AIM: To evaluate the feasibility and safety of performing laparoscopic cholecystectomy (LC) in nonteaching rural hospitals of a developing country without intra-operative cholangiography (IOC). To evaluate the possibi...AIM: To evaluate the feasibility and safety of performing laparoscopic cholecystectomy (LC) in nonteaching rural hospitals of a developing country without intra-operative cholangiography (IOC). To evaluate the possibility of reduction of costs and hospital stay for patients undergoing LC.METHODS: A prospective analysis of patients with symptomatic benign diseases of gall bladder undergoing LC in three non-teaching rural hospitals of Kashmir Valley from Jan 2001 to Jan 2007. The cohort represented a sample of patients requiring LC, aged 13 to 78 (mean 47.2) years. Main outcome parameters included mortality, complications, re-operation, conversion to open procedure without resorting to IOC, reduction in costs borne by the hospital, and the duration of hospital stay.RESULTS: Twelve hundred and sixty-seven patients (976 females/291 males) underwent laparoscopic cholecystectomy. Twenty-three cases were converted to open procedures; 12 patients developed port site infection, nobody died because of the procedure. One patient had common bile duct (CBD) injury, 4 patients had biliary leak, and 4 patients had subcutaneous emphysema. One cholecystohepatic duct was detected and managed intraoperatively, 1 patient had retained CBD stones, while 1 patient had retained cystic duct stones. Incidental gallbladder malignancy was detected in 2 cases. No long-term complications were detected up to now.CONCLUSION: LC can be performed safely even in non-teaching rural hospitals of a developing country provided proper equipment is available and the surgeons and other team members are well trained in the procedure. It is stressed that IOC is not essential to prevent biliary tract injuries and missed CBD stones. The costs to the patient and the hospital can be minimized by using reusable instruments, intracorporeal sutures, and condoms instead of titanium clips and endobags.展开更多
Purpose.To evaluate the diagnosis and treatment of adrenal incidentalomas.Methods.One hundred and twenty-six patients with incidentalomas were analyzed,among them98underwent operation.Results.Eighty-eight of the adren...Purpose.To evaluate the diagnosis and treatment of adrenal incidentalomas.Methods.One hundred and twenty-six patients with incidentalomas were analyzed,among them98underwent operation.Results.Eighty-eight of the adrenal incidentalomas were discovered by ultrasound.Of all the types of adrenal incidentalomas,52(41.3%)of them were adenomas;43(34.1%)were hypersecretory adrenal tumors,including29pheochromocytomas,9primary aldosteronisms ,1adrenogenitol syndrome combined with adrenal adenoma ,2Cushing’s syndrome combined with adenomas and2Cushing’s syndrome com-bined with nodular hyperplasias.All nonhypersecretory adrenal adenomas were under6cm,and all a-drenal carcinomas were above6cm.Conclusions.To search for hypersecretory adrenal tumors and to detect malignant adrenal tumors are quite essential in the process of diagnosing adrenal incidentalomas.For nonhypersecretory adrenal adeno-mas,the size of tumor is the most important index in determining whether the tumor is benign or malig-nant and whether the tumor needs to be treated with operation.展开更多
Objectives.To understand and grasp the diagnosis and treatment of chylothorax caused by various reasons. Method.The treatment results of 31 cases of chylothorax in PUMC hospital from 1963...Objectives.To understand and grasp the diagnosis and treatment of chylothorax caused by various reasons. Method.The treatment results of 31 cases of chylothorax in PUMC hospital from 1963～1997 were retrospectively analyzed. Results.Among 31 cases, 18 underwent surgery, 14 of 18 were cured, 2 died. In the 13 treated conservatively, 2 were cured, 3 died. Eleven cases were congenital, iatrogenic and traumatic chylothorax, 8 of them received surgical treatment and 6 of 8 were cured. The spontaneous chylothorax of unknown cause were 10 cases, 7 were treated by surgery and 6 were cured. Conclusion.Surgical intervention should be aggressively recommended for the traumatic, congenital, and iatrogenic chylothorax. The definite reason must be found out for the spontaneous chylothorax, corresponding management will be given according to the reason. Surgical ligation of the thoracic duct will contribute good result for the chylothorax of unknown cause, but combination of multiple treatment measures will be necessary for a successful management.d treatment of chylothorax caused by various reasons. [WT5”BX] Method.The treatment results of 31 cases of chylothorax in PUMC hospital from 1963～1997 were retrospectively analyzed. [WT5”BX] Results.Among 31 cases, 18 underwent surgery, 14 of 18 were cured, 2 died. In the 13 treated conservatively, 2 were cured, 3 died. Eleven cases were congenital, iatrogenic and traumatic chylothorax, 8 of them received surgical treatment and 6 of 8 were cured. The spontaneous chylothorax of unknown cause were 10 cases, 7 were treated by surgery and 6 were cured. [WT5”BX] Conclusion.Surgical intervention should be aggressively recommended for the traumatic, congenital, and iatrogenic chylothorax. The definite reason must be found out for the spontaneous chylothorax, corresponding management will be given according to the reason. Surgical ligation of the thoracic duct will contribute good result for the chylothorax of unknown cause, but combination of multiple treatment measures will be necessary for a successful management.展开更多
