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Objective:To analyze the clinical characteristics of PHPT in elderly patients, as well as the safety and effectiveness of surgical treatment.Methods:179 patients with PHPT treated from Jan. 2000 to Dec. 2020 were analyzed retrospectively. They were divided into elderly group ( n=51) and non-elderly group ( n=128) according to whether they were over 60 years old at the time of operation. The clinical data of symptoms, complications, preoperative and postoperative blood calcium, phosphorus, ALP, PTH, surgical cure rate and complication rate of the two groups were analyzed retrospectively. T-test was used for measurement data comparison. χ2 test was used for enumeration data comparison and single factor analysis. Logistic regression analysis (forward method) was used for multivariate analysis. Results:The proportion of non-specific symptoms in the elderly group, including fatigue, dizziness, loss of appetite, memory decline, was higher than that in the non-elderly group (21.6% vs 8.6%, P=0.019) . Elderly patients had lower blood ALP level[ (163.4±229.8) U/L vs (325.9±449.2) U/L, P=0.016], higher proportion of preoperative hypertension (47.1% vs 21.1%, P=0.001) , diabetes (31.4% vs 10.9%, P=0.001) , coronary heart disease (13.7% vs 3.1%, P=0.013) and tumor (13.7% vs 3.9%, P=0.025) . High proportion of non-specific symptoms was related to higher blood calcium [ OR=4.936 (95% CI 1.126-21.637) , P=0.034] and lower blood phosphorus[ OR=0.011 (95% CI 0.000-0.650) , P=0.030]. Between the two groups there was no significant difference in cure rate (94.1% vs 96.1%, P=0.564) or complication rate (27.5% vs 44.5%, P=0.127) . Conclusions:The surgical treatment of elderly patients with PHPT also has high effectiveness and safety. More attention should be paid to surgical diagnosis and treatment of elderly patients.
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Depression is one of the prevalent causes of health-related human suffering and is,first and foremost,a disorder of one of the least-studied biological phenomena:emotion.Therefore,it is critically important to understand emotion,in order to understand the etiology of depression.Chinese medicine is the oldest subject about emotion,has developed a theory about basic emotions and their interactions,and also their roles in causes and therapy in most of human diseases,including mental disorders,such as depression.Nowadays,major depressive disorder (MDD) is a prevalent mental disorder with cognitive,affective and behavioral symptoms,and has been identified as a leading cause of disability,and affecting about ～17％ of the populations worldwide.Decades of animal and clinical studies have pointed its etiology in dysfunctions in the monoamine transporters.Here we will review some literatures about the relationship between the monoamine neuromodulators and emotional theory in Chinese medicine,which might introduce theoretical perspectives in studies about emotion and depression.
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This paper aimed at comparing the differences of antidepressant effects of Yueju Pill between the Balb/c mice and C57 BL/6 J mice and analyzing the effects on synaptic transmission in mice prefrontal cortex. Healthy adult Balb/c mice and C57 BL/6 J mice were randomly divided into control group and Yueju Pill group. Control group was treated with saline, Yueju Pill group was treated with single dose of Yueju Pill (13.5 g·kg-1) . The forced swimming test (FST) was measured 30 min after administration. The field excitatory postsynaptic potential (fEPSP) and long-term potentiation (LTP) of mice prefrontal cortex were detected by the electrophysiological experiment. In FST, the immobility time of Balb/c mice in Yueju Pill group was significantly lower than that in control group (P ＜ 0.01), and the immobility time of C57 BL/6 J mice showed no remarkable difference between Yueju Pill group and control group (P＞ 0.05) . In electrophysiological experiment, the percentage of slope of fEPSP in Balb/c mice in Yueju Pill group was significantly higher than that in control group (P ＜ 0.01), while there was no significantly difference in C57 BL/6 J mice between Yueju Pill group and control group (P＞ 0.05) . The LTP of Balb/c mice in Yueju Pill group was significantly increased than that in control group (P ＜ 0.01), while there was no significantly difference in LTP of C57 BL/6 J mice between Yueju Pill group and control group (P＞ 0.05) . Yueju Pill may display rapid antidepressant effect via increasing fEPSP and LTP in prefrontal cortex of Balb/c mice and then enhancing the synaptic transmission.
