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Objective To investigate the predisposing locations of active hemorrhage in patients with esophageal variceal bleeding. Methods Data of 823 patients with acute esophageal and gastric variceal hemorrhage receiving emergency gastroscopy diagnosed from January 2003 to December 2013 were retrospectively studied. The location and site of active hemorrhage or stigmata were analyzed and its relationship with active hemorrhage was discussed. Results A total of 372(45. 2%,372/823) patients with active bleeding and stigmata were found under emergency endoscopy. Among 372 patients, 190 got accurate hemorrhage and stigmata location and site description. Bleeding or stigmata in 58(30. 5%) patients was 28-32 cm from incisor in group A, and that in 132 (69. 5%) patients was more than 35 cm in group B ( χ2＝57. 642, P＜0. 000 1). In 190 cases, the proportion of bleeding or stigmata at 3:00 point was the highest (37%,70/132), followed by those at 12:00 point(30%,58/132),6:00 point(24%,45/132),and 9:00 point (9%,17/132). The change trend of the percentage of each point in group A and group B was the same as that in all cases. The percentage of almost all points in group B was significantly higher than that in group A except that at 9:00 point ( P＜0. 000 1).Conclusion Esophageal variceal bleeding in cirrhosis is more common at 3:00 point, 6:00 point and 12:00 point of esophagus, and the high risk area is 35 cm below the incisors.
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Objective To evaluate the clinical effect of balloon closure combined with endoscopic therapy on spontaneous gastrorenal shunt ( SGRS ) and spontaneous splenorenal shunt ( SSRS ) . Methods The data of 33 patients of gastric varices with SGRS or SSRS diagnosed in the Chinese PLA General Hospital between January 2009 and February 2016 were collected. All patients were treated with the balloon retrograde distributary channel blocking technique and endoscopic histoacryl injection. Patients' clinical data, complications and effect of endoscopic therapy were retrospectively analyzed. Results In the 33 patients of gastric varices, gastrorenal shunt was found in 28 ( 84. 8%) cases and splenorenal shunt was found in 5 ( 15. 2%) cases. After the balloon blocking technique, 24 cases ( 72. 7%) were occluded successfully. Four cases failed in occlusion of SSRS due to tortuosity. There were no postoperative ectopic embolism, infection, hepatic encephalopathy, liver function deterioration, and other complication. Early latex varices were found in 21 cases after three months follow-up. Conclusion The balloon blocking technique combined with tissue adhesive injection could safely and effectively avoid the risk of ectopic embolism and plays an important role in the treatment of gastric varices in merger portasystemic shunt.
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Objective To evaluate the clinical effect of balloon closure combined with endoscopic therapy on spontaneous gastrorenal shunt ( SGRS ) and spontaneous splenorenal shunt ( SSRS ) . Methods The data of 33 patients of gastric varices with SGRS or SSRS diagnosed in the Chinese PLA General Hospital between January 2009 and February 2016 were collected. All patients were treated with the balloon retrograde distributary channel blocking technique and endoscopic histoacryl injection. Patients' clinical data, complications and effect of endoscopic therapy were retrospectively analyzed. Results In the 33 patients of gastric varices, gastrorenal shunt was found in 28 ( 84. 8%) cases and splenorenal shunt was found in 5 ( 15. 2%) cases. After the balloon blocking technique, 24 cases ( 72. 7%) were occluded successfully. Four cases failed in occlusion of SSRS due to tortuosity. There were no postoperative ectopic embolism, infection, hepatic encephalopathy, liver function deterioration, and other complication. Early latex varices were found in 21 cases after three months follow-up. Conclusion The balloon blocking technique combined with tissue adhesive injection could safely and effectively avoid the risk of ectopic embolism and plays an important role in the treatment of gastric varices in merger portasystemic shunt.
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Objective To evaluate the safety and efficacy of endoscopic treatment in patients with primary hepatic carcinoma and gastroesophageal variceal hemorrhage. Methods Thirty cases of hepatic carcinoma with gastroesophageal variceal hemorrhage diagnosed with gastroscopy between January 2008 and June 2015 in Chinese PLA General Hospital and Hainan branch were included. Patients′ clinical data, complications and therapeutic effects of endoscopy were retrospectively analyzed. Results All patients underwent endoscopy successfully. No recurrent bleeding was found in any case after treatment. Eight cases of varicosis nearly disappeared. Six?month follow?up showed three cases of gastrointestinal bleeding, one case of death of bleeding, and no recurrence hemorrhage in 27 others. Conclusion Endoscopic treatment could safely and effectively control the primary liver cancer combined with gastroesophageal variceal hemorrhage, hence may provide opportunity for further treatment of liver cancer.