Between 1974 and 1993, 22 patients with bronchogenic cysts were operated on in our hospital; there were 14 men and 8 women, ranging in age from 11 to 62 years. The cyst locations were mediastinal in 13 (59.1%) and int...Between 1974 and 1993, 22 patients with bronchogenic cysts were operated on in our hospital; there were 14 men and 8 women, ranging in age from 11 to 62 years. The cyst locations were mediastinal in 13 (59.1%) and intrapulmonary in 9 (40. 9%). There were symptoms (chest pain and recurrent bronchiolits) in 20 patients (91%). The preoperative complications included infection in the lung and in the cyst and dysphagia due to esophageal compression. Chest pain was the main symptom in mediastinal cyst and recurrent infection of lung in intrapulmonary cyst. Plain chest radiograms showed that a round shadow, occasional air-fluid levels, and peripheral calcification may be found in cysts. An operation is the best treatment for cysts. All cysts were completely excised. No postoperative cornphcations. late complications, or recurrence developed in our patients.展开更多
OBJECTIVE: To investigate the diagnosis and surgical techniques of intramedullary hemangioblastoma of the cervical spinal cord. METHODS: MR imaging and the methods and results of surgery were analyzed in 21 patients. ...OBJECTIVE: To investigate the diagnosis and surgical techniques of intramedullary hemangioblastoma of the cervical spinal cord. METHODS: MR imaging and the methods and results of surgery were analyzed in 21 patients. RESULTS: The tumors were divided into three types on MR imaging. Syringeal type, where the tumor varied in size and was accompanied by syringobulbia and syringomyelia; Cystic type, where the tumor presented as a cyst with a small mural node; and Solid type, where the tumor was revealed as a huge solid mass. All tumors were totally removed and diagnosis was confirmed by histological study. Post-operative neurological status was improved in 20 patients and aggravated in 1. CONCLUSIONS: The localization and the nature diagnosis of the tumor can be made by cervical MR imaging. Operative methods vary with tumor types. It is the most important that the tumor is dissected along the right interface and removed after devascularization.展开更多
Background and objective： Hepatic sinusoidal obstruction syndrome （HSOS） is characterized by painful hepatomegaly, ascites, increased body weight, and jaundice. Gynura segetum （Compositae）, a plant widely used in...Background and objective： Hepatic sinusoidal obstruction syndrome （HSOS） is characterized by painful hepatomegaly, ascites, increased body weight, and jaundice. Gynura segetum （Compositae）, a plant widely used in Chinese traditional medicine, often leads to the development of HSOS. However, the mechanism is unclear. The aim was to study the role of matrix metalloproteinase-9 （MMP-9） in the onset of HSOS induced by Gynura segetum. Methods： Twenty-five male Sprague-Dawley rats were randomly divided into two groups. Twenty were exposed to 600 mg/kg daily Gynura segetum extract solution for three weeks; five control rats were exposed to tap water alone. Liver sections were evaluated by light microscopy with a modified scoring system. Routine transmission electron microscopy （TEM） methods were used to evaluate the ultrastructual features of fixed liver tissue, and blood samples were collected to determine liver enzyme concentrations. MMP-9 expression was assessed by both immunohisto- chemical staining and enzyme-linked immunosorbent assay （ELISA） methods. Results： A stable and reproducible rat model of HSOS was achieved by long-term exposure to Gynura segetum extract. The treated rats presented clinical symptoms and the histopathological manifestation of HSOS, including abnormal liver enzyme concentrations （alanine aminotransferase （ALT）： （84.8＋13.62） vs. （167.0±72.63） U/L, P〈0.05; aspartate aminotransferase （AST）： （27.6±6.31） vs. （232.8±108.58） U/L, P〈0.05）. Hematoxylin and eosin （H＆E） staining and TEM together revealed deposition of red blood cells, the damage and destruction of hepatic sinusoidal endothelial cells, collapse of hepatic sinusoids, hem- orrhage of subendothelial cells, atrophy and destruction of hepatocytes, etc. Compared with controls, the expression of MMP-9 in the blood sample, the lung and liver tissues of HSOS rats was increased. Conclusions： MMP-9 may have an important role in early patholoclical chanqes of HSOS, and thus the onset of the disease.展开更多
