Left ventricular pseudoaneurysm(LVPA) is a rare type of abnormal ventricular wall bulge formed by injury to the inner wall of the left ventricle. The exterior wall only consists of epicardium or/and pericardium. In a systematic literature review, myocardial infarction(55%), surgery(33%), and trauma(7%) are the top three associations. Being affected by the high pressure of the left ventricle, LVPA has the risk of enlargement and rupture, which can lead to sudden death. The treatment of LVPA consists of three main modalities: medication, surgery, and transcatheter closure. In the past, surgery was the preferred treatment for LVPA, but the surgery was highly invasive, traumatic, and associated with increased risks. In recent years, transcatheter closure has been developed and applied clinically with good results. The benefits of minimal invasiveness and quick recovery have emerged as a popular treatment for LVPA. Currently, the etiology, formation, and treatment of LVPA are not clearly defined. Large-sample studies and authoritative guidelines to guide the treatment are scarce. The timing, imaging modality, and access routes to LVPA for both surgery and transcatheter closure are still controversial. In this article, we review the relevant literatures and draw the following conclusions as: (1) Diagnostic workup is essential for anatomical characterization of LVPA, which is mandatory to guide the decision on surgical methods.(2) For a subset of patients with LVPA and a well-defined fibrotic neck, and deemed at high surgical risk, transcatheter closure of the cavity has been described with encouraging results.

Left ventricular pseudoaneurysm(LVPA) is a rare type of abnormal ventricular wall bulge formed by injury to the inner wall of the left ventricle. The exterior wall only consists of epicardium or/and pericardium. In a systematic literature review, myocardial infarction(55%), surgery(33%), and trauma(7%) are the top three associations. Being affected by the high pressure of the left ventricle, LVPA has the risk of enlargement and rupture, which can lead to sudden death. The treatment of LVPA consists of three main modalities: medication, surgery, and transcatheter closure. In the past, surgery was the preferred treatment for LVPA, but the surgery was highly invasive, traumatic, and associated with increased risks. In recent years, transcatheter closure has been developed and applied clinically with good results. The benefits of minimal invasiveness and quick recovery have emerged as a popular treatment for LVPA. Currently, the etiology, formation, and treatment of LVPA are not clearly defined. Large-sample studies and authoritative guidelines to guide the treatment are scarce. The timing, imaging modality, and access routes to LVPA for both surgery and transcatheter closure are still controversial. In this article, we review the relevant literatures and draw the following conclusions as: (1) Diagnostic workup is essential for anatomical characterization of LVPA, which is mandatory to guide the decision on surgical methods.(2) For a subset of patients with LVPA and a well-defined fibrotic neck, and deemed at high surgical risk, transcatheter closure of the cavity has been described with encouraging results.

Objective To investigate the clinical value of high resolution ultrasound combined with radiological imaging in the diagnosis of Meckel′s diverticulitis (MD),and to analyze the causes of missed diagnosis as well as misdiagnosis by ultrasound.Methods The image data of 61 patients with MD were retrospectively analyzed,the essentials and the causes of missed diagnosis as well as misdiagnosis of ultrasound were summarized and compared with the results of operation,CT,gastrointestinal contrast,as well as radionuclide.Results The patients were divided into simple type(18,29.5%) and complex type(43,70.5%) according to ultrasonography.The simple type diagnostic accuracy rate was 100%,the ultrasonography showed the right lower abdominal tubular bowel shadow or cystic echo mass,and the structure of diverticulum could clearly showed by ultrasound.In another side,the complex type diagnostic accuracy rate was 55.8%,the ultrasonography showed the right lower abdominal mixed echo mass or concomitant with other alimentary tract malformation,while the diverticulum structure was difficult to be distinguished.The diagnostic accuracy rate of radionuclide imaging was 83.6%,CT was 37.0%,while gastrointestinal contrast was 30.0%.Among 19 cases of misdiagnosis by ultrasound,13 cases of MD were confirmed by radionuclide and CT examination,the diagnostic accuracy rate of ultrasound combined with radiological imaging diagnosis was 90.2%.Conclusions The sonographic features of MD are lack of specificity,especially in the complex type,while the patients with recurrent hemafecia or acute abdomen should be alert to the presence of MD.Patients who are suspected of MD by ultrasound diagnosis should also be examined by radiological imaging in order to make an early diagnosis and surgical treatment to improve the prognosis of patients.

