Surgical treatment of traumatic intrathoracic esophageal perforations by foreign bone / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the staging criteria and surgical treatment strategy of traumatic intrathoracic esophageal perforations by foreign bone.</p><p><b>METHODS</b>Fifty-seven patients with intrathoracic esophageal perforations caused by foreign bone in our department from January 1980 to June 2006 were studied. Patients were divided into 4 grades: grade I was esophageal perforation without mediastinitis (n=17), grade II was esophageal perforation with severe mediastinitis (n=13), grade III was esophageal perforation with severe empyema (n=21), grade IV was esophageal perforation with tracheal or aorto-esophageal fistula (n=6). Based on the stage of esophageal perforation, operative procedures were selected including esophagotomy, esophageal repair, esophagectomy, mediastinal drainage, and esophagus reconstruction with colon.</p><p><b>RESULTS</b>In grade I, II and III, all but one patient experienced satisfactory healing of the esophagus. One patient died of multi-organ failure from septic complication. No leakage was observed. Normal swallowing function and improved weight gain was achieved in all the patients. There were 2 deaths in grade IV (2/6).</p><p><b>CONCLUSIONS</b>Grading of esophageal perforation caused by foreign bone is helpful to the decision of surgical treatment strategy.</p>

Prevention and treatment of anastomotic leakage and intestinal ischemia after esophageal replacement with colon / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the effective management to prevent anastomotic leakage and intestinal ischemia after esophageal replacement with colon(ERC).</p><p><b>METHODS</b>Clinical data of 572 cases received ERC from March 1966 to March 2006 were analyzed retrospectively.</p><p><b>RESULTS</b>Most of patients received ERC were diagnosed as esophageal cancer and esophageal stenosis(92.5%). 55.6% of cases underwent esophageal reconstruction and 44.4% of cases underwent esophageal bypass. During ERC procedure, the colon interposition graft length should be 3-4 cm longer than expectation; good blood supply was maintained; the lifted passage was unobstructed, and the physiological peristalsis direction was kept. The incidence of anastomotic leakage was analyzed among different periods, which were 14.2%, 13.5%, and 5.6% during 1966-1975, 1976-1995 and 1996-2006 respectively(P<0.05). No intestinal ischemia was observed in all the patients.</p><p><b>CONCLUSIONS</b>When performing ERC, the main preventional managements of anastomotic leakage and intestinal ischemia are fully blood supply maintenance and intercepting enough length of the colon graft. Ensuring unobstructed passage is good for survival of the colon graft. Correct physiological peristalsis direction of colon interposition is beneficial to the healing of the anastomosis.</p>

Migration and distribution of bone marrow stromal cells in injured spinal cord with different transplantation techniques / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the regularity of migration and distribution of bone marrow stromal cells (BMSCs) in injured spinal cord with intradural space transplantation.</p><p><b>METHODS</b>Forty Wistar rats were randomly assigned into 4 groups. The spinal cord injury model was prepared according to the modified Allen method. BMSCs were labeled by CM-Dil. And 5.0 multiply 10(6) cells were transplanted by different channels including intraventricular injection (Group A),injured spinal cord intrathecally injection (Group B), remote intrathecally injection at the L(3)-L(4) level (Group C), and intravenous injection (Group D). Spinal cord was dissected at 24 hours, 1, 2, 3 and 4 weeks after transplantation. Sections of 4 micromolar were cut on a cryostat and observed under fluorescence microscopy.</p><p><b>RESULTS</b>No fluorescence was observed 24 hours after transplantation in spinal cord injury parenchyma except Group B. One week later, BMSCs in Groups A and C began to migrate to the injured parenchyma; 2-4 weeks later, BMSCs penetrated into the injured parenchyma except Group D. The number of BMSCs decreased at 3-4 weeks after transplantation. The number of cells in Group B decreased faster than that of Groups A and C.</p><p><b>CONCLUSIONS</b>BMSCs transplanted through intraventricular injection, injured spinal cord intrathecally injection and remote intrathecal injection could migrate to the injured parenchyma of spinal cord effectively. The number of BMSCs migrated into injured spinal cord parenchyma is rare by intravenous injection.</p>

