Aim To study the relationship between the substrate temperature and the morphology and properties of GaN. Methods\ Applying the hydride chemical vapor deposition method, GaN films were deposited on different kinds of...Aim To study the relationship between the substrate temperature and the morphology and properties of GaN. Methods\ Applying the hydride chemical vapor deposition method, GaN films were deposited on different kinds of substrates, including sapphire, Si(111),Si(100),GaAs and GaP(111) both on the P face and the Ga face. The growth was performed at low temperatures of below 700℃. XRD, Hall measurement, cathodoluminescence (CL) and atomic force microscopy (AFM) were used to characterise the film properties. Results\ It was found that the temperature and the nature of substrate materials influence the layer morphology. Conclusion\ The analysis shows that no apparent relationship exists between the optical properties and layer morphology.展开更多
GaN nanorods are successfully synthesized on Si(111) substrates with magnetron sputtering through ammoniating Ga2O3/Co films at 950℃. X-ray diffraction, scanning electron microscopy, high-resolution transmission el...GaN nanorods are successfully synthesized on Si(111) substrates with magnetron sputtering through ammoniating Ga2O3/Co films at 950℃. X-ray diffraction, scanning electron microscopy, high-resolution transmission electron microscopy,and Fourier-transform infrared spectroscopy are used to characterize the samples. The results demonstrate that the nanorods are single-crystal GaN with a hexagonal wurtzite structure and possess relatively smooth surfaces. The growth mechanism of GaN nanorods is also discussed.展开更多
The characters and ultrastructure of the intercellular connection were revealed in the outer epidermis of the garlic clove sheath by means of fluorescent probe TRITC_Phalloidin (TRITC_Ph) labeling combined with confoc...The characters and ultrastructure of the intercellular connection were revealed in the outer epidermis of the garlic clove sheath by means of fluorescent probe TRITC_Phalloidin (TRITC_Ph) labeling combined with confocal laser scanning microscopy (CLSM), immuno_gold labeling and transmission electron microscopy. These results show that transcellular channel is a complex of rod_like cytoplasm channel and grouped plasmodesmata (PDs) in pit. The former remains a portion of the cell protoplast. The diameter of PD is normally 60-70 nm. The PDs are the real intercellular symplasmic connections of the cells. The transcellular fibers labeled with the TRITC_Ph obviously become narrow in the primary pit fields, which is the same as the characters observed under the electron microscope. The bright fluorescent spot in the primary wall reflects the grouped PDs in pit, and hence the presence of F_actin in the PDs can be confirmed. In immuno_gold labeling experiment, a lot of gold particles were massively distributed in the rod_like cytoplasm channel and grouped PDs. The result provides effective support that these fluorescent filaments possibly are the existing form of F_actin.展开更多
AIM:To analyze the in vitro activity of moxifloxacin and piperacillin/sulbactam against pathogens isolated from patients with acute cholangitis. METHODS: In this prospective study a total of 65 patients with acute c...AIM:To analyze the in vitro activity of moxifloxacin and piperacillin/sulbactam against pathogens isolated from patients with acute cholangitis. METHODS: In this prospective study a total of 65 patients with acute cholangitis due to biliary stone obstruction (n = 7), benign biliary stricture (n = 16), and malignant biliary stricture (n = 42) were investigated with regard to spectrum of bacterial infection and antibiotic resistance. Pathogens were isolated from bile cultures in all study patients. In 22 febrile patients, blood cultures were also obtained. In vitro activity of moxifloxacin and piperacillin/ sulbactam was determined by agar diffusion. RESULTS: Thirty-one out of 65 patients had positive bile and/or blood cultures. In 31 patients, 63 isolates with 17 different species were identified. The predominant strains were Enterococcus species (26/63), Ecoli (13/63) and Klebsiella species (8/63). A comparable in vitro activity of moxifloxacin and piperacillin/sulbactam was observed for E.coli and Klebsiella species. In contrast, Enterococcus species had higher resistances towards moxifloxacin. Overall bacteria showed antibiotic resistances in vitro of 34.9% for piperacillin/sulbactam and 36.5% for moxifioxacin.CONCLUSION: Enterococcus species, E.co/i and Klebsiella species were the most common bacteria isolated from bile and/or blood from patients with acute cholangitis. Overall, a mixed infection with several species was observed, and bacteria showed a comparable in vitro activity for piperacillin/sulbactam and moxifloxacin.展开更多
