Table of Content

20 April 2010, Volume 10 Issue 02

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The treatment and cause of bile leakage after the hepatobiliary operation

2010, 10(02):  0-0. 

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[ Abstract] 　Objective 　To study the treatment and cause of bile leakage after hepatobiliary operation. Methods 　43 cases of bile leakage after hepatobiliary operation were analysised , including 5 cases of cholecystectmy , 18 cases of exploration of common bile duct and T tube drainage , 11 cases of hepalobectomy , 4cases of removing stone and biliary-enteric anastomoses for cholelithiasis, 2 cases of repair and reconstruction for bile duct injury, 2 cases of radical operation for hilar cholangiocarcinoma and one case of laparoscopic fenestration and drainage for hepatic cysts. Results 34 cases were cured by full drainage at early period. Only 2 cases were cured in 5 cases who were accepted reoperation, one suffered from external biliary fistula and the other 2 cases died(one died of hepatic function failure another died of renal failure and ARDS). 2 cases were cured by endoscopic nasobiliary drains. One case was cured by sinus tract resection. One case was cured by injection sclerotherapy for sinus tract. Conclusion The cause of bile leakage after the hepatobiliary operation is related to the lack of surgical techniques. Careful procedure can be effective in preventing the occurrence of postoperative bile leakage. Early and effective biliary drainage is conducive to bile leakage healing

The clinical analysis of vertebroplasty combined with posterior fixation with pedicle screw for the treatment of metastases in the thoracolumbar spine(19 cases reported)

2010, 10(02):  0-0. 

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Clinical study on combination of traditional Chinese and Western medicine and Music Therapy in the treatment of of Mammary Hyperplasia With Anxiety Symptom

2010, 10(02):  0-0. 

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[Abstract] Objective To study the effect on combination of traditional Chinese and Western medicine and music therapy in treatment of mammary hyperplasia with anxiety symptoms. Methods 160 patients with mammary hyperplasia were randomly divided into 2 groups, namely treatment group and control group. The treatment group was treated by tamoxifen, Rupixiao granule and music therapy. The control group was treated by tamoxifen. Patients of two groups were observed therapeutic effect , hormone in follicular phase and were evaluated on time with Beck Anxiety Inventory. Results: The total effective rate of treatment group was 91.3%, and was significantly higher than that in control group(68.8%). E2, PRL levels of two groups were significantly decreased. And PGN、TTE levels were significantly increased（P<0.05）. The anxiety score of the treatment group is lower than that control group（P<0.05）.Conclusion The combination of traditional Chinese and Western medicine and music therapy in treatment of mammary hyperplasia has good curative effect and can improve patients anxiety symptom significantly. And it is a popular accepting therapy for patient.

Combination of Partial Hepatectomy with Choledochoscopy for the treatment of Hepatolithiasis

2010, 10(02):  0-0. 

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To discuss the clinic effects of partial hepatectomy with choledochoscope for the treatment of hepatolithiasis. In recent 4 years, 42 cases with hepatolithiasis received combination of partial hepatectomy and choledochoscopy were retrospectively analyzed. There were no death after operation. Nine patients had complications, including incision infection (4 cases 9.6%), biliary leakage (2 cases 4.7%) and pulmonary infection (3 cases 7.1%). Excellent outcome was founded in 35 patients(86.8%) and 3 patients (13.2%) had recurrence of calculi . Combination of partial hepatectomy with choledochoscope was effective for treatment of hepatolithiasis. It would reduce postoperative residual calculi and recurrence rate of calculi.

Expression and clinical significance of tissue factor in human clorectal cancer

2010, 10(02):  0-0. 

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Objective To investigate the overexpression and clinical significance of tissue factor (TF) in human clorectal cancer cells. Methods Paraffin-embedded tissues from 32 cases of clorectal cancer undergone radical resection were detected for expression of TF protein by immunohistochemistry staining. The relationship between TF protein expression in clorectal cancer and related clinical parameters was analyzed. Results The overexpression of TF protein were found in 20 of 32 cases (62.5%) and the clorectal cancers with TF protein overexpression in Duke’s stage A, B, C and D were 0，41.6%，66.6% and 100%, respectively. The clorectal cancer with TF protein overexpression has high potential for metastasising to lymph nodes and liver. Conclusion The overexpression of TF was found in clorectal cancer and involved with lymph nodes and liver metastases.