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Objective To evaluate the diagnostic procedures and treatment choice of primary malignant tumor of the duodenum.Methods The clinical data of 170 cases with primary malignant tumor of the duodenum at Peking University People's Hospital from 1996 to 2015 were analyzed retrospectively.Results Tumors located in the first,second,third and fourth parts in 14 cases (8.2％),144 cases (84.7％),9 cases (5.3％),and 3 cases (1.8％) respectively,and among them,tumors within papillary area accounted for 62.4％ (106 cases).The main clinical presentations included jaundice,upper abdominal pain,abdominal distention,nausea and vomiting.Among the 170 cases,125 cases obtained accurate tumor stages,with 34 cases on stage Ⅰ (27.2％),45 cases on stage Ⅱ (36.0％),30 cases on stage Ⅲ (24.0％),16 cases on stage Ⅳ (12.8％).The accuracy rate of ultrasound and CT in preoperative diagnosis was 27.6％,and 72.3％ respectively.The pathological type of 144 cases (84.7％) was adenocarcinoma.The postoperative 1-,3-and 5-year survival rate was 69.1％,48.6％ and 33.9％.Conclusions Most primary malignant duodenal tumors are located in papillary region,necessitating radical pancreaticoduodenecomy,early diagnosis remains the key for longterm survival.
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Objective To analyze the risk factors for pancreatic fistula after pancreaticoduodenectomy.Methods Clinical data of 351 patients who underwent pancreaticoduodenectomy in our hospital from Jan 2001 to Dec 2015 were retrospectively analyzed.Results The overall incidence of pancreatic fistula was 20.2％ (71/351),with grade A in 34 (9.7％) patients,grade B in 25 (7.1％),and grade C in 12 (3.4％).Postoperative hospital stay was significantly prolonged in patients with grade B and C pancreatic fistula.Multivariate analysis using Logistic regression identified three variables as independent factors associated with pancreatic fistula,namely,BMI (OR =2.281),preoperative total bilirubin level (OR =2.180) and soft pancreatic texture (OR =3.653).Preoperative total bilirubin level (OR =2.684),soft pancreatic texture (OR =5.128) and postoperative hemorrhage (OR =9.030) were independent risk factors of grade B and C pancreatic fistula after pancreaticoduodenectomy.Conclusions The incidence of pancreatic fistula after pancreaticoduodenectomy is still high.Pancreatic fistula prolongs the postoperative hospital stay significantly.The incidence of grade B and C pancreatic fistula could be reduced by avoiding postoperative hemorrhage.
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Objective To investigate the diagnosis and management of focal nodular hyperplasis (FNH).Methods Clinical data of 36 FNH patients who were admitted to the Peking University People's Hospital from February 2009 to August 2015 were retrospectively analyzed.All the patients received serological and imaging examinations.Appropriate surgical treatment was done on symptomatic patients and those in which diagnosis was established but lesions progressly enlarged.Conservative treatment was done on FNH confirmed patients without symptoms.Results Of the 36 patients,22 were male and 14 were female.29 patients had no obvious clinical symptoms.The liver function was normal in 33 patients,HBsAg positive in 1 case.Serum tumor markers were normal in all patients.B ultrasound made no identification of FNH in all patients.CT was done in 10 cases,and FNH was suggested in 4 cases.MRI done on 12 cases and the diagnosis of FNH was made in 7 cases.Combination CT and MRI performed in 14 cases made definite FNH diagnosis in 10 cases.Surgical resection was performed in 30 cases,and 2 cases were treated with percutaneous radiofrequency ablation.No recurrence was found during a follow up of 14-72 months.4patients treated conservatively were imaging followed-up for 3-22 months without tumor development.Conclusion The clinical manifestations of FNH are atypical and unobvious.Combined CT and MRI examinations can help establish the diagnosis of FNH.Resection or ablation was suggested on patients in which malignancy can not be excluded.
