[Long-term outcome of tension-free hernioplasty for inguinal hernia complicated with liver cirrhosis and ascites].

OBJECTIVE: To review tension-free repairing for the patients with inguinal hernia complicated with cirrhosis and ascites. METHODS: Tension-free herniorrhaphy was performed in 16 cases with inguinal hernia complicated with cirrhosis and ascites from November 1999 to November 2003. The laboratory data before and after the operation were compared and analyzed in this group. RESULTS: Of the patients, 13 cases were male and 3 were female, the mean age was (64 ± 12) years (range, 37 - 85 years). The liver function was classified as A degree in 4 case, B degree in 10 cases and C degree in 2 patients by using Child score. The operation was successfully carried out in all patients without complications and post-operative hepatoencephalopathy. There was no significant change in the plasma total protein, bilirubin, prothrombin activity and international normalized ratio (INR) after the operation. And the levels of albumin, globulin and white blood cell count changed remarkably after the operation (all P < 0.05). Plasma albumin level was obviously effected by the operation and treatment (P = 0.006). The mean follow-up time was 72.5 months (57 - 102 months). No recurrence occurred during the follow-up. There was no patient died in 30 days after the operation. Seven cases (43.8%) died in the later period of follow-up. CONCLUSIONS: The tension-free repairing is feasible for the inguinal hernia complicated with cirrhosis and ascites. More attention should be paid to the level of plasma albumin and it should be corrected in time. The liver cirrhosis and its complications will progress after the operation with a poor prognosis.

[Preventive effect of endothelial nitric oxide synthase gene transfer on chronic hypoxic pulmonary hypertension in rats].

OBJECTIVE: To investigate the preventive effect of endothelial nitric oxide synthase (eNOS) gene transfer on chronic hypoxic pulmonary hypertension (CHPH) in rats. METHODS: Twenty-four male Wistar rats were randomly divided into four groups with 6 rats in each group: normoxia group (group N), hypoxia group (group H), hypoxia with LacZ group (group H-LacZ) and hypoxia with eNOS group (group H-eNOS). AdCMVceNOS, AdCMVLacZ or normal saline (NS) was injected intratracheally 3 days before the beginning of exposure to normoxia or hypoxia. Rats in group H-eNOS received 50 microl of AdCMVceNOS (5 x 10(12)pfu/L), rats in group H-LacZ received equal dose of AdCMVLacZ, rats in group N and group H received equal dose of NS. Hemodynamic parameters [including mean systemic arterial pressure (MSAP), heart rate (HR) and mean pulmonary arterial pressure (MPAP)], pulmonary vascular remodeling (percentage of muscularized arteries in small pulmonary vessels) and right ventricular hypertrophy (ratio of right ventricle to left ventricle + septum weight) were measured after 2 weeks of exposure to normoxia or hypoxia. The expression of eNOS, cyclic guanosine monophosphate (cGMP) and nitric oxide (NO) level were also measured in lungs. RESULTS: The MPAP, right ventricular hypertrophy index and pulmonary vascular remodeling in rats in group H-eNOS were obviously lower than those in group H and H-LacZ, but higher than that in group N (all P<0.01). There was no significant difference with regard to HR and MSAP in rats in all groups (all P>0.05). The eNOS protein in group H and H-LacZ was obviously higher than that in group N, but obviously lower than that in group H-eNOS (all P<0.01). The NO level in rat lungs in group H and H-LacZ was obviously lower than that in group N, and value in group H-eNOS was higher than that in the other groups (P<0.05 or P<0.01). With regard to cGMP in rat lungs, there was no significant difference among group N, H and H-LacZ (all P>0.05), but they were all obviously lower than that in group H-eNOS (all P<0.01). CONCLUSION: Intratracheal eNOS gene transfer upregulates the activity of eNOS protein, elevates the level of NO/cGMP in lungs, and alleviates CHPH in rats.

Endovascular stent-grafts for acute and chronic type B aortic dissection: comparison of clinical outcomes.