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OBJECTIVE To investigate the immunogenicities of Poria cocos polysaccharides, PCP-Ⅰand PCP-Ⅱ, as a vaccine adjuvant. METHODS ①Keyhole limpet hemocyanin (KLH) was linked to PCP-Ⅰor PCP-Ⅱrespectively to prepare immuno-antigen KLH-PCP-Ⅰor KLH-PCP-Ⅱ. Bovine serum albumin (BSA) was also linked to PCP-Ⅰor PCP-Ⅱrespectively to prepare screening-antigen. Rabbits were immunized with KLH-PCP-Ⅰor KLH-PCP-Ⅱplus Freund adjuvant by intradermal injection twice, and serum specific antibody titers were determined by ELISA. ②BALB/c mice were immunized with PCP-Ⅰ or PCP-Ⅱ alone intramuscularly twice, and serum polysaccharide antibody titers were determined by ELISA.③BALB/c mice were co-immunized intramuscularly or subcutaneously with PCP-Ⅰor PCP-Ⅱplus hepatitis B surface antigen (HBsAg) or porcine reproductive and respiratory syndrome virus inactivated vaccine (PRRSV) twice, and serum polysaccharide-antibody titers were determined by ELISA. RESULTS ①Serum anti-KLH and anti-polysaccharides (PCP-Ⅰor PCP-Ⅱ) antibodies were pro?duced after rabbits were immunized with KLH-PCP-Ⅰor KLH-PCP-Ⅱplus Freund adjuvant twice.②Serum anti-PCP-Ⅰor anti-PCP-Ⅱantibodies were not found after mice were immunized with PCP-Ⅰand PCP-Ⅱalone twice.③After mice were immunized with HBsAg or PRRSV plus PCP-Ⅰor PCP-Ⅱtwice, serum anti-PCP-Ⅰor anti-PCP-Ⅱantibodies were not found. CONCLUSION PCP-Ⅰand PCP-Ⅱshow weak immunogenicity, which may be quite safe as a vaccine adjuvant.
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ObjectiveTo investigate the clinical effect of endoscopic therapy for patients with esophagogastric variceal bleeding (EVB) after liver transplantation. MethodsA retrospective analysis was performed for the clinical data of 8 patients who experienced EVB after liver transplantation and underwent endoscopic therapy, especially endoscopic features. The clinical outcome was evaluated, including hemostasis rate, change in varicose veins after treatment, and short-term recurrence and bleeding rate. ResultsThe eight patients had a mean age of 55.00(4475-6150) years, and the mean time from liver transplantation to bleeding was 7150(1875-10725) months. As for primary diseases, 6 patients had hepatitis B cirrhosis (among whom one patient each was complicated by liver cancer, alcoholic cirrhosis, and acute liver necrosis, and three were complicated by subacute liver necrosis), one had hepatitis C cirrhosis, and one had unexplained liver cirrhosis. Of all patients, 2 underwent sclerotherapy, 6 underwent endoscopic variceal ligation, and 6 underwent tissue adhesive treatment. The endoscopic therapy achieved successful hemostasis in all patients. No patients experienced rebleeding at discharge or the 12-month follow-up visit. One patient underwent selective endoscopic therapy due to the recurrence of varices. ConclusionGastrointestinal bleeding remains a serious complication after liver transplantation. Besides antiviral therapy, the presence of varices should be closely monitored.
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Objective To investigate the safety and efficacy of endoscopic tissue adhesive injection combined with sequential endoscopic variceal ligation for gastroesophageal varices of Le,g type. Methods Twenty-three patients with gastroesophageal varices of Le,g type were enrolled to General Hospital of PLA from May 2013 to March 2015, who were treated with endoscopic tissue adhesive injection in the fundic and cardiac site in the first session, followed with endoscopic variceal ligation for esophageal varices. The clinical data, procedure complications and efficacy were retrospectively analysed. Results All procedures were successfully performed with no such evident complications as intraoperative and postoperative bleeding, embolization, mediastinal infection or death with an average hospitalization time of 15. 3±4. 09 days. Mild and moderate thoracalgia occurred in 13 patients(56. 5%), low-grade fever in 2 patients(8. 7%, recovered after symptomatic treatment for 1-2 days) . During the follow-up of 2 weeks, the rate of varices disappearance was 56. 5% (13/23) and no recurrent bleeding was observed. Six months after discharge, 10 patients underwent endoscopy again, varices disappeared in 4 and 6 with remains;the 13 others showed no hemorrhage according to follow-up call. Conclusion The therapy of endoscopic tissue adhesive injection with sequential endoscopic variceal ligation for gastroesophageal varices of Le,g type is safe and efficient.