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Objective To determine the expression of myosin heavy chain 9 (MYH9) in colorectal adenocarcinoma tissues and its clinical significance.Methods Immunohistochemistry and tissue-array were used to determine MYH9 expression in human colorectal adenocarcinoma tissues and matched adjacent tissues.A statistical analysis was performed to establish the potential correlation between MYH9 expression and the patients' clinicopathological characteristics,tumor progression,and prognosis.Results MYH9 is up-regulated in colorectal adenocarcinoma tissues compared with matched adjacent tissues (P =0.000),and it was shown that MYH9 expression is significantly correlated with age (P =0.050),clinical stage (P =0.000),lymph node (P=0.010) and distant (P =0.000) metastasis,but not with sex,primary sites,grade,infiltration,clinical stage (all P ＞ 0.05);it was also shown that MYH9 expression had a significant influence on prognosis (x2 =20.437,P =0.000).Multivariate analyses showed that high MYH9 expression is an independent poor prognostic factor for overall survival (P =0.013).Conclusions The up-regulation of MYH9 in colorectal adenocarcinoma closely correlates with age,clinical tumor stage,metastasis and patient's survival.
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Objective To investigate the situation of college students using cell phones,and explore the relationship between College Students' cell phones addiction and self-control and the regulation effect of academic performance.Methods Using the entity questionnaire survey and the online questionnaire survey to research the situation of the college students' intelligent cell phones use and self control and the regulation effect of academic performance.Results The smartphone was very popular among college students,with 84.9％ of college students using smartphones in the two surveys,and the smartphone addiction was about 10.6％.Smartphone addicts of college students related with origin of student (t=2.31,P=0.022),and had no correlation with gender (t=-0.46,P=0.647),and major (t=1.77,P=0.079).Students' phone addiction and self-control were positively correlated (r=0.506,P＜0.01).The academic record ranking was regulated by self-control and college smart-phone using.Conclusion Cell phones are widely used among college students.Self-control positively related with cell phones and cell phone addiction,and the academic record ranking regulates the strength of relationship between the cell phones using and self control.
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Objective To explore the application and effect of three-dimensional animation teaching software combined with case based learning ( CBL ) in inguinal hernia clinical teaching . Methods Totally 30 eight-year program students of Grade 2008 of Peking University People's Hos-pital were randomly divided into the teaching software combined with the CBL group(n=15) and tradi-tional teaching group(n=15). Three-dimensional animation teaching software was used to simulate the whole process of inguinal hernia anatomy and physiology, pathogenesis, clinical manifestations, diag-nosis and treatment in teaching software combined with CBL group. CBL teaching was conducted by setting problems through typical case and case discussion under the guidance of the teacher . The teacher-centered teaching, teaching rounds and watching operation were used in the traditional teaching group . Theory examination and physical examination were given at the end of the study and achieve-ment differences were compared between 2 groups. Questionnaire was used to investigate students' evaluation of the teaching method in teaching software combined with the CBL group and data were statistically described using t test. Results Theoretical exam score of the teaching software combined with the CBL group was (94.80±1.54), superior to the traditional teaching group(86.10±1.86), and the difference was statistically significant(t=8.242, P=0.000). Clinical skill test score of the teaching software combined with the CBL group was (91.10±1.01), superior to the traditional teaching group (85.90±2.17), and the difference was statistically significant(t=8.531, P=0.000). The survey result showed that more than 80.00% students thought that this teaching method could arouse students' learning enthusiasm, promote their mastery and application of knowledge, strengthen their self-study ability, cultivating their clinical thinking and improving their learning efficiency. Conclusion The teaching method of three dimensional animation teaching software combined with CBL , as a new teaching mode, helps to improve the quality of teaching.