Surgical treatment of 89 cases of nipple discharge

2010, 10(02):  0-0. 

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Objective Evaluation the effects of surgical treatment in 89 patients with nipple discharge . Methods : 89 cases of nipple discharge were treated by section of the excision, simple mastectomy, modified radical mastectomy Ⅰ type .Result: Pathological results of 57 cases were Intraductal papilloma ,21 cases were breast hyperplasia, 5 cases were ductal expansion , 4 cases were ductal carcinoma and 2 cases were Invasive ductal carcinoma. Conclusion: The most common cause of nipple discharge is intraductal papilloma, followed by breast hyperplasia, ductal expansion and ductal carcinoma。Surgical treatment is the main method of nipple discharge , surgical decision should be based on pathology.

The experiences of 36 cases with peptic ulcers perforation repaired by laparoscopy

2010, 10(02):  0-0. 

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Ｏbjective:To summarize the surgical experience of laparoscopic repair of perforation for gastroduodenal ulcer.Methods: 36 patients underwent laparoscopic repair of perforated peptic ulcers.Results:30 patients were suffered from perforated duodenal bulbar ulcer，and 6 patients were suffered from perforated gastric antrum ulcer. The diameter of the perforation was 0.5～1.1 cm，the operative time was 30～185 min,the average operative time were 75 min，all operations were completed by laparoscopy.35 patients got well successfully after operations, hospital stay was 4～8 days, the average time were 6.2 days, and complications such as incision infection, abdominal abscess ,intestinal adhesion were not experienced,but 1 patient were suffered from the failure of repair, got well by conservative treatment. Conclusions:Laparoscopic repair of perforated peptic ulcers is as safe and effective as the open repair as long as the operator has mature technique.

Application of combined lumbar plexus and sciatic nerve block in the operation of lower limbs for senile patients

2010, 10(02):  0-0. 

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Objective To investigate the applied value of combined lumbar plexus-andsciatic nerve block with epidural anesthesia in the elderly undergoing lower-extremity surgery. Methods: 60 old patients received unilateral lower limb operation were randomly divided into 2 groups: Combined lumbar plexus-andsciatic nerve block group (group NER) and epidural anesthesia group (group EPI). The SBP,DBP and HR were recorded before anesthesia and after anesthesia beginning 15, 30, 45 and 60 minutes respectively. The SBP,DBP , HR in 1 hour after operation and the onset time and recovered time of sensory, motor nerve block, analgestic persistent time and efficacy were recorded. Results After anesthesia onset ,the group EPI, DBP was significantly 1 hour declined. And the SBP and DBP in the 30,45 and 60 minutes and after operation the EPI group of SBP and DBP was significantly lower than that NER group. In the sensory and motor nerve onset time, the NER group was less than that EPI group,but the anesthetic recovered time, the group NER was longer than that EPI group. Conclusions Under localization of nerve stimulator,the combinations of lumbar plexus and sciatic nerve block possess high successful rate (better efficacy) stable hemodynamics, less compliation rapid onset and a longer analgestic time. And it is a better anesthetic method in the operation of unilateral lower bimbs,for elderly patients.

Off-pump coronary artery bypass(OPCAB) on the coronary heart disease (CHD) patient with low EF.

2010, 10(02):  0-0. 

