Herniation of intervertebral disc into thoracolumbar fracture vertebral body leads to malunion of fracture and decrease of intervertebral space height / 中国骨伤

OBJECTIVE@#To analyze the clinical characteristics of intervertebral disc tissue injury and herniation into the vertebral body in thoracolumbar fracture on fracture healing, vertebral bone defect volume and intervertebral space height.@*METHODS@#From April 2016 to April 2020, a total of 140 patients with thoracolumbar single vertebral fracture combined with upper intervertebral disc injury treated with pedicle screw rod system reduction and internal fixation in our hospital. There were 83 males and 57 females, aged from 19 to 58 years old, with an average age of (39.33±10.26) years old. All patients were followed up regularly 6 months, 12 months and 18 months after surgery. The patients with injured intervertebral disc tissue not herniated into the fractured vertebral body were the control group, and the patients with injured intervertebral disc and herniated into the fractured vertebral body were the observation group. By detecting the thoracolumbar AP and lateral X-ray films, CT and MRI of the thoracolumbar segment at different follow-up time, calculate the changes of the wedge angle of the fractured vertebral body, the sagittal kyphosis angle and the height of the superior adjacent intervertebral space, the changes of the fracture healing and bone defect volume after the reduction of the vertebral body, and the changes of the intervertebral disc degeneration grade. The prognosis was evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI). Finally, the differences of the above results among different groups were comprehensively analyzed.@*RESULTS@#All the patients had normal wound healing without complications. A total of 87 patients received complete follow-up data, at least 18 months after internal fixation. Thoracolumbar AP and lateral X-ray films showed that 18 months after the reduction and internal fixation operation, the vertebral wedge angle, sagittal kyphosis angle and the height of the upper adjacent intervertebral space in the observation group were greater than those in the control group(P<0.05). CT scanning showed that the deformity of the fracture healed 12 months after the vertebral body reduction in the observation group and formed a "cavity" of bone defect connected with the intervertebral space, and its volume was significantly increased compared with that before (P<0.05). MRI scanning showed that the degeneration rate of injured intervertebral discs in the observation group was more serious than that in the control group 12 months after operation(P<0.05). However, there was no significant difference in VAS and ODI score at each time.@*CONCLUSION@#Herniation of injured intervertebral disc tissue hernias into the fractured vertebral body leads to increased bone resorption defect volume around the fracture and forms a malunion "cavity" connected with the intervertebral space. This may be the main reason for the change of vertebral wedge angle, the increase of sagittal kyphosis angle and the decrease of intervertebral space height after removal of internal fixation devices.

Establishment of calcium-activated chloride channel -based second messenger Ca / 解剖学报

Objective To establish a cell model based on calcium-activated chloride channel (CaCC) that could sensitively detect the second messenger Ca

Effect of thyroxine level on gestational diabetes mellitus and pregnancy outcome / 解放军医学杂志

Objective: To investigate the effect of thyroxine level on the onset of gestational diabetes mellitus (GDM), pregnancy outcome and the basic conditions of neonates. Methods: The related information of 1903 cases of pregnant women were prospectively collected from the Department of Obstetrics, Shanghai Changhai Hospital. Selecting group A (gravida with low thyroxinemia, n=36), group B (gravida with pure thyroid peroxidase antibody (TPOAb) positive, n=113) and group C (gravida with normal thyroid function, n=1539) according to the results of thyroid function test in newly constructed card. The incidence of GDM and the related index of thyroid function and glucose metabolism during the second trimester of pregnancy were compared among the three groups. Gravida with GDM in the three groups were group D (9 cases), group E (32 cases) and group F (367 cases), respectively. The differences of pregnancy outcome and the basic conditions of neonates among them were compared. Results: No significant differences existed (P>0.05) in the incidence of GDM during different pregnant period in groups A, B and C (First trimester: 50.00% vs. 25.00% vs. 34.69%; Second trimester: 21.88% vs. 28.71% vs. 22.70%). In the second trimester, the level of glycosylated hemoglobin (HbA1c) was significantly higher in group A than in group C [4.80%(4.60%, 5.00%) vs. 4.70%(4.40%, 4.90%)], w hi le the fasting glucose level was significantly higher in group B than those in group C [(4.69±0.59) mmol/L vs. (4.58±0.43) mmol/L, P0.05). Conclusions: Different levels of thyroxine have no significant effect on the incidence of GDM, but throw some effects on the glucose metabolism in the second trimester. In addition, positive TPOAb may increase the incidence of premature delivery and fetal distress in pregnant women with GDM, and affect fetal growth and development to some extent. Thyroid function status should be evaluated in the early stages of pregnancy, and regular follow-up should be conducted for patients with TPOAb positivity and timely intervention if necessary.

