Bronchobiliary fistula caused after percutaneous transhepatic biliary drainage treatment: A case report.

RATIONALE: Percutaneous transhepatic biliary drainage (PTBD) plays a significant role especially in the diagnosis and decompression of bile duct obstruction. However, it is associated with complications such as hemobilia, occlusion of drainage, bile leakage, and even bronchobiliary fistula (BBF). PATIENT CONCERNS AND DIAGNOSES: We herein describe a patient with a complication of BBF caused by long-term indwelling PTBD catheters. She underwent multiple operations including bilioenteric anastomosis, hepatic left lateral lobectomy, and long-term PTBD treatment. Her symptoms were mainly cough, fever, and yellow sputum and her diagnosis was confirmed by sputum culture (bilirubin detection was positive). INTERVENTIONS AND OUTCOMES: The patient recovered uneventfully by minimally invasive treatment, was discharged after 1 week of hospitalization, and the drainage tube was removed 2 weeks later. During 2 years of follow-up, no recurrence of BBF was observed. LESSONS: Patients with long-term indwelling PTBD catheters for biliary tract obstruction may lead to BBF. The treatment plan of BBF is tailored to the patient's individualized characteristics. And minimally invasive treatments might be an effective alternate way for the treatment of BBF. The accurate diagnosis, precision treatment, and multidisciplinary team play important roles in the treatment of BBF.

Effect of Tempering Temperature on Microstructure and Sulfide Stress Cracking of 125 Ksi Grade Casing Steel.

The influence of tempering temperature on the microstructure of 0.5Cr0.4W steels was investigated by scanning electron microscope, and the roles of grain boundary character, dislocation, and Taylor factor in sulfide stress cracking (SSC) resistance were interpreted using the election backscattered diffraction technique. The 0.5Cr0.4W steels tempered at 690 °C, 700 °C, and 715 °C all showed tempered martensites. The specimen tempered at 715 °C exhibited a higher critical stress intensity factor (KISSC) of 34.58 MPa·m0.5, but the yield strength of 800 MPa did not meet the criterion of 125 ksi (862 MPa) grade. When the specimen was tempered at 690 °C, the yield strength reached 960 MPa and the KISSC was only 21.36 MPa·m0.5, displaying poorer SSC resistance. The 0.5Cr0.4W steel tempered at 700 °C showed a good combination of yield strength (887 MPa) and SSC resistance (KISSC: 31.16 MPa·m0.5). When increasing the tempering temperature, the local average misorientation and Taylor factor of the 0.5Cr0.4W steels were decreased. The reduced dislocation density, and greater number of grains amenable to slippage, produced less hydrogen transport and a lower crack sensitivity. The SSC resistance was, thus, increased, owing to the minor damage to hydrogen aggregation. Therefore, 700 °C is a suitable tempering temperature for 0.5Cr0.4W casing steel.

Mixed-ligand copper(ii) Schiff base complexes: the role of the co-ligand in DNA binding, DNA cleavage, protein binding and cytotoxicity.

Four novel mononuclear Schiff base copper(ii) complexes, namely, [Cu(L)(OAc)]·H2O (), [Cu(HL)(C2O4)(EtOH)]·EtOH (), [Cu(L)(Bza)] () and [Cu(L)(Sal)] () (HL = 1-(((2-((2-hydroxypropyl)amino)ethyl)imino)methyl)naphthalene-2-ol), Bza = benzoic acid, Sal = salicylic acid), were synthesized and characterized by X-ray crystallography, elemental analysis and infrared spectroscopy. Single-crystal diffraction analysis revealed that all the complexes were mononuclear molecules, in which the Schiff base ligand exhibited different coordination modes and conformations. The N-HO and O-HO inter- and intramolecular hydrogen bonding interactions linked these molecules into multidimensional networks. Their interactions with calf thymus DNA (CT-DNA) were investigated by UV-visible and fluorescence spectrometry, as well as by viscosity measurements. The magnitude of the Kapp values of the four complexes was 10(5), indicating a moderate intercalative binding mode between the complexes and DNA. Electrophoresis results showed that all these complexes induced double strand breaks of pUC19 plasmid DNA in the presence of H2O2 through an oxidative pathway. In addition, the fluorescence spectrum of human serum albumin (HSA) with the complexes suggested that the quenching mechanism of HSA by the complexes was a static process. Moreover, the antiproliferative activity of the four complexes against HeLa (human cervical carcinoma) and HepG-2 (human liver hepatocellular carcinoma) cells evaluated by colorimetric cell proliferation assay and clonogenic assay revealed that all four complexes had improved cytotoxicity against cancer cells. Inspiringly, complex , with salicylic acid as the auxiliary ligand, displayed a stronger anticancer activity, suggesting that a synergistic effect of the Schiff base complex and the nonsteroidal anti-inflammatory drug may be involved in the cell killing process. The biological features of mixed-ligand copper(ii) Schiff base complexes and how acetic auxiliary ligands manipulate these features are also discussed.