Purpose To investigate the diagnostic value of fetal echocardiography in total anomalous pulmonary venous connection (TAPVC),and to analyze the reasons ofmisdiagnosis so as to improve accuracy of prenatal diagnosis.Materials and Methods The prenatal echocardiographic data of 24 cases of TAPVC confirmed by postnatal echocardiography and prenatal MRI from October 2001 to December 2015 in Children's Hospital Affiliated to Nanjing Medical University and Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine were retrospectively analyzed.Results In 24 cases,there were 14 fetuses of supracardiac type,7 cases of intracardiac type,2 cases of infracardiac type,and 1 case of mixed type.15 fetuses had TAPVC only,whereas 9 cases were associated with other cardiovascular anomalies,most commonly including bilateral right atria,single atrium,single ventricle,common atrioventricular valve and pulmonary stenosis.On 4-chamber views,the common sonographic sign was absent of pulmonary venous return to the left atrium in 24 cases (100.0％),and the presence of venous confluence between left atrium and descending aorta was observed in 22 cases (91.7％).In all 24 cases,1 case was missed diagnosis,and 3 cases were misdiagnosed as persistent left superior vena cava,common pulmonary vein atresia and patent left atrial cardinal vein.Conclusion TAPVC can be accurately diagnosed by fetal echocardiography,but it is prone to be misdiagnosed.

Objective To observe clinical efficacy and explore clinical value of a modified procedure of double-stapling technique for mid-low rectal cancer.Methods Clinical data of patients undergoing laparoscopic anterior resection at the Department of General Surgery,the First Affiliated Hospital of Soochow University from February 2011 to February 2015 was analyzed retrospectively.According to the different ways in doing double-stapling technique,we divided patients into modified group (51 cases) and conventional group (74 cases).Parameters were compared between the two groups as general considerations,oncologic outcomes.Data were analyzed by SPSS 17.0 software packet,using t and x2 inspection.Results The difference of the general data of two groups was not statistically significant (P ＞ 0.05).Operation time in the modified group was longer than that of the conventional group [(169 ± 23) vs.(150 ±42)min,t =-3.150,P ＜0.05],but it had shorter drainage tube indwelling days [(7.9 ±2.9)d vs.(10.8±11.6)d,t=1.999,P＜0.05] and length of hospital stay after surgery [(10.0±3.6)d vs.(13.3 ± 13.7) d,t =1.025,P ＜ 0.05].The incidence of anastomotic leakage (2.0％ vs.18.9％,x2 =4.402,P ＜ 0.05) and tenesmus(3.9％ vs.17.6％,x2 =4.110,P ＜ 0.05) in the modified group was less than that of the conventional group.The difference in those areas was not statistically significant (P ＞ 0.05),such as intraopretive blood loss,per-anal exhaust time,consumption of liquid diet time,anastomotic bleeding,intestinal obstruction,reoperation for neostomy and infections.Conclusions Compared with traditional laparoscopic anterior resection,End-Corner anastomosis has the benefits of less postoperative anastomotic leakage and fewer low anterior resection syndrome.

Objective To investigate the clinical value of ultrasonic diagnosis for neonatal annular pancreas,analyze the reasons of missed diagnosis and misdiagnosis,and improve diagnostic accuracy of ultrasonography for this disease.Methods Clinical data of 98 newborns with annular pancreas confirmed by gastrointestinal contrast and surgery were analyzed retrospectively.Preoperative ultrasonogram were compared with the result of gastrointestinal contrast and surgery.Ultrasound images failed to be correctly dignosed were further studied to summarize diagnostic points for this disease.Results Among the 98 cases, 75 were correctly diagnosed by ultrasound with a diagnostic accordance rate of 76.5%,1 8 were missed diagnosed and 5 were misdiagnosed with a total misdiagnosis rate of 23.5%.Ten cases associated with other congenital gastrointestinal tract anomalies were missed diagnosed due to ignoring scanning pancreas.Five cases were missed diagnosed due to obvious intestinal cavity flatulence.Three cases were missed diagnosed due to lack of awareness of the disease.Five cases were misdiagnosed for duodenal stenosis or duodenal atresia.Conclusions Ultrasound has important diagnostic value for neonatal annular pancreas,providing the dignostic evidences for clinical treatment.Thus it can be used as the preferred auxiliary examination of the disease.Since annular pancreas is often accompanied by other gastrointestinal malformations and can be interfered by abdominal gas,missed diagnosis and misdiagnosis occurred easily.To improve the accuracy of ultrasonic diagnosis,all causes of neonatal gastrointestinal tract obstructions should be considered during the examination.

