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Objective:To explore influence of intensive atorvastatin therapy on contrast-induced nephropathy(CIN) and systemic inflammatory response in patients with ischemic cerebrovascular disease(ICD)after interventional sur-gery.Methods:A total of 118 ICD patients undergoing interventional surgery in our hospital were selected.Accord-ing to atorvastatin dose,they were divided into intensive group(n=59,received atorvastatin 80mg/d before surgery and 40mg/d after surgery)and routine control group(n=59,received atorvastatin 20mg/d 3d before surgery and af-ter surgery).Levels of renal function indexes and inflammatory indexes 24h before and 72h after surgery were com-pared between two groups.Results:Compared with before treatment,after treatment,there was significant rise in cystatin C(CysC)level in intensive group;significant rise in levels of serum CysC,creatinine(Scr),and β2-micro-globulin(β2-MG),and significant reduction in creatinine clearance rate(Ccr)in routine control group(P<0.05 or<0.01);compared with routine control group after treatment,there were significant reductions in levels of Scr [(93.97 ± 13.83)μmol/L vs.(78.44 ± 17.36)μmol/L],β2-MG[(2.88 ± 0.64)mg/L vs.(2.46 ± 0.61)mg/L] and CysC[(1.24 ± 0.07)mg/L vs.(0.88 ± 0.10)mg/L],and significant rise in Ccr[(68.92 ± 17.38)ml/min vs. (82.22 ± 15.94)ml/min]in intensive group,P=0.001 all.There were significant reductions in inflammatory index levels in both groups after surgery,compared with routine control group,there were significant reductions in levels of high sensitive C reactive protein[(13.53 ± 3.82)mg/L vs.(11.31 ± 3.72)mg/L],interleukin-6[(99.87 ± 24.76)ng/L vs.(85.73 ± 24.17)ng/L]and tumor necrosis factor α[(286.67 ± 78.38)ng/L vs.(252.61 ± 80.02) ng/L]in intensive group,P<0.05 or <0.01. Incidence rate of CIN in intensive group was significantly lower than that of routine control group(1.69% vs.11.90%,P=0.028).Conclusion:Intensive atorvastatin therapy can sig-nificantly lower incidence rate of CIN and inhibit systemic inflammatory response in ICD patients after intervention -al surgery,and it′s safe and reliable.
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Objective To summarize the domestic design for placebo acupuncture and the placebo effect and explore an ideal design for placebo acupuncture.Method Three large Chinese databases CNKI, Wan Fang and Vip were searched to systematically review the application of placebo acupuncture in randomized controlled trials published at home in recent 5 years (2011.01—2016.11).Results and conclusions A total of 48 articles were included according the inclusion and exclusion criteria. An analysis was made of the kinds of diseases for acupuncture study, the methods of designing placebo acupuncture, the effects of placebo acupuncture and comparisons with foreign placebo acupuncture. Pain syndrome and insomnia were the main kinds of diseases for acupuncture study, accounting for 10 and 8 articles respectively. Acupuncture needles were the main kind of needles for placebo acupuncture, accounting for 66.6%. Sites beside acupoints were the main positions selected for placebo acupuncture, accounting for 58.3%. Not penetrating the skin predominated in the depth of needle insertion, accounting for 37.5%. The kinds of needles for placebo acupuncture were fewer than abroad. The effects of placebo acupuncture were not superior to those of acupuncture.
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Objective To analyze the medical environmental distribution characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP).Methods On April 25 and August 29,2016,random sampling was performed be-fore cleaning and disinfecting the surrounding of patients who isolated CRKP in a hospital,sampling were mainly object surfaces and medical devices.Distribution characteristics of CRKP were analyzed.Results The number of environmental sampling in surgical intensive care unit(SICU),respiratory ICU(RICU),and emergency ICU(EICU) were 90,41,and 56 respectively.CRKP was not found in SICU and RICU specimens;6 strains of CRKP were iso-lated in EICU,the isolation rate was 10.71%.In April 2016,103 specimens were taken,and 6 strains of CRKP were isolated,isolation rate was 5.83%,which was higher than in August of 2016(P <0.05).There were no sig-nificant differences in isolation rates of CRKP among different specimens and different responsible persons (all P >0.05).Conclusion Key departments,such as EICU,should be intensified cleaning and disinfection,so as to re-duce the spread of CRKP in the medical environment.
