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ABSTRACT:Objective To assess the effect of prolonged laparoscopic surgery on peritoneal mesothelial cells and fibrinolysis in humans.Methods We examined prospectively 1 6 consecutive patients who underwent laparoscopic surgery (LAP)and 2 1 patients who underwent conventional open surgery (OP)for high-medium rectal cancer with curative intent.During the procedure,biopsy of the parietal peritoneum was made before operation and at 45 min,90 min,and 120 min after operation.The tissue-type plasminogen activator (tPA)and plasminogen activator inhibitor-1 (PAI-1 )were determined by enzyme-linked immunosorbent assay in peritoneal tissues.The cellular injury was detected by LDH assay.The proliferation was quantified by MTT assay.Results PAI-1 activity in the peritoneal tissue was significantly lower in LAP group than in the OP group.tPA activity decreased after 45min of open surgery,but there was no significant change in the LAP group.With time extension,the LDH activity increased and the proliferation of the mesothelial cells decreased.Conclusion Preservation of a prolonged hypofibrinolytic state by inhibition of PAI-1 up-regulation during LAP may predispose patients to less postoperative peritoneal adhesion. The cellular injury becomes apparent and the proliferation is inhibited during prolonged laparoscopic surgery.
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Objective To investigate feasibility and clinical application value of improved percutaneous transhepatic biliary internal-external drainage (PTBIED).Methods Consecutive patients from April 2007 to April 2010 with malignant obstructive jaundice were diagnosed by medical imaging or pathological confirmation whenever possible.The patients with proximal malignant biliary obstruction and intact inferior common bile ducts ＞ 3 cm in length,and a bilirubin of 70 μmol/L or higher,were included in the experimental group.The control group included patients with low malignant biliary obstruction,and those who met the criteria for the experimental group but refused to receive the altered method of PTBIED.The patients underwent traditional PTBIED in control group.The patients in the experimental group received the procedure as following:according to percutaneous transhepatic cholangiography,a biliary external drainage catheter was modified by adding side-holes.Then under fluoroscopic guidance,the loop tip of the modified biliary drainage catheter was positioned in the inferior common hepatic duct/common bile duct,while the additional side-holes were located in the expanded hepatic duct.Technical success rate,complications,hepatic function and white cell count (WBC) were recorded pre- and post-procedure.All patients were followed-up until death.A t-test was used to compare continuous variable data changes,the Chi-square test was used to compare categorical variable data in two groups,and survival time was assessed using the Kaplan-Meier method.Results Forty-six patients were included in the study,with 21 in the experimental group and 25 in the control group.The procedures were successfully performed in all patients in the two groups.There was no procedure-related death in the two groups.Symptoms were improved similarly after procedures in the two groups.The mean quantity of drained bile per day [experimental group (521 +136) ml/d,control group (606 + 159 ) ml/d,t =1.930,P ＞ 0.05],decrease of the serum total bilirubin after the procedures [ experimental group (87 ± 51 ) μmol/L,control group( 105 ± 66 ) μmol/L ( t =1.061,P ＞ 0.05 ) ] and the median survival time ( experimental group 7.7 months,control group 6.9 months,x2 =0.610,P ＞0.05 ) of the patients showed no statistically significant difference between two groups.The mean WBC amount of patients was higher after the traditional procedure [ ( 10.9 ±5.2) × 109/L] than before the procedure [ (7.8 ±2.9) × 109/L] in the control group ( t =3.606,P ＜ 0.05 ),but the converse change occurred in the experimental group [ pre-procedure (8.2 ± 3.4) × 109/L ],post-procedure [ (7.4 ± 2.6) × 109/L] ( t =2.649,P ＜ 0.05 ).No reflux of duodenal juice was observed in all patients of the experimental group,and 1 patient had infection of biliary tract.The reflux was observed in 11 patients of the control group after conventional PTBIED.Of them,8 patients had infection of biliary tract.Incidence rate of infection of biliary tract in the control group was higher than that in the experimental group( x2 =5.381,P ＜ 0.05 ).Conclusions Improved PTBIED is convenient and feasible,and compared with traditional PTBIED,it can reduce the complications of infection of biliary tract.