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Objective To explore the manipulation,feasibility and safety of laparoscopy assisted natural orifice translumenal endoscopic surgery(NOTES).Methods The technique was performed in 4 female porcine models.Diagnostic laparoscopy was performed first,and followed by transgastric access through the anterior gastric wall under the monitor of laparoscopy.The stoma was extended with the dilation ballon and the endoscope was sent to the abodominal cavity.Such procedures as endoscopic peritoneoseopy,fallopian tube ligation,oophorectomy,eholeeysteetomy and closure of gastrostomy were performed.The drainage tube and antibiotics of 3 days were used after operation according to the bleeding and potential risk of fistula and peritonitis.The animals were feeded on a semiliquid diet.Two weeks later,routine gastroseopy was pedbrmed to examine the healing of luminal incision.Subsequently,all models were sacrificed for the evaluation of the validity of NOTES.Results With the assistance of the laparoscope,endoscopic peritoneoseopy and,fallopian tube ligation,oophorectomy and cholecystectomy,twice for each,were successfully performed in all models.Abdominal drainage were used in two animals'after eholecystectomy.All porcines survived for 2 weeks postoperatively with no weight loss.Autopsic examination showed good healing of transgastric incisions,with little adhesion,no massive heinan'hage,abcesses,or injury to adjacent organs.Conclusion Combined laparoscopy and endoscopy for NOTES is feasible with relative safety.Laparoscopic assistance could facilitate the NOTES procedures at the present stage.
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Objective To explore the clinical trait and relationship between clinicopathological characteristics and prognosis in Uygurs women with breast cancer of Xinjiang. Methods The clinicopathological data of 74 cases with breast cancer of Uygurs women were analyzed, multivariate analysis was done by COX proportional hazard model. Results 74 cases have followed up: there-year and five-year survival rates were 75.00 %(48/64) and 43.50 %(20/46)respectively. Multivariable COX regression revealed that patient age, menstruation, status of involved lymph node, TNM and the expression of PR were five important and independent prognostic factors for breast cancer of Uygurs women, the hazard rations of these factors were 0.037, 0.103, 13.851, 18.877, and 0.046, respectively. Conclusions The proportion of breast cancer of Uygurs women was low in patient of Xinjiang, but patient age was young, age of onset were more than half between 36 and 50 years old and mainly belong to Ⅱ, Ⅲ stage of TNM, prognosis was poorly. Patient age, menstruation, status of involved lymph node, TNM and the expression of PR serve as independent prognostic indexes of breast cancer of Uygurs women. Early diagnosis and treatment are very important to improve the survival rate of breast cancer patients
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Objective To investigate the clinical characteristics and the treatment of pancreatic encephalopathy (PE) and Wernicke's encephalopathy (WE). Method A retrospective study was conducted on 596 cases of acute pancreatitis. Results There were 93 cases of severe acute pancreatitis (SAP),among them encephalopathy was discovered in 10 patients (1.7%). All 6 patients of PE developed in SAP (6.5%);3 patients died (3% of SAP,50% of PE). Four cases of WE developed in AP (0.7%);2 patients died (0.3% of AP,50% of WE). Two patients of WE were treated with parenteral thiamine (vitamin B_ 1 ),and they survived. Conclusions PE occurred in early stage of SAP or recrudescence,while WE usually occurred in convalescent stage of SAP/AP. Long fasting,repeated vomiting,and total parenteral nutrition (TPN) without VitB_ 1 were main causes of VitB_ 1 deficiency,which might be the main causative factor in WE.
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Eighty six patients with chronic superficial gastritis, atrophic gastritis and peptic ulcer without autoimmune diseases underwent gastroscopy and biopsy in the gastric antrum and body. Hp was identified by histopathological analysis (Warthin Starry silver stains) and rapid urease test (RUT). Lymphoid tissue was observed by HE stain and immunohistochemistry method. Results showed that Hp infection was found in 68 6% of the patients.Lymphoid follicles were present in 35 6% of the Hp positive patients ,and no lymphoid follicles were found in the Hp negative patients.In six Hp positive patients,Lymphoepithelial lesions were found.Hp infection was closely associated with gastric mucosal lymphoid infiltration,lymphoid follicles and active inflammation( P