Objective:Combined laparoscopy and hysteroscopy in the diagnosis and therapy of the female infertity is and advanced means in the gynecologcial field.We analysed the causes and the treatments of the 71 infertile patients.Pelvic adhesions,endometrosis and salpingtis were the main causes of infertity in our 71 cases.Of 71 cases,29 cases were primary infertity,in whichc endometriosis,PCOS and anatomic uterine defect were the main causes,and 42 cases were secondary infertity,in which 35 cases (83%) had previous intrauterine operations.All the patients were treated for the causes.We concluded that combined laparoscopy and hysteroscopy can diagnose the causes of infertity and can observe the tubal patency by hysteroscopic tubal cathertetization and hydrotubation,which will direct the treatments and estimate the results of the therapy.Methods:Infertity;Combined Laparoscopy and Hysteroscopy.

Objective To observe the clinical manifestations,therapeutic efficacy and results of bacterial culture of seven patients of scleral buckle (SB) infection after scleral bulking surgery.Methods Seven patients (seven eyes) underwent SB removal for SB infections were enrolled in this study.The patients included four males (four eyes) and three females (three eyes).The patients aged from 12 to 69 years,with a mean age of 42.7 years.There were four right eyes and three left eyes.The duration (interval between primary surgery and SB removal) ranged from two weeks to ten years,with a mean of 47.5months.Six patients were concurrent with systemic disease.All the patients were examined for visual acuity,slit lamp microscope and indirect ophthalmoscope examination.Some patients also received external eye examination and fundus photography.Whether SB exposure or not and the clinical manifestations were observed.SB removal was performed in all the patients and the SB were sent to the laboratory for bacterial culture.The follow-up time ranged from two weeks to eight months,with a mean of 3.2 months.Whether infections recurrence and retinal detachment or not were observed.Results SB exposure was in three eyes.Obvious ocular pain and swelling,conjunctival hyperemia and visible yellow-white discharge in the conjunctival sac were presented in two eyes; irritation and discharge were in one eye.No SB exposure was in four eyes.Ocular pain and swelling,conjunctival hyperemia and visible yellow-white discharge in the conjunctival sac were presented in two eyes.Repeated subconjunctival hemorrhage and diplopia were presented in one eye.Visual acuity decline,conjunctival sac discharge and total retinal detachment were in one eye.All patients had no intraocular inflammation.The infection was controlled after SB removal and the retina was attached during the follow up.The bacterial culture were all positive,which included Staphylococcus aureus,Staphylcoccus epidermidis and Erysipelothrix rhusiopathiae,Gram positive corynebacterium,Aspergillus flavus,Kocuria roseus,Streptococcus oralis,Maxwell Corynebacterium.Conclusions The clinical manifestations of SB infection and the pathogenic microorganisms are variable.SB removal can control the infection.

Objective To explore the clinical value of total laparoscopic hysterectomy(TLH).Methods Retrospective analysis was conducted on clinical data of 38 cases of TLH(Laparoscopic Group)and 40 cases of total abdominal hysterectomy(Open Group)from November 2005 to October 2006 in our hospital,to compare operative time,intraoperative blood loss,the incidence of postoperative pyrexia,recovery time of bowel movement,and hospital stay in both groups.Results The operative time in the Laparoscopic Group(85.8?13.8)min was significantly shorter than that in the Open Group(99.3?9.3)min(t=-5.923,P=0.000).The blood loss was significantly less in the Laparoscopic Group(105.8?32.4)ml than that in the Open Group(166.0?67.4)ml(t=-4.930,P=0.000).The incidence of postoperative pyrexia was distinctively lower in the Laparoscopic Group(3 cases)than that in the Open Group(15 cases)(?2=9.270,P=0.002).The time to first flatus was significantly shorter in the Laparoscopic Group(26.2?4.2)h than that in the Open Group(40.5?4.9)h(t=-13.601,P=0.000).The postoperative hospital stay in the Laparoscopic Group(6.8?0.9)d was distinctively shorter than that in the Open Group(10.6?0.8)d(t=-19.612,P=0.000).Follow-up examination for six months showed that two cases of poor healing of incision and two cases of vaginal residual granulation in the Open Group and one case of vaginal residual granulation in Laparoscopic Group,and no other complications were found.Conclusions TLH gets the advantage over total abdominal hysterectomy.If surgeons are familiar with the laparoscopic operative skills,TLH can be an ideal procedure for hysterectomy.

Objective To summarize the recent progress in pathogenetic,diagnostic and therapeutic researches on the intestinal barrier dysfunction(IBD) of severe acute pancreatitis(SAP).Methods The advancement of IBD in SAP,which was published recently at home and abroad,was collected and reviewed.Results The pathogenesis of IBD in patients with SAP was complex.Ischemia-reperfusion injury,endotoxin,inflammatory mediators and gastrointestinal hormone played an important role in the process of IBD.There were many ways to detect IBD,and the ratio of lactulose and mannitol,plasma diamine oxidase were relatively ideal markers.Medical therapies,such as treatment of SAP and maintaining the perfusion of intestines,were essential to cure IBD.On this basis,the propulsives,nutritional support and traditional Chinese drugs should be administered reasonably.Conclusions IBD is a sophisticated process of pathophysiology.In recent years,abundant of animal experiments and clinical researches have provided new clue for prevention and cure of IBD,but further researches are still needed on the mechanism of the cells and molecules implicated.

