【 Abstract 】 Objective To investigate the cause, management and prevention of biliary fistula with un-typical after laparoscopic cholecystectomy (LC). Methods Twenty-one cases of biliary fistula with un-typical after LC were reviewed retrospectively. Results All patients displayed with un-typical expression and had no obvious signs of peritonitis. Lump of right upper quadrant (6 cases) ， vague pain of epigastric zone (11 cases) ， abdominal distention (3 cases) and bowel obstruction (1 case) after operation were main manifestations. Abdominal paracentesis (14 cases) ， bile exuded from incisional opening of trocar (6 cases) and exploratory laparotomy (1 caes) were the methods of final diagnosis. The cause of biliary fistula included cystic stump fistula (2 cases) ， aberrant bile-duct fistula (9 cases) ， and accessory hepatic duct fistula (4 cases). Laparoscopic approach and puncturation and drainage under ultrasound were the main therapeutic methods. All patiens were discharged successfully with no death case. Nineteen cases were followed up for 3 months to 2 years, and all patients recovered very well. Conclusion The biliary fistula with un-typical after LC is scarce ， and it can lead to missed diagnosis and treatment. Strengthening recognition of biliary fistula after LC ， and paying attention to chief complaint and abdominal sign can help discover biliary fistula early. Laparoscopic approach and puncturation under ultrasound are the recommended therapeutic methods.
Abstract： Marfan syndrome （MFS） is a congenital and heritable autosomal dominant disorder of the connective tissue which is often passed down through families. Its clinical presentation typically involves the skeletal， cardiovascular and ocular systems with a high natural mortality. Aortic root aneurysm and consecutive acute aortic dissection represent the main cardiovascular manifestations and main causes of morbidity and mortality in MFS. At present， the predominant therapeutic method is surgery， but surgical outcomes are quite unsatisfactory. Recent studies demonstrate that losartan， a common antihypertensive agent， is useful to treat MFS， the mechanism of which may results from inhibiting overactivation of transforming growth factor β （TGF-β） signaling. This discovery will definitely promote the transition of traditional surgical treatment of MFS into pharmacotherapy. In this review， we focus on the molecular biological pathogenesis， traditional and new therapeutic strategies for MFS patients.
Objective To investigate the fungal species distribution, liability factors, therapy and prevention of fungal septicemia.Methods A time-matched case-control study was conducted in 30 patients fromApril 2011 to November 2012 with fungal septicemia. Results Of the pathogens in 30 cases with fungal septicemia, 43.3% was Candida albicans, 23.3% was Candida tropicalis, and 10% was Candida parapsilosis. All 30 cases with fungal septicemia were hospital acquired. Malignant hematological system disease( 33.3% ) , COPD( 23.3% ) , and diabetes ( 20.0% ) were the main predisposing diseases. Broadspectrumantibiotic use( 86.7% ) , endovascular prosthesis( 60.0% ) , parenteral alimentation( 53.3% ) were the major risk factors. All 30 cases received systemic anti-fugal therapy. The efficacy rate of amphotericin B therapy was higher than that of fluconazol ( P =0.002) and voriconazole( P = 0.006) . 13 cases( 43.3% ) were cured or significantly improved, and 17 cases( 56.7% ) were dead. Conclusions The most frequently fungi was Candida albicans in fungal septicemia. Malignant hematological system disease and COPD were main predisposing diseases. Broad-spectrumantibiotic use and parenteral alimentation were independent risk factors. Anti-fugal therapy with amphotericin B can achieve better prognosis. Early diagnosis, controlling risk factors, and earlier empirical antifungal therapy are keys to reduce mortality of fungal septicemia.
Objective To study the cl inical features of infantile hemangioma and vascular malformation, to find out a proper strategy of deal ing with them. Methods From March 2000 to August 2007, 2 957 cases of infantile hemangioma and vascular malformation were treated, including 860 operative cases and 2 097 non-operative cases. There were 441 male and419 female patients in operation group, aging 6 months to 18 years (median 5 years). In 1 950 hemangioma patients of nonoperation group, there were 575 male and 1 375 female patients, aging 1 month to 14 years (median 6 months); in 147 vascular malformation patients of non-operation group, there 67 male and 80 female patients, aging 2 years to 17 years (median 7 years). In non-operative group, 147 vascular malformation patients and 1 525 infantile hemangioma patients were followed up without any medical intervention, while other 425 hemangioma patients recceived triamcinolone plus dexamethasone intralesional injection treatment. All the treatments and outcomes were recorded. Results Vascular malformation cases and infantile hemangioma cases presented totally different cl inical features. To the deadl ine of this study, 522 (34%) of 1 525 un-intervented hemangioma cases turned into involuted phase and 383 (90%) of 425 cases receiving triamcinolone plus dexamethasone intralesional injection treatment turned into involuted phase after injection treatment; no regression was noted in 147 cases of vascular malformation. The constituent ratio of infantile hemangioma in 860 operative cases was decreased gradually and the constituent ratio of vascular malformation was increased gradually as the age increasing. Conclusion Infantile hemangioma has a distinct l ife pattern. Except several specific cases need medical intervention for their special location or large ambit and unacceptable growth, most infantile hemangioma need no medical intervention. Most vascular malformations can not regress spontaneously, proper intervention is in need.
