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Though the primary data on fully covered self-expandable metal stents (FCSEMS) in the treatment of benign biliary strictures caused by chronic pancreatitis and anastomotic stricture following orthotopic liver transplantation is encouraging,the risks including stent translocation,biliary infection,pancreatitis and inability to remove stents should be considered before replacing plastic stents with FCSEMS for the first-line treatment of benign biliary strictures in routine practice.FCSEMS is effective in treating benign pancreatic ductal strictures,but it is also associated with a high rate of stent translocation.To overcome this problem,FCSEMS with better conformability and flared ends need to be designed.There is a theorectial risk of pancreatic ductal infection caused by the blockage of side branches of the pancreas by covering membrane of the stents.However,no such complication was reported.Given the uncertain long-term efficacy and safety of FCSEMS for benign pancreatic ductal strictures,their use may be reserved for the management of retractory,symptomatic benign strictures only in selected groups of patients.
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Objective This article aims to study the impact of cyclopamine,a Hedgehog signaling pathway inhibitor,on the proliferation and apoptosis of QBC939 cholangiocarcinoma cells.Methods The proliferation of QBC939 cells was detected with the MTT assay,and the apoptotic rate was analyzed with the flow cytometry assay.RT-PCR and Western blow were used to detect the expressions of tumor-related genes and proteins in QBC939 cells before and after cyclopamine treatment.Results Our results show that cyclopamine inhibited the growth of QBC939 cells in time and dose dependent manners.After a 5,10,or 20 μmol/L cyclopamine treatment for 48 hours,QBC939 cells showed increased apoptotic rates significantly higher than those in the control group (P＜0.01).Furthermore,cyclopamine down regulated the mRNA and protein levels of PTCH1,GLI1,and EGFR in QBC939 cells.Conclusion Therefore,blockage of the Hedgehog signaling pathway with cyclopamine could suppress the proliferation and promote the apoptosis of QBC939 cholangiocarcinoma cells.
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Objective To explore the diagnosis and treatment of iatrogenic bile duct injury during choledochocystectomy. Methods Clinical data of 24 cases of iatrogenic bile duct injury were analyzed retrospectively from 2005 to 2009. Results Eight patients underwent early repair of bile duct within 4 days after the injury. 14 patients with later recognized bile duct injury underwent selective operations, and two patients were discharged after their jaundice were relieved without any surgical treatment. Supporting T tubes were left in place in 22 patients for 8 to 14 months after operations, without any biliary obstruction found after one year and six months to five year follow-up. Conclusions Early bile duct injury within 4 days was easily treated, but later bile duct injury should have selective operation. The patients with jaundice could be diagnosed with PTCD and ERCP to observe the bile duct injury. During operation membrane-to-membrane wide hepatojejunostomy helps prevent later anastomotic stenosis. The left in drainage tube in anastomotic stoma for more than 8 months improves success rate in the process of injuried bile duct repair.
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Hemolymphangioma is a kind of deformity of the lymphatic vessel and venule,which is rarely seen in clinical practice.A 66-year-old female patient who had a chief complaint of distention in left upper quadrant of the abdomen for 6 months was admitted to the General Hospital of Chengdu Military Region of PLA.Examination of computed tomography and B ultrasound confirmed that the patient had a retroperitoneal cystic mass.During the exploratory laparotomy,the soft mass was found at the left upper quadrant of the abdomen and had invaded to the pancreas.Postoperative pathological examination confirmed that the mass was a pancreatic hemolymphangioma.