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Objective To investigate the results of MRI and electroencephalogram examination and pathological examination of drug refractory epilepsy. Methods 70 cases with drug refractory epilepsy were treated with systemic antiepileptic drugs, but they still could not control their condition, and they were given MRI, EEG and pathological examination respectively. MRI, EEG and pathological findings of 70 cases were recorded, and the conclusion was drawn after statistical analysis. Results Compared with pathological examination, the localization accuracy of MRI for epileptogenic foci and related lesions was 88.57%, the accuracy of localization of EEG for epileptogenic foci and related disease was 51.43%, the difference was statistically significant (P<0.05); MRI examination of the epileptogenic lesions and qualitative accuracy the rate of up to 75.71%. Conclusion According to the patients with drug intractable epilepsy, the coincidence rate of MRI examination and pathological examination is higher. Compared with EEG, it can provide clinicians with more reliable basis for the diagnosis and treatment of drug refractory epilepsy. It is helpful to protect the curative effect of these patients.
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Objective To summarize the domestic design for placebo acupuncture and the placebo effect and explore an ideal design for placebo acupuncture.Method Three large Chinese databases CNKI, Wan Fang and Vip were searched to systematically review the application of placebo acupuncture in randomized controlled trials published at home in recent 5 years (2011.01—2016.11).Results and conclusions A total of 48 articles were included according the inclusion and exclusion criteria. An analysis was made of the kinds of diseases for acupuncture study, the methods of designing placebo acupuncture, the effects of placebo acupuncture and comparisons with foreign placebo acupuncture. Pain syndrome and insomnia were the main kinds of diseases for acupuncture study, accounting for 10 and 8 articles respectively. Acupuncture needles were the main kind of needles for placebo acupuncture, accounting for 66.6%. Sites beside acupoints were the main positions selected for placebo acupuncture, accounting for 58.3%. Not penetrating the skin predominated in the depth of needle insertion, accounting for 37.5%. The kinds of needles for placebo acupuncture were fewer than abroad. The effects of placebo acupuncture were not superior to those of acupuncture.
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Objective To analyze the medical environmental distribution characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP).Methods On April 25 and August 29,2016,random sampling was performed be-fore cleaning and disinfecting the surrounding of patients who isolated CRKP in a hospital,sampling were mainly object surfaces and medical devices.Distribution characteristics of CRKP were analyzed.Results The number of environmental sampling in surgical intensive care unit(SICU),respiratory ICU(RICU),and emergency ICU(EICU) were 90,41,and 56 respectively.CRKP was not found in SICU and RICU specimens;6 strains of CRKP were iso-lated in EICU,the isolation rate was 10.71%.In April 2016,103 specimens were taken,and 6 strains of CRKP were isolated,isolation rate was 5.83%,which was higher than in August of 2016(P <0.05).There were no sig-nificant differences in isolation rates of CRKP among different specimens and different responsible persons (all P >0.05).Conclusion Key departments,such as EICU,should be intensified cleaning and disinfection,so as to re-duce the spread of CRKP in the medical environment.
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Objective To investigate the results of MRI and electroencephalogram examination and pathological examination of drug refractory epilepsy. Methods 70 cases with drug refractory epilepsy were treated with systemic antiepileptic drugs, but they still could not control their condition, and they were given MRI, EEG and pathological examination respectively. MRI, EEG and pathological findings of 70 cases were recorded, and the conclusion was drawn after statistical analysis. Results Compared with pathological examination, the localization accuracy of MRI for epileptogenic foci and related lesions was 88.57%, the accuracy of localization of EEG for epileptogenic foci and related disease was 51.43%, the difference was statistically significant (P<0.05); MRI examination of the epileptogenic lesions and qualitative accuracy the rate of up to 75.71%. Conclusion According to the patients with drug intractable epilepsy, the coincidence rate of MRI examination and pathological examination is higher. Compared with EEG, it can provide clinicians with more reliable basis for the diagnosis and treatment of drug refractory epilepsy. It is helpful to protect the curative effect of these patients.