Experiments on treatment of domestic wastewater by membrane bioreactors were carried out.The results showed that this process could produce good quality effluent with low COD,turbidity and total count of bacteria.With...Experiments on treatment of domestic wastewater by membrane bioreactors were carried out.The results showed that this process could produce good quality effluent with low COD,turbidity and total count of bacteria.With intermittent operation and continuous aeration,the membrane flux was kept steady.The mechanisms of removing COD through membrane,the structure of membrane and filtration resistance were also discussed.展开更多
Contacting mode atomic force microscopy (AFM) is used to measure the In 0.35 Ga 0.65 As/GaAs epilayer grown at low temperature (460℃).Unlike the normal layer by layer growth (FvdM mode) or self organized i...Contacting mode atomic force microscopy (AFM) is used to measure the In 0.35 Ga 0.65 As/GaAs epilayer grown at low temperature (460℃).Unlike the normal layer by layer growth (FvdM mode) or self organized islands growth (SK mode),samples grown under 460℃ are found to be large islands with atomic thick terraces.AFM measurements reveale near one monolayer high steps.This kind of growth is good between FvdM and SK growth modes and can be used to understand the evolution of strained epitaxy from FvdM to SK mode.展开更多
A case of pedunculated Brunner's gland hamartoma (BGH) of the duodenum causing upper gastrointestinal (GI) hemorrhage is reported. The patient was a 47-year-old man who visited our hospital for further evaluation...A case of pedunculated Brunner's gland hamartoma (BGH) of the duodenum causing upper gastrointestinal (GI) hemorrhage is reported. The patient was a 47-year-old man who visited our hospital for further evaluation of tarry stools and shortness of breath. Endoscopic examination of the upper digestive tract revealed a large peduncular polyp with bleeding, about 30 mm in diameter, arising from the wall of the second portion of the duodenum. GI bleeding occurred from the base of the stalk of the polyp. Endoscopic polypectomy was performed. Histological examination of the specimen revealed that the main body of the polyp contained several Iobules of mature Brunner's gland with areas of cystic dilatation. The surface epithelium consisted of normal duodenal mucosa with areas of focal ulceration. This polyp was diagnosed as a BGH. The symptom of tarry stools resolved after endoscopic resection. Our case shows that treatment is necessary for duodenal BGH if GI bleeding occurs.展开更多
Objective To report a case of the implantation of thyroid hyperplastic or neoplastic tissue after endoscopic thyroidectomy and discuss this complication in aspects of prevalence, pathogenesis, protection, and therapie...Objective To report a case of the implantation of thyroid hyperplastic or neoplastic tissue after endoscopic thyroidectomy and discuss this complication in aspects of prevalence, pathogenesis, protection, and therapies. Methods A systematic search of literature from the PubMed database was conducted for identifying eligible studies on implantation of thyroid hyperplastic or neoplastic cells after endoscopic thyroid surgery. Results Overall, 5 reported cases on patients suffering from endoscopic thyroid surgery with implantation of thyroid hyperplastic or neoplastic cells were included in the systematic review. Conclusions Unskilled surgeons, rough intraoperative surgical treatment, scarification or rupture of tumor, contamination of instruments, chimney effect, aerosolization of tumor cells may be associated with the implantation after endoscopic thyroidectomy. To minimize the risk of such complication, we should be more meticulous and strict the endoscopic surgery indications.展开更多
