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双眼真性小眼球，右眼葡萄膜渗漏综合征一例

Clinical Evaluation of Immune-Enhanced Enteral Nutrition in The Elderly Patients after Total Gastrectomy

ObjectiveTo evaluate the effect of glutamineenhanced enteral nutritional support on elder patients after total gastrectomy. MethodsA total of eightyfour cases of elder patients receiving total gastrectomy were included in this study from February 2008 to August 2010. The patients were randomly divided into three groups: glutamineenhanced enteral nutrition (Gln) group, enteral nutrition (EN) group and parenteral nutrition (PN) group. The complications and hospital stay after operation were compared, and the levels of serum total protein, albumin, proalbumin， and transferrin of patients were measured before operation, on 2 d and 10 d after operation, respectively. Furthermore, the percentage of CD4 and CD8 T cells, CD4/CD8 ratio， and the levels of serum IgM and IgG of patients in peripheral blood before and after operation were detected. ResultsNutritional therapy was successfully performed in patients of three groups. The anal exhaust time and hospital stay after operation of patients in Gln group and EN group were significantly lower than those in PN group (Plt;0.05). The difference of postoperative complications and digestive tract symptoms of patients in three groups was not obvious (Plt;0.05). Anastomotic fistula occurred in one patient of PN group on 6 d after operation and was cured by conservative treatment for 54 d. The difference of total protein, albumin, proalbumin, and transferrin levels of patients in three groups before operation was not significant (Pgt;0.05), and these indexes fell dramatically on 2 d after operation and lower than before operation (Plt;0.05), although the intergroup difference was not statistically significant (Pgt;0.05). On 10 d after operation, all indexes recovered in different extent, while those data in Gln group and EN group were significantly higher than those on 2 d after operation (Plt;0.05). The levels of total protein, albumin, and proalbumin of patients in Gln group and EN group were markedly higher than those in PN group (Plt;0.05), although there was no difference between the former groups (Pgt;0.05). The difference of several immunological parameters of patients in three groups before operation was not significant (Pgt;0.05). On 10 d after operation, the percentage of CD4 and CD8 T cells, CD4/CD8 ratio, and the levels of serum IgM and IgG of patients in Gln group returned and even exceeded the preoperative results, which were significantly higher than those in EN group and PN group other than IgM (Plt;0.05). The postoperative results of all parameters except IgG in EN group were significantly lower than preoperative results in patients of EN group and PN group (Plt;0.05). ConclusionsIt is safe and feasible to elder patients who had received total gastrectomy and perioperative glutamine-enhanced nutritional support, which can improve nutrition and immune status, promote the recovery and reduce the duration of hospital stay, and nutritiional support after total gastrectomy is one of the optimal choices for these patients.

Influence of Different Pressures and Time of CO2 Pneumoperitoneum on Adhesive and Invasive Ability of Gastric Cancer Cells

Objective To investigate the influence of different pressures and duration of CO2 pneumoperitoneum on the adhesive and invasive ability of gastric cancer cells based on the expressions of adhesive and invasive molecules. Methods With an artificial CO2 pneumoperitoneum model in vitro, human gastric cancer cell lines including MKN-45, SGC-7901, and MKN-28 were exposed to CO2 in different environments: 0 mm Hg （1 mm Hg=0.133 kPa）, 9 mm Hg （2 h, 4 h）, and 15 mm Hg （2 h, 4 h）. The expressions of mRNA of E-cadherin, intercellular adhesion molecule-1 (ICAM-1), matrix metalloproteinase-2 (MMP-2), and vascular endothelial growth factor-A (VEGF-A) in the different environments were measured by RT-PCR. The expressions of protein of E-cadherin and ICAM-1 in the environments of 0 mm Hg and 15 mm Hg （4 h） were measured by FCM. Results With the increase of duration or pressure, RT-PCR showed that there was a downward trend in the expression of E-cadherin mRNA as well as there were upward trends in the expressions of ICAM-1, MMP-2, and VEGF-A mRNA; FCM showed that there was a downward trend in the expression of E-cadherin protein while the expression of ICAM-1 protein showed the opposite change. But there were no obvious differences under different environment (P＞0.05). Conclusions Under low pressure (≤15 mm Hg) and short time (≤4 h) of CO2 pneumoperitoneum, the adhesive and invasive ability of gastric cancer cells could not be affected, which means that under this environment, CO2 pneumoperitoneum will not increase the possibility of neoplasm metastasis.

Advancement of Gene Diagnosis and Gene Therapy on Gastric Cancer

Objective To review the advance of gene diagnosis and gene therapy on gastric cancer. Methods Literatures about the advance of gene diagnosis and therapy on gastric cancer were reviewed. Results Detection of tumor marker by gene technique is important for early diagnosis, follow-up and therapy evaluation of gastric cancer in clinic. But there are still many problems in gene therapy of gastric cancer. Conclusion Gene detection and gene therapy will become important supplementary means for diagnosis and treatment of gastric cancer.