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Objective To investigate the effects of maternal deprivation at different time periods in rat pup development on depressions in adults.Methods Newborn SD rat pups were randomly divided into 5 maternal deprivation groups(n=5 in each group) and one control group (n=7).The rat pups in the maternal deprivation groups were separated from their mother for 6 hours in one day,at p0,p5,p 10,p15,p20 respectively,lasting for five days.Then the rats will be screened for depression at the age of 10 weeks,using different behavioral tests,which included forced swim,coat score,sucrose preference test.Norepinephrine concentration in the cerebral spinal fluid was also measured through high performance liquid chromatography (HPLC).Results Maternal deprivation for rat pups induced depression like behavior in adults.The floating time during forced swim test increased from(58.5 ±7.5) s in control group to(p0(75.6±9.4) s,p5(150.4±12.5) s,p10(174.5±14.3) s,p15(155.4±11.4)s,p20 (112.4±10.3) s respectively in maternal deprivation groups;and it was significant different among the groups(P＜ 0.01).Compared with the control group(0.87±0.1),the sucrose preference in maternal deprivation groups decreased(p0 (0.73±0.12),p5 (0.53±0.09),p10 (0.5±0.06),p15 (0.54±0.07),p20 (0.67±0.05)).And the coating scores in maternal deprivation groups decreased from 4.5±0.6 in control group to p0(3.3±0.6),p5 (2.3±0.4),p10 (1.9±0.3),p15 (2.4±0.4),p20 (4.4± 0.4).Finally,maternal deprivation also induced low concentration of catecholamine in the cerebral spinal fluid compared with that in control group (p0 (94.5± 11.5) ％,p5 (78.5± 9.6) ％,p10(67.6±±7.4)％,p1S(64.5±6.6)％,p20(88.5±7.5)％,P＜0.01,n=5-7).Conclusion Maternal deprivation at different lactation periods may induce depression behaviors in rat offspring,and also lead to lower concentration of catecholamine in the cerebral spinal fluid.
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<p><b>BACKGROUND</b>OX40/OX40 ligand (OX40/OX40L) and programmed death-1/programmed death ligand-1 (PD-1/PD-L1) costimulatory signals play important roles in T cell-induced immune responses. The aim of this study was to investigate the roles of OX40/OX40L and PD-1/PD-L1 costimulatory pathways in mouse islet allograft rejection.</p><p><b>METHODS</b>Lentiviral vectors containing OX40L siRNA sequences and an adenovirus vector containing the PD-L1 gene were constructed. The streptozotocin-induced model of diabetes was established in C57BL/6 (H-2(b)) mice. Diabetic C57BL/6 mice were randomly allocated into five groups: group 1, untreated control; group 2, Ad-EGFP treatment; group 3, Ad-PD-L1 treatment; group 4, OX40L-RNAi-LV treatment; group 5, OX40L-RNAi-LV combined with Ad-PD-L1 treatment. Lentiviral vector and the adenovirus vector were injected, singly or combined, into the caudal vein one day before islet transplantation. The islets of DBA/2 (H-2(d)) mice were transplanted into the renal subcapsular space of the diabetic recipients. Recipient blood glucose and the survival time of the allografts were monitored. Antigen-specific mixed lymphocyte reaction was also evaluated.</p><p><b>RESULTS</b>The recombinant lentiviral RNA interference vector OX40L-RNAi-LV reduced OX40L protein expression by 70%. The recombinant adenovirus vector Ad-PD-L1 increased PD-L1 protein expression in vivo in C57BL/6 recipient mice. Combined OX40L-RNAi-LV/Ad-PD-L1 treatment induced a synergistic protective effect in pancreatic islet allografts. Allograft survival time in the combined treatment group was (92.27±9.65) days, not only longer than that of the control ((6.51±0.27) days) and Ad-EGFP groups ((7.09±0.13) days) (P < 0.01), but also significantly longer than that of Ad-PD-L1 and OX40L-RNAi-LV single treatment groups ((40.64±3.95) days and (55.14±5.48) days respectively, P < 0.01). The blood glucose concentration of recipient mice in the combined treatment group was also stable and kept within the normal range. Flow cytometry analysis showed that combined OX40L-RNAi-LV/Ad-PD-L1 treatment significantly decreased proliferation in an antigen-specific mixed lymphocyte reaction. After donor DBA/2 lymphocyte stimulation, 89.71% of lymphocytes from recipient combination treatment C57BL/6 mice were not split and proliferated. In contrast, after stimulation with third party Lewis rat lymphocytes, only 45.84% lymphocytes of C57BL/6 mice were not split and proliferated.