Effect of microvascular invasion on long-term prognosis of liver resection for multiple hepatocellular carcinomas / 医学研究生学报

ObjectiveOnly few studies have been published of the effect of microvascular invasion (MVI) on long-term prognosis of liver resection (LR) for multiple hepatocellular carcinomas (mHCCs). Therefore, we investigate the efficacy of MVI on long-term prognosis of the patients undergoing LR formHCCs.MethodsThe clinical data of 505 patients undergoing LR for mHCCs in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between March 2009 and March 2015 were retrospectively analyzed. Patients were divided into the MVI(+) group （n=279）and MVI (-) group (n=226), and146 patients in MVI (+) group and 124 patients in MVI (-) group received adjuvant transarterial chemoembolization (TACE). The Kaplan-Meier approach was used for survival analysis and the Cox proportional-hazards regression model was used forthe risk factors of long-term survival rate.ResultsThe early recurrence rate of MVI (+) group was significantly higher than that of MVI (-) group (60.4% vs 40.5%, P<0.01), and the 1-, 3-, 5-year overall survival rate of MVI (+) group was significantly lower than those in MVI (-) group (70.5%, 47.4%, 33.4% vs 86.6%, 66.8%, 50.1%, P<0.05). Among MVI (+) patients, the early recurrence rate and 1-, 3-, 5-year overall survival rate in the adjuvant TACE group were better than those in the control group (early recurrence rate 41.3% vs 39.3%, P<0.05; 1, 3, 5 year overall survival rate 92.8%, 72.5%, 53.1% vs 78.6%, 59.5%, 47.3%, P<0.05). Multivariate Cox model indicated that the Alpha-foetoprotein (AFP) level, maximum tumor diameter/minimum tumor diameter, MVI and adjuvant TACE were independent risk factors for early recurrence (HR=1.48, 1.51, 1.34, 0.76, P<0.05); maximum tumor diameter, intraoperative blood transfusion, MVI and adjuvant TACE were independent risk factors for postoperative overall survival (HR=1.75, 1.75, 1.36, 0.68, P<0.05).ConclusionMVI is a risk factor for early recurrence and poor long-term prognosis after LR for mHCCs. For mHCCs with MVI, adjuvant TACE after LR could reduce the early recurrence rate and improve the long-term survival rate.

Value of Serum Tumor Marker Isocitrate Dehydrogenase 1 in the Diagnosis of Lung Cancer / 中国医学科学院学报

To investigate the clinical value of serum tumor marker isocitrate dehydrogenase 1(IDH1)in the diagnosis of lung cancer. The general data were collected in lung cancer patients and non-lung cancer patients.The serum level of IDH1 was detected by enzyme-linked immunosorbent assay to evaluate its clinical significance in diagnosing lung cancer. The serum IDH1 level was significantly higher in lung cancer patients than in non-lung cancer patients [(7.12±6.98)ng/ml (2.09±1.83)ng/ml,=11.540,<0.001].The serum IDH1 level in patients with adenocarcinoma or squamous cell carcinoma was significantly higher than that in patients with small cell lung cancer [(7.91±7.26)ng/ml (2.76±2.27)ng/ml, =6.345,<0.001].The sensitivity of IDH1 in detecting lung cancer,stage Ⅰ/Ⅱ lung cancer,and stage Ⅲ/Ⅳ lung cancer was 47.4%,49.1%,and 46.3%,respectively. Serum IDH1 has high sensitivities and specificities in the diagnosis and differential diagnosis of non-small cell lung cancer(squamous cell carcinoma and adenocarcinoma)and small cell lung cancer as well as the auxiliary diagnosis of stage Ⅰ and Ⅱ lung cancer.It is a valuable marker for the auxiliary diagnosis of lung cancer.

