Objective To evaluate the clinical efficacy of multiple stents placement in the management of hilar cholangiocarcinoma,especially in the complex cases of which the hepatic ducts are invaded.Methods Forty-five consecutive patients with hilar cholangiocarcinoma were treated with percutaneous transhepatic placement of two or three self-expandable metallic endoprostheses.The cause of hilar obstructions in these patients were all cholangiocarcinoma,including Bismuth classification type Ⅱ(n 12 ),Ⅲa(n 17),Ⅲb(n 10),and Ⅳ(n 6).Two or 3 stents were placed in the configuration of T,Y or X over the strictures.Results Stent placement with 2 or 3 endoprostheses was successful in all patients.All patients showed significant decrease in serum bilirubin level.The mortality rate within 30 days of stent placement was 2.2%(1/45).The mean survival and stent patency times were 215.3 d(26— 516 d)and 181.5 d(26—473 d),respectively.Conclusion Deploying of multiple metallic stents is an effective method to treat complex hilar cholangiocarcinoma,especially for the cases of which hepatic ducts are invaded:the henatic ducts should be drained as much as nossible.

OBJECTIVETo explore the clinical effect of continual jejunal interposition in digestive tract reconstruction after subtotal gastrectomy.

METHODSThirty-four patients with distal gastric cancer were divided randomly into two groups. In group A, the digestive continuity was reconstructed by continual jejunal interposition in 16 patients after subtotal gastrectomy. In group B, the digestive tract of other 18 cases were reconstructed by Billroth II procedure. The postoperative comp1ications, nutritional status, food intake and gastroscopic results were compared.

RESULTSThere were no complications such as anastomotic leakage or obstruction in the two groups. The Visick scoring of group A was better than that of group B, and the difference was significant one year after operation (mu= 1.98, P< 0.05). All patients retrieved 85% of preoperative food intake per meal in group A, while only l4 patients got such results in group B. The weight loss was significantly higher in group B than that in group A(t = - 2.181, P= 0.037) after operation. The serum albumin level after operation in group A was significantly higher than that in group B (t=2.125, P=0.041), the level one year after operation in group A was also significantly higher than that before operation (t= - 2.175, P= 0.011). Gastroscopy one year after operation revealed fluent stoma,no bile reflux,and no congestion and edema in stomal mucosa and interposed jejunum in group A, while bile retention in 11 cases (61.1%), stomal inflammation in 13 cases (72.2%), and stomal ulcer in 2 cases (11.1%) in group B.

CONCLUSIONContinual jejunal interposition after subtotal gastrectomy can recover physiological continuity of digestive tract and improve the quality of 1ife without reflux gastritis.

Digestive System Surgical Procedures ; methods ; Female ; Gastrectomy ; methods ; Humans ; Jejunum ; surgery ; Male ; Middle Aged ; Stomach Neoplasms ; surgery

OBJECTIVETo discuss the surgical treatment of chiari-I malformation complicated with syringomyelia.

METHODSThe surgical treatments of 247 cases were analyzed retrospectively. The indication of operation styles was proposed by various surgical treatment to different MRI (magnetic resonance imaging) findings. MRI findings includes: tonsillar herniation with no or slight syringomyelia (126 cases), tonsillar herniation with syringomyelia above C(2) (second cervical vertebrae) vertebral level (38 cases), serious tonsillar herniation (to C(2) approximately C(3) level) with syringomyelia of isolated spinal segments (67 cases), serious tonsillar herniation (to C(2) approximately C(3) level) with syringomyelia above C(2) vertebral level (16 cases). They were performed by posterior fossa decompression, posterior fossa decompression and incision of the syringomyelia, posterior fossa decompression and resection of the cerebellar tonsils, posterior fossa decompression and incision of the syringomyelia combined with resection of the cerebellar tonsils respectively.

RESULTSThe clinical signs and symptoms had been markedly improved or improved in 197 cases (79.8%) until patients were discharged from hospital, unchanged in 39 cases (15.8%), deteriorated in 7 cases (2.8%). there were 4 death in all cases after surgery. 107 cases were followed up from 5 months to 9 years. The postoperative MRI findings in the 107 patients demonstrated that the cavities in spinal cords disappeared completely or nearly in 78 cases, reduced in 14 cases, unchanged in 15 cases.

