent endoscopic therapy, especially endoscopic features. The clinical outcome was evaluated, including hemostasis rate, change in varicose veins after treatment, and short-term recurrence and bleeding rate. ResultsThe eight patients had a mean age of 55.00(4475-6150) years, and the mean time from liver transplantation to bleeding was 7150(1875-10725) months. As for primary diseases, 6 patients had hepatitis B cirrhosis (among whom one patient each was complicated by liver cancer, alcoholic cirrhosis, and acute liver necrosis, and three were complicated by subacute liver necrosis), one had hepatitis C cirrhosis, and one had unexplained liver cirrhosis. Of all patients, 2 underwent sclerotherapy, 6 underwent endoscopic variceal ligation, and 6 underwent tissue adhesive treatment. The endoscopic therapy achieved successful hemostasis in all patients. No patients experienced rebleeding at discharge or the 12-month follow-up visit. One patient underwent selective endoscopic therapy due to the recurrence of varices. ConclusionGastrointestinal bleeding remains a serious complication after liver transplantation. Besides antiviral therapy, the presence of varices should be closely monitored.