Resection of rib tumors by video-assisted thoracoscopic surgery(24 case reports) / 中华胸心血管外科杂志

Objective To explore the possibility of minimally invasive resection of chest wall tumor by video-assisted tho-racoscopic surgery( VATS) .Methods Retrospective analysis of 24 cases of chest wall tumors with minimally invasive resec-tion by VATS from June 2013 to May 2017, including 13 cases of bone fibrous dysplasia, 7 cases of rib abnormal hyperplasia of fiber, 2 cases of cartilaginous tumor, 1 case of Langerhans histiocytosis and 1 case of extramedullary single plasma cell tumor.3 cases with C arm positioning in operation and 4 cases with computer navigation and positioning .Results 24 cases of rib tumors were successfully removed .No surgical death and serious complications occurred in this group .All patients followed up 1-3 years, there is no recurrence.Conclusion Resection of rib tumors with VATS can bring precise resection and lead to minimally invasive.

The utility of 3D printing for implant design for rib fracture fixation / 中华胸心血管外科杂志

Objective 3D printing has been used in the assistanceof surgical planning and the development of personal-ized prostheses.This study was to determine the feasibility of using a 3D printer for the purpose of producing personalized pros-theses for complex rib fracture fixation .Methods Using data from a high-resolution CT scan of 10 ribs of 3 cases with rib frac-ture, rib moldswere generated with computer software and fabricated with the 3D printer using the fused deposition modeling method.The 3D printing molds were used for custom-designed titanium plate.Results The average length of the 3D models of ribs is 8.45 cm.The mean time of fabricating models was 18.8 minutes and 4.6 gram polylactic acid was consuming on aver-age.The mean error of dimension of 3D models is less than 0.2 mm.Reshaping plates spends 3.3 minutes on average.Radio-logical follow-up for bothcases demonstrated successful fixation at 3 months.Conclusion These cases demonstrate the feasibili-ty of the use of 3D modeling and printing to develop personalizedplates and can ease the difficulty of complex rib fracture .

Glucose metabolism in hospitalized patients: A retrospective analysis of 1 726 cases / 第二军医大学学报

Objective To analyze the blood glucose levels and related data of inpatients of different clinical departments, so as to provide a basis for normalized management of blood glucose in hospital. Methods Medical records of 1 726 discharged patients from 9 different clinical departments of Changhai Hospital in November 2014 were retrospectively analyzed using medical record inquiry system. The data included admission blood glucose, metabolic indexes, hospital stay and hospitalization expenses. The abnormal blood glucose and related factors were analyzed. Results We found that 99.19% (1 712) of the 1 726 inpatients had their blood glucose monitored once at least. According to their past medical history and blood glucose levels on admission or during hospitalization, 42.76% (738) patients had pathoglycemia. Endocrinology department (73.79%,76/103), geriatrics department (54.17%, 13/24) and pancreatic surgical department (50.54%, 93/184) had more pathoglycemia patients than other departments. The patients with newly discovered pathoglycemia (393) accounted for 22.77% of the inpatients, and the hospital stay and hospitalization expenses in these patients were significantly higher than patients with diabetes and impaired glucose regulation (IGR) and those with normal blood glucose (P<0.01). The levels of serum triglyceride (TG) and blood urea (BUN) of diabetic and IGR inpatients were significantly higher than patients with newly discovered high glucose and normal glucose (P<0.01); the levels of high density lipoprotein cholesterol (HDL-C) in diabetic and IGR inpatients and those with newly discovered pathoglycemia were significantly lower than that in those with normal blood glucose (P<0.01), but there was no significant difference between the former two groups. Conclusion Newly discovered hyperglycemia during hospitalization should not be overlooked. The blood glucose monitoring of high risk population should be reinforced on admission and during hospitalization, and a standard management of hyperglycemia should be established.