Pancreatic fistula is a quite rare complication in patients who undergo living donor liver transplantation(LDLT).However,in the cases that show pancreatic fistula,the limited volume of the graft and the resultant inad...Pancreatic fistula is a quite rare complication in patients who undergo living donor liver transplantation(LDLT).However,in the cases that show pancreatic fistula,the limited volume of the graft and the resultant inadequate liver function may complicate the management of the fistula.As a result,the pancreatic fistula may result in the death of the patient.We present 2 cases in whichendoscopic treatment was effective against pancreatic fistulas that developed after LDLT.In case 1,a 61-yearold woman underwent LDLT for primary biliary cirrhosis.Because of a portal venous thrombus caused by a splenorenal shunt,the patient underwent portal vein reconstruction,and a splenorenal shunt was ligated on postoperative day(POD)7.The main pancreatic duct was injured during the manipulation to achieve hemostasis,thereby necessitating open drainage.However,discharge of pancreatic fluid continued even after POD 300.Endoscopic naso-pancreatic drainage(ENPD)was performed,and this procedure resulted in a remarkable decrease in drain output.The refractory pancreatic fistula healed on day 40 after ENPD.In case 2,a 58-year-old man underwent LDLT for cirrhosis caused by the hepatitis C virus.When the portal vein was exposed during thrombectomy,the pancreatic head was injured,which led to the formation of a pancreatic fistula.Conservative therapy was ineffective;therefore,ENPD was performed.The pancreatic fistula healed on day 38 after ENPD.The findings in these 2 cases show that endoscopic drainage of the main pancreatic duct is a less invasive and effective treatment for pancreatic fistulas that develop after LDLT.展开更多
AIM:To investigate perception of natural orifice transluminal endoscopic surgery(NOTES)as a potential technique for appendectomy.METHODS:One hundred patients undergoing endoscopy and 100 physicians were given a questi...AIM:To investigate perception of natural orifice transluminal endoscopic surgery(NOTES)as a potential technique for appendectomy.METHODS:One hundred patients undergoing endoscopy and 100 physicians were given a questionnaire describing in detail the techniques of NOTES and laparoscopic appendectomy.They were asked about the reasons for their preference,choice of orifice,and extent of complication risk they were willing to accept.RESULTS:Fifty patients(50%)and only 21 physicians(21%)preferred NOTES(P<0.001).Patients had previously heard of NOTES less frequently(7%vs73%,P<0.001)and had undergone endoscopy more frequently(88%vs 36%,P<0.001)than physicians.Absence of hernia was the most common reason for NOTES preference in physicians(80%vs 44%,P= 0.003),whereas reduced pain was the most common reason in patients(66%vs 52%).Physicians were more likely to refuse NOTES as a novel and unsure technique(P<0.001)and having an increased risk of infection(P<0.001).The preferred access site in both groups was colon followed by stomach,with vagina being rarely preferred.In multivariable modeling,those with high-school education[odds ratio(OR):2.68,95% confidence interval(CI):1.23-5.83]and prior colonoscopy(OR:2.10,95%CI:1.05-4.19)were more likely to prefer NOTES over laparoscopic appendectomy.There was a steep decline in NOTES preference with increased rate of procedural complications.Male patients were more likely to consent to their wives vaginal NOTES appendectomy than male physicians(P=0.02).CONCLUSION:The preference of NOTES for appendectomy was greater in patients than physicians and was related to reduced pain and absence of hernia rather than lack of scarring.展开更多
The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed ...The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis.There is an increasing volume of evidence-although mostly retrospective-that if traditional conservative management is adopted,there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms.On the other hand,the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate.It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology.Moreover,it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration.If emergency LA is to become the standard of care for appendiceal mass,I.A will certainly become 'something' of the past.展开更多
Primary splenic cyst is a relatively rare disease, and the majority of cases are classified as epithelial cysts. Three cases with nonparasitic splenic cysts are presented: two epithelial and one pseudocyst. All cases ...Primary splenic cyst is a relatively rare disease, and the majority of cases are classified as epithelial cysts. Three cases with nonparasitic splenic cysts are presented: two epithelial and one pseudocyst. All cases had an atypical symptomatology, consisted mainly of fullness in the left upper abdomen and a palpable mass. Preoperative diagnosis was established with ultrasonography and computerized tomography. Two cases with large cysts located in the splenic hilum were treated with open complete splenectomy. The most recent case, a pseudocyst, was managed laparoscopically with partial cystectomy. All cases did not have any problems or recurrence during follow-up. Laparoscopic partial cystectomy is an acceptable procedure for the treatment of splenic cysts, because it cures the disease preserving the splenic tissue. Complete splenectomy is reserved for cases in which cyst excision cannot be done otherwise.展开更多