CONCLUSIONSPosterior fossa decompression, posterior fossa decompression and incision of the syringomyelia, posterior fossa decompression and resection of the cerebellar tonsils, posterior fossa decompression and incision of the syringomyelia combined with resection of the cerebellar tonsils should be an effective method for treatment of chiari-I malformation complicated with syringomyelia. Surgical treatment may fully ameliorate the clinical syndromes.

Adolescent ; Adult ; Aged ; Arnold-Chiari Malformation ; complications ; surgery ; Child ; Craniotomy ; Female ; Humans ; Laminectomy ; Male ; Middle Aged ; Retrospective Studies ; Syringomyelia ; complications ; surgery

OBJECTIVESTo investigate the incidence of intra- and extrauterine growth retardation (EUGR) and growth restriction in premature infants, and to illustrate the growth pattern of them in postnatal and infantile period.

METHODSAll premature infants were admitted to our neonatal intensive care unit (NICU) during the recent 7 years. The criteria for enrollment were (1) gestational age < 37 weeks; (2) single fetus; (3) admitted within the first 24 hours of life; (4) hospitalization period ≥ 14 days; (5) clinical follow-up persisted till ≥ 3 months of corrected gestational age. Intrauterine growth restriction (IUGR), EUGR and growth restriction were defined as having a measured growth value (weight) that was ≤ 10(th) percentile of Chinese infants' growth curve in corrected age on admission, discharge and follow-up period. Results were analyzed by using SPSS 12.0 statistical software package by chi-square test, rank-sum test, and t test.

RESULTSTwo hundred and thirty nine infants were involved, 134 were boys and 105 girls. The incidence of IUGR and EUGR assessed by weight was 25.5% and 40.6%, respectively. The lower the birth weight was, the higher the incidence of IUGR and EUGR was. The percentile of body weight in the growth curve at discharge was lower than that at birth (Z = -7.784, P = 0.000). The incidence of growth restriction assessed by weight was 20.5%, 15.0%, 8.8%, 17.0%, 10.4%, 10.1%, 11.9%, 7.0% at corrected gestational age of 38 - 40 weeks, corrected age of 28 d, 61 d, 91 d, 122 d, 152 d, 183 d, and 274 d, respectively. The incidences of growth restriction were stable when the corrected age was older than 91 days. The incidence of growth restriction in female premature infants at 183 days' corrected age was higher than that in male children (χ(2) = 6.181, P = 0.017), the incidence was 19.3% and 3.8% respectively. During the follow-up period, most of the average body weight of premature infants whose gestational age was < 32 weeks or birth weight ≤ 1500 g were lower than the 50(th) percentile of the growth curve except the average body weight of boys whose gestational age < 32 weeks at corrected age of 2 and 4 months.

CONCLUSIONSPremature and/or low birth weight infants are at high risk of growth restriction, especially very low birth weight infants. The incidence of growth restriction decreased with growth. Long-term prognosis requires further investigation.

Body Weight ; Female ; Fetal Growth Retardation ; Follow-Up Studies ; Humans ; Infant, Newborn ; Infant, Premature ; growth & development ; Male ; Weight Gain

INTRODUCTIONThis study aimed to determine the early growth patterns of preterm infants who required prolonged hospitalisation in terms of body weight Z-score, and to explore the influencing factors and predictors of their growth.

METHODSThe criteria of enrolment included preterm birth, singleton pregnancy, hospitalisation within the first 24 hours of life, hospital stay ≥ 28 days and clinical follow-up beyond 91 days of corrected age. Body weight Z-scores and the incidence of underweight infants were reviewed periodically, and the influencing factors and possible predictors of growth analysed.

RESULTSBody weight Z-scores of all infants of gestational age (GA) groups kept decreasing, with a trough seen at 36 weeks corrected gestational age (CGA). At corrected full-term, body weight Z-scores for all birth weight groups achieved birth level and were higher than that at 36 weeks CGA. Body weight Z-scores at 61 days corrected age was (-0.300 × GA [weeks] + 0.210 × birth weight [g] + 0.682 × body weight Z-score) at 40 weeks CGA. The cut-off values for body weight Z-score at birth (cut-off, -1.79; sensitivity, 100%; specificity, 91.3%) and 61 days corrected age (cut-off, -1.95; sensitivity, 100%; specificity, 97.1%) were selected to predict the risk of being underweight at 183 days corrected age.

