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Transurethral resection of prostate (TURP) syndrome during hysteroscopic surgery is a severe complication due to the absorption of irrigating fluids and pressure in uterine cavity, fluid overload and/or dilution hyponatremia cause a series of clinical symptoms. It can be a dread complication if it is not timely diagnosed and treated. The relevant pathophysiology of TURP syndrome was discussed through the analysis on four typical cases, the relative major factors include high-pressure perfusion and venous sinuses open during the surgery. The principles of preventive measures and treatments of this complication were discussed in order to strengthen the safety awareness of doctors, to reduce the incidence of this complication. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the characteristics of pulmonary infection and its risk factors after orthotopic liver transplantation (OLT)., Methods: Clinical data of 250 cases having liver transplantations from April 2001 to August 2005 were retrospectively studied in order to analyse the differences between patients with and without pulmonary infection., Results: Fifty-seven (57/250, 22.8%) recipients had 72 episodes of pulmonary infection after liver transplantation. Bacterial infection was the most common followed by fungal infection (13/72, 18.1%), and cytomegalovirus infection (12/72, 16.7%). There were 36 episodes of pulmonary infection caused by one kind of bacteria, 5 episodes by two kinds of bacteria and 6 episodes by multiple kinds of bacteria. Seven episodes of fungal infection were accompanied with bacterial infection, and three episodes of cytomegalovirus infection were accompanied with bacterial infection simultaneously. The 1-, 2- and 3- year survival rates were 71.9%, 61.4%, and 53.4% of the patients with pulmonary infection and 93.1%, 75.8%, and 67.2% of those without the infection. Logistic regression analysis suggested that preoperative infection, mechanical ventilation > 12 hours, a long duration of the operation, total volume of blood transfusion during operation >1000 ml, reoperation after OLT, postoperative pleural effusion and the duration of stay in the intensive care unit were independent risk factors of pulmonary infection after OLT., Conclusion: Bacterial infections were the main pulmonary infection after OLT and the infections caused by multiple pathogens or multiple-antibiotic-resistant bacteria were seen more frequently. The risk factors of pulmonary infection should be controlled to decrease the infection rate after OLT. It is important to make a correct diagnosis for pulmonary infection after OLT and use appropriate antibiotics as soon as possible.

Plenty of data and tests suggested that flavonoids have strong physiological and pharmacological activities. In this paper, the absorption, distribution and metabolism of flavonoids in gaster, gut and liver were introduced. The research of absorption, distribution and metabolism on flavonoids will provide theoretical basis for developing new drugs of flavoniods.

Objective: To investigate the effects of rapamycin (RPM) in inhibiting the growth and metastasis of hepatocellular carcinoma (HCC)., Methods: Human HCC cells of the line MHCC97H with a high potential of metastasis were divided into 3 groups to be cultured with cyclosporine A (CsA) 100 ng/ml, RPM 10 ng/ml, or CsA + RPM for 48 hours. Flow cytometry was used to examine the apoptosis and cell cycle MTT method was used to examine the effect of RMP on the proliferation of the MHCC97H cells. RT-PCR was used to detect the mRNA expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), hypoxia-inducible factor-1alpha (HIF-1alpha), and transforming growth factor b (TGFb). Another MHCC97H cells were cultured in complete medium without RPM for 48 hours, then the protein expression of VEGF in the supernatant was detected by ELISA. Twenty-eight nude LCI-D20 mice were inoculated with human HCC cells and then divided into 4 groups to be fed with CsA (25 mg/kg), RPM (2 mg/kg), CsA + RPM, and normal saline (0.2 ml, as control group) for 35 days. Then the mice were killed to take the weight of inoculated tumor, measure the blood drug concentration, calculate the lung metastasis rate and number of metastatic foci, and observe pathology of the lung., Results: CsA showed no effect on the cycle of the MHCC97H cells. The MHCC97H cells of the RPM and CsA + RPM groups arrested at the stage G(0)/G(1) (both P = 0.000). MMT method also showed that the proliferation of the MHCC97H cells in the RPM and CsA + RPM groups were blocked (P = 0.003 and P = 0.002). However, CsA did not influence the proliferation of the MHCC97H cells. Flow cytometry showed that RPM did not promote the apoptosis of the MHCC97H cells. RT-PCR showed that RPM down-regulated the mRNA expression of VEGF and HIF-1alpha (both P < 0.05), however, did not influence the mRNA expression of bFGF, TGFb, and TGFb. The VEGF protein level in the supernatant of the culture fluid of MHCC97H cells of the RPM group was (890.3 +/- 25.1) pg/ml, significantly lower than that of the control group, (1583.7 +/- 17.3) pg/ml (P = 0.000). The tumor inhibiting rate of the RPM group was 63.7%, not significantly different from that of the RPM + CsA group (80.9%, P = 1.000). The metastatic rate of the CsA and control groups were both 100% with a higher number of metastatic tumors in the CsA group (P = 0.046)., Conclusion: RPM significantly inhibits the growth and metastasis of HCC. RPM-based immunosuppressive regimen may be of value in HCC patients receiving liver transplantation.