OBJECTIVE: To investigate the clinical efficacy of revision surgery of nasal septum with reformed incision under nasal endoscope. METHOD: Thirty-seven patients with failed septoplasty were carried out revision surgery of nasal septum with reformed incision. RESULT: Revision surgery of nasal septum with reformed incision was successful in all cases. The symptoms resulting from the nasal septal deviation disappeared or significantly relieved. Following successful revision surgery, the treatment outcomes of concomitant nasal and/or sinusal diseases also significantly improved. CONCLUSION The adhesive fibrous tissue in septal mucosa were successively separated in patients with revision surgery of nasal septum with reformed incision under nasal endoscope. Revision surgery of nasal septum with reformed incision was easily and safely, and with fewer complications.
Adolescent ; Adult ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Nasal Septum ; surgery ; Nasal Surgical Procedures ; methods ; Rhinoplasty ; methods ; Treatment Outcome ; Young Adult

Objective To analyze the characteristics ot lymph node metastasis and prognostic factors for carcinoma of papilla of Vater (CPV) after pancreaticoduodenectomy (PD).Methods From January 2005 to December 2010,94 patients with CPV underwent PD and dissection of regional lymph nodes at the Eastern Hepatobiliary Surgery Hospital.We carefully evaluated nodal involvement in the patients to determine the lymphatic spread of CPV and analyzed the clinicopathological variables in relation to prognosis.Results The overall rate of nodal involvement was 46.8％.Using the UICC staging (7th edition),lymphatic invasion in pT1,pT2,pT3 and pT4 were 15.4％ (2/13),62.7％ (32/51),80.0％ (8/10) and 100％ (2/2),respectively.The metastatic rates in the posterior pancreaticoduodenal lymph nodes,the mesopancreatic lymph nodes,the hepatoduodenal ligamental lymph nodes and the proper hepatic periarterial lymph nodes were 30.9％ (29/94),21.3％ (20/94),11.7％(11/94) and 6.4％ (6/94),respectively.Significant prognostic factors were tumor pT stage (P＜0.01),duodenal wall infiltration (P =0.001),liver metastasis (P =0.001),pancreatic paren chymal invasion (P=0.004),nodal involvement (P＜0.01) and different regional lymph nodes invasion (the posterior pancreaticoduodenal,P＜0.01; the mesopancreatic,P＜0.01; the hepatoduodenal ligamental,P＜0.01; the proper hepatic periarterial,P=0.010).Cox regression analysis for overall survival revealed that the posterior pancreaticoduodenal nodal involvement (P＜0.01),the mesopancreatic nodal involvement (P＜0.01) and duodenal wall infiltration (P=0.019) were significant independent prognostic risk factors.Conclusions The mesopancreatic lymph nodes and the posterior pancreaticoduodenal lymph nodes should equally be regarded as the first stop in lymphatic spread of CPV.Therefore,we should pay much attention to these regional lymph node dissections,especially to ensure complete resection of the uncinate process and the mesopancreas.

Objective To evaluate the effect of the lactate clearance rate as a guide of the fluid resuscitation in multiple trauma patients with hemorrhage shock .Methods Sixty‐three multiple trauma patients with hemorrhage shock were divided into two groups ,which were group A (32 patients) and group B (31 patients) .In group A ,the central venous pressure (CVP) between8 and 12 mm Hg ,and the mean arterial pressure (MAP) (65 ± 5) mm Hg served as the goals of the fluid resuscitation .The B group ap‐plied the same goals of the CVP and MAP as group A .In addition ,the calculated lactate clearance rate (≥10% ) was used as the treatment target .The percent of patients reaching resuscitation goals and the ratio of the lactate clearance rate (≥10% ) at 2 hours after surgery ,the volume difference of infusion during the first 24 hours ,the incidences of organ dysfunction ,and the average days in ICU were compared between the two groups .Results The percent of patients reaching resuscitation goals at 2 hours after sur‐gery of group A was significantly higher than that of group B(P<0 .01) .The volume of the infusion of 24 hours in group A was less than that in group B(P< 0 .01) .There was no difference in the percent of patients reaching the lactate clearance rate at 24 hours after surgery(≥10% )and the infusin of red blood cells and plasma volume at 24 hours after surgery between the two groups (P>0 .05) .The incidence of organ dysfunction of group A was higher than that of group B (P<0 .05) .The average days in ICU of group A were longer than that of group B(P<0 .01) .Conclusion Based on monitoring CVP and MAP ,fluid resuscitation under the guidance of the lactate clearance rate(≥10% )may decrease the incidences of organ dysfunction and the days of patients in ICU .