Objective: To evaluate the lumbar stability and the primary clinical results of unilateral facetectomy, transforaminal lumbar interbody fusion (TLIF) and unilateral pedicle screw fixation by X-Tube system. Methods...Objective: To evaluate the lumbar stability and the primary clinical results of unilateral facetectomy, transforaminal lumbar interbody fusion (TLIF) and unilateral pedicle screw fixation by X-Tube system. Methods: Five human lumbar cadaveric functional spine units(FSU) were obtained and graded facetectomy by 0, 1/4, 1/2, 3/4 and 4/4 were performed respectively on the left articular process of them. The stability of these 5 models was evaluated at flexion, extension, lateral bending and axial rotation. After a serial of biomechanical researches, 23 patients from June 2004 to March 2006 in our department underwent unilateral facetectomy, transforaminal lumbar interbody fusion (posterior lumbar interbody fusion) and unilateral pedicle screw instrumentation by X-Tube system. After general anaesthesia, with the guide of fluoroscopy and using X-Tube system, procedures of unilateral endoscopic facetectomy, spinal nerve root decompression, autologus spongy bone transplantation, one cage oblique insertion and unilateral pedicle screw instrumentation were performed. Results: There was no significant difference in flexion, extension, lateral bending and axial rotation of lumbar motion range after unilateral graded facetectomy. The stability of left/right axial direction was greatly affected when the range of graded facetectomy exceed 1/2. According to the Nakai criteria, for the 23 patients, the clinical result was excellent in 15 (65.2%), good in 6 (26.1%) and fair in 2 (8.7%). The fusion rate was 95.6% in excellent and good cases. Although partial absorption of bone grafts was observed in 1 case which might indicate a unsuccessful fusion, there was no loosing and replacement of instrument and no clinical symptoms occurred. Conclusion: The lumbar stability will be affected significantly when the range of graded facetectomy exceeds 1/2. Procedures of unilateral facetectomy, transforaminal lumbar interbody fusion and unilateral pedicle screw fixation is an optional strategy for microsurgical reconstruction, though the indications of the procedure should be carefully restricted.展开更多
AIM: To analyze the differences of clinical characteristics of colorectal neoplasm including polyps between the elderly and young Thai patients.METHODS: Colonoscopy database from December 2000 to October 2004 was retr...AIM: To analyze the differences of clinical characteristics of colorectal neoplasm including polyps between the elderly and young Thai patients.METHODS: Colonoscopy database from December 2000 to October 2004 was retrospectively analyzed. There were 1822 eligible patients who underwent colonoscopy (with a mean age of 56.6 years). Patients were classified into two groups: the older age group (aged ≥ 60 years; n = 989) and the younger age group (aged < 60 years; n = 833). Data were recorded on age, colonoscopic indications, tumor location, colonoscopic findings and their related histological findings. RESULTS: Colorectal malignancy related lesions were more often found in the older age group (21%) than in the younger age group (12%). Left-sided lesions were detected more commonly than right-sided in both age groups in approximately two-thirds of all cases. Hematochezia showed greater association with left-sided lesions in the elderly. No relationship was found between age and neoplasm staging and severity.CONCLUSION: The chance of detecting colorectal neoplasm by colonoscopy was higher in the elderly than in the young Thais. However, both groups had the lesions predominantly located in the left side.展开更多