BACKGROUND: Endovascular stent-graft treatment has emerged as an alternative for patients with type B aortic dissection (AD), either at acute or chronic phase, in selected patients. This study aimed to investigate the results of endovascular stent-graft repair for acute and chronic type B AD. METHODS: From May 2002 to July 2007, 67 patients with type B AD were treated by endovascular stent-graft placement. There were 32 patients in the acute phase (AAD group) and 35 patients in the chronic phase (CAD group). The patients were followed up from 1 to 65 months (average, 17 +/- 16 months). The immediate and follow-up clinical outcomes were documented and compared between the 2 groups. RESULTS: Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 67 patients. Compared with patients in the CAD group, those in the AAD group had higher percentages of pleural effusion (15.6% vs 0, P = 0.02) and visceral/leg ischemia (21.9% vs 2.9%, P = 0.02). Procedure related complications, including endoleak and post-implantation syndrome occurred more frequently in AAD group than in CAD group (21.9% vs 2.9% and 31.3% vs 8.6%, respectively; P = 0.02 and P = 0.02). Kaplan-Meier analysis showed no significant difference in survival rate at 4 years between the 2 groups (86.4% vs 92.3%, P = 0.42 by Log-rank test). But the 4-year event-free survival rate was higher in patients with chronic dissection than in patients with acute dissection (96.2% vs 73.9%; P = 0.02 by Log-rank test). CONCLUSIONS: Endovascular repair with stent-graft was safe and effective for the treatment of both acute and chronic type B AD. However, both immediate and long term major complications occurred more frequently in patients with acute dissection than in those with chronic dissection.

[Percutaneous transluminal stenting in patients with acute and chronic aortic dissections].

OBJECTIVE: To compare the clinical therapeutic results of percutaneous transluminal stenting between patients with acute and chronic aortic dissections. METHODS: From May 2002 to October 2007, 42 patients with acute type B aortic dissection and 40 patients with chronic aortic dissection underwent stenting. The clinical data of the patients were analyzed. RESULTS: Comparing with the chronic aortic dissection group, the acute aortic dissection group had higher percentage of pleural effusion (16.7% vs 0, P =0.01) and visceral/leg ischemia (23.8% vs 2.5%, P = 0.01). The acute aortic dissection group had higher complications in early term (38.1% vs 15.0%, P = 0.02). All patients were followed up for an average of (18.7 +/- 17.3) months. The rate of complications were higher in the patients with acute aortic dissection than those with chronic aortic dissection (21.4% vs 5.0%, P = 0.03). Kaplan-Meier analysis showed no difference of survival rate between the 2 groups during follow-up period (P = 0.38). The 5-year survival rate was 90.0% in acute aortic dissection group years and 92.5% in chronic aortic dissection group, respectively. The event-free survival rate was higher in the patients with chronic dissection than that with in the patients acute aortic dissection (P = 0.04). CONCLUSIONS: Percutaneous transluminal stenting is effective in the treatment of type B aortic dissection, but there are more complications in acute than in chronic aortic dissection group.

[Relationship between recurrence and metastasis of gastric cancer and expression of EGFR, IL-6R, PCNA, and DI].

BACKGROUND AND OBJECTIVE: The primary reasons for the failure were recurrence and metastasis in the treatment of gastric cancer. This study was designed to investigate the distributive regularity of EGFR, IL-6R, PCNA, DI and the diploid in the gastric cancer patients with recurrence and metastasis, to provide reliable basis to judge whether it has metastasis before operation and recurrence post operation. METHOD: Immunohistochemistry SP method and image analyzer (Fegulgen staining) were used to test the EGFR, IL-6R, PCNA, DI and the diploid in 199 patients with gastric cancer, 20 cases with normal gastric mucous membrane, and 20 cases of atypical hyperplasia. RESULTS: The level of expression of EGFR was higher in the patients with metastasis and residual gastric cancer(61.11%, 66%, 66.67%) than in the patients with other cancers, normal gastric mucous membrane, atypical hyperplasia(47.83%, 0%, 35%) (P < 0.01); In the distribution form of DNA diploid, the rate of non-diploid cells was remarkably higher in the patients with metastasis and residual gastric cancer(56.9 +/- 13.3% vs 12.8 +/- 6.3%, 0%, 12.2), and so is the DNA index (2.91 +/- 0.33 vs 2.17 +/- 0.29), but the rate of 2C cells is lower(43.8 +/- 12.9 vs 10.2 +/- 7.5, P < 0.01). CONCLUSION: EGFR, DI, and the diploid are valuable targets for judging metastasis and recurrence of gastric cancer before and after operation.