Objective: To analyze the risk factors influencing the prognosis of orthotopic liver transplantation for hepatocellular carcinoma (HCC) and sum up the relevant clinical experience in diagnosis and treatment of HCC., Methods: The clinical data of 198 HCC patients, 177 males and 21 females, aged 49 (24-83), were analyzed., Results: The 0.5-, 1-, and 2-year survival rates were 89%, 78%, and 65 respectively. The rates of disease-free survival (DFS) were 85%, 73, and 67% respectively. Univariate analysis revealed that tumor size, presence of vascular invasion, Edmondson grade, TNM classification, and preoperative alpha-fetoprotein (AFP) were significantly related to DFS, and the 4 foregoing factors were also related to the survival rate. Cox regression analysis suggested that presence of vascular invasion was an independent prognostic factor of survival rate and DFS., Conclusion: Vascular invasion plays a leading role in evaluating the prognosis of orthotopic liver transplantation for HCC. It is important to discover the micro-metastasis and explore more effective approaches to prevent recurrence after transplantation.

Objective: To evaluate the effects of different selection criteria on the prognosis of hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) and to explore the new criteria adapted for Chinese National Situation., Methods: A retrospective analysis was performed on 251 consecutive patients with HCC who underwent LT between April 2001 and January 2006 at our institution. We compared the outcome of the patients meeting different criteria such as milan, UCSF and the Pittsburgh modified TNM criteria. Survival rates were calculated using the Kaplan-Meier method, and differences between the curves were assessed by log-rank test., Results: There was no significant difference in 1, 2, 3-year survival rates and recurrence-free survival rates between milan criteria (n = 93; 86%, 77%, 77% and 91%, 86%, 86%) and UCSF criteria (n = 131; 90%, 83%, 83% and 92%, 89%, 89%). According to Pittsburgh criteria (n = 207), the 1, 2, 3-year survival rates and recurrence-free survival rates were 84%, 74%, 67% and 85%, 83%, 73%, respectively. For advanced tumors (over all the criteria), the survival rates and recurrence-free survival rates decreased significantly (n = 44; 65%, 43%, 43% and 47%, 43%, 43% respectively). When criteria (named as Shanghai Fudan Criteria) were expanded to HCC patients with solitary lesions < or = 9 cm in diameter, or no more than 3 lesions, the largest < or = 5 cm, with a total tumor diameter < or = 9 cm, there was no significant difference in 1, 2, 3-year survival rates and recurrence-free survival rates (n = 151; 88%, 80%, 80% and 90%, 88%, 88%, respectively) as compared with milan criteria, but more patients using Shanghai Fudan Criteria could undergo liver transplantation., Conclusion: Shanghai Fudan Criteria, which expanded the tumor size limits, does not adversely impact survival of HCC patients after LT.