Effects of kinesio taping on biomechanics characteristics of ankle joint: theoretical research and application advances / 中国组织工程研究

BACKGROUND:Kinesio taping is commonly used,but there is a lack of rigorous and scientific research,especially in biomechanics and exercise.OBJECTIVE:To overview the biomechanics characteristics of the ankle joint after treatment with kinesio taping,and to summarize the biomechanics difference in kinematics,kinetics,and electromyography of the ankle joint between non-kinesio and kinesio taping.METHODS:Ovid Medline,Elsevier SDOL,PubMed and CNKI databases were retrieved for the Chinese and English literatures concerning the biomechanics and exercise performance of kinesio taping published before December 2015.Subsequently,all literatures were classified according to the Oxford Centre for Evidence-based Medicine Levels of Evidence.RESULTS AND CONCLUSION:Most of literatures support the viewpoint that kinesio taping can improve ankle joint stability,increase the arch height and decrease the external load of key muscles of the ankles and feet.Some studies have suggested that during landing,kinesio taping shortened the duration of the peak of support reaction forces,reduced the flexion force,and increased the loading rate of lower extremities,thereby resulting in an increased risk for injury.Other studies have shown that kinesio taping increases the recruitment of motor units and changes the order of neuromuscular contraction,but it cannot improve the athletic performance,and even decrease the athletic performance in most cases.Whether kinesio taping improves muscular force,increases the muscular performance,and increases the power of lower extremities is under discussion;hence,in-depth studies are needed in the future.

Protective effects of glycyrrhizic acid against lupus nephritis in MRL/lpr mice / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate protective effect of glycyrrhizic acid (GA) against lupus nephritis in MRL/lpr mice and explore its underlying mechanisms.</p><p><b>METHODS</b>Forty MRL/lpr mice were randomized equally into blank control group, dexamethasone (1.5 mg/kg) group, GA (20 mg/kg) group, and GA (40 mg/kg) group with corresponding treatments for 7 days, with 10 wild-type mice as the control group. Serum levels of uric acid and creatinine and inflammatory cytokines in the serum and kidney were tested after the treatments using enzyme-linked immunosorbent assays (ELISA). The pathological changes in the kidneys were detected using HE staining, and the protein expressions of NLRP3, ASC, caspase-1, IL-1β, p-NF-κB, NF-κB, p-IκBα, and IκBα were detected with Western blotting.</p><p><b>RESULTS</b>GA obviously decreased serum levels of uric acid and creatinine, decreased inflammatory cytokines in the serum and kidney, ameliorated renal pathologies and inhibited the expressions of NLRP3, ASC, caspase-1, IL-1β, p-NF-κB, and p-IκBα proteins in MRL/lpr mice.</p><p><b>CONCLUSION</b>GA has protective effects against lupus nephritis in MRL/lpr mice.</p>

Effects of diammonium glycyrrhizinate on hepatic and intestinal UDP-Glucuronosyltransferases in rats: Implication in herb-drug interactions / 中国天然药物

Glycyrrhizin is a major bioactive component of liquorice, which exerts multiple biochemical and pharmacological activities and is frequently used in combination with other drugs in the clinic. Mycophenolate mofetil (MMF), an immunosuppressant widely used in transplant patients, is metabolized by UDP-glucuronyltransferases (UGTs). Although significant evidence supports that glycyrrhizin could interact with the cytochrome P450s (CYPs), few studies have addressed its effects on UGTs. The present study aimed at investigating the regulatory effects of diammonium glycyrrhizinate (GLN) on UGTs in vitro and in vivo. We found that long-term administration of GLN in rats induced overall metabolism of MMF, which might be due to the induction of UGT1A protein expression. Hepatic UGT1A activity and UGT1A mRNA and protein expression were significantly increased in GLN-treated rats. UGT1A expression levels were also increased in the intestine, contradicting with the observed decrease in intestinal UGT1A activities. This phenomenon may be attributed to different concentrations of glycyrrhetinic acid (GA) in liver and intestine and the inhibitory effects of GA on UGT1A activity. In conclusion, our study revealed that GLN had multiple effects on the expression and activities of UGT1A isoforms, providing a basis for a better understanding of interactions between GLN and other drugs.