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Objective To investigate the short term effect of gastric bypass surgery for the treatment of nonobese type 2 diabetes mellitus and possible mechanisms. Methods The clinical data of 58 patients with nonobese type 2 diabetes mellitus who received gastric bypass surgery from March to August, 2009 were retrospectively analyzed. The levels of fasting plasms glucose (FPG), 2-hour postprandial plasma glucose (2h PG) and glycosylated hemoglobin (HbA1c) were dynamically monitored, and the insulin resistance index (HOMA-IR) and body mass index ( BMI) were calculated. All data were analyzed using variance of analysis and LSD test. Results Of the 58 patients, 48 (83% ) met the requirement of complete response criteria and stopped administration of hypoglycemic agents; 7( 12% ) had to use hypoglycemic agents, but the dose of the agents was lowered by 50% compared to that before surgery. The surgery was ineffective in 3 patients (5% ). The levels of FPG, 2h PG, HbAlc and HOMA-IR of the 58 patients showed a significant decreasing trend after surgery when compared to those before surgery (F = 67. 867, 50. 885, 78. 278, 572. 757, P 0. 05 ). Conclusions Gastric bypass surgery has a good effect on nonobese patients with type 2 diabetes mellitus whose BMI was less than 25 kg/m2. The improvement of insulin resistance after the surgery might be the main reason.
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Objective To investigate the relationship between portal vein pressure and liver regeneration after 90% portal branch ligation in rats.Methods Forty-five male SD rats underwent 90% portal branch ligation (including 5 rats underwent sham operation),and then the changes of portal vein pressure and weight of unligated hepatic lobes were detected.The morphological changes of hepatocytes of the unligated hepatic lobes were observed under a light microscope.Proliferative cell nuclear antigen(PCNA)index was detected by immunohistochemistry,and hepatocyte apoptosis of the unligated hepatic lobes by TUNEL method.All data were analyzed by Pearson rank correlation analysis and t test.Results Thirty-eight out of 40 rats survived(95%).The ligated hepatic lobes diminished progressively,whereas the unligated hepatic lobes regenerated.Preoperative portal vein pressure was(9.1±1.8)cm H_2O(1 cm H_2O=0.098 kPa),and it was increased significantly shortly after the ligation and reached (15.8±2.7)cm H_2O 12 hours later(t=6.847,P＜0.05).The portal vein pressure decreased from(13.6±2.3)cm H_2O at day 1 to(9.3±2.0)cm H_2O at day 28.Preoperative positive PCNA index was 7%±3%,which was significantly lower than 14%±5%at postoperative 12 hours,21%±6%at day 3 and 26%±7%at day 5(t=9.129,P＜0.05),and it began to return to normal at day 5.Few apoptotic hepatoeytes were observed in preoperative liver tissue and unligated hepatic lobes.The expression of PCNA in unligated hepatic lobes and portal vein pressure had apositive correlation at postoperative day 1,3,5(r=0.913,0.896,0.908,P<0.05)and a negative correlation at postoperative day 14(r=-0.926,P<0.05).Conclusions The regeneration of hepatocytes in unligated hepatic lobes is activated after 90% portal branch ligation,and the regenerated liver compensates the weight loss of the ligated hepatic lobes.Liver is regenerated mainly by speeding hepatocyte proliferation rather than reducing hepatocyte apoptosis.Changes of portal vein pressure may play an important role in liver regeneration.
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Objective To investigate the therapeutic effectiveness of endoscopic self-expandable metal stent implantation for hilar cholangiocarcinoma. Methods The clinical data of 73 patients with hilar cholangiocar-cinoma who had received endoscopic metal stent implantation at the General Hospital of PLA Chengdu Command from July 2004 to July 2009 were retrospectively analyzed. The success rate of stent implantation, effective rate of jaundice release, duration of patency of the stent, survival time and postoperative complications were analyzed. Results Among the patients, 70 were successfully implanted with the stents. Unilateral metal stents were implan-ted in 62 patients, bilateral metal stents in three patients, and metal + plastic stents in five patients. The effective rate of jaundice release was 87% (61/70), the median duration of patency of the stent was 190 days, and the median survival time was 246 hours. Seven patients had complications of cholangitis, three had pancreatitis and two had bleeding. Conclusions The advantages of endoscopic metal stent implantation include minimal trauma and good efficacy in alleviating jaundice. It is the option of choice for the treatment of malignant biliary obstruction in patients with inoperable hilar cholangiocarcinoma.
