Selective role for endoscopic retrograde cholangiopancreatography in abdominal trauma

Background: Emergency endsocopic retrograde cholangiopancreatography (ERCP) is rarely indicated in trauma patients; however, in cases of suspected pancreatic or bile duct injury or bile leak, it may be useful. The purpose of this paper is to review our ERCP experience in trauma patients. Our Level I Trauma Center admits 1800 patients annually. Methods: Since January 1991, we have performed ERCP in 12 trauma patients, nine after blunt injury and three after penetrating injury. Results: ERCP was used as a diagnostic tool to evaluate the pancreatic duct in six stable patients with equivocal CT scans and unexplained abdominal pain, fever, and an elevated amylase or a peripancreatic pseudocyst. Based on their ERCP findings—one intact pancreatic duct, one transected duct, and four pseudocysts—five of the six patients had operations. We performed ERCP in six patients for persistent bile leaks (five cases) or jaundice (one case). The findings were one case of bilemia (intrahepatic biliovenous fistula), one case of common bile duct disruption, and four cases of persistent bile leaks from the liver after liver injuries. Endobiliary stents placed in five patients successfully stopped the four bile leaks and closed the biliovenous fistula. The one case of ductal disruption required an open choledochojejunostomy. The only ERCP complication was an episode of cholangitis treated with antibiotics. The earliest ERCP was 3 days after injury, and most were performed within 2 months. Conclusions: ERCP is a helpful procedure for diagnosing biliary and pancreatic duct injury in a select group of trauma patients who do not have obvious indications for exploration. In addition, ERCP techniques are also effective for treating most bile leaks. Received: 21 April 1997/Accepted: 22 September 1997     

胰腺癌癌块大小部位与手术切除关系

１０９例胰腺癌除１６例行非手术治疗外，９３例采用了手术治疗。发现：①癌块大小与浸润、转移率和手术切除率有明显关系（Ｐ＜０．００５）。＜３ｃｍ浸润、转移率为１６．７％，手术切除率为７５％；＞１０ｃｍ者无１例切除。②癌肿部位与手术切除率也有明显关系（Ｐ＜０．０１）。按切除率由高至低排列为：胰尾癌（１００％），胰体尾癌（６６．７％），胰头癌（３８．１％），胰头体癌（５％）。影响切除率的主要因素是肠系膜上动、静脉，门静脉，下腔静脉是否受侵犯     

Origin of ascending projections to the nuclei of the lateral lemniscus in the big brown bat,Eptesicus fuscus

The nuclei of the lateral lemniscus in the echolocating bat, Eptesicus fuscus, are large and highly differentiated. In each nucleus, different characteristic response properties predominate. To determine whether the dissimilar response properties are due in part to dfferential ascending input, we examined the retrograde transport from small deposits of horseradish peroxidase (HRP) or HRP conjugated with wheat germ agglutinin (WGA-HRP) in the nuclei of the lateral lemniscus. The intermediate nucleus (INLL) and the two divisions of the ventral nucleus (VNLL) receive almost exclusively monaural input from the anteroventral and posteroventral cochlear nuclei and from the medial nucleus of the trapezoid body. Lesser inputs originate in the lateral nucleus of the trapezoid body and the ventral periolivary area. Although the three monaural nuclei of the lateral lemniscus all receive input from the same set of nuclei, and from the same identified cell types in the cochlear nucleus, there is a difference in the relative proportions of input from these sources. The dorsal nucleus (DNLL) receives input mostly from binaural structures, the lateral and medial superior olives and the contralateral DNLL, with only a minor projection from the coc hlear nucleus. The lateral and medial superior olives project bilaterally; the bilateral projection from the medial superior olive is unusual in that it is found in only a few mammalian species. The results show a segregated pattern of binaural projections to DNLL and monaural projections to INLL and VNLL that is consistent with the binaural response properties found in DNLL and the exclusively monaural response properties found in INLL and VNLL. The differences in response properties between monaural nuclei, however, are not due to input from different nuclei or cell types but may be influenced by differing magnitudes of the constituent ascending projections. © 1995 Wiley-Liss, Inc.     

低位直肠癌局部切除术的合理选用

1988·1-1994·12手术治疗结直肠癌886例中，癌肿局限肠壁内者324例，按照国际TNM分期，属Tis17例，T2 264例，Tis组中全部为No，T1组中有3例N1，占6.98%，无M1-T2组中N1 74例，占28.03%，M1 10例，占3.79%，不同大体类型癌肿的Tis和T1并无明显区别，增生型T1的N1占27.12%，溃疡型T1的N1占28.95%，浸润型T2的N1占28.13%，三者亦无差异（P>0.05），不同恶性程度Tis与T1间并无区别，低恶性T2的N1占21.43%，一般恶性的N1占27.93%，二者相比P>0.05，高恶性T3的N1占42.86%，与前二者相比，差异显著（P<0.05），324例中有35例低位直肠癌采用局部切除术治疗，占同期低位直肠癌的9.38%，无手术死亡，除1例T1于术后2年出现局部复发，再次行Miles术后又2年死亡外，余均健在，21例术后存活已大农业3年心上，10例存活已满5年，表明肌层浸润不但具有较高淋巴播散率，且有远处转移可能，为保证手术手术疗效，局部切除术应仅限于病变局限在粘膜或粘膜下，≤3cm，低恶性或一般恶性的癌肿。     