</p><p><b>CONCLUSIONS</b>This study demonstrates the successful construction of the recombinant lentivirus vector OX40L-RNAi-LV and adenovirus vector Ad-PD-L1 for the blockade of OX40/OX40L and activation of PD-1/PD-L1 costimulatory pathways simultaneously in pancreatic islet allografts in diabetic mice. Combination therapy with these two vectors resulted in inhibition of T cell activation, synergistically prolonging the survival time of pancreatic islet allografts.</p>
Subject(s)
Animals , Male , Mice , B7-H1 Antigen , Genetics , Metabolism , Graft Rejection , Genetics , Islets of Langerhans Transplantation , Allergy and Immunology , Mice, Inbred C57BL , OX40 Ligand , Genetics , Metabolism , Receptors, OX40 , Genetics , Metabolism , Transplantation, HomologousABSTRACT
Objective To determine the expression of G-protein coupled receptor 34 (GPR34) in hepatocellular carcinoma tissues.Methods Immunohistochemistry and tissue-array were used to determine GPR34 expression in human hepatocellular carcinoma tissues and matched adjacent tissues.A statistical analysis was performed to establish the potential correlation between GPR34 expression and the patients'clinicopathological characteristics,tumor progression,and prognosis.Results GPR34 is up-regulated in primary hepatocellular carcinoma tissues compared with matched adjacent tissues (P =0.003),and it was shown that GPR34 expression is significantly correlated with tumor size (P =0.024),small hepatocellular carcinoma(0.030) and infiltration(P =0.012),but not with sex,age,grade,chnical stage (all P ＞0.05) ; it was also shown that GPR34 expression had a significant influence on prognosis (X2 =5.617,P=0.018).Multivariate analyses showed that high GPR34 expression is an independent poor prognostic factor for overall survival (P =0.037).Conclusions The up-regulation of GPR34 acts as an potential prooncogene in the development and progression of hepatocellular carcinoma.GPR34 may be a useful diagnostic or prognostic molecular biomarker,and a potential target for therapeutic intervention.
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Objective To analyze the cause and treatment of the postoperative gastrointestinal hemorrhage after pancreaticoduodenectomy(PD).Methods Clinical data of 213 patients who underwent PD in our hospital from January 1996 to December 2011 and 2 patients who suffered from gastrointestinal hemorrhage after PD transferred to our hospital from other hospitals were retrospectively analyzed.Results The incidence of postoperative gastrointestinal hemorrhage was 8.5％ (18/213),the mortality rate of which was 22.2％ (4/18).Among the twenty patients with postoperative gastrointestinal hemorrhage (including the 2 patients transferred from other hospitals),stress ulcer was the most common reason of gastrointestinal hemorrhage (11/20,55 ％).There were 8 patients suffering from mild hemorrhage who were treated by medications.Seven of 12 patients who suffered from severe hemorrhage underwent reoperation.Univariate analysis showed that duration of operation above 420 min (x2 =3.976,P =0.046) and volume of intraoperative blood loss above 1200 ml (x2 =6.753,P =0.009) were significantly associated with postoperative stress ulcer bleeding.Multivariate logistic regression analysis showed that intraoperative blood loss was the only independent factor associated with postoperative stress ulcer bleeding (OR =5.677,P =0.035).Conclusion Gastrointestinal hemorrhage is one of the common complications after PD.The incidence of stress ulcer bleeding could be reduced by skillful operation and decreasing intraoperative blood loss.Operation should be used properly according to the cause and location of bleeding if hemorrhage could not be stopped by medications.