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<p><b>OBJECTIVE</b>To observe the biomechanical effects of the lateral wall of the femur in treating femoral intertrochanteric fractures with intramedullary or extramedullary fixation to guide the choice of clinical fixed methods.</p><p><b>METHODS</b>Twelve adults femur specimens of intertrochanteric fractures were belong to the type A1 of the AO fracture classification and randomly divided into the lateral wall complete PFNA group, the lateral wall complete PF-LCP group, the lateral wall breakage PFNA group, lateral wall breakage PF-LCP group, every group had 3 specimens. The four groups of specimens were subjected to compressive loading experiment with Universal Material Testing Machine. The maximum loading force was observed. The distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments along the intertrochanteric were measured with Calipers.</p><p><b>RESULTS</b>The maximum loading force of lateral wall complete PFNA group were larger than that of lateral wall complete PF-LCP group, and the maximum loading force of lateral wall breakage PFNA group were larger than that of lateral wall breakage PF-LCP group, there were significant differences (<0.05). The distance between fracture ends of the four groups before compression were not significant differences(>0.05). The distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments were not significant differences between lateral wall complete PFNA group and lateral wall complete PF-LCP group after compression (>0.05). But the distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments of lateral wall breakage PFNA group were less than that of lateral wall breakage PF-LCP group(<0.05).</p><p><b>CONCLUSIONS</b>Intramedullary fixation of intertrochanteric fractures have stronger loading force. Both intramedullary and extramedullary fixation of intertrochanteric fractures have strong stability when the lateral wall of the femur is complete, but intramedullary fixation of intertrochanteric fractures is stronger stability than extramedullary fixation when the lateral wall of the femur is broken. So the intramedullary fixation is the first choice for the treatment of intertrochanteric fracture.</p>
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Objective To investigate the relationship between platelet-activating factor acetylhydrolase gene Arg92His(4, 275; G→A), Ile198Thr(7, 593; T→C) and Val279Phe(9, 994; G→T) mutation and cerebral artery athero-sclerosis stenosis. Methods Six hundred forty-twopatients with cerebral infarction underwent cerebral digital subtrac-tion angiography (DSA).The patients were then divided into cerebral artery atherosclerosis stenosis (CAAS) group(n=477) and control group(n=81) accroding to the site and severity of their cerebral artery stenosis. Furthermore, the CAAS group were divided into intracranial artery stenosis(ICAS) subgroup(n=251), extracranial artery stenosis(ECAS) subgroup (n=115) and extracranial-intracerebral artery stenosis(ECAS) subgroup(n=111). The distributions of genotype and allele frequencies of Arg92His,Ile198Thr and Val279Phe mutation of platelet-activating factor acetylhydrolase gene were ex-amined and comparied in different groups. Results There were significant differences in the distributions of genotype and allele of Arg92His mutation between ICAS subgroup and control group(42.6% vs. 30.3%;23.3% vs. 16.4%, P 0.05). The distributions of genotype and allele of Arg92His, Ile198Thr and Val279Phe mutation were no significantly difference between CAAS group and control group (P >0.05). Conclusions Arg92His mutation may be associated with intracranial artery atherosclerotic stenosis.
