Objective To analyze the reason of the misdiagnosis on carcinoma of gallbladder and to search the measure of prevention. Methods The clinical data of 91 cases of gallbladder carcinoma with misdiagnosis(from 1998 to 1999 operation) was retrospectively analyzed.Results There were 48(52.7%) patients who had been misdiagnosed before operation,major cause was gallbaldder other complication,of them,gallstones was commonest reason 26/54 cases,54.2%.The following misdignosed causes were the acute attack of chronic cholecystitis,gallbladder sandpaper and polypoid lesions of gallbadder.Conclusions On clinic,for those patients ⑴aged-women with chronic cholecystitis for a long term and their gallbladder become atrophy.⑵Local symptom aggravation and/or with complication of gastricism recently. ⑶Imaging inspections such as B ultrasongraphy or CT suggest that somatopleure of gallbladder intensified irreguarly or the cubic capacity of solely tuberculum in gallbladder expands obviously in short term. Prophylactic cholecystectomy should be perfomed,and dissect the sample of the gallbladder as routine operation,so it can elevate the precuse diagnosis rate on carcinoma of gallbladder.

Objective　To study the experience in surgical treatment of gastric mucosa-associated lymphoid tissue lymphoma (GMALTL). Methods　The clinical data of 69 cases of GMALTL from 1984 to 1996 were reviewed. Results　In this series, there were 26 cases in stage Ⅰ, 21 in stageⅡ, 13 in stage Ⅲ and 9 in stage Ⅳ. Diagnosis was proved by both surgery and pathology in all the cases. 61 cases underwent curative resection, 4 incomplete resect and 4 unresectable. Among them, 5 cases were treated by surgery only, surgery plus postoperative radiotherapy used in 25 cases, 19 received surgery plus postoperative chemotherapy, and 20 cases received surgery plus chemotherapy and radiotherapy. 57 cases (82.6%) were following up for 1 to 12 years.The 5,10-year survival rate was 71%(49/69)and 31.9%(22/69) respectively. Conclusions　Clinical stage and therapeutic modality adopted do the major prognostic foctors ,while age and gender do not count much to the recovery. Surgery remains to be the most important treatment model.

ObjectiveTo determine the clinicopathological characteristics, the diagnosis, treatment and prognosis of anorectal malignant melanoma. MethodsRetrospective analysis was unducted for the clinical manifestation,treatment and prognosis of11 cases of anorectal malignant melanoma confirmed by surgery and pathology from 1978 to 1999. Results Of the 11 patients,7 had hematochezia of various degrees and suffered pain surrounding the auns.Seven patients had been misdiagnosed before the operation.The median survival time was 18 months,the longest survivor 39 months.ConclusionsAnorectal malignant melanoma is a highly malignant with early metastasis and poor prognosis.Radical surgery combined with chemotherapy,immunotherapy and biotherapy may be more effective.

Acute organophosphorus pesticides poisoning(AOPP)is one of the common critical emergency problems and the fatality is extremely high. Organophosphorus pesticides(OPS)are highly effective acetylcholinesterase(AChE)inhibitors. The AChE inhibition results in accumulation of acetyl?choline and overestimation of acetylcholine receptors in synapses of the autonomic nervous system, central nervous system,and neuromuscular junctions,causing a series of symptoms including musca?rinic,nicotinic,and central nervous system dysfunctions. In the early stage of AOPP,the core treat?ment is the use of anticholinergic drugs coupled with cholinesterase reactivator. Atropine and penehycli?dine hydrochloride(Tuoning)are the most commonly used anticholinergic drugs,which can effectively compete with acetylcholine receptors,block the effect of acetylcholine,and relieve the symptoms of re?spiratory failure,bronchospasm,pulmonary edema caused by AOPP. Oximes are believed to function as AChE reactivators,that can promote enzymatic reactivation and restore the activity of hydrolysis of ace? tylcholine. Recently,new avproaches,such as intravenous lipid emulsion,new detoxification drugs, blood purification,and traditional Chinese medicine,have attracted more attention. Overall,great prog?ress has been made in AOPP treatments. A better understanding of AOPP mechanism,and the support from pharmacology,toxicology,and related fields can contribute to the treatment of AOPP. Improved medical management of AOPP can also result in fewer deaths from poisoning worldwide.