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Objective To investigate the change of gastroesophageal reflux including acid reflux,duodenogastroesophageal reflux (DGER) and its effect on expression of COX-2 and TNF-α in the remnant esophagus in different period after esophagectomy for cancer.Methods Thirty-two patients who underwent esophagectomy for cancer were selected randomly.Twentyfour-hour pH and spectrometric bilirubin monitoring,endoscopy were periodically performed.Esophageal mucosa samples were obtained by endoscopic biopsy.Expression of COX-2 and TNF-α within remnant esophageal mucosa was detected using immunohistochemical assay.Results ( 1 ) The incidence of reflux esophagitis and extent of acid reflux gradually increased over time after surgery for cancer ( P ＜ 0.05 ).(2) Very low level of COX-2 and TNF-α expression was detected in normal esophageal squamous mucosa.The expression of COX-2 and TNF-α was observed in cytoplasm of basal cell of esophageal epithelium after esophagectomy for cancer.High intensity of COX-2 and TNF-α expression was detected in the metaplastic columnar mucosa.The level of TNF-α expression in the remnant esophagus where reflux esophagitis occurred was higher than that in the normal remnant esophagus ( P =0.0274 ).There was no significant difference in level of COX-2 expression in the remnant esophagus between reflux esophagitis occurred and not ( P =0.7403 ).Conclusion ( 1 ) The extent of acid reflux and incidence of esophagitis gradually increases over time.(2) The expression of COX-2 and TNF-α may represent an early change associated with gastroesophageal reflux.The expression of COX-2 may serve as a molecular marker of gastroesophageal reflux occurred.( 3 ) The durative expression TNF-α is likely involved with the pathogenesis of chronic reflux esophagitis.
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Objective To evaluate the treatment experience on primary retroperitoneal neoplasms involving large blood vessels.Methods In this study 82 patients with primary retropetropeal neoplasms were treated surgically from 1990 to 2010 and the clinical data of these patients including preoperative radiological examinations and surgery were retrospectively analyzed.Result The sensitivity and specificity of preoperative imaging examination for identifing large blood vessel involvement was 70％ and 73％respectively.Compared with those of no large blood vessel involvement,patients with large blood vessels involvement had a lower rate of tumor complete removal,more intraoperative blood loss and longer operation time( P ＜ 0.05).In group of large vascular involvement,patients undergoing complete tumor resection were all alive after 12 months,and none of those undergoing palliative resection survived more than 9 months.Conclusions Preoperative imaging allows precise evaluation on the status of large blood vessel involvement in patients of retroperitoneal tumors.Involving large vessels often predicts inability in total resection of retroperitoneal tumors.