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Abstract: Objective The purpose of this study is to estimate the effect of OPCAB on the CHD patient with low EF．Method we retrorespectively analysis the patients who have been undergone the OPCAB in our department from 2005 12 to 2009 8.Among these cases, 41 patients’ EF which are measured by echocardiography and LV angiography are lower than 45%.Then we registered the EF、LVSD、 LVDD before operation and compared them with the results which measured a week and three months later; measured Cr、 BUN and PLT before operation and compared them with the results measured 8h after operation. Result In those cases, 1 patient died of low cardiac output syndrome in the 14 hours after operation. Compared with preoperative results, there are no obvious changes in EF and LVSD which measured a week later, but LVDD shortened obviously.After 3 months of operation ,the EF hanced and LVDD shortened greatly, but LVSD has no changes. 34 patients’ Cr、 BUN、 PLT measured after 8h of operation has no obvious changes. After operation, the all patients’angina pectoris syndrome disappeared or relieved and active ability improved greatly. Conclusion Through the study ,we conclude that the OPCAB is safe operation . It may minimize the surgical trauma and complication of CBP. CHD patient with low EF could avoid CBP impairment by undergoing OPCAB .This kind of operation is feasible to perform and has satisfied early postoperative effect. However it’s postoperative long-term outcome will be observed.

Treatment and prevention of bladder neck contracture after transurethral resection of prostate

mianlin zeng

2010, 10(02):  0-0. 

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Objective：To discuss the treatment and prevention of bladder neck contracture（BNC） by transurethral resection of prostate （TURP）. Methods： Analyze the diagnosis and treatment in 32 cases with BNC retrospectively. Results：Transurethral resection of bladder neck rear lip, resection of scar tissue accompanied with cold-knife incision of bladder neck were performed in those cases. after an average follow-up of 28 months ，28 cases were cured for the first time excluding the recurrence of 4 cases who were cured after twice or three times operations. Conclusions: Endourethral surgery is safe and efficient treatment for bladder neck contracture by transurethral resection of prostate.

Solitary fibrous tumors of the peritoneum： CT and MRI findings with the pathologic correlation

zhang jiayun

2010, 10(02):  0-0. 

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Objective The purpose of this study is to determine the CT and MRI features of solitary fibrous tumors(SFT) of the peritoneum with the pathologic correlation . Methods Three CT images and two MR images of histologically proven cases of solitary fibrous tumors of the peritoneum were retrospectively reviewed respectively.These CT and MRI findings were correlated with the pathological fingdings of their surgical specimens. Results CT demonstrated well-defined and solid tumors with strikingly demonstrated two diferent solid components and smooth contour. On the contrast-enhanced CT images ,heterogenously strong enhancement were observed in the tumors.On the arterial stage,several tumor vessels appeared within the tumors.On the delayed stage,the masses showed persistent and intensive enhancement.The other tow SFTs on the MR imagins sohwed that the masses were isointense to the muscle on the T1- weighted images and hyperintense on the T2-weighted images.On the contrast-enhanced T1-weighted images , homogenously strong enhancement was observed. Histologically,photomicrograph showed that the tumors were composed of a haphazard proliferation of spindle cells ,which were separated from the hyalinized collagen tissue. Characteristically, alternating hypercellular and sclerotic hypocellular regions were observed. . Immunohistochemistry revealed that the tumor cells were strongly positive for CD34 and Vimentin.Conclusion The solitary fibrous tumors of peritoneum are characteristic of CT and MRI findings, which showed well-defined solid mass with two compositions of various density,smooth contour, isointense to the muscle on the T1- weighted MR images , heterogenously strong enhancement. CT and MRI play significant roles in the diagnosis of SFTs.

Clinical analysis of the minimally invasive incision operational system treating the lumbar disc herniation in the adolescents

2010, 10(02):  0-0. 

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【Abstract】Objective To evaluate the clinical effects of minimally invasive incision operational system in treating the lumbar disc herniation in the adolescents. Methods Clinical data of 21 cases of the lumbar disc herniation in the adolescents in our hospital treated by the minimally invasive incision operational system were reviewed and analyzed. Results Of all the 21cases followed up, evaluated by Nakai standard, 17 were excellent, 2 good, 2 fair, 0 poor, with 90.05% as excellent and good rate. Conclusion The minimally invasive incision operational system treating the lumbar disc herniation in the adolescents is an ideal surgical operating method with less trauma to the tissue, less bleeding, more stability to the spinal vertebrae, and better treating results.