ObjectiveToinvestigatethecorrelationbetween-2578C>Apolymorphismofvascular endothelium grow th factor (VEGF) gene and carotid atherosclerosis in Chinese Han population in Shandong, China. Methods A total of 384 subjects aged 45-85 in Chinese Han population in Shandong, China w ere enroled. They were divided into either an increased intima-media thickness (IMT) group ( n=248) or a control group (n=136) according to the vascular ultrasound results. The baseline clinical data, such as the demographic data, vascular risk factors, and blood biochemical indicators in both groups were colected. Polymerase chain reaction w as used to detect the VEGF gene -2578C>A polymorphism genotype and alele. Multivariate logistic regression analysis was used to identify the independent risk factors for increased carotid IMT. Results The proportions of hypertension ( 70.6%vs.59.6%;χ2 =4.793, P=0.032), diabetes (18.4%vs.29.0%; χ2 =5.281, P=0.027), hyperlipidemia ( 45.2%vs.33.1%; χ2 =7.883, P=0.006), previous previous stroke or transient ischemic attack (29.0%vs.16.9%;χ2 =6.294, P=0.009), smoking (35.9%vs.19.9%;χ2 =10.708, P=0.001), as w el as total cholesterol ( 4.82 ±1.25 mmol/L vs.4.57 ± 0.94 mmol/L; t= -2.072, P= 0.039 ), triglyceride ( median, interquartile range; 1.71[0.84-2.22] mmol/L vs.1.53[1.08-2.59] mmol/L;Z= -2.560 P=0.010), low-density lipoprotein cholesterol (2.86 ±1.01 mmol/L vs.2.64 ±0.85 mmol/L; t= -2.407, P= 0.033 ), and high-density lipoprotein cholesterol (1.58 ±0.72 mmol/L vs.1.43 ±0.46 mmol/L;t= -2.183, P=0.030) in the increased IMT group, and there w ere significant differences compared w ith the control group. There w as significant difference in genotype frequency betw een the 2 groups (χ2 =10.131; P=0.006). There w as significant difference in C alele frequency between the increased IMT group and the control group (78.2% vs. 70.2%;χ2 =6.068, P=0.014). Multivariate logistic regression analysis showed that CC genotype (odds ratio 1.132, 95%confidence interval 1.021-2.141;P=0.029) w as an independent risk factor for increased carotid IMT. In 248 patients w ith increased IMT, 213 had at least 1 plaque, 76 (39.6%) of them w ere 1-2, 107 (43.15%) w ere 3-4, and 30 (12.1%) w ere 5-8 in plaque index. There w ere no significant differences in frequencies of genotypes (χ2 =6.766, P=0.149) and alele (χ2 =0.185, P=0.667) in the different plaque index groups. Conclusions -2578 single nucleotide polymorphism in the VEGF gene promoter is associated w ith carotid atherosclerosis, and C al ele may be its genetic susceptibility factor in Chinese Han population in Shandong, China.

Aim To explore the mechanism of neuro-protecting effects of TGRP on ischemic cerebral injury.Methods The middle cerebral artery was occluded for 2 h to produce focal ischemic followed by 24 h reperfusion.HE staining,TUNEL labeling and immunohistochemical methods were used to investigate changes of neuronal apoptosis and expression of the apoptosis-related proteins after administration of TGRP.Result TGRP decreased the pathologic changes significantly.The apoptosis of neural cells and the expression of Bax positive cells in the TGRP groups significantly decreased compared with the control group(P

Aim To screen alteration in protein level in brain tissue between middle cererbral artery occlusion(MCAO) and the total saponins of Rubus Parviflolius L(TSRP) treated rats and to learn the mechanism of nerve-protecting effects of TSRP after focal cerebral ischemia-reperfusion.Methods The MCAO 2 h reperfusion of 24 h model was established in rats,2-DE was applied to preparein step 1 for the separation of protein,and imaging analysis of gels was done with Image-Master 2D software.Different protein spots expressing between cerebral ischemic reperfusion(CIR) model and TSRP group were cut from the gels for the MS analysis,Different protein spots expressing between cerebral ischemic tissue administered with or without TSRP were also cut from the gels for the MS analysis.MALDI-TOF-MS and database search: protein spots from step 2 were subject to in-gel digestion and MALDI-TOF-MS analysis,which resulted in the peptide mass fingerprint spectra(PMF).PMF were search against swiss-prot database using search program of Ms-Fit.Results By comparative proteome analysis,29 expression-altered spots were excised for MS and informatics analysis,comparing to the CIR model,18 proteins up-regulated in the TSRP group,11 proteins down-regulated,7 spots of them were identified and characterized.Conclusion The protective effect of TSRP on cerebral ischemia-reperfusion is the result of the participation of a number of proteins.