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<p><b>OBJECTIVE</b>To compare clinical outcomes of swing shoulder and internal fixation in treating proximal humeral fractures.</p><p><b>METHODS</b>From June 2007 to June 2012, totally 89 elderly patients with humeral proximal fractures were treated by swing of shoulder or internal fixation, and 81 patients were followed up. In swing shoulder group, there were 38 patients including 13 males and 25 females aged from 62 to 84 with an average of (67.11±6.18) years old; 27 cases were 2-part fractures and 11 cases were 3-part fractures according to Neer classfication. In internal fixation group, there were 43 patients including 16 males and 27 females aged from 60 to 80 with an average of (66.47±5.48) years old; and 29 cases were 2-part fractures and 14 cases were 3-part fractures according to Neer classfication. VAS score and complications were compared between two groups after treatment, and Constant-Murley functional scoring was used to evaluate shoulder function of patients.</p><p><b>RESULTS</b>Eighty-one patients were followed up from 13 to 26 months with an average of 18.3 months. There was no significant difference in preoperative VAS score between two groups. After treatment, VAS score in swing shoulder group was (3.11±0.95), and (3.88±1.14) in internal fixation group, and had significant difference between two groups (t=-3.313,P<0.05). There was no significant difference in Constant-Murley scores between swing shoulder group (79.53±3.73) and internal fixation group (77.98±4.11) (t=1.768,P>0.05). Postoperative complications in swing shoulder group was 18.4%(7/38), 39.5%(17/43) in internal fixation group, and had significant differences between two groups (χ2=4.313,P<0.05).</p><p><b>CONCLUSION</b>Swing shoulder for the treatment of proximal humeral fractures in elderly has advantages of low cost, less complications and good recovery of joint function; while internal fixation has a good therapeutic effect but increased complications.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Fracture Fixation, Internal , Methods , Manipulation, Orthopedic , Methods , Shoulder Fractures , TherapeuticsABSTRACT
<p><b>BACKGROUND</b>Surgery is regarded as the most effective treatment to relieve pain and reduce complications in chronic pancreatitis (CP). Two major strategies exist: duodenum-preserving pancreatic head resection (DPPHR) and pancreatoduodenectomy (PD). Many studies suggest that DPPHR offers advantages during surgery and in the short-term; however, the long-term effects have not been thoroughly investigated. We analyzed the long-term outcomes of DPPHR and PD, over follow-up times of at least 1 year, to determine the optimal surgical treatment for CP.</p><p><b>METHODS</b>We systemically reviewed all CP surgical treatment reports, and only included randomized controlled trials (RCT) comparing DPPHR and PD, excluding unqualified studies using several pre-specified criteria. When multiple publications of a single trial were found, the most comprehensive current data were selected. Characteristics of the study populations and long-term postoperative outcome parameters were collected. The quality of the studies and data was analyzed using RevMan 4.2 software.</p><p><b>RESULTS</b>Five trials were qualified for meta-analysis, with 261 participants in total (114 in the DPPHR group and 147 in the PD group). There were no significant differences in the age, gender, or indications for surgery of each group. At the mean of 5.7-year (1 - 14 years) follow-up examination, DPPHR and PD resulted in equally effective pain relief, exocrine and endocrine function, and similar mortality rates (P > 0.05); however, DPPHR patients had improved global quality of life and weight gain, and reduced diarrhea and fatigue (P < 0.05).</p><p><b>CONCLUSION</b>DPPHR and PD result in equal pain relief, mortality, and pancreatic function; however, DPPHR provides superior long-term outcomes.</p>
Subject(s)
Humans , Duodenum , General Surgery , Pancreatectomy , Methods , Pancreaticoduodenectomy , Methods , Pancreatitis, Chronic , Psychology , General Surgery , Quality of Life , Time FactorsABSTRACT