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Objective To investigate the efficacy of balloon dilatation in the treatment of traumatic biliary stricture(TBS).Methods Eighty-one patients with TBS who had been admitted into General Hospital of Chengdu Command from February 1997 to February 2007 were divided into 2 groups.In the control group,40 patients underwent choledoco-jeiunostomy with T tube stenting in the anastomotic stoma for 6 months.In the balloon dilatation group,41 patients received implantation of the balloon catheters along with the two arms of the T tube in the anastomotic stoma.The efficacy of different surgical procedures were analyzed by chi-square test.Results Seven patients in the control group were failed with a failure rate of 18%.Of the 7 palients,6 were transferred to receive balloon dilatation and 5 were cured.In the balloon dilatation group,only 1 patient was failed and the failure rate was 2%.The diameter of the anastomotic stoma ilq the balloon dilatation group was dilated gradually to 12 mm in 3 months.The difference upon the success rate of the operation between the 2 groups had statistical significance (x2=5.10,P＜0.05).Conclusions Balloon dilatation is effective in the treatment of TBS.
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The main causes of early mortality after the earthquake are traumatic shock, hemorrhage and dehydration, and the ratios of shock and hemorrhage are high in patients with abdominal injuries. Prompt triage is very important to persons with abdominal injuries who were rescued in 48 hours after the earthquake. Primary triage should be carried out in the rescue field, and then followed by the secondary triage in the hospital. We improved the efficiency and accuracy of triage by following the principle of "5 steps, 3 categories and 1 indication". Nineteen persons with identified abdominal injuries and unstable vital signs received operation. The false positive rate was 5% (1/19), and the successful rate of the operation was 95% (18/19). During the process of rescue, the lives of the injured persons should be put in the first place. The operation should be performed under the principle of simpleness, rapidity and safeness.
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Objective To explore the management strategy of damage control operation(DCO) for extrahepatic bile duct injury.Methods Clinical data of 15 cases with extrahepatic bile duct injury from June 2002 to September 2007 were selected as the object of this study.Results DCO was performed in all of 15 patients,then all cases were underwent reoperation after surgery intensive care unit resuscitation.All cases survived.Two cases(13.3%) occurred biliary fistula and 1 case(6.7%) occurred intestinal fistula of colon after reoperation,2 cases(13.3%)occurred infection and disruption of incisional wound,and 1 case(6.7%) occurred acute liver function failure.All complications were cured by drainage,symptomatic and supportive treatment.The cure rate of these 15 cases was 100%.There were no stricture of bile duct and correlative complications during 28 months of median follow-up.Conclusion To increase survival rate and reduce complications,severe trauma patients with extrahepatic bile duct injury should be made positively under DCO and choose eligible operations modus.
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Objective To study the relationship between hepatocellular apoptosis and glycogen contents during hepatic cold preservation reperfusion and its mechanism.Methods Based on the model of four groups of rabbit livers with different hepatocellular glycogen contents, hepatocellular apoptosis and bax gene expression were observed during hepatic cold preservation reperfusion.Results Apoptotic hepatocytes were obviously found in 60 minute reperfusing livers subsequent to 9 hour cold storage, and there was significant difference in the numbers of apoptotic hepatocytes among all the groups. In the same time, there was the close relationship between the levels of bax gene expression and the glycogen contents of hepatocytes.Conclusion Intracellular abundant glycogen may significantly depress the hepatocellular apoptosis during hepatic cold preservation reperfusion by decreasing hepatocellular bax gene expression.