Astragaloside IV prevents lipopolysaccharide-induced injury in H9C2 cardiomyocytes / 中国天然药物

This study aimed to investigate the protective effects of astragaloside IV (AS IV) on lipopolysaccharide (LPS)-induced injury in H9C2 cardiomyocytes. H9C2 Cardiomyocytes were cultured with LPS (10 μg·mL(-1)) for 4 h and treated with AS IV at 50, 100, and 150 μmol·L(-1) for various durations. Cell viability was determined by MTT. The content of released TNF-α and IL-6 from cardiomyocytes were evaluated by enzyme-linked immunosorbent assay (ELISA). The levels of superoxidase dismutase (SOD), malondialdehyde (MDA), lactate dehydrogenase (LDH), and creatine phosphate kinase (CK) were measured by using commercial available kits. The mRNA and protein expression levels of NF-κB p65 were measured by RT-PCR and Western blotting, respectively. And the NF-κB p65 activity was measured by ELISA. Our results demonstrated that AS IV at 50, 100, and 150 μmol·L(-1) markedly inhibited the release of TNF-α and IL-6 and decreased NF-κB expression, compared with the model group. Moreover, the improved SOD activity and decreased MDA, LDH and CK levels were detected after AS IV treatment. In summary, AS IV could increase the activities of antioxidant enzymes, inhibite lipid peroxidation, and down-regulate the inflammatory mediators involved in the inflammatory responses. These results demonstrated that AS IV could prevent LPS-induced injury in cardiomyocytes.

Computer navigation-guided excision of rib tumor / 中华胸心血管外科杂志

Objective To evaluate the advantage of using computer navigation system in the resection of rib tumors.Methods We carried out rib tumor resection in 5 patients using computer navigation system.Preoperative CT of each patient was performed.The preoperation CT-based planning was made for every patient with the navigation system software including confirming the tumor surgical margin and designing resection margin.A C-arm scan was carried out intraoperatively.With image fusion of both data,tumor resection were performed under navigation image guidance.Results The mean time of image fusion was 58 minutes.Four tumor resection specimens showed safe and clear margins.Histological examination of all tumor specimens showed tumor-free margins.One patient who was suspected lung cancer with bone metastases was performed a biopsy under navigation image guidance and obtained a pathology diagnose successfully.Conclusion The computer navigation system helps surgeons determine the surgical margin,implement precision tumor resection and reduce surgical damage.

A preliminary study on the mutation of TLR4 gene in patients with invasive aspergillosis / 医学研究生学报

Objective Toll-like receptor ( TLR) gene family is the most important pathogen recognition receptor and animal experiment have found TLR4 mice is inclined to infect aspergillosis ( IA) .The study was to investigate the variation of TLR4 gene in Chinese Han nationality and its relation with the susceptibility of IA. Methods 25 patients diagnosed with proven IA from June 2011 to December 2012 in our hospital were enrolled, among which 17 were males.Their average age was 52.4 ±12.3, and 12 pa-tients had underlying diseases, the others had no underlying diseases.The control group consisted of 103 normal persons, among which 70 were males.Their average age was 56.0 ±17.2.All of the subjects were Chinese Han population.DNA was extracted from periph-eral blood.Polymerase chain reaction ( PCR) was applied to amplify the coding sequence of TLR4 gene followed by sequencing.The sequencing result was compared with TLR4 coding sequence in NCBI GenBank along with the analysis on amino acid change caused by genetic mutation and its effect on protein function.Comparison analysis was made on genetic mutation rate between IA group and con-trol group. Results Two missense mutations,TLR4 219 C>G and 1420 C>T, were identified in TLR4.The prediction result of protein structure showed 219 C>G resulted in the change of functional area for TLR4 to recognize pathogen and 1420 C>T caused no change in domains.The variation rate of TLR4 in IA group was 8%( 2/25 ) and both the patients had no underlying diseases. No mutation has been founded in control group and the difference between two groups was of statistical significance (P=0.037). Conclusion Two missense mutations (219 C>G and 1420 C>T) have been detec-ted in encoding area of TLR4 gene of IA patients.Variation in the cod-ing region of TLR4 gene may increase the susceptibility to IA.