[Objective]The experiment aimed to explore a new way for observing surface structure of Nostoc sphaeroides Kutzing. [Method] The scanning electron microscope was used to observe the epidermal ultrastructure of wild an...[Objective]The experiment aimed to explore a new way for observing surface structure of Nostoc sphaeroides Kutzing. [Method] The scanning electron microscope was used to observe the epidermal ultrastructure of wild and cultured Nostoc sphaeroides Kutzing. [ Result] The epidermis of wild and cultured Nostoc sphaeroides Kutzing showed mixture structure of fibril colloid which was reticular arranged. The difference between wild and cultured Nostoc sphaeroides Kutzing was that the outer epidermis of cultured Nostoc sphaeroides Kutzing had trichome distribution but the wild Nostoc sphaeroides Kutzing did not has such distribution. The obsevation results of under smaller than 10 μm by scanning electron microscope was touched thick and showed many folds and distortions. [ Conclusion] The scanning electron microscope was an effective way to study development of Nostoc sphaeroides Kutzing colony and it was worth popularizing.展开更多
AIM: To report 13 patients with benign esophagea stenosis treated with the biodegradable stent. METHODS: We developed a Ultraflex-type stent by knitting poly-/-lactic acid rnonofilaments. RESULTS: Two cases were es...AIM: To report 13 patients with benign esophagea stenosis treated with the biodegradable stent. METHODS: We developed a Ultraflex-type stent by knitting poly-/-lactic acid rnonofilaments. RESULTS: Two cases were esophageal stenosis caused by drinking of caustic liquid, 4 cases were due to surgical resection of esophageal cancers, and 7 cases were patients with esophageal cancer who received the preventive placement of biodegradable stents for postendoscopic mucosal dissection (ESD) stenosis. The preventive placement was performed within 2 to 3 d after ESD. In 10 of the 13 cases, spontaneous migration of the stents occurred between 10 to 21 d after placement. In these cases, the migrated stents were excreted with the feces, and no obstructive complications were experienced. In 3 cases, the stents remained at the proper location on d 21 after placement. No symptoms of re-stenosis were observed within the follow-up period of 7 mo to 2 years. Further treatment with balloon dilatation or replacement of the biodegradable stent was not required. CONCLUSION: Biodegradable stents were useful for the treatment of benign esophageal stenosis, particularly for the prevention of post-ESD stenosis.展开更多
文摘Aim To study the relationship between the substrate temperature and the morphology and properties of GaN. Methods\ Applying the hydride chemical vapor deposition method, GaN films were deposited on different kinds of substrates, including sapphire, Si(111),Si(100),GaAs and GaP(111) both on the P face and the Ga face. The growth was performed at low temperatures of below 700℃. XRD, Hall measurement, cathodoluminescence (CL) and atomic force microscopy (AFM) were used to characterise the film properties. Results\ It was found that the temperature and the nature of substrate materials influence the layer morphology. Conclusion\ The analysis shows that no apparent relationship exists between the optical properties and layer morphology.
文摘GaN nanorods are successfully synthesized on Si(111) substrates with magnetron sputtering through ammoniating Ga2O3/Co films at 950℃. X-ray diffraction, scanning electron microscopy, high-resolution transmission electron microscopy,and Fourier-transform infrared spectroscopy are used to characterize the samples. The results demonstrate that the nanorods are single-crystal GaN with a hexagonal wurtzite structure and possess relatively smooth surfaces. The growth mechanism of GaN nanorods is also discussed.
文摘The characters and ultrastructure of the intercellular connection were revealed in the outer epidermis of the garlic clove sheath by means of fluorescent probe TRITC_Phalloidin (TRITC_Ph) labeling combined with confocal laser scanning microscopy (CLSM), immuno_gold labeling and transmission electron microscopy. These results show that transcellular channel is a complex of rod_like cytoplasm channel and grouped plasmodesmata (PDs) in pit. The former remains a portion of the cell protoplast. The diameter of PD is normally 60-70 nm. The PDs are the real intercellular symplasmic connections of the cells. The transcellular fibers labeled with the TRITC_Ph obviously become narrow in the primary pit fields, which is the same as the characters observed under the electron microscope. The bright fluorescent spot in the primary wall reflects the grouped PDs in pit, and hence the presence of F_actin in the PDs can be confirmed. In immuno_gold labeling experiment, a lot of gold particles were massively distributed in the rod_like cytoplasm channel and grouped PDs. The result provides effective support that these fluorescent filaments possibly are the existing form of F_actin.