吻合血管逆行皮瓣静脉压变化的实验研究

目的观察吻合1条伴行静脉的逆行血供游离皮瓣成活情况,探讨静脉回流机制和静脉压随时间的变化。方法新西兰大白兔15只,随机分为3组,每组5只10个皮瓣,血管吻合前,每只兔分别制备以胫后动脉为轴的逆行游离皮瓣2个。测量三组兔胫后血管外径。A组吻合2条伴行静脉,B、C组吻合1条伴行静脉。A、B组分别行兔胫后静脉术前、术后即刻、30 m in、1 h和2 h的静脉压测定;术后观察B组皮瓣的成活情况;C组行伴行静脉造影观察,于注射完毕即刻、30 m in和1 h观察造影剂的流动情况;组织学观察B组蒂部血管通畅情况。结果实验兔胫后动脉直径为8.0±0.3 mm,伴行静脉11.0±0.5 mm。B组10个皮瓣,除2个撕脱、感染坏死外,余均成活。B组术后即刻和30 m in静脉压为2.56±0.84和3.08±0.97 kPa,与术前1.81±0.63 kPa比较,差异有统计学意义(P<0.05);1 h后趋于正常,差异无统计学意义(P>0.05)。A组和B组皮瓣的静脉压在各时间点比较差异均无统计学意义(P>0.05)。C组注射造影剂1 h后基本回流入肢体近端。结论吻合1条伴行静脉逆行血供游离皮瓣的静脉回流可保证回流循环。静脉血直接通过失效的瓣膜是逆行血供游离皮瓣静脉回流的主要方式。     

Leep刀治疗宫颈良性病变188例

目的观察Leep刀治疗宫颈良性病变188例的临床疗效。方法临床选取188例宫颈良性病变患者,根据病变性质和范围选用不同型号的环形电极,距碘不着色区外缘0.5cm处开始,从左至右或从上至下锥形切除,切除深度约为0.6～1.0cm,然后改用方形或小环形电极切除中央部分的组织,包括部分颈管,深1～2cm。结果176例患者宫颈表面光滑,宫颈质软,呈粉红色,刮片正常。有12例颈管粘膜增生,以球形电极再次电凝处理。有30例患者术后10～22d脱痂时创面出血量多于月经量,经棉球压迫、抗炎、止血剂应用后均治愈。结论Leep刀临床治疗宫颈良性病变疗效明显,不留瘢痕,术后不影响生育,值得推广应用     

高位胆管癌49例临床分析

目的：探讨高位胆管癌的手术方式及其临床意义。方法：对49例高位胆管癌患者的临床资料进行了回顾性分析。49例高位胆管癌，其中行根治性手术16例，姑息性手术33例。结果：根治性手术切除率32．9％。手术切除者生存8～38个月，姑息手术者生存3～11个月。无手术死亡及严重并发症。结论：高位胆管癌的手术疗效与早期诊断及术式密切相关．改进手术技术．提高手术切除率，对改善疗效有重要意义。     

Reoperative retroperitoneal lymph-node dissection for testicular germ cell tumor

Purpose  We sought to discuss the indications for reoperative retroperitoneal surgery, preoperative evaluation of patients, distribution of retroperitoneal recurrences and technical considerations for reoperative procedures. In addition, the histologic findings, clinical outcomes and perioperative complications were reviewed. Methods  A PubMED and Medline search was performed to identify reoperative retroperitoneal surgery series for patients with nonseminomatous germ cell tumor. Results  A reliance on cisplatin-based chemotherapy to treat residual disease after RPLND is inadequate for most patients. If retroperitoneal failure does occur, reoperative RPLND should be considered as the recurrence can harbor viable GCT or teratoma, which both necessitate surgical excision. The left para-aortic and left renal hilar regions are the most common sites of retroperitoneal failure. Reoperative retroperitoneal surgery can be performed with an acceptable morbidity as long as surgeons are equipped to handle significant intraoperative complications. Clinical outcomes after reoperative RPLND are influenced by serum tumor markers, histologic findings and completeness of surgical resection. Conclusions  Overall survival rates in men requiring redo RPLND appear significantly lower than similar patients who are successfully treated with their initial RPLND. Given the potential complexity of this operation and its impact on a patient’s prognosis, reoperative RPLND surgery should be limited to specialized quaternary care centers.     

Effects of Cholera Toxin on Small Intestinal Motor Activity in the Fasted State

We sought to determine the effect of cholera toxin on small intestinal motor activity in the fasted state and relate it to secretion in conscious dogs. Motor activity was recorded by strain gauge force transducers and secretion was measured by diverting it to the outside through a two-way cannula. Inoculation of the study segment with cholera toxin resulted in a 10-fold increase in fluid output by 120 minutes postinjection. At the same time that fluid output increased Significantly changes in fasting motor activity occurred. The cycle length of the migrating motor complex was significantly reduced, the percentage of phase II activity was significantly increased, and migrating clustered contractions were inhibited. Perfusion of the study segment by a nonabsorbable electrolyte solution at a rate similar to the rate of secretion induced by cholera toxin did not change the cycle length of migrating motor complexes, but the percentage of phase II activity was significantly increased as with cholera toxin, and migrating clustered contractions were inhibited. The reduction in the cycle length of migrating motor complexes seems to be a direct effect of cholera toxin on the gut wall while the increase in percentage of phase II activity and inhibition of migrating clustered contractions appear to be indirect effects due to fluid accumulation.