BACKGROUND:Conditioned medium from mesenchymal stem cels (MSC-CM) may represent a promising alternative to MSCs transplantation. Previous studies have shown that inflammatory activation can strengthen the multiple biological potencies of MSCs; however, normal MSCs with insufficiency of immunocompetence and migration ability are not effective for tissue damage repair. OBJECTIVE:To investigate differential effects of MSC-CM with and without inflammatory activation on radiation-induced intestinal injury.METHODS:MSCs from the bone marrow of SD rats were separated, cultured and identified, and then co-cultured with non-irradiated IEC-6 or irradiated IEC-6 in a transwel system for 24 hours. Then, MSCs with inflammatory activation were cultured alone for another 48 hours. After that, the supernatant was colected as non-activated MSC-CM (MSC-CMNOR) and MSC-CM under radiation-induced inflammatory condition (MSC-CMIR). Rats were exposed to 14 Gy whole abdominal irradiation and randomly divided into four groups: control group, radiation injury group (DMEM/F12), MSC-CMNOR group and MSC-CMIR group. Continuous administration was givenvia tail vein and intraperitoneal implantation of Alzet microosmotic pumps. Intestinal samples were colected at 1, 3, 7 days after radiation for analysis of short circuit variation, at 3 days after radiation for analysis of intestinal epithelium ultrastructure, and at 1, 3, 5, 7, 14 days after radiation for histological observation of the intestinal epithelium using hematoxylin-eosin staining. Blood samples were colected at 1, 3, 7 days after radiation for analysis of serum xylose levels. In addition, the survival state and survival time of rats were observed and recorded. RESULTS AND CONCLUSION: The short circuit variation responding to electrical field stimulation was significantly reduced at al frequencies, but it was significantly improved in the MSC-CMIR group. Similarly, the intestinal absorption (serum xylose levels) was also significantly impaired by irradiation, but improved by delivery of MSC-CMIR (P < 0.05). At 3 days after MSC-CMIR infusion, the intestinal epithelium exhibited an increase in crypt size and vilous length (P < 0.05). Under the electron microscope, a reduction in intestinal microvili and open tight junctions in irradiated intestinal epithelium was found, and the intestine from rats treated with MSC-CMIR had more obvious tight junctions. In addition, treatment with MSC-CMIR dramaticaly improved the survival rate and mean survival time of irradiated rats as compared to those treated with DMEM/F12 or MSC-CMNOR (P < 0.05). Taken together, the present study demonstrated that MSC-CMIR , but not non-activated MSC-CM, improves the structural and functional restoration of the smal intestine after radiation-induced intestinal injury.

OBJECTIVETo explore a new procedure of laparoscopic dual anastomosis for mid-low rectal cancer to reduce postoperative complications.

METHODSClinical data of 56 patients with mid-low rectal cancer undergoing laparoscopic rectal cancer resection(modified double-stapling technique, MDST, modification group) in the Department of General Surgery, the First Affiliated Hospital of Soochow University from February 2010 to June 2014 were compared with the data of 64 patients with mid-low rectal cancer (conventional double-stapling technique, DST, convention group) in the same period based on gender, age, tumor size, the distance from lower edge to the dentate line and tumor staging, etc. Patients in the modification group received operation as follows: (1) the rectum distal end was closed vertically instead of horizontally. (2) the anastomosis was conducted in an "end-corner" approach. (3) upper corner of the closed line in the distal end of rectum was removed. (4) the lower corner of closed line in the distal end of rectum was removed using vascular occlusion clamp method. (5) two T-shaped interchanges ("dangerous triangle") of stapled sutures formed after anastomosis were strengthened with absorbable suture. Patients in the convention group received laparoscopic dual anastomosis using conventional method: two corners and "dangerous triangles" were kept without any treatment. The clinical outcomes of two groups were analyzed retrospectively.

RESULTSThe intraoperational blood loss, postoperative drainage volume, postoperative anastomotic stoma bleeding, bowel function return and hospital stay were not significantly different between the two groups (all P>0.05). As compared to the convention group, the modification group had longer operation time [(211 ± 91) min vs. (174 ± 57) min, P<0.05], lower incidence of postoperative anastomotic leakage [1.8%(1/56) vs. 12.5% (8/64), P=0.030], lower tenesmus rate [3.6% (2/56) vs. 14.1% (9/64), P<0.05], less postoperative stoma re-creation [0 vs. 9.4% (6/64), P<0.05].

CONCLUSIONModified laparoscopic dual anastomosis for mid-low rectal cancer can significantly reduce the incidence of post-surgical complications such as anastomotic leakage.