Clinicopathological analysis of esophageal carcinosarcoma:a report of 22 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinicopathological characteristics and surgical treatment of esophageal carcinosarcoma.</p><p><b>METHODS</b>The patients with esophageal carcinosarcoma were divided into two types according to barium swallow: intraluminal carcinosarcoma (n=20) and fungating carcinosarcoma (n=2). Only one esophageal carcinosarcoma case was diagnosed by esophagoscopic biopsy preoperatively. Twenty patients underwent left thoracic approach esophagectomy and esophagogastrostomy above aortic arch, and two patients underwent esophagectomy and esophagogastrostomy below aortic arch.</p><p><b>RESULTS</b>All the cases survived during operation and had no severe complication. Post-operative biopsy revealed that 21 cases had definite boundary between the carcinoma and the sarcoma. Only one case showed the invasion of carcinomatous tissues into sarcomatous tissues and mixed growth. Four cases had lymph node metastases (18.2%). The 1-, 3- and 5-year survival rates were 90.9% (20/22), 77.3% (17/22) and 68.2% (15/22) respectively.</p><p><b>CONCLUSIONS</b>Esophageal carcinosarcoma is a rare malignant tumor with little invasiveness, low lymph node metastasis, early clinical symptom occurrence, low preoperative accurate diagnostic rate and good prognosis. Surgical resection is the main treatment for esophageal carcinosarcoma.</p>

Observation on the long-term complications after esophageal replacement with colon / 中华外科杂志

<p><b>OBJECTIVE</b>To study the etiology and preventive measures of the long-term postoperative complication after esophageal replacement with colon for esophageal benign disease.</p><p><b>METHODS</b>To review the clinical data of 577 patients with esophageal replacement with colon our department, including 123 cases of esophageal benign disease. Of all, there were 25 cases-time for 11 cases following with severe complication: redundancy and dilated colon 12 cases-time, severe stricture of stoma 4, macrocyst esophagus 2, colon-stomach stoma expansion 4, mechanical obstruction of colon 3. The etiology included iatrogenic and functionality. The therapy included stricture form or resection, redundancy segment resection, obstructed segment solution and stoma resection and form.</p><p><b>RESULTS</b>Eight cases underwent once operation, 2 case twice, 1 case three times. After operation, 9 cases took food normally, 2 improved symptoms obviously.</p><p><b>CONCLUSIONS</b>The iatrogenic and functionality factor contributed to severe complication after esophageal replacement with colon for esophageal benign disease. The preventive measure is followed during operation: cervical esophageal-colon anastomosis exceed 2.5 centimeter, abdominal colon-stomach anastomosis reflux, channel width of colon passage, intestinal canal lay up straight. Re-operation is best choice to for local stricture, colon expansion, redundancy and dilated colon.</p>

The clinical study on the surgical treatment of thoracic aortic aneurysm associated with coronary artery disease / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the factors which influence the safety and prognosis of aorta replacement combined with coronary artery bypass grafting (CABG) for thoracic aortic aneurysm associated with coronary artery disease.</p><p><b>METHODS</b>From May 1982 to October 2002, 67 patients with thoracic aortic aneurysm were admitted, and 24 of them combined with CABG. Of the 24 patients, 9 received descending aorta replacement combined with CABG, and the other 15 received the ascending aorta replacement combined with CABG. The treatment results were compared with the other 43 patients only undergoing the thoracic aortic replacement.</p><p><b>RESULTS</b>The mortality rate of the patients with aorta replacement combined with CABG was 13% (3/24). Though the descending aorta replacement combined with CABG could make the cardiopulmonary bypass time and selective cerebral perfusion time longer, (278 +/- 54) min and (188 +/- 59) min respectively, no significant difference was observed in postoperative complications, 3-year survival rate, 3-year-cardiac-event-free rate compared with the patients only undergoing the thoracic aortic replacement (P > 0.05).</p><p><b>CONCLUSIONS</b>The aorta replacement combined with CABG can be performed safely, and the revascularization for coronary artery disease is useful for preventing occurrence of cardiac events.</p>