<p><b>OBJECTIVE</b>To evaluate the effectiveness of dynamic SPECT (99m)Tc-galactosyl human serum albumin (GSA) scintigraphy on the assessment of reserve function of cirrhosis liver.</p><p><b>METHODS</b>From January 2010 to December 2011, 55 patients with cirrhosis liver were enrolled in this study. The case numbers of male and female were 43 and 12 respectively and the age was (51 ± 9) years (ranging from 35 to 69 years). After routine biochemistry test, CT scan and (99m)Tc-GSA dynamic SPECT scan were performed in turn using a juxtaposed SPECT/CT system. Then the morphologic volume of liver parenchyma (MLV), functional liver volume (FLV) and the hepatic cell absorption rate constant (GSA-K) were calculated. The correlations between GSA-K and routine biochemistry test, Child-Pugh score, indocyanine green clearance rate (ICG-K) were analyzed. The patients were further divided into 3 groups according to whether there was occlusion or stenosis in the main branch of left portal vein (group 1, n = 5), right portal vein (group 2, n = 13) or not (group 3, n = 37) and the regional hepatic functions index of the 3 groups were compared.</p><p><b>RESULTS</b>The value of FLV of the whole, left and right liver was (594 ± 152) ml, (244 ± 119) ml and (356 ± 171) ml, respectively. There were correlations between GSA-K and total bilirubin, prothrombintime, Child-Pugh score and ICG-K (r = -0.730--0.298, P < 0.05). The FLV and MLV ratios of involved hemiliver to uninvolved hemiliver were 0.09 ± 0.06 and 0.30 ± 0.14 in group 1, 0.57 ± 0.43 and 1.08 ± 0.63 in group 2, 0.71 ± 0.30 and 0.71 ± 0.48 in group 3. The difference in MLV-FLV ratio was signifcant between group 1 and group 3, between group 2 and group 3 (P = 0.000).</p><p><b>CONCLUSIONS</b>The dynamic SPCECT (99m)Tc-GSA scintigraphy can not only assess the whole liver function of cirrhosis liver effectively, but also evaluate the variation of regional liver function accurately.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Liver , Liver Cirrhosis , Liver Function Tests , Technetium Tc 99m Aggregated Albumin , Metabolism , Technetium Tc 99m Pentetate , Metabolism , Tomography, Emission-Computed, Single-PhotonABSTRACT
<p><b>OBJECTIVE</b>To evaluate the role of anatomic hepatectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method.</p><p><b>METHODS</b>From January 2009 to February 2011, 11 hepatocellular carcinoma patients with bile duct tumor thrombi underwent anatomic hepatectomy with removal of the biliary tumor thrombus. There were 10 male and 1 female patients. The average age was 49 years (ranging from 31 to 67 years). The initial symptom of 9 out of the 11 patients was jaundice. After anatomy and ligation of Glissonean pedicle of pre-resection segment, methylene blue was injected into its far-end portal vein in order to dye the segment.</p><p><b>RESULTS</b>Persistent methylene blue dyeing method was successful in all patients. Primary foci were found in all patients. Hepatectomy were performed, including 4 patients of segmentectomy, 3 patients of subsegmentectomy, 2 patients of hemihepatectomy, and 2 patients of hepatic sectionectomy. The mean operation time and blood loss was 137 minutes and 246 ml respectively. Severe complications such as liver function failure and sub-diaphragm abscess was avoided in all patients. No perioperative death. Post-operation radiotherapy was performed on 2 patients . Over a mean follow-up time of 14.6 months, liver cancer recurrence occurred in 2 patients, abdomen seeding metastasis in 1 patient, bile duct tumor thrombi recurrence in 1 case, and 2 patients died.</p><p><b>CONCLUSIONS</b>Anatomic hepatectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method can make resection more precise and improve curative effect.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Bile Duct Neoplasms , Carcinoma, Hepatocellular , General Surgery , Hepatectomy , Methods , Liver Neoplasms , General Surgery , Methylene Blue , Staining and LabelingABSTRACT
<p><b>OBJECTIVE</b>To explore the effects of different hepatic inflow occlusion methods on liver regeneration in rats after partial hepatectomy (PH).</p><p><b>METHODS</b>Male Wistar-Furth rats were randomly assigned to three groups: control group, underwent 68% hepatectomy alone; occlusion of portal triad (OPT) group, subjected to occlusion of portal triad under portal blood bypass; and occlusion of portal vein (OPV) group, subjected to occlusion of portal vein under portal blood bypass. Blood flow was occluded for 20, 30, and 40 minutes before 68% hepatectomy. According to the 7-day survival of each group, a same occlusion time T was set. Each group was divided into two subgroups (n = 8), in which animals were killed 3 and 7 days later. Liver regeneration was calculated as a percent of initial liver weight. Immunohistochemistry for proliferating cell nuclear antigen (PCNA) and Ki-67 was performed to quantify proliferating cells. In addition, functional liver volume represented by 99Tc(m)-GSA radioactivity was assessed.</p><p><b>RESULTS</b>The safe tolerance limit time was 30 minutes for OPT group and 40 minutes for OPV group. At 3 days after PH, no significant difference was observed in the regeneration rate of each group (P > 0.05). However, liver radioactive activity, PCNA labeling index, and Ki-67 index of OPV group was significantly higher than those of OPT group (P < 0.05); the latter were similar to those of control group (P > 0.05). At 7 days after PH, no significant difference was observed in all indexes among three groups (P > 0.05).</p><p><b>CONCLUSION</b>Compared with Pringle maneuver, preserving the hepatic artery flow during portal triad blood inflow occlusion can promote remnant liver regeneration early after PH.</p>