In order to choose the appropriate antibiotics for treating secondary pancreatic infection, permeability of antibiotics to pancreatic tissue was investigated on experimental dogs with acute hemorrhagic necrotizing pancreatitis. The concentrations of 8 different antibiotics were determined in the blood and the pancreatic tissue using highperformance liquid chromatography. Pancreatic tissue permeability of Cefotaxime, Ofloxacin, Amikacin, Piperacllin, Cefoperazone, Ampicillin, Metronidazole and Ciprofloxacin was 12%, 19%, 20%, 46%, 55%, 63%, 71% and 132% respectively. The study shows that this eight antibiotics have different permeability to the pancreatic tissue. Such observations support the existence of a bloodpancreas barrier, which acts to restrict the permeation of antibiotics into the pancreas. The results suggest that antibiotics with high permeability rate be used to treat the patient with secondary pancreatic infection.
Objective To study the advances in research of breast cancer during pregnancy. Methods The literatures in recent years were reviewed. Results A lot of evidences suggested that the diagnosis may be delayed easily. The diagnosis was primarily made by needle aspiration cytology and biopsy. The treatment of pregnant breast cancer was not different from ordinary breast cancer, however the factor of foetus should be taken into account. Termination of pregnancy did not improve survival. Conclusion Pregnant breast cancer is mostly at later stage at the time of diagnosis and has poorer prognosis than ordinary breast cancer. The patients with breast cancer during pregnancy usually have an equivalent survival rate when compared with age and stagematched ordinary group. Future pregnancy may be allowed after two years of treatment in patients with early breast cancer.
ObjectiveTo improve the knowledge of pulmonary actinomycosis.MethodsThree cases of pulmonary actinomycosis in this hospital and 65 cases reported in China were analyzed retrospectively.ResultsAmong the 68 patients 49 were male and 19 were female aged 6 to 77 years old. The most common clinical manifestations were cough, sputum and fever. Inflammatory indicators was slightly elevated. The most common site was on the right upper lung. The typical CT manifestations were the low-density liquefaction necrotic zone in the center of the mass with vacuoles of different sizes, namely, "air-space consolidation". Positron emission computed tomography showed a mild metabolic increase in lesions. The 68 patients were confirmed by surgery, CT guided percutaneous lung puncture or bronchoscopic biopsy. The average time of the diagnosis was 10 months while the longest time was 6.4 years. The rate of first diagnosis was 5.9%. Forty-one cases were treated with antibiotics alone and 12 cases were treated with simple operation, the rest were treated by antibiotics combined with surgical treatment. The cure rate was 88.7%. Although active treatment was conducted 3 patients in this hospital were not cured.ConclusionsThe clinical features of pulmonary actinomycosis are atypical and the misdiagnosis rate is high. When pulmonary actinomycosis is suspected, it should be fully communicated with the microbiologist to ensure the cultivation in anaerobic environment and extension of the incubation cycle. Tissue culture and pathological biopsy should be actively performed. Treatment depends on antibiotics or surgery with good prognosis, but for some cases the prognosis is not optimistic.
Fifteen patients with rectal carcinoid tumors were treated from 1975 to 1991. Before admision, nine patients (60%) had been misdiagnosed as polyps ,hemorrhoids or proctitis. Diagnosis may be delayed because of failure to recognize their charasteristics and by the negligeuce of doing digital examination or proctoscopy. Some aspects of the management of these tumors remain controversial. However, present-day treatment programs call for radical cancer resections only for lesions 2cm in diameter or larger, and local resections for all others. In reviewing this series of cases and other studies, we advocate that both the size of the lesion and the depth of tumor invasion should be taken as the criteria of surgical managements. If the tumor is 2cm in diameter, or smaller than that, local resection can be performed, but whenever the nuscularis propria is invaded, radical resection should be performed. Radical resection is bly indicated for tumors larger than 2cm.
ObjectiveTo analyze risk and therapy strategy of tiny gallbladder stones during laparoscopic cholecystectomy (LC).MethodThe clinical data of 932 patients with tiny gallbladder stones performed LC from September 2013 to July 2014 were analyzed retrospectively.ResultsThe LC was successful in all the patients. The gallbladders were ruptured in 86 (9.23%) patients during operation. Following up 1-3 months, there were 26 patients with right upper abdominal pain and with residual small stones in the abdominal cavity, 57 patients without uncomfortable symptoms and without residual gallstone, 2 cases complicated with lesser abdominal abscess, 1 case complicated with incision infection. The incisional hernia and acute pancreatitis were not found.ConclusionsThe gallbladder with full of tiny stones performed LC easily leads to choledocholithiasis or acute pancreatitis. If intraoperative gallbladder rupture, the tiny stones might be residual in the peritoneal cavity and lead to abdominal infection or abscess, and incision infection or trocar site hernia. Specific operation could effectively avoid adverse complications.
Large cell neuroendocrine lung cancer（LCNEC） is the rare subtype of nonsmall cell lung cancer. Because of its low incidence rate and the special biological behaviour, it is hard to define in pathology. And we also know little about its epidemiological feature and the purposeful therapy view of LCNEC, and the therapeutic effect is unsatisfactory. This article will review and introduce the advance of research, clinical diagnosis and therapeutic of the LCNEC.