Classification and surgical treatment of intrathoracic esophageal injury caused by foreign body / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the classification criterion and surgical treatment strategy of intrathoracic esophageal injury caused by foreign body.</p><p><b>METHODS</b>Eighty-four patients with intrathoracic esophageal injury caused by foreign body in our department from January 1980 to April 2004 were divided into 4 grade: grade I was non-penetrated injury of esophagus (18 cases); grade II was esophageal perforation with mild mediastinitis (39 cases); grade III was esophageal perforation with severe intrathoracic infection (17 cases); grade IV was aortoesophageal fistula (10 cases). Based on the degree of esophageal injury and the extension of inflammation, operative procedures were selected including esophagotomy, esophageal reparation, esophagectomy, mediastinal drainage, reparation of fistula and replacement of aorta.</p><p><b>RESULTS</b>Patients in grade I and II were all cured . One death occurred in grade III (1/17), the same in Grade IV was 9 (9/10).</p><p><b>CONCLUSIONS</b>Classification of esophageal injury caused by foreign body is helpful to the decision of surgical treatment strategy. The prevention of aortoesophageal fistula is the key point of reducing of mortality.</p>

The ultrastructure change of cardiomyocyte in Athlete's Heart / 中华心血管病杂志

<p><b>OBJECTIVE</b>This study is to see the pathologic change of cardiac myocyte in Athlete's Heart, and explore the mechanism of the pathologic change.</p><p><b>METHODS</b>Fifteen male SD rats were separated randomly into control group (without any exercise), aerobic exercise group (Ae group, swimming for 75 min every day), and overloading exercise group (Oe group, swimming for 180 min with a loading of 5 percent of body weight every day). After 5 days per week for 12 weeks, swimming stopped, the rat hearts were prepared to specimens and examined under Transmission Electron Microscope.</p><p><b>RESULTS</b>The Ae group, the number and volume of mitochondria increased, and the membrane of mitochondria remained entire. Few of dense bodies were found in cytoplasm. The nucleus envelopes of expansion nucleus appear as dentition. These changes were considered as the adaptation to exercises. At the same time, some pathologic changes of the cardiac myocytes similar to senescence also appeared, such as mitochondria expanse, the crista disorder or disappearance, unclear mitochondria membrane, many dense bodies in cytoplasm, nucleus disfiguration and chromatin collection at edge.</p><p><b>CONCLUSION</b>After exercise training, some pathologic changes of cardiac myocyte also occur with physiological changes. With the raise of exercise intension, the pathologic changes become more obvious, even appearance of cardiac myocyte death.</p>

Surgery for upper or middle thoracic esophageal carcinoma after gastrectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the surgical treatment and technical key-points of upper or middle thoracic esophageal carcinoma in patients with history of gastrectomy.</p><p><b>METHODS</b>Eighty-six patients with upper or middle thoracic esophageal carcinoma after previous gastrectomy received surgical treatment between 1980 and 2004. Among them, tumor location was in middle thoracic esophagus in 50 patients, in upper thoracic esophagus in 31 and cervical esophagus in 5. Postoperative pathological staging was stage I in 16 patients, stage IIa in 62, stage IIb in 5 and stage III in 8. The interval between gastrectomy and the diagnosis of esophageal carcinoma ranged from 2 to 22 years. Surgical procedures included esophagectomy and reconstruction with nonreversed gastric tube in 2 patients and reversed gastric tube in 3. The esophagus was reconstructed with short segment of colon in 5 patients and long segment of colon in 74. Two cases underwent jejunostomy only.</p><p><b>RESULTS</b>Seventy-six patients (88%) were treated with curative intent. Seven patients (8%) received palliative surgery. Postoperative complication rate was 12% (10/86). One patient died of multiple organ dysfunction syndrome (MODS). Sixty-seven patients were followed up, the 1-, 3-, 5-year survival rates were 84% (56/67), 57% (38/67) and 22% (15/67), respectively.</p><p><b>CONCLUSIONS</b>Surgical treatment is the first choice for esophageal cancer patients after gastrectomy although the procedures are complicated. The surgery should be considered as a reliable therapeutic modality because of favorable patient prognosis. The replacement with colon is recommended for those patients.</p>