Subject(s)
Animals , Male , Rats , Hepatectomy , Methods , Liver , General Surgery , Liver Regeneration , Physiology , Postoperative Period , Rats, WistarABSTRACT
<p><b>BACKGROUND</b>Hepatectomy is a standard hepatic surgical technique. The safety of hepatectomy has been improved in line with improvements in surgical techniques. This study analyzed the operative and perioperative factors associated with hepatectomy.</p><p><b>METHODS</b>A total of 2008 patients who underwent consecutive hepatectomies between January 1986 and December 2005 were investigated retrospectively. Diagnoses were made based on pathological findings.</p><p><b>RESULTS</b>Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively, of the conditions requiring resections. Primary liver cancers accounted for 76.1% of the malignant tumors, while hilar cholangiocarcinomas accounted for 6.7%. Hemangiomas (41.7%) and hepatolithiasis (29.6%) were the most common of the benign conditions. Microwave in-line coagulation was used in 236 of our liver resection cases. The overall postoperative complication rate was 14.44%, of which 12.54% of resections were performed for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. The overall hospital mortality was 0.55%, and that for malignant liver disease was 0.51%. A high mortality (2.53%) was associated with extensive liver resections for hilar cholangiocarcinomas (two deaths in 79 cases). Microwave in-line pre-coagulation resection, Child-Pugh grading, operating time, postoperative length of stay, and preoperative serum albumin level were independent predictors of morbidity. Blood loss, Child-Pugh grading, operating time and preoperative serum albumin level were independent predictors of mortality.</p><p><b>CONCLUSIONS</b>Hepatectomy can be performed safely with low morbidity and mortality, provided that it is carried out with optimal perioperative management and innovative surgical techniques.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Hepatectomy , Mortality , Liver , Liver Neoplasms , General Surgery , Morbidity , Postoperative ComplicationsABSTRACT
<p><b>OBJECTIVE</b>To evaluate the early results of precise liver resection.</p><p><b>METHODS</b>Between May 2006 and June 2009, 65 patients with complicated liver space-occupying lesions were included in the study. Fifty-one patients underwent curative liver resection. Liver resections performed included 16 trisectionectomies, 11 hemihepatectomy, 5 meso hepatectomies, 3 combined segmentectomies, 5 caudate lobectomies and 11 irregular local resections.</p><p><b>RESULTS</b>Patients undergoing resection had no mortality with a major morbidity of 9.8%. Nineteen vascular repairs and reconstructions were patent at last follow-up. The postoperative 1-year survival rate was 100% in 10 patients with benign lesions and 92.7% in 41 patients with malignant tumors. The 1-year survival rate was zero in patients with malignant tumors, who underwent no liver resection.</p><p><b>CONCLUSIONS</b>Precise liver resection, as an aggressive surgical approach, offers hope for these patients, who would otherwise have a dismal prognosis.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Hepatectomy , Methods , Liver , General Surgery , Liver Diseases , General Surgery , Prognosis , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To summarize the methods, safety and efficiency of surgical resection for hilar cholangiocarcinoma.</p><p><b>METHODS</b>The clinical and follow-up data of 48 patients with hilar cholangiocarcinoma underwent surgical resection from January 2003 to December 2007 were analyzed retrospectively. There were 26 male and 22 female, aged from 38 to 72 years old with a mean of 63.6 years old.</p><p><b>RESULTS</b>Perioperative management including percutaneous transhepatic biliary drainage applied in 19 cases and portal vein embolization applied in 2 cases. Eight patients were treated with extrahepatic bile duct resection with or without parital hepatic segment II resection, 10 cases with perihilar hepatic resection (segment IVB, partial V, partial VIII, I), 28 cases with extended hemihepatectomy and 2 cases with central hepatic resection (segment IVB, V, VIII, I). R0 resection rate was 89.5% and the operative mortality was 2.1%. The 1-, 3- and 5-year survival rate were 93.5%, 51.8% and 36.5%, respectively. Patients undergoing extended hepatic resection survived significantly longer than those undergoing partial hepatic resection (P = 0.034).