Objective: To sum up the experience in liver transplantation in a period of ten years at a single center.
Methods: We retrospectively reviewed the clinical records of 120 patients receiving liver transplantation from April 1993 to October 2002. The patients clinical characteristics, surgical techniques, complications and survival were compared in the phases of 1993-1997 (phase I), 1999 (phase II), and 2000-2002 (phase III).
Results: Malignant liver diseases were major indications for liver transplantation in phase I (100%) and II (53.3%), but decreased markedly in percentage in phase III (34.0%). When compared with recipients in phase I and II, the survival of recipients with benign liver diseases in phase III was significantly improved with the 3-month, 6-month and 1-year survival rates of 85.7%, 84.5% and 83.1%, respectively. For patients with malignant liver diseases, the 3-month, 6-month and 1-year survival rates were 87.4%, 81.1% and 46.0%, respectively. The reinfection rate of hepatitis B virus was 24% 12 months after transplantation. With technical refinements, the incidence of postransplantation vascular complications has significantly decreased from 29.4% in phase I and II to 4.9% in phase III. Biliary complications remained one of the major obstacles to long-term survival. No veno-venous bypass was applied in phase III, providing a promising outcome.
Conclusion: Strict selection of potential recipients, technical refinement, appropriate management of vascular and biliary complications, and prophylaxis of recurrences of hepatitis B and malignant liver diseases are important to obtain long-term survival of patients receiving liver transplantation in China.

Objective: To present a good tacrolimus (FK506) administration protocol in liver transplantation.
Methods: Fifty liver transplantation patients were classified into FK506 high-concentration (20 patients), FK506 mid-concentration (20), CsA-FK506 (5) and FK506-CsA (5) groups. Clinical manifestations, FK506 side-effects and pathological changes were observed.
Results: The FK506 high-concentration group showed complications such as infection and liver function damage. The FK506 mid-concentration group showed excellent therapeutic results and some complications easy to deal with.
Conclusion: FK506 is a highly effective immunosuppressive agent and the mid-concentration protocol is a better one.

Objective: To study the markers of early rejection and pathological changes in simultaneous pancreaticoduodenal and kidney transplantation (SPKT).
Methods: Thirty hybrid pigs were used as donors and recipients. A renoportal end-to-end anastomosis between the left renal vein and the distal end of the portal vein was performed. Two vascular end-to-side anastomoses between the donor portal vein and recipient inferior vena cava, and between the donor aortic segment including the celiac and superior mesenteric, and left renal arteries and recipient abdominal aorta were carried out. Pancreas exocrine secretion drainage was established with duodenocystostomy. Ureterostomosis of the graft was performed. Urine amylase level, fasting blood glucose and urine volumes of kidney allograft were monitored, and pathological changes of graft were observed.
Results: Of 15 recipients, 2 died of disturbance of internal environment and anastomotic bleeding, respectively. Satisfactory results were obtained in the remaining 13 recipients. The changes of urine amylase concentration were prior to those of fasting blood glucose and urine volumes of kidney allograft. The degree of rejection of the kidney allograft was more severe than that of the pancreas and duodenum allograft.
Conclusions: Urine amylase is the early marker of acute rejection in SPKT with bladder drainage of pancreatic exocrine secretion. The pathological change of kidney allograft is most significant in SPKT.

Budd-Chiari syndrome was formerly described as hepatic vein thrombosis within the liver, but it now includes inferior vena cava (IVC) thrombosis and other conditions that cause hepatic vein outflow obstruction. The author[1] consider that primary hepatic vein thrombosis and primary IVC thrombosis represent two different clinical disorders.

Objective: To investigate intestinal permeability in patients with portal hypertension and its relationship with portal pressure.
Methods: Twenty patients with portal hypertension were divided into two groups (A, B), 10 patients per group. In group A, patients were treated with combined transjugular intrahepatic portosystemic shunt (TIPS) and modified Sugiura. In group B, patients were treated with modified Sugiura only. Intestinal permeability was assessed before operation, two weeks after TIPS, and two weeks after modified Sugiura; 20 healthy control subjects were also assessed.
Results: Intestinal permeability was significantly higher in the patients than in the control group (P<0.01). In group A, portal pressure, intestinal permeability decreased two weeks after TIPS (P<0.05), and no obvious change was noted two weeks after modified Sugiura; but they were significantly lower than those before TIPS (P<0.05). In group B, intestinal permeability was not different before and after operation. Intestinal permeability in group A was not different from that in group B before treatment, but significantly lower after modified Sugiura (P<0.05). Portal pressure was significantly correlated with intestinal permeability (r=0.627, P<0.01).
Conclusions: This study shows that combined TIPS and modified Sugiura can lower portal pressure and intestinal permeability, and enhance the therapeutic efficacy on portal hypertension.