文摘AIM:To analyze the in vitro activity of moxifloxacin and piperacillin/sulbactam against pathogens isolated from patients with acute cholangitis. METHODS: In this prospective study a total of 65 patients with acute cholangitis due to biliary stone obstruction (n = 7), benign biliary stricture (n = 16), and malignant biliary stricture (n = 42) were investigated with regard to spectrum of bacterial infection and antibiotic resistance. Pathogens were isolated from bile cultures in all study patients. In 22 febrile patients, blood cultures were also obtained. In vitro activity of moxifloxacin and piperacillin/ sulbactam was determined by agar diffusion. RESULTS: Thirty-one out of 65 patients had positive bile and/or blood cultures. In 31 patients, 63 isolates with 17 different species were identified. The predominant strains were Enterococcus species (26/63), Ecoli (13/63) and Klebsiella species (8/63). A comparable in vitro activity of moxifloxacin and piperacillin/sulbactam was observed for E.coli and Klebsiella species. In contrast, Enterococcus species had higher resistances towards moxifloxacin. Overall bacteria showed antibiotic resistances in vitro of 34.9% for piperacillin/sulbactam and 36.5% for moxifioxacin.CONCLUSION: Enterococcus species, E.co/i and Klebsiella species were the most common bacteria isolated from bile and/or blood from patients with acute cholangitis. Overall, a mixed infection with several species was observed, and bacteria showed a comparable in vitro activity for piperacillin/sulbactam and moxifloxacin.
基金Supported by the Ministry of Science and Technology of China!(No.96- 92 0 - 0 9- 0 4 )
文摘Experiments on treatment of domestic wastewater by membrane bioreactors were carried out.The results showed that this process could produce good quality effluent with low COD,turbidity and total count of bacteria.With intermittent operation and continuous aeration,the membrane flux was kept steady.The mechanisms of removing COD through membrane,the structure of membrane and filtration resistance were also discussed.
文摘Contacting mode atomic force microscopy (AFM) is used to measure the In 0.35 Ga 0.65 As/GaAs epilayer grown at low temperature (460℃).Unlike the normal layer by layer growth (FvdM mode) or self organized islands growth (SK mode),samples grown under 460℃ are found to be large islands with atomic thick terraces.AFM measurements reveale near one monolayer high steps.This kind of growth is good between FvdM and SK growth modes and can be used to understand the evolution of strained epitaxy from FvdM to SK mode.
文摘A case of pedunculated Brunner's gland hamartoma (BGH) of the duodenum causing upper gastrointestinal (GI) hemorrhage is reported. The patient was a 47-year-old man who visited our hospital for further evaluation of tarry stools and shortness of breath. Endoscopic examination of the upper digestive tract revealed a large peduncular polyp with bleeding, about 30 mm in diameter, arising from the wall of the second portion of the duodenum. GI bleeding occurred from the base of the stalk of the polyp. Endoscopic polypectomy was performed. Histological examination of the specimen revealed that the main body of the polyp contained several Iobules of mature Brunner's gland with areas of cystic dilatation. The surface epithelium consisted of normal duodenal mucosa with areas of focal ulceration. This polyp was diagnosed as a BGH. The symptom of tarry stools resolved after endoscopic resection. Our case shows that treatment is necessary for duodenal BGH if GI bleeding occurs.
文摘Objective To report a case of the implantation of thyroid hyperplastic or neoplastic tissue after endoscopic thyroidectomy and discuss this complication in aspects of prevalence, pathogenesis, protection, and therapies. Methods A systematic search of literature from the PubMed database was conducted for identifying eligible studies on implantation of thyroid hyperplastic or neoplastic cells after endoscopic thyroid surgery. Results Overall, 5 reported cases on patients suffering from endoscopic thyroid surgery with implantation of thyroid hyperplastic or neoplastic cells were included in the systematic review. Conclusions Unskilled surgeons, rough intraoperative surgical treatment, scarification or rupture of tumor, contamination of instruments, chimney effect, aerosolization of tumor cells may be associated with the implantation after endoscopic thyroidectomy. To minimize the risk of such complication, we should be more meticulous and strict the endoscopic surgery indications.