Research progress of targeted drugs in breast cancer treatment / 基础医学与临床

Because of its specificity , significant effect , low side effect , molecular targeted therapy has been applied in the treatment of breast cancer .Recently, various molecular targeted drugs have been exploited including targeted HER family, VEGF, multi-targeted therapeutic drugs , and drugs combination .

Clinical analysis of endoscopic minimally invasive cholecystolithotomy and laparoscopic cholecystectomy / 重庆医学

Objective To discusses the clinical application value and safety of endoscopic minimally invasive cholecystolithotomy in gallstones treatment .Methods To retrospectively analyzes the clinical data of 94 patients with gallbladder stone from Feb .2010 to Feb .2013 ,and divided into endoscopic minimally invasive cholecystolithotomy (EMIC) group (46 cases) and laparoscopic chole-cystectomy (LC) group (48 cases) .Observed two groups of operation time ,intraoperative blood loss ,intraoperative bile duct inju-ry ,anal exhaust time ,postoperative hospitalization time ,bile reflux gastritis ,abdominal distention ,diarrhea ,common bile duct calculi and hospitalization expenses ,etc .Results Two groups of operation time ,hospitalization expenses ,length of hospital stay ,and intra-operative blood loss have no obvious difference(P>0 .05) ,in EMIC set ,the exhaust time ,postoperative bile duct calculi incidence , intraoperative bile duct injury ,bile reflux gastritis incidence and the incidence of abdominal distension ,diarrhea are significantly less than LC group (P<0 .05) .Conclusion The endoscopic minimally invasive cholecystolithotomy compared with laparoscopic chole-cystectomy had high security ,light pain ,quicker recovery ,less complications advantages .It has already achieved the purpose of min-imally invasive treatment ,while maintaining the integrity of bile duct and gallbladder function ,thus it is worthy of promoting .

Microsurgical treatment of spinal cord hemangioblastoma: An analysis of long term prognosis / 第二军医大学学报

Objective To discuss the diagnosis, treatment and long term prognosis of the spinal hemangioblastoma. Methods The clinical data of 33 spinal hemangioblastoma cases, verified by microsurgeries and pathological results, were retrospectively analyzed. Twenty-four of them were males and nine were females. The magnetic resonance imaging (MRI) showed that the 33 cases included 1 medulla-cervical hemangioblastoma, 9 cervical hemangioblastomas, 2 cervical-thoracic hemangioblastomas, 16 thoracic hemangioblastomas, 1 thoracic-lumbar hemangioblastoma, and 4 lumbar hemangioblastomas. Results Total removal of hemangioblastomas was achieved in32 patients and subtotal removal in 1, with no operation associated death. Postoperative follow-up period ranged from 16 months to 12 years. According to the McCormick scale, the functional outcomes were verified as 15(45. 5%) improved, 14(42. 4%) unchanged, and 4(12. 1%) deteriorated. According to the Klekamp-Samn score, the functional outcomes were verified as 24 (72. 7%) improved, 5(15. 2%) unchanged, and 4(12. 1%) deteriorated. Fisher's exact test showed that the pre-operation neuronal function was significantly associated with the prognosis (P = 0. 033). Conclusion Spinal hemangioblastomas are highly vascularized benigntumors, and should be resected early when the symptoms or signs present. Microsurgery is the prior protocol of treatment, and the prognosis after microsurgery is generally fine. Post-operative functional status is determined by pre-operation functional status. Klekamp-Samii score system is more suitable for the functional evaluation of spinal hemangioblastoma.