Factors predicting surgical resection in patients with intrahepatic cholangiocarcinoma and cirrhosis.

Here, we investigate the potential factors that affect the outcome of patients with intrahepatic cholangiocarcinomas (ICC) and cirrhosis. We retrospectively reviewed the clinical data and pathological features of 58 patients with ICC and cirrhosis who underwent liver resection between July 2000 and March 2008, and analyzed the prognostic risk factors by means of univariate and multivariate analyses. The overall morbidity and mortality were 40% and 3.3%, respectively. The overall median survival was 24 months, and the 1-, 3-, and 5-year actuarial survival rates were 53%, 18%, and 10%, respectively. Univariate analysis showed that Child-Pugh classification, hypoalbuminemia, vascular invasion, lymphnodes metastasis, tumor-nodes-metastasis (TNM) staging system, positive surgical margins, and high perioperative blood transfusion volumes were all significantly associated with poor survival. Multivariate analysis confirmed that hypoalbuminemia, vascular invasion, positive surgical margins, and high perioperative blood transfusion volume were survival related, with hazard ratios (HR) of 2.58, 3.12, 3.57, and 1.98, respectively. Surgical resection is an effective treatment for patients affected by ICC and cirrhosis. Predictive factors, including hypoalbuminemia, vascular invasion, positive surgical margins, and high perioperative blood transfusion volumes are all related to poor survival.

Major hepatectomy is a safe modality for the treatment of intrahepatic cholangiocarcinoma in selected patients complicated with cirrhosis.

OBJECTIVE: The objective of this paper is to evaluate the perioperative outcomes of major hepatectomy for intrahepatic cholangiocarcinoma (ICC) in patients with cirrhosis. METHODS: We retrospectively evaluated the preoperative, intraoperative, and postoperative findings in 42 consecutive patients with cirrhosis and in 102 patients with normal livers who underwent major hepatectomy for ICC. RESULTS: Preoperative liver function was worse in patients with cirrhosis compared to patients without cirrhosis. Cirrhotic patients had significantly higher intraoperative blood loss, longer operation time, and longer hospital stay than non-cirrhotic patients. However, the two groups had similar overall morbidity and hospital mortality rates and similar rates of liver failure or other complications. Their R0 resection rates, resection margin widths and disease-free survival rates were also similar. CONCLUSIONS: Major hepatectomy for ICC can be performed in selected cirrhotic patients with acceptable morbidity and mortality rates, as compared to patients without cirrhosis.

[Effects of electroacupuncture anesthesia of different frequencies on stress reaction in thyroid surgery].

OBJECTIVE: To probe into the optimal frequency of electroacupuncture for the access to the best anesthesia. METHODS: Sixty cases of optional thyroid surgery were randomly divided into group A, group B and group C, 20 cases in each group. In group A, 2 Hz/100 Hz disperse-dense wave was selected in stimulation. In group B, 2 Hz/15 Hz disperse-dense wave was selected. Group C was the control group without electric stimulation applied. Hegu (LI 4) and Neiguan (PC 6) were stimulated bilaterally. Cervical plexus block was produced after 15 min acupuncture. The concentration changes in plasma cortisone (COR) and beta-endorphin (beta-EP) were compared among 4 time-points, named before anesthesia (T1), before skin incision after induction (T2), thyroid traction in surgery (T3) and the end of surgery (T4). RESULTS: Group B achieved the highest significant rate of analgesia (50.0%, 10/20) and that in group C was the lowest (10.0%, 2/20). COR content was the highest at T2 in group A and that was the lowest at T3 in group B. At the end of surgery, COR content was up the maximum in 3 groups, but still COR content was the lowest in group B in comparison. The plasma beta-EP content decreased apparently at T3 and T4 in group B as compared with the value before (both P < 0.05). CONCLUSION: In electroacupuncture-assisted anesthesia, 2 Hz/15 Hz disperse-dense wave achieves the optimal anesthesia compared with 2 Hz/100 Hz disperse-dense wave, and moreover inhibits stress reaction induced by anesthesia surgery.