Surgical Treatment of Enteric Fistula (Report of 24 Cases)

目的 探讨小肠瘘的外科综合治疗方法。方法 对我科2003年2月至2007年5月收治的24例小肠瘘患者的临床资料进行回顾性分析。结果 24例患者中包括十二指肠瘘5例，空肠瘘7例，回肠瘘12例。予以营养支持、抗感染、腹腔引流和手术的综合治疗。治愈21例，死亡3例。结论 早期规范的外科综合治疗可明显提高小肠瘘的治愈率。

Application of MRA, IPVG and DUS in Hemodynamics Evaluation for Portal Hypertension

【Abstract】ObjectiveTo evaluate the role of MRA, IPVG and DUS in the hemodynamics studies of portal hypertension. MethodsThirtyeight patients with portal hypertension were examined with Philips Gyroscan 1.0 Tesla MR imaging system. 3DDCE MRA and 2DPC MR were used for study of portal venous anatomy and its hemodynamics. The results were compared with those obtained from IPVG and DUS. Results3DDCE MRA could clearly display the anatomical imaging of portal venous system and its imaging quality was better than that of IPVG. The data of hemodynamics from 2DPC MR including diameter, blood velocity and blood flow were closely correlated to those from DUS. ConclusionAs a noninvasive technique, MRA can display the anatomy of portal venous system and measure its hemodynamics exactly. It should be applied as the first choice in hemodynamics evaluation for portal hypertension.

Clinical Evaluation of Paclitaxel Liposome Combined with Continuous Intravenous Infusion of Large-Dose 5-Fluorouracil as First-Line Chemotherapy for Advanced Gastric Cancer

ObjectiveTo evaluate the therapeutic effect and adverse reaction of paclitaxel liposome combined with continuous infusion of large-dose 5-fluorouracil(5-fu) in treatment for advance gastric cancer(AGC). MethodsFrom May 2009 to August 2012, 63 consecutive patients with AGC in this hospital were enrolled in this study. All the patients were given chemotherapy including paclitaxel liposome and continuous infusion of large-dose(2.5 g/m2) 5-fu. The efficacy and toxicity of this regimen were observed. ResultsThere was no patient who could not tolerate adverse reaction related to such regimen. Five cases achieved complete response and 31 cases achieved partial response, the overall response rate was 57.1%(36/63). Hematologic toxicity included gradeⅢ/Ⅳleucopenia 8 cases(12.7%) and neutropenia 10 cases(15.9%), while there was no occurrence of gradeⅢ/Ⅳanemia or thrombopenia. Non-hematologic toxicity was fairly mild. ConclusionsPaclitaxel liposome is safe, well tolerated, highly targeted, and has long duration of effect. Paclitaxel liposome combined with continuous infusion of large-dose 5-fu is safe and effective in treatment for patients with AGC.

氨基胍干预实验性大鼠糖尿病视网膜病变

单肺移植同期对侧肺减容治疗终末期肺气肿二例

肺气肿是一种十分常见的慢性阻塞性肺疾病（COPD），终末期患者最终心肺功能衰竭。肺减容及肺移植为这类患者提供了有效的外科治疗方法。2004年7月及2004年12月，我们分别为2例终末期肺气肿患者成功实施了单肺移植，同期对侧肺减容术，现报告如下。

电视纵隔镜在胸部疾病诊断与治疗中的应用

摘要: 　目的　探讨电视纵隔镜在胸部疾病诊断和治疗中的应用价值, 总结其临床经验。　方法　对2006 年3 月至2007 年5 月开展的47 例电视纵隔镜手术资料进行回顾性分析, 其中经颈部纵隔镜手术38 例, 左胸纵隔镜手术8 例,右胸纵隔镜手术1 例。　结果　本组手术时间10～ 100m in, 平均44. 2min; 术中出血5～ 200ml, 平均33. 5ml 。肺癌术前分期12 例, 纵隔淋巴结病理检查阴性4 例, 阳性8 例, 均与开胸手术后检查结果相符, 其敏感性、特异性、准确性均为100%。纵隔疑难疾病诊断31 例, 经过纵隔镜手术后30 例(96. 8%) 明确诊断, 其中恶性肿瘤16 例, 分别为纵隔转移性肿瘤8 例、纵隔淋巴瘤3 例, 恶性纤维组织细胞瘤、食管鳞状细胞癌、促纤维组织增生性小圆细胞肿瘤、胸腺类癌、淋巴上皮癌各1 例; 良性疾病14 例, 分别为结节病8 例、慢性淋巴结炎4 例、纵隔淋巴结结核2 例。纵隔镜辅助纵隔或肺部病变切除4 例, 均顺利完成手术。本组手术无死亡及严重并发症发生, 均治愈出院。　结论　电视纵隔镜手术安全、可靠,可作为纵隔疑难疾病诊断和鉴别诊断的有效方法以及肺癌术前分期的金标准。