文摘AIM: To evaluate the feasibility and safety of performing laparoscopic cholecystectomy (LC) in nonteaching rural hospitals of a developing country without intra-operative cholangiography (IOC). To evaluate the possibility of reduction of costs and hospital stay for patients undergoing LC.METHODS: A prospective analysis of patients with symptomatic benign diseases of gall bladder undergoing LC in three non-teaching rural hospitals of Kashmir Valley from Jan 2001 to Jan 2007. The cohort represented a sample of patients requiring LC, aged 13 to 78 (mean 47.2) years. Main outcome parameters included mortality, complications, re-operation, conversion to open procedure without resorting to IOC, reduction in costs borne by the hospital, and the duration of hospital stay.RESULTS: Twelve hundred and sixty-seven patients (976 females/291 males) underwent laparoscopic cholecystectomy. Twenty-three cases were converted to open procedures; 12 patients developed port site infection, nobody died because of the procedure. One patient had common bile duct (CBD) injury, 4 patients had biliary leak, and 4 patients had subcutaneous emphysema. One cholecystohepatic duct was detected and managed intraoperatively, 1 patient had retained CBD stones, while 1 patient had retained cystic duct stones. Incidental gallbladder malignancy was detected in 2 cases. No long-term complications were detected up to now.CONCLUSION: LC can be performed safely even in non-teaching rural hospitals of a developing country provided proper equipment is available and the surgeons and other team members are well trained in the procedure. It is stressed that IOC is not essential to prevent biliary tract injuries and missed CBD stones. The costs to the patient and the hospital can be minimized by using reusable instruments, intracorporeal sutures, and condoms instead of titanium clips and endobags.
文摘Purpose.To evaluate the diagnosis and treatment of adrenal incidentalomas.Methods.One hundred and twenty-six patients with incidentalomas were analyzed,among them98underwent operation.Results.Eighty-eight of the adrenal incidentalomas were discovered by ultrasound.Of all the types of adrenal incidentalomas,52(41.3%)of them were adenomas;43(34.1%)were hypersecretory adrenal tumors,including29pheochromocytomas,9primary aldosteronisms ,1adrenogenitol syndrome combined with adrenal adenoma ,2Cushing’s syndrome combined with adenomas and2Cushing’s syndrome com-bined with nodular hyperplasias.All nonhypersecretory adrenal adenomas were under6cm,and all a-drenal carcinomas were above6cm.Conclusions.To search for hypersecretory adrenal tumors and to detect malignant adrenal tumors are quite essential in the process of diagnosing adrenal incidentalomas.For nonhypersecretory adrenal adeno-mas,the size of tumor is the most important index in determining whether the tumor is benign or malig-nant and whether the tumor needs to be treated with operation.
文摘Objectives.To understand and grasp the diagnosis and treatment of chylothorax caused by various reasons. Method.The treatment results of 31 cases of chylothorax in PUMC hospital from 1963～1997 were retrospectively analyzed. Results.Among 31 cases, 18 underwent surgery, 14 of 18 were cured, 2 died. In the 13 treated conservatively, 2 were cured, 3 died. Eleven cases were congenital, iatrogenic and traumatic chylothorax, 8 of them received surgical treatment and 6 of 8 were cured. The spontaneous chylothorax of unknown cause were 10 cases, 7 were treated by surgery and 6 were cured. Conclusion.Surgical intervention should be aggressively recommended for the traumatic, congenital, and iatrogenic chylothorax. The definite reason must be found out for the spontaneous chylothorax, corresponding management will be given according to the reason. Surgical ligation of the thoracic duct will contribute good result for the chylothorax of unknown cause, but combination of multiple treatment measures will be necessary for a successful management.d treatment of chylothorax caused by various reasons. [WT5”BX] Method.The treatment results of 31 cases of chylothorax in PUMC hospital from 1963～1997 were retrospectively analyzed. [WT5”BX] Results.Among 31 cases, 18 underwent surgery, 14 of 18 were cured, 2 died. In the 13 treated conservatively, 2 were cured, 3 died. Eleven cases were congenital, iatrogenic and traumatic chylothorax, 8 of them received surgical treatment and 6 of 8 were cured. The spontaneous chylothorax of unknown cause were 10 cases, 7 were treated by surgery and 6 were cured. [WT5”BX] Conclusion.Surgical intervention should be aggressively recommended for the traumatic, congenital, and iatrogenic chylothorax. The definite reason must be found out for the spontaneous chylothorax, corresponding management will be given according to the reason. Surgical ligation of the thoracic duct will contribute good result for the chylothorax of unknown cause, but combination of multiple treatment measures will be necessary for a successful management.