Effects of Ulinastatin on Activated Leukocytes and Platelets during Intraoperative Autotransfusion

2010, 10(02):  0-0. 

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Objective To observe the effect of ulinastatin on activated leukocytes and platelets during intraoperative autotransfusion Methods Forty patients aged 35 to 60 years old, scheduled for selective orthopedic surgery were randomly divided into ulinastatin group (Group A, 20 cases) and the control group (Group B, 20 cases). Ulinastatin (5000U/kg doses) were administered in A group before operation. Intraoperative autotransfusion were performed according to the standard procedure with all patients during operation. The activation of leukocytes and platelets in salvaged blood and in vivo after transfusion of salvaged blood were tested by flow cytometer. Results Leukocytes and platelets were activated during intraoperative autotransfusion. Percentages of the activated platelets and CD11b expression on leukocytes were significantly higher than those in vivo (P<0.05); in group B, percentages of the activated platelets and CD11b expression on leukocytes were significantly higher than in group A; activation of platelets and leukocytes were more significantly higher after salvaged blood transfusion but significantly lower in group A than in group B (P<0.05). Conclusions Using ulinastatin can inhibited or alleviated the activation of leukocytes and platelets during intraoperative conservation and decreased the harmful effects of salvaged blood, combined using ulinastatin and intraoperative autotransfusion can play an active effect on blood conservation.

Efficacy of Combination of 11C-Acetate and 18F-FDG Positron Emission Tomography in Diagnosis of Hepatocellular Carcinoma: systematic review and meta-analysis

2010, 10(02):  0-0. 

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Abstract Objective systematically evaluated the efficacy of combination of 11C-Acetate and 18F-FDG positron emission tomography in diagnosis of hepatocellular carcinoma. Methods Search correlated database for English or Chinese articles, which study about using 11C-Acetate and 18F-FDG positron emission tomography in diagnosis of hepatocellular carcinoma. Recruited the articles strictly for high quality, and give a mark to those articles which brought into systematic review study. Extracted results from recruited articles, and systematically analysis those results. Results 5 articles recruited in system review, 4 were English language but one was Chinese, evaluated the quality of those articles, witch got 78.8% of total score, the total efficacy of combination of 11C-Acetate and 18F-FDG positron emission tomography in diagnosis of hepatocellular carcinoma was 82.9%, the efficacy of FDG to hepatocellular carcinoma witch diameter were less than 2cm,2cm-5cm were 25%、45.9%、80.9%, and Acetate were 79.2%、80.1%、78.7% respectively. For 1-2 differentiated grade , the efficacy of FDG was 48%, Acetate was 73.3%, and for 3-4 differentiated grade, FDG was 89.5%, Acetate was 86.8%. For Liver funcation Child A, the efficacy of FDG was 59%, Acetate was 72%, and for Child B, both FDG and Acetate were 63.6%. For male patiends, the efficacy of FDG was 54.7%, Acetate was 75.5%; For female patiends, FDG was 65.4%,Acetate was 69.2%. Conclusion combination of 11C-Acetate and 18F-FDG positron emission tomography can elevate efficacy in diagnosis of hepatocellular carcinoma.

Clinlical Contrastive Analysis of Three Different Internal F ixation s of Femor al Intertrochanteric Fracture

2010, 10(02):  0-0. 

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Meta-analysis：The Significance of the Methylation of RASSF1A Promoter in the Early Diagnosis of Non-small Cell Lung Cancer

2010, 10(02):  0-0. 

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Objective: To study the significance of the methylation of RASSF1A promoter in early diagnosis of NSCLC with evidence methods that analyse the relation between methylation and the TNM stages. Methods: The literature on the methylation of RASSF1A promoter in the tissue of NSCLC were collected. Articles which satisfied strict acceptance and excluding rule were acepted. These articles were evaluated by Review Manager 5.0 and the combined OR between methylation of RASSF1A and TNM stages was get. Results: A total of 5 articles were accepted, the difference analysis between I stage and II-IV stages of NSCLC showed that the combined OR was 1.14(0.87-1.48), and Z=0.96, P=0.34 when CI was 95%, which indicated that the rate of methylation of RASSF1A promoter had not significance difference between early and mid-late NSCLC tissues(P>0.05). Conclusions: there was not distinct correlation between methylation of RASSF1A promoter and the TNM stages of NSCLC and the methylation can be a candidature of early diagnosis of NSCLC.