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Objective To investigate the effect of different operative approaches on perioperative respiratory and cardiac function of patients with gastric cardia carcinoma. Methods The perioperative changes of SpO2 ,Breath Rate (BR) and Heart Rate(HR) of patients with gastric cardia carcinoma underwent surgical therapies through transthoracic ( n = 30 ), transabdominal ( n = 37 ) or trans-thoracoabdominal ( n = 10 )approaches were compared respectively. Results On the postoperative 1st,2nd,4th and 7th day,the changes of BR in transthoracic (5. 20 ± 0. 96,5. 17 ± 1. 58,3.93 ± 1.53,2. 63 ± 1.25 )/min and trans-thoracoabdominal (5.80 ±0. 79,6. 10 ± 1.20,4. 80 ± 1.32,3.00 ± 1.49)/min approach groups were significantly greater than that of transabdominal group (4. 35 ± 1.06,3.89 ±0. 99,2. 24 ± 1.30,1.16 ±0. 65)/min (Ps ＜0. 05). At the meanwhile, the changes of SpO2 at 2nd, 4th postoperative day of transthoracic ( [ 8. 30 ± 1.95 ] %, [ 7.23 ±2. 01 ] % ) and trans-thoracoabdominal ( [ 8.60 ± 1.43 ] %, [ 7. 70 ± 2. 11 ] % ) approach groups were significantly greater than that of transabdominal group ( [ 7. 08 ± 1.82 ] %, [ 6.24 ± 1.88 ] % ) ( Ps ＜ 0. 05 ), but there were no significant differences observed among three groups on the postoperative 1st,7th day. On the postoperative 1 st,2nd and 4th day, the changes of HR of transthoracic ( 18.00 ± 3.79,13.47 ± 4. 42,8. 60 ±4. 13 )/min and trans-thoracoabdominal ( 19. 80 ± 4. 96,14. 80 ± 3.33,8.70 ± 3.47)/min approach groups were significantly greater than that of transabdominal group ( 13.62 ± 4. 00,10. 84 ± 4. 16,6. 32 ± 2. 53 )/min, too (Ps ＜0. 05) ,but no differences were observed among three groups on the postoperative 7th day (Ps ＞0. 05).Coniclusion Transthoracic,transabdominal and trans-thoracoabdominal approachs resulted in different effects on respiratory and cardiac function in patients with gastric cardia carcinoma.
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Objective To evaluate the application of helix hydro-jet in laparoscopic hepatectomy (LH).Methods Clinical data of 18 patients who underwent laparoscopic hepatectomy by helix hydro-jet were analyzed retrospectively.Results There were 18 cases including 9 cases of hepatic cavernous hemangioma,5 cases of primary hepatocellular carcinoma,2 cases of hepatic focal nodular hyperplasia,1 case of hepatic metastasis from colon carcinoma and 1 case of biliary cystadenoma in left liver.In 17 out of 18 patients laparoscopic hepatectomy was successfully completed by using helix hydro-jet.Only 1 patient was converted to open hepatectomy during operation due to uncontrollable hemorrhage from the branch of left hepatic vein.Partial hepatectomy was performed in 14 cases and hepatic left lateral hepatectomy was performed in 3 cases.Average intraoperative blood loss was 230 ml and average operation time was 170 minutes.No postoperative hemorrhage and hepatic function failure was observed.Postoperative bile leakage was observed in 1 patient,which was cured by drainage.Asymptomatic pleural effusions was found in 2 patients,necessitating no special intervention.The average hospital stay after the surgery was 5.6 days.5 patients with hepatocellular carcinoma were followed up for an average of 17 months and the patient converted to open hepatectomy suffered from tumor recurrence 13 month postoperatively.No implantation metastasis was observed on the trocar sites.Conclusions Laparoscopic hepatectomy by helix hydro-jet device can provide excellent visualization of vessels and bile ducts,which can assure the safe margin of hepatic neoplasm.No severe complications were observed.Laparoscopic hepatectomy by helix hydro-jet is a safe and feasible technique.