文摘Pancreatic fistula is a quite rare complication in patients who undergo living donor liver transplantation(LDLT).However,in the cases that show pancreatic fistula,the limited volume of the graft and the resultant inadequate liver function may complicate the management of the fistula.As a result,the pancreatic fistula may result in the death of the patient.We present 2 cases in whichendoscopic treatment was effective against pancreatic fistulas that developed after LDLT.In case 1,a 61-yearold woman underwent LDLT for primary biliary cirrhosis.Because of a portal venous thrombus caused by a splenorenal shunt,the patient underwent portal vein reconstruction,and a splenorenal shunt was ligated on postoperative day(POD)7.The main pancreatic duct was injured during the manipulation to achieve hemostasis,thereby necessitating open drainage.However,discharge of pancreatic fluid continued even after POD 300.Endoscopic naso-pancreatic drainage(ENPD)was performed,and this procedure resulted in a remarkable decrease in drain output.The refractory pancreatic fistula healed on day 40 after ENPD.In case 2,a 58-year-old man underwent LDLT for cirrhosis caused by the hepatitis C virus.When the portal vein was exposed during thrombectomy,the pancreatic head was injured,which led to the formation of a pancreatic fistula.Conservative therapy was ineffective;therefore,ENPD was performed.The pancreatic fistula healed on day 38 after ENPD.The findings in these 2 cases show that endoscopic drainage of the main pancreatic duct is a less invasive and effective treatment for pancreatic fistulas that develop after LDLT.
基金Supported by Grant NT 11234-3 of the Czech Ministry of Healththe Institutional Research Plan AV0Z10300504
文摘AIM:To investigate perception of natural orifice transluminal endoscopic surgery(NOTES)as a potential technique for appendectomy.METHODS:One hundred patients undergoing endoscopy and 100 physicians were given a questionnaire describing in detail the techniques of NOTES and laparoscopic appendectomy.They were asked about the reasons for their preference,choice of orifice,and extent of complication risk they were willing to accept.RESULTS:Fifty patients(50%)and only 21 physicians(21%)preferred NOTES(P<0.001).Patients had previously heard of NOTES less frequently(7%vs73%,P<0.001)and had undergone endoscopy more frequently(88%vs 36%,P<0.001)than physicians.Absence of hernia was the most common reason for NOTES preference in physicians(80%vs 44%,P= 0.003),whereas reduced pain was the most common reason in patients(66%vs 52%).Physicians were more likely to refuse NOTES as a novel and unsure technique(P<0.001)and having an increased risk of infection(P<0.001).The preferred access site in both groups was colon followed by stomach,with vagina being rarely preferred.In multivariable modeling,those with high-school education[odds ratio(OR):2.68,95% confidence interval(CI):1.23-5.83]and prior colonoscopy(OR:2.10,95%CI:1.05-4.19)were more likely to prefer NOTES over laparoscopic appendectomy.There was a steep decline in NOTES preference with increased rate of procedural complications.Male patients were more likely to consent to their wives vaginal NOTES appendectomy than male physicians(P=0.02).CONCLUSION:The preference of NOTES for appendectomy was greater in patients than physicians and was related to reduced pain and absence of hernia rather than lack of scarring.
文摘The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis.There is an increasing volume of evidence-although mostly retrospective-that if traditional conservative management is adopted,there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms.On the other hand,the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate.It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology.Moreover,it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration.If emergency LA is to become the standard of care for appendiceal mass,I.A will certainly become 'something' of the past.
文摘Primary splenic cyst is a relatively rare disease, and the majority of cases are classified as epithelial cysts. Three cases with nonparasitic splenic cysts are presented: two epithelial and one pseudocyst. All cases had an atypical symptomatology, consisted mainly of fullness in the left upper abdomen and a palpable mass. Preoperative diagnosis was established with ultrasonography and computerized tomography. Two cases with large cysts located in the splenic hilum were treated with open complete splenectomy. The most recent case, a pseudocyst, was managed laparoscopically with partial cystectomy. All cases did not have any problems or recurrence during follow-up. Laparoscopic partial cystectomy is an acceptable procedure for the treatment of splenic cysts, because it cures the disease preserving the splenic tissue. Complete splenectomy is reserved for cases in which cyst excision cannot be done otherwise.