</p><p><b>CONCLUSIONS</b>Extended hepatic resection for hilar cholangiocarcinoma offers good outcomes with an acceptable mortality rate.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Bile Duct Neoplasms , General Surgery , Bile Ducts, Intrahepatic , Cholangiocarcinoma , General Surgery , Follow-Up Studies , Hepatectomy , Methods , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To analyze operative and perioperative factors associated with hepatectomy.</p><p><b>METHODS</b>2008 consecutive patients undergoing hepatectomy from January 1986 to December 2005 at Chinese People's Liberation Army General Hospital were investigated retrospectively according to their medical documentation. Diagnoses were made on basis of pathological results.</p><p><b>RESULTS</b>Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively. In the former, primary liver cancer accounted for 76.1% and hilar cholangiocarcinoma for 6.7%. Hemangioma (41.7%) and hepatolithiasis (29.6%) were listed in the first two in the latter group with relatively more patient ratios. Isolated caudate lobe resection was performed in 25 patients and micro-wave inline coagulation was induced in 236 cases of liver resection. In all cases, those with blood loss less than 200 ml accounted for 50.5% (1015/2008), whereas those with more than 400 ml accounted for 28.4% (570/2008). In patients performed micro-wave inline coagulation liver resection, those with blood loss less than 200 ml and more than 400 ml accounted for 60.6% (143/236) and 19.9% (47/236), respectively, which differed significantly from the average level (P < 0.05). The postoperative complication incidence was 14.44% for all cases, 12.54% for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. Complication incidence of primary liver cancer with tumor size smaller than 5 cm was 11.65% and that with tumor larger than 10 cm was 14.69%. There was no significant difference between the two groups. All-case hospital mortality was 0.55% and that for liver malignant disease was 0.60%, hilar cholangiocarcinoma 2.53%.</p><p><b>CONCLUSION</b>Hepatectomy can be performed safely with low mortality and low complication incidence, provided that it is carried out with optimized perioperative management and innovative surgical technique.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Blood Loss, Surgical , Hepatectomy , Methods , Mortality , Perioperative Care , Postoperative Complications , Epidemiology , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To investigate HLA genotyping by oligonucleotide arrays.</p><p><b>METHOD</b>Unsymmetrical PCR was used to amplify HLA-A gene exon 2, 3. The PCR products were used as templates for hybridization. The oligonucleotide probes were spotted on glass to make microarrays. High signal and specific probes were selected. The effects of the length and location of probes on hybridization signal were studied. A set of computer software was designed for scanning and genotype differentiation.</p><p><b>RESULT</b>The genotypes of 30 samples analyzed by microarray showed concordance to that by SBT and PCR-SSP.</p><p><b>CONCLUSION</b>HLA-A genotyping by oligonucleotide array is a good method with advantage of high speed, low cost and high flux.</p>
Subject(s)
Humans , Genotype , HLA-A Antigens , Genetics , Oligonucleotide Array Sequence Analysis , Methods , Oligonucleotide Probes , Sensitivity and SpecificityABSTRACT
HLA genes constitute a highly polymorphic multigene system. In the present study, HLA-B oligonucleotide chips were manufactured by using a set of sequence-specific oligonucleotide probes derived from polymorphic regions in exon 2 and exon 3 of HLA-B gene spotted by microarrayer onto the aldehyde modified glass slides. In addition, the sequenced HLA-B gene clones used as standard samples were amplified from exon 2 and exon 3 by PCR. Together with the correct hybridization and wash conditions, the PCR products were bound with the array probes on the chip, and the hybridization patterns were transformed to HLA-B genotypes. The results showed that the genotypes of standard samples by the HLA-B oligonucleotide chips were completely identical with the sequenced clones. In conclusion, the oligonucleotide chip method presented here for HLA-B genotyping is a rapid, accurate, sensitive and attractive high throughput biochemical way.