CONCLUSIONEarly growth restriction is a practical problem in preterm infants with prolonged hospitalisation. Body weight Z-scores at 40 weeks CGA and 61 days corrected age can be used to predict body weight gain prior to 183 days corrected age in these infants.

Female ; Follow-Up Studies ; Gestational Age ; Growth Disorders ; epidemiology ; etiology ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; growth & development ; Infant, Premature, Diseases ; epidemiology ; etiology ; Length of Stay ; trends ; Male ; Pregnancy ; Retrospective Studies ; Singapore ; epidemiology

Objective To study the clinical and experimental efficacy of end-to-side gastro jejunostomy with circular stapler after distal subtotal gastrectomy.Methods Twelve Beagle dogs were randomly divided into group A and B. End-to-side gastroduodenostomy was finished with circular staplers or hand-sewn after gastrectomy. Side-to-side gastroduodenostomy was done in the second operation after three months.Healing and diameter of end-to-side gastroduodenostomy in Beagle'S were observed dogs.Perimeter of side-to-side gastroduodenostomy and duodenum adjacent to anastomosis were measured. One hundred and forty-five patients suffered from stomach cancer were randomly divided into group A and B.Group A had 71 cases and Group B 74 cases.End-to-side gastrojejunostomy was finished with circular stapler or hand-sewn after distal subtotal gastrectomy.Leakage and stricture of anastomosis were observed after operation.Size of anastomosis and track of Barium fluid and gastric residual Barium fluids two hours later were observed one year after operation.Results All operations in 12 dogs were successful.Healing of anastomoses and triangles at small curvature were satisfied three months after operation.Diameters of end-to-side gastroduodenostomy in group A and B were (1.18±0.13)am and(1.20±0.09)cm respectively，which were not significantly different between the two groups(t=-0.255，P=0.804).Circumferences of side-to-side gastroduodenostomy and duodenum adjacent to anastomosis were(6.46±0.06)cm and(7.26±0.12)cm respectively.All operations in 106 cases were successful and no complications of leakage and stricture of anastomosis occurred.Thin Barium fluid passed over anastomosis quickly under X-ray after one year.There was a little Barium fluid in the residual stomach in two hours later. Conclusion End-to-side gastrojejunostomy with circular stapler after distal subtotal gastrectomy is feasible. Anastomosis at the original position of residual stomach ensures adequate remove of stomach and prevents from trauma of spleen and vessel around spleen.

Objective To study the clinical and experimental efficacy of end-to-side gastro jejunostomy with circular stapler after distal subtotal gastrectomy.Methods Twelve Beagle dogs were randomly divided into group A and B. End-to-side gastroduodenostomy was finished with circular staplers or hand-sewn after gastrectomy. Side-to-side gastroduodenostomy was done in the second operation after three months.Healing and diameter of end-to-side gastroduodenostomy in Beagle'S were observed dogs.Perimeter of side-to-side gastroduodenostomy and duodenum adjacent to anastomosis were measured. One hundred and forty-five patients suffered from stomach cancer were randomly divided into group A and B.Group A had 71 cases and Group B 74 cases.End-to-side gastrojejunostomy was finished with circular stapler or hand-sewn after distal subtotal gastrectomy.Leakage and stricture of anastomosis were observed after operation.Size of anastomosis and track of Barium fluid and gastric residual Barium fluids two hours later were observed one year after operation.Results All operations in 12 dogs were successful.Healing of anastomoses and triangles at small curvature were satisfied three months after operation.Diameters of end-to-side gastroduodenostomy in group A and B were (1.18±0.13)am and(1.20±0.09)cm respectively，which were not significantly different between the two groups(t=-0.255，P=0.804).Circumferences of side-to-side gastroduodenostomy and duodenum adjacent to anastomosis were(6.46±0.06)cm and(7.26±0.12)cm respectively.All operations in 106 cases were successful and no complications of leakage and stricture of anastomosis occurred.Thin Barium fluid passed over anastomosis quickly under X-ray after one year.There was a little Barium fluid in the residual stomach in two hours later. Conclusion End-to-side gastrojejunostomy with circular stapler after distal subtotal gastrectomy is feasible. Anastomosis at the original position of residual stomach ensures adequate remove of stomach and prevents from trauma of spleen and vessel around spleen.

OBJECTIVETo investigate the gene differential expression patterns in hepatocirrhosis and non-hepatocirrhosis tissues within different ischemic time.