Percutaneous renal micro-ureteroscopy pneumatic lithotripsy in the treatment of urinary tract stones experience (106 cases)

2010, 10(02):  0-0. 

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【Abstract】 Objective To analyze the upper urinary tract calculi in patients with percutaneous renal micro-ureteroscopy pneumatic lithotripsy (mPCNL) the efficacy and complications prevention and treatment. Methods Pairs of 106 cases in the C-arm machine under the guidance of percutaneous renal micro-ostomy to ureteroscopy, pneumatic crushing stones in patients with upper urinary tract calculi of care back to the clinical data analysis, concluded that the treatment effect and security. Results The average length of hospital stay 13d, 106 patients, 93 cases of stones were removed successfully I phase (87.7%). The average time of the urine turned clear 2.5d, kidney fistula retention time 4-11d, an average of 7.5d. 2 cases (1.9%) patients after high fever, after anti-inflammatory, symptomatic improvement after treatment. Around the organ injury without surgery, intraoperative blood transfusion were not. Conclusion mPCNL treatment of urinary tract calculi with a stone-free rate, the damage is small, the advantages of fewer complications worthy of clinical application.

Operating cooperation of internal fixation on odontoid process fracture by transoral-transpharyngeal approach

QIU YI-HONG

2010, 10(02):  0-0. 

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Objective To explore the nursing cooperation of internal fixation on odontoid process fracture by transoral-transpharyngeal approach. Methods Pre-operation visit patients with mental care and health guidance; sufficient instruments preparation before operation, care of patients’ body positons; skilled cooperation with operators and intensive observation of patients’ condition during operation were made. Results All operations were successful and operators were satisfied with nursing cooperation. No severe complications were occurred during operation. Conclusion Sufficient mental , instruments preparation before operation and skilled cooperation during operation are the key points to make operation successful.

Inguinal hernia tension-free hernia repair filling Clinical Efficacy（Attached to the report of 312 cases）

2010, 10(02):  0-0. 

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Purpose: To investigate the plug tension-free hernioplasty of inguinal hernia treatment methods and clinical efficacy. Methods: Retrospective analysis of 312 cases of inguinal hernia patients using the United States Bard's filled polypropylene cone-shape and patch line plug tension-free hernia repair. Results: it takes only 30 minutes-90 minutes to complete the operation, and the Patients can get out of bed to participate in activities in 24h-36hours after the operation.　6 cases of postoperative wound pain, 26 patients with mild foreign body sensation incision, the incision 8 cases of hematoma; 11 cases of scrotal fluid. No incision caused by infection and other complications, 2 cases of recurrence after 6 months. Conclusion: The plug tension-free hernia repair in line with human physiological anatomy, postoperative pain and rapid recovery, fewer complications and lower recurrence rate advantages.

Therapy of hypertensive intracerebral homorrhage in small bone window craniotomy operation in super early stage

2010, 10(02):  0-0. 

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Objective To summarize the experience of minimally invasive operation on hypertensive intracerebral hemorrhage. Methods The clinical datas of 45 patients treated with small bone window craniotomy from August 2004 to August 2009 in our department were reviewed. Results Of all 45 cases operated with small bone window craniotomy.12cases died and the other 33 cases survived. the quality of activities of daily life(ADL) were in grade Ⅰin 4 cases(9.0%),in grade Ⅱ in 9 cases(20%),in grade Ⅲ in 14 cases(31.1%),in gade Ⅳ in 6 cases(13.3%),in grade Ⅴ in 0 cases. Conclusion The minimally invasive operation is an effective method for majority patients with hypertensive intracerebral hemorrhage