Reconstruction of the remnant penis: a 52-case report / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the effects of the combined method of abdominal axial flap transposition and penile elongation for the treatment of the remnant penis.</p><p><b>METHODS</b>Fifty-two cases of the remnant penis treated with the combined method from 1984 April to February 2004 were analyzed retrospectively. Follow-up ranged from 0.5 to 20 years postoperatively.</p><p><b>RESULTS</b>The lengths (both in normal and erectile conditions) and the circumferences of the penis gained after operation were (5.6 +/- 1.4) cm, (6.8 +/- 2.5 cm and (6.9 +/- 2.3) cm respectively. The recovery rates of the sensory function were 94.2% and 100% in the glans (immediately and 3 months after operation) and 32.7%, 51.9% and 75% in the flap area (3, 6 and 12 months postoperatively). The two-point distinguishing sense in the glans and the flap area was (5.1 +/- 0.9) mm and(7.9 +/- 1.3) mm 5 years after operation. Early complications included distant flap necrosis (3 cases), disruption of the wound (2 cases), part necrosis of the skin graft in the abdominal wall (2 cases) and poor contours occurred in 4 cases in the later period because of the thickness of the flaps. All of them were corrected with satisfactory results.</p><p><b>CONCLUSION</b>The combined method of abdominal axial flap transposition and penile elongation was recommendable for the treatment of the remnant penis because of its positive effects and less complications.</p>

The ultrastructure change of heart capillary in athlete's heart / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To see the change of capillary of heart in Athlete's Heart, so that to discover the mechanism of pathologic change.</p><p><b>METHOD</b>18 male SD rats were separated randomly into control group (without any exercise), aerobic exercise group (swimming for 75 min every day), and overload group (swimming for 180 min with 5% weight of its body every day). After 5 days per week, 12 weeks, exercise training stopped and heart of rats were observed under Transmission Electron Microscope.</p><p><b>RESULTS</b>In aerobic exercise group, the capillary cavities in heart expand, the walls of capillary become thick; the number of mitochondrion increases; endothelium cells become active in growth. However, after overload exercise, the walls of capillary cockle and protuberances appear. The mitochondrion swell and the cristae become disorder. Most of endosomes expand and their number increases. The karyons become abnormity in shape and uniformity in electronic density, besides the nuclear envelope cockle. The basilar membranes become thick and unclear.</p><p><b>CONCLUSION</b>After exercise training, both physical and pathologic changes in heart capillary are found. In suitable exercises group, the capillaries change physically; the pathologic changes are becoming visible after overload exercise however.</p>

Expression of different RASSF1 transcripts and its clinical significance in lung carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the expression of three different RASSF1 transcripts and its clinical significance in lung carcinomas.</p><p><b>METHODS</b>The mRNA expression of RASSF1A, RASSF1B and RASSF1C was detected by RT-PCR in 51 human lung cancer tissues and 51 matched normal tissues.</p><p><b>RESULTS</b>1. The mRNA expression of three RASSF1 transcripts was detectable in all non-cancer tissues. However, high rate of expression loss of RASSF1A and RASSF1B existed in lung cancer tissues, which was 53.2% (2851) and 37.3% (19/51), respectively. RASSF1C was expressed in all of the tumor tissues. 2. Loss or abnormal down-regulation of RASSF1A was positively related with lymph node metastasis and TNM stage (P < 0.05) and 3. RASSF1B and RASSF1C mRNA expression was not correlated with TNM stage, histological type, differentiation grade or smoking index.</p><p><b>CONCLUSION</b>There is a significant expression difference among the three RASSF1 transcripts in lung carcinoma. RASSF1A, closely associated with lymph metastasis and TNM stage of lung carcinoma, should be a new tumor suppressor gene.</p>

Clinical observation of elderly patients with coronary heart disease undergoing coronary artery bypass grafting through descending thoracic aorta / 中华老年医学杂志

Objective To investigate the clinical effectiveness of coronary artery bypass grafting through descending thoracic aorta in elderly patients with coronary heast disease and to decrease the post-operative complication.Methods Thirteen elderly patients underwent coronary bypass surgery with minimally invasive direct coronary artery bypass (MIDCAB).Age range from 70 to 82 years with a mean of(72.1?6.0)years.Patients suffered from multi vessel disease.Many minimally invasive techniques of“Y”blood vessel graft anastomosis,anastomosis of blood vessel graft to descending aorta,minimally invasive direct,thoracoscope assist were used.Results All patients were survived.The mean duration of intubation was (6.9?0.9) hours.The average ICU stay was (2.5?0.5)days.No patients received blood transfusion.During the short-term follow-up(3 to 14 months) patients had no complaint of angina,Conclusions The technique of“Y”blood vessel graft anastomosis,descending aorta blood vessel graft,minimally invasive direct and thoracoscope assist in combination with coronary artery bypass grafting is a safe and cost-effective new procedure for elderly patients with multi-coronary artery disease.