Objective: To evaluate the significance of intraoperative reassessment of liver function reserve in the selection of surgical procedures to optimize therapeutic results in the treatment of portal hypertension.
Methods: The data of 146 patients with portal hypertension treated in the past 10 years were retrospectively reviewed. Posthepatitis cirrhosis was found in 118 patients, schistosomial cirrhosis in 6, alcoholic cirrhosis in 1, mixed cirrhosis in 5, and other diseases in 16. According to Child’s criteria, 45 patients were classified into class A, 92 class B, and 9 class C. At operation, 33 patients were reclassified into class A, 78 class B, and 35 class C. Disconnection procedure was performed in 89 patients (61.0%) and shunt procedure in 57 (39.0%). These operations included prophylactic operations in 27 patients (18.5%) and emergency disconnection operations in 2 (1.4%).
Results: One patient (0.7%) died of upper gastrointestinal bleeding during operation. Early rebleeding following operation occurred in 9 patients (6.1%) (disconnection in 5 patients and shunt in 4). Early encephalopathy after operation occurred in 2 patients (1.4%) (disconnection in 1 patient and shunt in 1). A total of 98 patients (67.6%) (disconnection in 61 patients and shunt in 37) were followed up (6 months to 9 years). Bleeding occurred again in 12 patients (12.2%) (disconnection in 9 patients and shunt in 3) 17 months after operation (4 to 41 months). Late encephalopathy occurred in 6 shunt patients at 19 months (3-40 months). The late rebleeding rates of shunt patients and disconnection patients were 8.1% (3/37 patients) and 14.9% (9/61) (P>0.05) respectively. The late encephalopathy rates of shunt patients and disconnection patients were 16.2% (6/37) and 0% (0/61) respectively (P<0.01). Eight patients (5.5%) died of upper gastrointestinal bleeding (2), hepatic failure (3), liver cancer (2), and rectal cancer (1) in the period of follow-up.
Conclusions: The success and effectiveness of surgical procedures for portal hypertension are closely related to the status of patient’s liver function reserve. Intra-operative reassessment of hepatic function reserve is crucial. Selection of procedures based on patient’s hepatic function reserve, local anatomical conditions and surgeon’s experience would optimize therapeutic results.

Objective: To identify the impact of lamivudine on HBV e antigen (HBeAg) seroconversion and HBV DNA level, and the appearance of Tyr-Met-Asn-Asp (YMDD) resistants.
Methods: Forty-seven hepatitis B patients were treated with oral lamivudine. ALT level and HBeAg were detected in the treatment on the zero, 3rd, 6th and 9th month respectively. The levels of HBV DNA and YMDD resistants were analyzed with PCR microplate hybridization-ELISA.
Results: After 9 months of treatment, HBV DNA became negative and ALT level was normal in 74% patients. Among these patients, 17% patients had HBeAg converted to negative and anti-HBe antibody positive, whereas another 15% patients showed HBeAg negative. YMDD resistants appeared in 19% patients (9/47). One, three and five resistants were detected in the treatment on the 3rd, 6th and 9th month respectively.
Conclusions: Most HBV DNA in serum became negative after 9 months of treatment, and the rate of HBeAg seroconversion was 17% (HBV DNA level was lower than 100 pg/ml before treatment). YMDD resistants appeared in 19% patients.

Objective: To assess the influence of preoperative transcatheter arterial chemoembolization (TACE) on liver resection in patients with resectable hepatocellular carcinoma (HCC).
Methods: Of 126 patients with resectable HCC, 62 received preoperative TACE (TACE group) and the remaining 64 patients were selected as controls (non-TACE group). Perioperative risk factors including liver function alteration, mean blood loss during operation, mean time of clamping the porta hepatis, length of operation, postoperative abdominal drainage at day 1, 2 and 3, morbidity and mortality were compared between the two groups.
Results: Neither significant difference in liver function alteration nor mortality was observed between the two groups. More severe hepatic cirrhosis, longer operation time, more blood loss and postoperative abdominal drainage were noted in the TACE group than in the non-TACE group. There was no significant difference in postoperative morbidity between the two groups.
Conclusions: Preoperative TACE for resectable HCC increases surgical difficulty and risk, and therefore should be considered prudently according to the individuality of patients.