Objective: To investigate the measures to further improve the therapeutic efficacy of liver transplantation., Methods: The clinical data of 203 consecutive cases of orthotopic liver transplantation (OLT) performed in Zhongshan Hospital, Fudan University April 2001 to October 2004, with the indications for considering OLT of hepatocellular carcinoma (HCC) (142 cases), liver cirrhosis (36 cases), fulminant hepatic failure (7 cases), Wilson's disease (6 cases), and other end-stage liver diseases (12 cases), including 199 cases of cadaveric OLT, inclusive of 2 cases of reduced-size and 1 case of splitting liver transplantation, and 4 cases of living-donor liver transplantation, were retrospectively analyzed. Multivariate analysis using Cox proportional hazards regression model was applied to determine the risk factors predicting liver transplantation prognosis for HCC., Results: For the whole group of the 201 patients, the 1-year and 2-year cumulative survival rates were 85.0% and 82.4% respectively and the rejection rate was 12.3%. In the HCC group the 1- and 2-year cumulative survival rates were 80.2% and 78.4%, and the 1- and 2-year disease-free survival (DFS) rates were 85.3% and 80.3% respectively. HCC recurrence was observed in 20 patients after OLT with a recurrence rate of 14.1%. Multivariate analysis revealed that the tumor size and portal vein tumor thrombus were the most independent and statistically significant factors affecting the DFS., Conclusion: OLT may be the most effective treatment option for patients with end-stage liver diseases and may also provide the opportunity of curative treatment or survival improvement for selected patients with hepatic malignancies.

Objective: To explore the diagnosis and management of early hepatic artery thrombosis (HAT) after liver transplantation., Methods: Routine examination of Color Doppler Imagine (CDI) was used to detect hepatic artery flow after liver transplantation in 220 cases from April 2001 to November 2004. Suspected patients were further confirmed by immediate hepatic artery angiography, and continuous infusion of urokinase through hepatic artery with catheter was performed to the patients with HAT., Results: HAT was identified in 6 patients (2.7%), occurring 5.5 days (2 - 19 days) after liver transplantation. Hepatic artery recanalization was obtained in 6 cases. One patient died from lung infection 2 months after liver transplantation. One patient underwent the second liver transplantation because of the recurrence of HAT 6 months after the first transplantation, but died from multiple system organ failure 2 months after the operation. The other 4 cases have been surviving well disease-freely., Conclusions: CDI is useful for the diagnosis of early HAT after liver transplantation. Contributes to recovery of the hepatic artery flow, continuous infusion of urokinase through hepatic artery with catheter may be the first choice of the therapy for early HAT.

Objective: To study the technique and effect of transcervical resection of myoma (TCRM) in treatment of hysteromyoma., Methods: 962 women suffering type 0 hysteromyoma (n = 281), 316 type 1 hysteromyoma (n = 316), type 2 hysteromyoma (n = 282), submucous and intramural myoma (n = 34), cervical myoma (n = 11), prolapse myoma (n = 23), and adenomyoma (n = 15) underwent TCRM with "five-step technique", monitored by B-ultrasound or laparoscopy, Follow-up lasted more than 6 months., Results: The primary operation successful rate was 99.77%. The mean size and depth of uterus were 7.44 +/- 1.3 gestation weeks and (8.31 +/- 1.43) cm, the diameter of the biggest myoma was 7.2 cm. The mean weight of the resected tissues was (22.63 +/- 31.41) g, and the mean operation time and blood loss during the operation were 32.50 +/- 172.72 minutes and (7.75 +/- 19.49) ml. No transfusion was needed. The complications included postoperative fever (3 cases), uterine bleeding (1 case), uterine perforation (1 case), and TURP syndrome (2 cases). Postoperative scanty menstrual rate was 100% in the type 0 hysteromyoma group, 99.1% in the type I hysteromyoma group, 94.02% in the type II hysteromyoma group, 100% in the cervical myoma and prolapse myoma group, 84% in the multiple myoma and intramural myoma group, and 87% in the adenomyoma group respectively. The alleviation rates of dysmenorrhea and anemia were 78% and 82.95% respectively. Those who have severe complications of internal medicine showed obvious improvement. The residual myoma of 2 cases were resected during the secondary operation 9 days and 3 months after the primary operation. 455 cases (52.17%) resumed their work in 1 month postoperatively. 32 living infants were delivered., Conclusion: Safe and highly effective, TCRM can be the first choice in treatment of submucous and intramural hysteromyoma.