Clinical analysis of combined treatment of laparoscopy and choledochoscope for preservation of gallbladder on cholecystolithiasis * / 重庆医学

Objective To discusses the feasibility of selective mini-cholecystolithotomy in treatment of gallstones .Methods To retrospectively analyzes the clinical data of the function good gallstones patients who treatmented by mini-cholecystolithotomy .Re-sults 4 cases treatmented by Laparoscopic cholecystectomy because of the severe cholecystitis ,1 case treatmented by laparoscopic cholecystectomy because of the severe adhesion around the gallbladder .51 cases treatmented by mini-cholecystolithotomy .In the fol-low-up of 1-3 years ,1 case of recurrence ,and the recurrence rate was 1 .96% .Conclusion The mini-cholecystolithotomy is a safe , effective ,feasible ,minimally invasive treatment method in treatmented gallstones ,but should be strictly grasp the surgical indica-tions .

Clinical application of intraoperative cholangiography in laparoscopic cholecystectomy / 局解手术学杂志

Objective To investigate the clinical value of intraoperative cholangiography( IOC) by cystic duct during laparoscopic chol-ecystectomy( LC) . Methods The clinical data of 58 patients with LC received intraoperative cholangiography by cystic duct were analyzed retrospectively. Results In this group,Successful treatment of 55 cases(94. 83%),failed in 3 cases(5. 17%),no common bile duct calculi in 50 cases(90. 91%),small common bile duct calculi(0. 4 cm) in 5 cases(9. 09%). Among them 4 cases were received common bile duct exploration via laparotomy,1 case treated by laparoscopic transcystic biliary calculus extraction with Dormia basket. The cystic duct drained into the right hepatic duct in 1 patient. In all the cases,no bile duct injury,residual choledocholith,bile leakage,intra-abdominal infection and IOC related complications. Conclusion IOC during LC is simple and easy,with high success rate and good development effect,which can promptly discover the anatomical variations of biliary tract. It has important clinical application value to reduce biliary negative exploration,in-traoperative injury of biliary tract and postoperative common bile duct residual stone in basic hospital.

Diagnosis and microsurgical treatment of symptomatic rathke cleft cysts in 23 cases / 第二军医大学学报

Objective To discuss the diagnosis and surgical treatment of symptomatic Rathke cleft cysts (RCCs). Methods Twenty-three symptomatic RCCs, who were verified by microsurgeries and pathological examination from Jan. 2001 to Oct. 2010, were retrospectively analyzed. Nine of them were males and fourteen of them were females. The main clinical manifestations included headache (65. 2%), visual disturbance (34. 8%) and pituitary dysfunctions (47. 8%). The magnetic resonance imaging (MRI) showed 10 pure intrasellar lesions, 10 lesions of intrasellar with a suprasellar extension, and 3 pure suprasellar lesions. Sixteen cases were treated by transsphenoidal microsurgery and 7 were treated by craniotomy. The contents of the cysts were drained totally during the operation, and part of or the total cyst wall were safely moved and kept open. Results Postoperative follow-up period ranged from 14 months to 10 years. All the 8 patients were released from visual disturbance. Headache was improved in 13 of the 15 patients and pituitary dysfunction was improved in 7 of the 11 patients. Recurrence was noted in 1 patient. Conclusion Preoperative definite diagnosis for the symptomatic RCCs is difficult due to a variety of clinical manifestations and MRI signals. Most of the lesions can be treated via transsphenoidal approach. Transcranial approach is necessary for the pure suprasellar RCCs. Microsurgery is an effective strategy for the treatment of symptomatic RCCs, because it can safely relieve the symptoms and make definite diagnosis.