Anastomosis, Surgical ; Anastomotic Leak ; Humans ; Laparoscopy ; Neoplasm Staging ; Operative Time ; Postoperative Complications ; Rectal Neoplasms ; surgery ; Retrospective Studies

Background and purpose:Anastomotic leakage and low anterior resection syndrome(LARS) are both common complications in dual-anastomosis for patients with low rectal cancer. The aim of this study was to observe and explore the signiifcance and role of vertical cutting of the closed distal rectum in dual-anastomosis for patients with low rectal cancer.Methods:A total number of 120 patients with mid-low rectal cancer who admitted to and completed laparoscopic rectal cancer resection in the Department of General Surgery, the First Afifliated Hospital of Soochow University from Feb. 2010 to Jun. 2014 were pair-matched into Groups A and B based on their gender,age, tumor size, the distance of lower edge to the dentate line and tumor staging, etc. For the 55 patients in Group A (observation group), the rectum distal end was closed vertically instead of horizontally while disposing “the ifrst intestinal anastomosis”, intestine-intestine anastomosis was conducted in an “end-corner” approach when dealing with “the second intestinal anastomosis”, upper corner (“dog ear”) of the closed line in the distal end of the rectum was removed, the lower corner (“dog ear”) of the closed line in the distal end of the rectum was removed using vascular occlusion clamp method, and the T-shaped interchanges (“dangerous triangle”) of stapled sutures formed after anastomosis were strengthened with absorbable suture. For the 65 patients in Group B (control group), laparoscopic dual anastomosis was conducted using conventional method, and the two “dog-ears” and “dangerous triangles” were kept without any treatment. The clinical outcomes of the two groups of patients were analyzed retrospectively. Results:In group A, It was convenient to complete the operation when the “dog ears” and “dangerous triangle” on the vertical line after cutting the closed distal rectum vertically by “end-corner” anastomosis. The axis of intestine formed a certain angle making the closed distal rectum into “ampulla” sample without “dog ears”. the “dangerous triangle” were strengthened with absorbable suture. In group B, The distal and proximal intestine located on the same axis after intestine-intestine anastomosis leaving two “dog ears” and a “dangerous triangle”. The general clinical data of patients in the two groups were comparable and not signiifcantly different (P>0.05). The two groups of patients showed no signiifcant differences in blood loss, postoperative drainage, postoperative anastomotic bleeding, anal exhaust time, and length of hospital stay (P>0.05). However, the operation time as well as the numbers of anastomotic ifstula occurrence, defecation, tenesmus and post-operation re-ostomy differed significantly (P<0.05).Conclusion:Vertical cutting of the closed distal rectum with dual anastomosis made the “new” intestine closer to the physiological bending and morphology of the rectum, meanwhile, it simpliifed the approach of removing “dog ear” and strengthening “dangerous triangle”, ifnally it signiifcantly reduced the incidence of post-surgical complications.

Objective To explore the ultrasound imaging and the clinical analysis of eosinophilic cystitis in children and to improve the understanding of this very rare clinical disease.Methods The ultrasound imaging of 9 patients who were diagnosed as eosinophilic cystitis in Nanjing Children's Hospital Affiliated to Nanjing Medical University from Jul.2007 to May 2013 were analyzed retrospectively,and the relevant literatures were reviewed.Results The ultrasound imaging of the 9 patients were described as follows:4 cases showed a diffuse thickening bladder wall,2 cases showed a localized mass-like thickening bladder wall,and 3 cases showed a markedly thickening anterior bladder wall and bilateral bladder wall.Laboratory studies showed that all the patients were presented with eosinophilia.Six patients underwent cystoscopy that showed an erythematous,and velvety appearance of the bladder mucosa.Histopathology disclosed a bladder mucosal tissue with dense interstitial eosinophilic infiltration consistent with eosinophilic cystitis.Three patients had clinical resolution under the treatment of anti-infections and urine alkalinization.Other 6 patients received prednisone at 0.5-1.0 mg/kg and an antihistamine treatment.Prednisone was eventually tapered off after 2-week reemission.Regular follow-up by urinary bladder ultrasound and urine routine did not show any disease recurrence in 9 children.Conclusions The combination of bladder wall thickening and peripheral eosinophilia may suggest the likely diagnosis of eosinophilic cystitis.Cystoscopy with bladder biopsy is the most important step in the diagnosis of eosinophilic cystitis.Anti-histamines and corticosteroids can be used as the primary management and have good results.