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Objective To study the expression of survivin protein in primary hepatocellular carcinoma(PHC) and its relationship to the proliferation of the tumor cells and prognosis of PHC. Methods The expression of survivin protein and the proliferation of tumor cells marked by proliferating cell nuclear antigen (PCNA) in 48 cases of PHC were determined by immunohistochemical method. Results The survivin protein was expressed in 31 of 48 cases of PHC (64.6%). The expression of PCNA was significantly higher in hepatocellular carcinoma (HCC) with positive survivin expression than in HCC with negative survivin expression. The patients with positive survivin expression had the worse prognosis than those with negative survivin expression. Conclusion The expression of survivin may play an important role in the proliferation of PHC cells and closely associate with the prognosis of PHC, and probably become the prognostic factor and an important target of therapy.
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<p><b>OBJECTIVE</b>To evaluate the effect of glycogen on calcium concentration of rabbit donor liver during ischemia-reperfusion period.</p><p><b>METHODS</b>Donor group (n=21) was divided into 3 subgroups randomly: Group A (n=7): fasting for 24 hours before harvesting; Group B (n=7): normal laboratory chew; Group C (n=7): normal laboratory chew plus glucose supplement intravenously. Based on the self-created animal model for ischemia-reperfusion, the levels of glycogen content, ATP level, viability of Ca(2+)ATPase and plasmic free Ca(2+) concentration ([Ca(2+)]i) of liver tissue were measured.</p><p><b>RESULTS</b>Before cold preservation, there was a significant difference of glycogen content among the three groups at all time points except at the end of rewarming period. ATP level and Ca(2+)ATPase viability were significantly higher in group C than in other two groups. But the plasmic free Ca(2+) concentration was lower in groups with higher glycogen content.</p><p><b>CONCLUSIONS</b>Donor liver with high glycogen content can provide relatively sufficient ATP, maintain better Ca(2+)ATPase viability and prevent plasmic free Ca(2+) concentration overloading. This maybe an important mechanism for glycogen to ameliorate ischemia-reperfusion injury to the donor livers.</p>
Subject(s)
Animals , Female , Male , Rabbits , Adenosine Triphosphate , Metabolism , Calcium , Metabolism , Calcium-Transporting ATPases , Metabolism , Cytosol , Chemistry , Glycogen , Metabolism , Liver Diseases , Metabolism , Liver Transplantation , Physiology , Models, Animal , Reperfusion Injury , MetabolismABSTRACT
Objective To investigate the effect of intracellular glycogen on mitochondrial respiratory function of the ischemic reperfusion hepatocytes and its values.Methods During liver ischemia-reperfusion in the 21 rabbits,the tissue ATP content,hepatic enzymological change,respiratory control ratio(RCR) and P/O ratio of hepatocellular mitonchondria were observed in liver glycogen content significantly different three groups.Results Rabbit liver tissue with the higher content of glycogen has shown the higher mitonchondrial ATP content,also showed the higher RCR and P/O ratio of hepatocellular mitonchondria and the slighter injury of liver function.Conclusion Intracellular abundant glycogen may significantly improve respiratory functon of mitochondria,which can play an important role in keeping the hepatocellular function well during liver ischemia-reperfusion.
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Objective To summarize the clinical effects of cholecystocholangiostomy (STHG) in the treatment of hepatocholangiolithiasis and hepatic portal bile duct stenosis. Methods The early complications, clinical effects, and functions of gallbladder in a total of 135 patients, admitted since 1994 were for STHG were retrospectively analyzed. Results No early complications were observed after the operation. The contraction and concenration function of the gallblader remained basically normal. The color of gallbladder mucosa was normal,and no edema or erosion was found under choledochoscopy. Conclusions This operation not only maintained the normal physiological functions of the gallbladder and Oddi sphincter, but also the physiological flow of the bile, farthermere it prevented reflux of intestinal juice and reflax chdangitis. Because the anastomotic stoma was large, concentrated bile within the gallbladder could freely get access to the intrahepatic biliary tract, the concentration of bile acid in the intrahepatic bile duct was markedly elevated, so that the solubility of bilirubin crystal, was increased and recurrence of calculus formation eould be retarded. There fore, STHG should be considered to be an optimal operation in dealing with hepatocholangiolithiasis and biliary stenosis.