Objective To investigate the causes of clinical misdiagnosis for gastric mucosa associated lymphoid tissue lymphoma (GMALT). Methods The clinical manifestations of and accessory examination for GMALT in 32 cases were retrospectively analyzed. Results Clinical misdiagnosis was made on 32 out of 78 cases (41%) of GMALT for a period of 5 days to 13 months. Radiographic misdiagnosis rate was 40% and endoscopic misdiagnosis rate was 37%. Conclusion The preoperative diagnosis of GMALT was difficult because the incidence of GMALT is low, the symptoms are nonspecific, and radiologic and fibergastroscopic features were very similar to those of gastric carcinoma and peptic ulcer.

Objective To study the clinical characteristics and treatment of primary appendicular tumor. Methods The clinical data of 13 patients with primary appendicular tumor treated in our hospital from 1979 to 1999 were retrospectively analyzed. Results The primary appendicular tumors included 4 cases of mucinous tumor, 5 cases of carcinoid, 3 cases of adenocarcinoma and 1 case of leiomyosarcoma. None was diagnosed correctly before operation. All 13 cases were treated by operation. Right hemicolectomy was performed in carcinoid, diameter of which was longer than 1cm, right hemicolectomy and regional lymphadenectomy were performed in adenocarcinoma, and the other five cases were only received appendectomy. The patients were in good general condition after operation. Conclusions Primary appendicular tumor lacked particular symptoms, and the rate of misdiagnosis was extremely high. Barium radiography and ultrasonography were helpful for diagnosis. Intraoperative frozen section detection was very important for diagnosis. Operation is a principle therapy, and suitable operation plan may be key factor for improving the prognosis of the patients with appendicular tumor.

Objective To study the early diagnosis and treatment of liver trauma.Methods Retrospective(analysis) of the clinical data of different therapeutic means for liver trauma was made on 124 cases of liver trauma.Of these, 99 patients underwent operative treatment and 25 patients nonoperative treatment .Results In nonoperative treatment group ,22 patients were cured and 3 patients changed to operation.In operative treatment group, including 3 non-opcrative treatment patients changed to opcration,95 patients were cured ,7 patients died.In this series,the cure rate was 94.4%(117/124); mortality rate was 5.6%(7/124),including 5 patients who died of major blood vessel injury ,and 2 patients who died of multiple organ failure. All patients with postoperative(complications) were cured, including subphrenic infection in 3(cases), hepatic(abscess) in 6 cases , pleural(hydrops) in 8 cases, incisional infection in 7 cases,and(intraabdominal)(abscess) in 2 cases. Conclutions Type I liver trauma can be treated by(nonoperation) ; type II～IV blunt liver trauma can be treated by(nonoperation) under the condition of hemodynamic stability and(intensive)(monitoring) .Type II～VI liver trauma accompanied by massive intra-abdominal bleeding and(injury) of other(organs) should be (operated) (emergently .)