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Objective To analyze the clinical and CT manifestations of the chest and abdomen lymphangioleiomyomatosis (LAM). Methods The clinical and CT manifestations of 13 patients with LAM proved histopathologically were reviewed retrospectively.Results Twelve patients onset with intrapulmonary manifestations all had progressive dyspnea, other symptoms included pneumothorax of recurrent attacks, chest distress, hemoptysis, cough, chylothorax and so on. During the course of disease, 12 patients had no extrapulmonary symptoms, abdominal great goiter was found unintentionally in the rest one without any intrapulmonary symptoms. Pectoral CT manifestations included sporadic or asystematic cysts in pulmones with size of 2-20 mm, and most had thin and clear capsule wall. The lung parenchyma among cysts was mostly normal. Four patients had pneumatocele, 2 had pleural effusion. Abdominal CT was performed in 10 patients and 7 had abnormal findings: renal angiolipoleiomyoma (ALL) in 3 including one had retroperitoneal multiple lymphangiomyomas and effussion and seroperitoneum, another 2 had multiple liver ALL and spleen accretion. The rest 4 patients included retroperitoneal lymphadenectasis in 2, seroperitoneum in one, as well as retroperitoneal lump and spleen accretion in one patient.Conclusion Pectoral and abdominal symptoms in LAM are not specific, but the CT manifestations somehow specific, which are helpful to the identification and early diagnosis of LAM.
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Objective To analyze the clinical and CT manifestations of lung involvement of microscopic polyangiitis (MPA). Methods The clinical manifestations,laboratory ANCA examinations and CT features of 16 patients with lung involvement of MPA were retrospectively reviewed. Results (1) Clinical manifestations: 11 cases had hemoptysis or bloody sputum. Eight cases, who first presented with lung symptoms, were misdiagnosed with other lung diseases. All cases had mulfiorgans injuries involved kidney, cardiovascular and endocrine system, etc. (2) Laboratory examinations: all cases were pANCA positive and 14 cases were MPO-ANCA positive. (3) CT examinations: all cases had interstitial changes, 15 cases were interstitial predominately and 1 case was parenchymal predominately. Eight cases had pulmonary interstitial fibrosis and 11 cases had consolidation and 6 of them had both interstitial and consolidation. Two case had accompanied multiple nodulesand one of them had multiple cavitates. Six cases had mediastinal lymphoadenopathy. Conclusions Most of MPA patients have clinical manifestations of hemoptysis and bloody sputum, the CT examination show interstitial lung disease. Middle or advanced age population presented with above-mentioned manifestations should be alert to MPA, whether or not they have kidney and other organs injury.
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Objective To discuss the experiences of management of female duplicated kidney with urinary incontinence. Methods The clinical data of 25 cases with duplicated kidney with urinary incontinence were retrospectively analyzed. They were all female, age ranged from 2 to 12 years old, averaging 7. Fifteen cases were with right side lesions, 10 with left side. The main complaint was urinary incontinence and itching of pudendum. The diagnosis was set up by physical examinations and imaging methods. Results Twenty-five cases reported continent after operation. For the patients taken ureteral replant, the upper kidney function kept or recovered during follow-up. Conclusions Sonography, IVU, and MRU play an important part in the diagnosis of duplicated kidney with urinary incontinence. Operation is the key treatment for this disease.
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Objective To study the accuracy and practical value in the clinical diagnosis of Budd-Chiari syndrome by B ultrasonography and postcaval vein contrast examination.Methods 42 patients received B ultrasonographic scanning of the postcaval vein and the liver before the use of angiography.Angiography included Seldinger single-direction postcaval intubation(14 cases) and double-direction intubation(28 cases),and quick photographic observation.Results B ultrasonography showed that 18 cases had postcaval segmental or membranous obstruction 24 cases had postcaval stricture at its opening,and 20 cases complicated with single right hepatic stricture,8 cases with left vein stricture and 12 cases with central hepatic caval stricture.Communicating branched vessels were formed among 16 cases between hepatic vessels were formed among 8 cases between hepatic left-middle,and middle-right hepatic veins each.Reticular communicating vessels were formed in 8 cases between left middle and right.5 cases had slight postcaval stricture and their blood flowed non-obstructedly postcaval veinography showed 12 cases had postcaval stricture at proximal end,28 cases total segmental or membranous obstruction.There were 8 cases respectively for hepatic central vein and right hepatic vein development each.The remaining 26 cases had no hepatic venous development.There were 30 cases who had obvious branched circulaltion formation,and even their branched circular vessels had tumous-like expansion.Conclusion B ultrasonography,as a way of easy,and no-trauma examination,is the first-choice means to screen the patients.Postcaval angiography is a means to diagnose Budd-Chiari syndrome,which is neccessary for the cases with total segmental or membranous obstruction to have double-direction postcaval angiography,especially for the cases to have interventive therapy.