文摘Objective: To evaluate the lumbar stability and the primary clinical results of unilateral facetectomy, transforaminal lumbar interbody fusion (TLIF) and unilateral pedicle screw fixation by X-Tube system. Methods: Five human lumbar cadaveric functional spine units(FSU) were obtained and graded facetectomy by 0, 1/4, 1/2, 3/4 and 4/4 were performed respectively on the left articular process of them. The stability of these 5 models was evaluated at flexion, extension, lateral bending and axial rotation. After a serial of biomechanical researches, 23 patients from June 2004 to March 2006 in our department underwent unilateral facetectomy, transforaminal lumbar interbody fusion (posterior lumbar interbody fusion) and unilateral pedicle screw instrumentation by X-Tube system. After general anaesthesia, with the guide of fluoroscopy and using X-Tube system, procedures of unilateral endoscopic facetectomy, spinal nerve root decompression, autologus spongy bone transplantation, one cage oblique insertion and unilateral pedicle screw instrumentation were performed. Results: There was no significant difference in flexion, extension, lateral bending and axial rotation of lumbar motion range after unilateral graded facetectomy. The stability of left/right axial direction was greatly affected when the range of graded facetectomy exceed 1/2. According to the Nakai criteria, for the 23 patients, the clinical result was excellent in 15 (65.2%), good in 6 (26.1%) and fair in 2 (8.7%). The fusion rate was 95.6% in excellent and good cases. Although partial absorption of bone grafts was observed in 1 case which might indicate a unsuccessful fusion, there was no loosing and replacement of instrument and no clinical symptoms occurred. Conclusion: The lumbar stability will be affected significantly when the range of graded facetectomy exceeds 1/2. Procedures of unilateral facetectomy, transforaminal lumbar interbody fusion and unilateral pedicle screw fixation is an optional strategy for microsurgical reconstruction, though the indications of the procedure should be carefully restricted.
文摘AIM: To analyze the differences of clinical characteristics of colorectal neoplasm including polyps between the elderly and young Thai patients.METHODS: Colonoscopy database from December 2000 to October 2004 was retrospectively analyzed. There were 1822 eligible patients who underwent colonoscopy (with a mean age of 56.6 years). Patients were classified into two groups: the older age group (aged ≥ 60 years; n = 989) and the younger age group (aged < 60 years; n = 833). Data were recorded on age, colonoscopic indications, tumor location, colonoscopic findings and their related histological findings. RESULTS: Colorectal malignancy related lesions were more often found in the older age group (21%) than in the younger age group (12%). Left-sided lesions were detected more commonly than right-sided in both age groups in approximately two-thirds of all cases. Hematochezia showed greater association with left-sided lesions in the elderly. No relationship was found between age and neoplasm staging and severity.CONCLUSION: The chance of detecting colorectal neoplasm by colonoscopy was higher in the elderly than in the young Thais. However, both groups had the lesions predominantly located in the left side.
文摘[Objective]The experiment aimed to explore a new way for observing surface structure of Nostoc sphaeroides Kutzing. [Method] The scanning electron microscope was used to observe the epidermal ultrastructure of wild and cultured Nostoc sphaeroides Kutzing. [ Result] The epidermis of wild and cultured Nostoc sphaeroides Kutzing showed mixture structure of fibril colloid which was reticular arranged. The difference between wild and cultured Nostoc sphaeroides Kutzing was that the outer epidermis of cultured Nostoc sphaeroides Kutzing had trichome distribution but the wild Nostoc sphaeroides Kutzing did not has such distribution. The obsevation results of under smaller than 10 μm by scanning electron microscope was touched thick and showed many folds and distortions. [ Conclusion] The scanning electron microscope was an effective way to study development of Nostoc sphaeroides Kutzing colony and it was worth popularizing.
文摘AIM: To report 13 patients with benign esophagea stenosis treated with the biodegradable stent. METHODS: We developed a Ultraflex-type stent by knitting poly-/-lactic acid rnonofilaments. RESULTS: Two cases were esophageal stenosis caused by drinking of caustic liquid, 4 cases were due to surgical resection of esophageal cancers, and 7 cases were patients with esophageal cancer who received the preventive placement of biodegradable stents for postendoscopic mucosal dissection (ESD) stenosis. The preventive placement was performed within 2 to 3 d after ESD. In 10 of the 13 cases, spontaneous migration of the stents occurred between 10 to 21 d after placement. In these cases, the migrated stents were excreted with the feces, and no obstructive complications were experienced. In 3 cases, the stents remained at the proper location on d 21 after placement. No symptoms of re-stenosis were observed within the follow-up period of 7 mo to 2 years. Further treatment with balloon dilatation or replacement of the biodegradable stent was not required. CONCLUSION: Biodegradable stents were useful for the treatment of benign esophageal stenosis, particularly for the prevention of post-ESD stenosis.