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Objective To evaluate the effect of pancreatic elastase on the expression of TNF ? and IL 1? in Kupffer cells induced by lipopolysacchride. Method Cultivating Kupffer cells were divided into 3 groups. In group A, physiological saline was added into the culture medium as control (control group). Lipopolysacchride (LPS) was added instead of saline in group B (LPS group). In group C both lipopolysacchride and pancreatic elastase were added to the cultere medium (LPS+elastase group). The expressions of TNF ?, IL 1? and TLR4 mRNA in Kupffer cells were determined by RT PCR, and concentrations of TNF ? and IL 1? in the culture media by ELISA. Results The results of both RT PCR and ELISA indicated that the expressions of TNF ? and IL 1? in group C was significantly higher than that in group B. Conclusion It was concluded that pancreatic proteases such as elastase could enhance the expressions of TNF ? and IL 1? of hepatic Kupffer cells induced by lipopolysacchride, and the results the might offer the explanation why inflammatory reaction could be amplified in the course of acute pancreatitis
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To treat residual or recurrent stones after operation on hepatolithiasis conveniently and effectively, a subcutaneous permanent tunnel to bile duct (SPTBD) was established in 564 cases of hepatolithiasis by using an afferent jejunum or a well-functioned gallbladder in order to provide a postoperative way to remove residual or recurrent stones through cholangioscopy. We found that by cutting SPTBD open to remove residual or recurrent stones through cholangioscopy in 96 out of 238 followed-up cases, all the patients got good clinical effects without death or complications. The results suggest that it is a good method to establish a SPTBD during operation in patient with hepatolithiasis. It is a simple and effective way to cut SPTBD open to remove residual or recurrent stones after operation.
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Objective To evaluate the role of early growth response gene1 (Egr-1) in liver injury in taurocholate-induced acute pancreatitis rat model. Methods Twenty-four male rats were divided into 4 groups. Egr-1 immunohistochemistry staining and pancreatic pathologic scoring were assessed, and the serum levels of AST, LDH, TNF-? and IL-1 ? were measured. Egr-1 mRNA levels of primary hepatocyte culture stimulated with TNF-? and pretreated primary hepatocytes with PD98059 followed by TNF-? stimulation were also observed. Results Egr-1 expression of liver correlated with degree of liver injury in acute pancreatitis in rat, and high Egr-1 mRNA expression of primary hepatocyte was observed when hepatocyte injury occurred. After pretreated with PD98059, TNF-?-stimulated hepatocytes showed a lower level of Egr-1 mRNA compared with hepatocytes without pretreatment. Conclusions Egr-1 may play an important role in liver injury in acute pancreatitis, and this effect depended partly upon extracellular signal-regulated kinase 1/2 (ERK1/2) pathway.
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Objective To study the preventive effect of hepatic metastasis from colorectal cancer and the immune function influence on postoperative patients with colorectal cancer treated by TIL, rIL-2 and cyclophosphamide by portal vein infusion. Methods One hundred and twenty-four patients with advanced colorectal cancer (Dukes B and Dukes C stage) were randomly divided into immunotherapy group and control group. The control group were treated with 5-Fu and MMC by intravenous injection after resection of colorectal cancer. The immunotherapy group were treated with TIL, rIL-2 and cyclophosphamide by portal vein infusion after resection of the tumor, then with chemotherapy as the control group. All cases were followed-up for 3 years. Results Eight cases (12.3%) had hepatic metastases from colorectal cancer in the immunotherapy group, but nineteen cases (33.2%) in the control group. There was significant difference between the two groups (P>0.05). The NK, IL-2 activity and CD3, CD4, CD4/CD8 levels in peripheral blood of the immunotherapy group increased significantly after treatment (P<0.05). Conclusions The TIL, rIL-2 and cyclophosphamide treatment after resection of colorectal cancer is effective in improving antitumorgenic immune function, and preventing hepatic metastases.