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Objective To evaluate the therapeutic effect of microwave ablation in combination with TACE for the treatment of primary liver carcinoma (PLC). Methods From Jan. 2004 to Dec. 2008, 63 PLC patients underwent ultrasound-guided microwave ablation (percutaneous or open) under general anesthesia. Repeated microwave ablation or TACE was used when an incompleted ablation or recurrence was found during postoperative regular follow-up. Results These 63 PLC patients have received a total of 82 sessions of microwave ablation procedure (1 to 5 sessions for each patient). There were 2 early postoperative deaths with a procedure-related mortality of 3.2%. At the end of the follow-up, 22 patients were alive and 38 died,and the other one was lost to follow-up. The survival rates in 1,2 and 3 years were 63.3%,42.1% and 26.5%, respectively, with a median survival of 20 months for all patients. The survival for PLC patients with early stage (TNM Ⅰ and Ⅱ) was significantly longer than that of advanced stage (TNM Ⅲ and Ⅳ). The 1,2 and 3 year's cumulative survival rate was 93.3%,86.7% and 65.0% respectively in those 15 cases with only single tumor and the diameter≤3 cm, which were significantly longer than that of other PLC patients. Of 23 patients with recurrence,9 had solitary tumor without lymphnode and distal metastases, for which the survival rates in 1,2 and 3 years were 100%,88.9%, and 35.6%, respectively, whereas in other recurrent patients the survival rates in 1,2 and 3 years were 21.4%, 10.7% and 0%, respectively(P< 0.01). Conclusions Ultrasound-guided microwave ablation in combination with TACE is effective for PLC patients with early stage. In recurrent PLC patients after ablation therapy with solitary tumor and no lymphnode and distal metastases the survival is significantly longer than that of the others.
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Objective To evaluate the experience in the diagnosis and surgical treatment of primary retroperitoneal tumor (PRT). Methods Clinical data of PRT 63 cases from January 1990 to March 2007 confirmed by pathology were retrospectively analyzed including clinical manifestation, surgical procedures, pathological examination and follow-up. Results Tumors were benign in 25 patients and malignant in 38. The main symptoms and signs were abdominal mass. The Youdon's index of CT examination for distinguishing benign from malignant tumors was 85%. The complete surgical resection rate was 88% for benign tumors and 68% for malignances. Removal of the involved organs or vessels was needed in 40% patients in complete surgical resection group. Postoperative recurrence was high in those the tumor was not completely removed and those the tumor was malignant. The 5-year survival rate for complete surgical resection of benign tumors was 83.6% ,and that of malignant tumors was 27.3%. After a median follow-up of 36 months (range 5 ～ 168)for the resection of malignant tumors, the local recurrence rate was 53%. Median time between initial surgery and recurrence was 25 months (range 3 ～ 108). For local recurrence of malignant tumor, the complete surgical resection rate was 62.5%. One patient died of intraabdominal hemorrhage in the first day after operation. Conclusion For PRT patients, early diagnosis is often difficult. Preoperative imaging results are essential to predict the surgical resectability. The optimal treatment of patients with PRT is radical resection, an bloc organ resection if necessary. Regularly postoperative follow-up is mandatory for early finding recurrence.
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<p><b>OBJECTIVE</b>To study a group of patients with abnormalities of esophageal motility in manometric investigation.</p><p><b>METHODS</b>From 1990 to 1999, 14 patients with dysphagia (9), chest pain (3), or both (2) were studied. All patients denied symptoms of heartburn, regurgitation, odynophagia, epigastric discomfort, and investigation failed to show any evidence of ischemic heart disease. A perfused catheter with 4 separate lumens was used and connected to output transducers (Medtronic, PC Polygraf HR).</p><p><b>RESULTS</b>Of the 14 patients, 11 had motor disorders of the esophageal body including simultaneous contractions without normal peristalsis (5), alternative occurrence of simultaneous contractions and normal peristalsis (3), aperistalsis (2) and very low amplitude peristalsis (1). Seven patients were diagnosed with motility disorders of the lower esophageal sphincter including incomplete relaxation or no relaxation on swallowing (6), short relaxation duration (1). Four patients had more than one abnormal manometric findings.</p><p><b>CONCLUSIONS</b>Non-specific esophageal motility disorder is not a real diagnostic entity, but only a group of manometric abnormalities. The relationship between the symptoms of the patients and the manometric findings was analysed. It is uncertain that these disorders have a common etiology. The revision of these abnormalities is difficult because the pathogenesis is unknown.</p>