Objective: To evaluate the short term and long term outcomes of abnormal uterine bleeding (AUB) treated by transcervical resection of endometrium (TCRE) as well as the factors which influence the outcomes., Methods: From May 1990 to September 2002 there were 1431 cases who suffered from menorrhagia. A total of 1468 times of TCRE were performed. Hysteroscopic diagnosis and endometrium biopsy was performed to rule out malignant diseases in 1203 cases. One stage TCRE was performed in 265 cases. Resistance index (RI) and pulse index (PI) of every level uterine artery were measured by ultrasound and serum levels of were 6 steroid sex hormones were measured by laboratory in 32 cases. The mean duration of follow-up was 68.5 months (3 - 148 months)., Results: Three cases of uterine perforation were encountered. Smog like echo in the anterior uterine wall was found in 714 cases (49.9%) by B ultrasonography, among them 21 cases (63.6%) were proved adenomyosis by pathological examination. One hundred and fifty nine cases (10.8%) had been treated by drugs, such as homeostasis, analgesic agent, antibiotics, progesterone and endometrium inhibiting agents, etc. Repeat TCRE was performed in 37 cases. Owing to recurrent bleeding, dysmenorrhea or uterine myoma 87 cases (6.1%) were finally received hysterectomy., Conclusions: (1) The main cause of recurrence was incomplete destruction of or leak from basal layer of endometrium. Shift wire loop with the sheath together to resect endometrium from the fundus to cervix smoothly can solve the problem of incomplete resection. Upon completion of operations, "blind area" and "blind point" should be examined and resected again if there is some endometrium left behind which could solve leak from basal layer of endometrium. (2) The duration of follow-up and adenomyosis are the main factors, which influence the long-term successful rate. (3) TCRE dose not influence the ovarian function obviously.

Objective: To analyse the cause, diagnosis, treatment and preventive methods of uterine perforation resulting from hysteroscopic electro-surgeries., Methods: Data of cases with uterine perforation were collected from 5 hospitals where overall 3,541 hysteroscopic electro-surgeries were done from May 1990 to July 2002. There were 1 468 transcervical resections of endometrium (TCRE), 797 cases of transcervical resection of myoma (TCRM), 783 cases of transcervical resection of endometrial polyp (TCRP), 189 cases of transcervical resection of uterine septa (TCRS), 112 cases of transcervical resection of uterine adhesion (TCRA) and 192 cases of transcervical removal of foreign body (TCRF). All operations were performed under B-ultrasonographic or laparoscopic monitoring. Cervical dilator stick was inserted into cervical canal or 200 micro g of misoprostol put in the posterior fornix the evening before operation. The procedures were done according to different indications and purposes. Cases of uterine perforation were divided into two groups: caused by approaching (entry-related) and by surgical instruments (technique-related)., Results: Totally sixteen cases (0.45%) of uterine perforation occurred. Seven cases occurred during cervical dilatation and 1 during hysteroscopy inserting lentry-related. Eight cases were technique-related caused by electrode. The incidences of uterine perforation of different operations were: TCRA 4.46% (5/112), TCRF 3.12% (6/192), TCRE 0.27% (4/1 468), TCRM 0.13% (1/797). TCRP and TCRS none. These 16 cases were all diagnosed during operations. 10 cases (62%) by B ultrasound and (or) laparoscopy, 6 cases (38%) by hysteroscopy and clinical features. 13 cases were complete uterine perforations, among them 2 were diagnosed by laparoscopic monitoring, 5 by B-ultrasonic monitoring, 4 by hysteroscopy and 2 by symptoms and B-ultrasound, 3 cases were incomplete uterine perforations in which 2 were diagnosed by laparoscopic monitoring and one by B-ultrasound monitoring., Conclusions: Half of uterine perforation cases were entry-related, so attention has to be paid to entry of Hegar or hysteroscopy (i.e., not dilate the cervix as possible and introduce the scope under direct vision). The other half were related to surgeons' experience and type of operation. TCRA and TCRF run more risks. B-ultrasound and (or) laparoscopy monitoring during hysteroscopic electro-surgery may help to prevent but not completely avoid uterine perforation.