METHODSThe liver tissues were divided into two groups: Group A (non-hepatocirrhosis), Group B (hepatocirrhosis), each of which consisted of 3 groups with different ischemic time: 15, 30 and 45 minutes. The gene differential expression patterns in the two groups within different ischemic time were detected and compared with those in normal liver tissues by using 4000 points gene microarray.

RESULTSIn non-hepatocirrhosis tissues, the homeostatic maintenance genes expressed highly during hepatic ischemia for 15 minutes, and no apoptotic gene was expressed; but in hepatocirrhosis tissues, many apoptotic genes expressed highly. As for 30 minutes, in both two groups liver tissue genes expressed to the peak, and the genes related to cell death, oxidative stress and nuclear factors expressed highly. The difference lies in the facts that in Group B pro-apoptosis genes expressed more than those in Group A, and the Ratio values were higher than those in Group A. Many genes of heat shock protein family and antioxidant proteins expressed highly simultaneously in Group A, but comparatively low in Group B. As for 45 minutes, genes of heat shock proteins and antioxidant proteins expressed lowly in Group B.

CONCLUSIONSIt suggests that the safe time limit of hepatic ischemia for cell survive is 30 minutes or so. Non-hepatocirrhosis tissues could endure 30 minutes of ischemia and even longer, but it should be restricted within 30 minutes in hepatocirrhosis tissues.

Gene Expression Profiling ; Humans ; Ischemia ; genetics ; Liver ; blood supply ; metabolism ; Liver Cirrhosis ; genetics ; pathology ; Oligonucleotide Array Sequence Analysis ; methods ; Time Factors

Objective To survey the incidence of acute coronary events and its trend in three years,and explore the distribution of the incidence across Beijing residents aged 25 years and more from 2007 to 2009.Methods The present study incorporated and linked the routinely collected data from the Hospital Discharge Information System and Cause of Death Register System in Beijing,estimated the incidence of acute coronary events,and analyzed the distribution of the incidence across gender,age groups and regions.Acute coronary event was defined as non-fatal myocardial infarction and death from coronary heart disease. Numbers of residents by age,gender and area were obtained from the Beijing Statistics Bureau.Results A total of 68 390 acute coronary events were identified among permanent residents of Beijing aged 25 years and more from 2007 to 2009.The age-standardized incidence was 166.4 per 100 000 people in overall population,with 218.5 in males and 115.2 in females.The age-standardized incidence was 144.3,154.7,and 195.8 per 100 000 people in urban,suburban,and exurban area,respectively.The incidence was the highest in Huairou district (263.8 per 100 000),while was the lowest in Haidian district ( 121.5 per 100 000 ).The age-standardized incidence was 158.4,169.4,and 171.2 per 100 000 in 2007,2008,and 2009,respectively.The age-standardized incidence increased by 8.1％ in 2009 compared to 2007,increase in men ( 11.1％ ) was greater than in women (2.5％ ).The incidence increased significantly with age in each year.The incidence raised by 30.3％ in 2009 compared to 2007 for men aged 35 - 44 years.In 2009,the incidence was 146.7,155.9,and 207.4 per 100 000 people in urban,suburban,and exurban area,respectively.The rates increased by 3.2％ in both urban and suburban areas,and 16.4％ in exurban areas in 2009 compared to 2007.Conclusion The incidence of acute coronary events increased from 2007 to 2009 among the permanent residents of Beijing aged 25 years and over,especially in young men,and people living in the exurban areas.

BACKGROUNDThe main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation (OLT) include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT.

METHODSThe clinical data of 25 patients diagnosed with hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement.

RESULTSAmong five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients' liver function was stable and one patient received late liver retransplantation due to ischemic bile duct lesion.

CONCLUSIONSIndividualized therapeutic regimens should be adopted in treating hepatic artery complications after OLT, according to postoperative periods, types and whether ischemic bile duct lesion exists or not. Liver retransplantation is the best treatment for patients with hepatic artery thrombosis. Interventional treatments of late HAS without irreversible liver failure or bile duct ischemia are appropriate, whereas retransplantation is recommended for early HAS.

Adult ; Aged ; Constriction, Pathologic ; Female ; Hepatic Artery ; pathology ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Reoperation ; Retrospective Studies ; Thrombosis ; therapy