文摘Between 1974 and 1993, 22 patients with bronchogenic cysts were operated on in our hospital; there were 14 men and 8 women, ranging in age from 11 to 62 years. The cyst locations were mediastinal in 13 (59.1%) and intrapulmonary in 9 (40. 9%). There were symptoms (chest pain and recurrent bronchiolits) in 20 patients (91%). The preoperative complications included infection in the lung and in the cyst and dysphagia due to esophageal compression. Chest pain was the main symptom in mediastinal cyst and recurrent infection of lung in intrapulmonary cyst. Plain chest radiograms showed that a round shadow, occasional air-fluid levels, and peripheral calcification may be found in cysts. An operation is the best treatment for cysts. All cysts were completely excised. No postoperative cornphcations. late complications, or recurrence developed in our patients.
文摘OBJECTIVE: To investigate the diagnosis and surgical techniques of intramedullary hemangioblastoma of the cervical spinal cord. METHODS: MR imaging and the methods and results of surgery were analyzed in 21 patients. RESULTS: The tumors were divided into three types on MR imaging. Syringeal type, where the tumor varied in size and was accompanied by syringobulbia and syringomyelia; Cystic type, where the tumor presented as a cyst with a small mural node; and Solid type, where the tumor was revealed as a huge solid mass. All tumors were totally removed and diagnosis was confirmed by histological study. Post-operative neurological status was improved in 20 patients and aggravated in 1. CONCLUSIONS: The localization and the nature diagnosis of the tumor can be made by cervical MR imaging. Operative methods vary with tumor types. It is the most important that the tumor is dissected along the right interface and removed after devascularization.
基金Project supported by the National Natural Science Foundation of China (No.30925033)the Administration of Traditional Chinese Medicine of Zhejiang Province (No.2007ZA016),China
文摘Background and objective： Hepatic sinusoidal obstruction syndrome （HSOS） is characterized by painful hepatomegaly, ascites, increased body weight, and jaundice. Gynura segetum （Compositae）, a plant widely used in Chinese traditional medicine, often leads to the development of HSOS. However, the mechanism is unclear. The aim was to study the role of matrix metalloproteinase-9 （MMP-9） in the onset of HSOS induced by Gynura segetum. Methods： Twenty-five male Sprague-Dawley rats were randomly divided into two groups. Twenty were exposed to 600 mg/kg daily Gynura segetum extract solution for three weeks; five control rats were exposed to tap water alone. Liver sections were evaluated by light microscopy with a modified scoring system. Routine transmission electron microscopy （TEM） methods were used to evaluate the ultrastructual features of fixed liver tissue, and blood samples were collected to determine liver enzyme concentrations. MMP-9 expression was assessed by both immunohisto- chemical staining and enzyme-linked immunosorbent assay （ELISA） methods. Results： A stable and reproducible rat model of HSOS was achieved by long-term exposure to Gynura segetum extract. The treated rats presented clinical symptoms and the histopathological manifestation of HSOS, including abnormal liver enzyme concentrations （alanine aminotransferase （ALT）： （84.8＋13.62） vs. （167.0±72.63） U/L, P〈0.05; aspartate aminotransferase （AST）： （27.6±6.31） vs. （232.8±108.58） U/L, P〈0.05）. Hematoxylin and eosin （H＆E） staining and TEM together revealed deposition of red blood cells, the damage and destruction of hepatic sinusoidal endothelial cells, collapse of hepatic sinusoids, hem- orrhage of subendothelial cells, atrophy and destruction of hepatocytes, etc. Compared with controls, the expression of MMP-9 in the blood sample, the lung and liver tissues of HSOS rats was increased. Conclusions： MMP-9 may have an important role in early patholoclical chanqes of HSOS, and thus the onset of the disease.