Objective To explore the possible mechanism and protective effect of mesenchymal stem cell (MSC) on rats with paraquat-induced acute lung injury. Method The solution of 20% paraquat (PQ) in dose of 18 mg/kg was injected intra-peritoneally into rats to induce poisoning,and phosphate buffered solution (PBS) was given to rats instead of PQ in rats of control group. Eighty specific pathogen free (SPF) Wistar rats were randomly divided into four group: PQ plus PBS group (n = 20), PQ plus MSCs group (n = 20), MSCs plus PBS group (n=20), normal group (n = 20). The forth generation of MSCs were transfected with Ad5-EGFP virus vector, and then the MSCs-EGFP was delivered to rats through the tail vein of rats 4h after PQ. Five rats of each group were sacrificed 1 d, 3 d, 7 d and 28 days after MSCs administration, and lung tissues of rats were taken to make sections for histological observation of the migration of MSCs under fluorescence inverted microscope. The lung tissues of rats sacrificed on the 28 th day after PQ poisoning were taken for detecting pulmonary coefficient and the content of hydroxyproline (HYP) in the lung tissue homogenate, and at the same time, the levels of serum transforming growth factor-β1(TGF-β1) were assayed. Results The pathological changes of lung tissue showed that the pulmonary fibrosis and consolidation in the MSCs treatment group were milder than those in PQ poisoning model group. In the MSCs treatment group, the levels of serum TGF-β1 and lung tissue HYP, and pulmonary coefficient were lower than those of PQ poisoning model group (P＜0.05). Conclusions The use of MSCs for treatment of paraquat intoxication can protect pulmonary structure by decrease in TGF-B1 and inhibiting the fibroblast migration, suppressing the production of collagenous protein.

BACKGROUND:Bone marrow mesenchymal stem cells (BMSCs) of mice are different from human and rats.The difficulties of culture,sustaining impermanency activity of BMSCs after passage and short-term effect of stem cells tracking limited the study of mice.OBJECTIVE:To obverse modified isolated culture method of BMSCs of mice and the feasibility of long-term fluorescent labeling stem cells.DESIGN,TIME AND SETTING:The experiments were conducted at the Affiliated Hospital of Academy of Military Medicine Science from June to December in 2008.MATERIALS:C57BL/6 mice,males and females,4-6 weeks of age,mean weighing 20 g,were used.METHODS:Stem cell culture fluid serum and liquid change manner were optimized using adherent screening and Percoll separation method.Rat BMSCs were incubated.In accordance with previous experiences of MSCs between human and macaque,Hyclonehigh-grade fetal bovine serum was selected for mouse MSC incubation.Serum was 10% of the medium.Bone marrow cells were washed out using LG-DMEM to filter bone dregs and small muscle blocks.Subsequently,samples were added on the Percoll separating medium at relative density of 1.082,and then incubated in 75 cm~2 culture flask at the concentration of 1.5×10~6/cm~2.BMSCs at the second passage were labeled with CM-Dil.MAIN OUTCOME MEASURES:Morphological changes in primary cultured and subcultured mouse BMSCs were measured.BMSC surface antigen of the second passage of mice (CD105,CD44,CD25,CD34) were determined using flow cytometry.The modified method was assessed to harvest the purity of stem cells.Activity of mouse BMSCs was identified using adipogenic and osteoplastic differentiation.The strength of fluorescent cells following multiple passage was observed.RESULTS:①The attached cells were observed 48 hours after primary cells culture and changed shuttles,triangles and flats at 7 days after culture.The figure become bunches and radial pattam at 3 passages.②MSCs highly expressed CD105,CD44 phenotypes and seldom expressed CD34 and CD45.③Spindle shape of cells gradually disappeared,with increased cell body.Some cells grew in cluster.MSCs changed figures to multilayer knots 10 days after inducing osteoplastic differentiation.MSCs became roundness and appeared fat drops in cells 9 days after inducing adipogenic differentiation.Red fat particles were shown following oil O staining.④The labeling cells gave out oranges light,and marked rates were over 80% in MSCs under the fluorescent microscope.The labeling cells were over 47% in 4 passages MSCs using flow cytometry.CONCLUSION:The modified method gained high-dosage cells in shorten culture time at passage 2 and made CM-Dil long lime labeling cells,which made more convenient for MSCs experiment on mice and stem cells tracer experiment in vivo.

OBJECTIVE To investigate dynamics of bacteria in biliary tract infections and their sensitivity to antibiotics.METHODS All bile specimens were collected from surely patients with biliary infection by endoscopic nasobiliary drainage or surgery in Union Hospital affiliated to Fujian Medical University,from Jan 2002 to Dec 2005.All specimens were cultured,and followed by bacterial identification and antibiotics resistance assay.RESULTS The ratio of Gram-negative bacteria in all bacteria of biliary tract infections was decreased(r=-0.983,P