Objective: To study the clinical relations of portal hypertensive gastropathy (PHG) of hepatitis B cirrhosis to other factors.
Methods: Three groups of subjects were studied prospectively at our hospital from March 2000 to March 2001: 159 hepatitis B cirrhotic patients with portal hypertension, 114 hepatitis B cirrhotic patients without portal hypertension, and 97 control subjects. Free portal vein pressure (FPP) was measured during surgery. Liver function was assessed by Pugh’s modification of Child’s criteria. The area of liver collagen fibrin was studied using color image analysis system. Esophageal varices were identified by Dagradi grading. Gastric varices were identified according to Northern Italian Endoscopic Council (NIEC) grading. Hypersplenism was assessed with the reduction of WBC, HGB and PLT. Hepatitis B virus in the gastric mucosa was detected by immunizing histochemistry. Helicobacter pylori (H. pylori) organisms were identified by rapid urease testing and/or examination of the stained biopsy specimens (haematoxylin and eosin). To analyze the correlation between these endoscopic signs at the gastric level and other factors.
Results: The differences of FPP among the three groups (patients with grade Ⅰ, Ⅱ, and Ⅲ gastropathy) were not significant. There was no correlation between Child-Pugh classification grading and the severity of gastropathy (P=0.153). The differences of the area of liver collagen fibrin among the three grade gastropathy were not statistically significant (P=0.801). There was a significant difference in the prevalence of severe PHG among grade Ⅰ, Ⅱ, Ⅲ, Ⅳ and Ⅴ esophageal varices (P<0.001). PHG was present in a similar percentage of patients with gastric varices compared with those without gastric varices (P=0.209). There was a significant difference in the severity between PHG and hypersplenism (P=0.003). Seven patients with PHG had no microscopic evidence of hepatitis B virus infection in the gastric wall. There was no correlation between Child-Pugh classification grading and infection of H. pylori (P=0.7491).
Conclusions: The most important element causing PHG is the increased portal pressure as a prerequisite. In addition, other factors may contribute to the development of PHG. PHG often occurs in patients with the presence of esophageal varices. There is a marked correlation between the severity of PHG and hypersplenism. Hepatitis B virus and H. pylori infection are unlikely to be involved in the pathogenesis of PHG. The development of PHG is less influenced either by the severity of liver disease (Child-Pugh grade) and cirrhosis or by the presence or non presence of gastric varices.

Objective: To study the mechanism of hepatocellular glycogen in alleviation of liver ischemia-reperfusion injury during hepatic vascular occlusion for partial hepatectomy.
Methods: Seventeen patients were randomly divided into experimental group (n=9) and control group (n=8). In the experimental group, patients were given high concentration glucose intravenously during 24 hours before operation. The hepatic lesion was resected after portal triad clamping in the two groups. Non-cancer liver tissue was biopsied to measure hepatic tissue ATP content and change of malondialdehyde (MDA) and superoxide dismutase (SOD). Liver function of all patients was assessed before operation and the first and fifth day after operation.
Results: Hepatic tissue ATP content of the experimental group was significantly higher than that of the control group both at the end of hepatic vascular occlusion and the point of one-hour reperfusion. Besides, liver function of the experimental group was significantly better than that of the control group the first and fifth day after operation. There was significant difference in SOD activity or MDA content between the two groups at the end of hepatic vascular occlusion and at the point of one-hour reperfusion.
Conclusions: Abundant intracellular glycogen may reduce liver ischemia-reperfusion injury caused by hepatic vascular occlusion. It is beneficial to give a large amount of glucose before a complex liver operation, in which temporary occlusion of hepatic blood flow is necessary.

Objective: To differentiate diffuse liver cancer from portal cirrhosis by using ultrasonography.
Methods: We analyzed the sonographic images of 15 patients with diffuse liver cancer and 30 patients with portal cirrhosis.
Results: The patients with diffuse liver cancer showed enlarged liver and obvious echo of nodules. The rate of portal embolism and swelling of lymph nodes around the porta hepatis was high. The patients with portal cirrhosis showed diminished liver and the obvious echo of fiber proliferation. The rates of spleen enlargement and ascites as well as gallbladder edema were high.
Conclusions: To identify sonographic characteristics inside and outside of the liver. It is helpful in differentiating diffuse liver cancer from portal cirrhosis. The sonographic characteristics inside the liver include surface and size, node echo, echo of fibrous tissue hyperplasia. They are difficult to identify when diffuse liver cancer merges with considerable cirrhosis. The acoustic image characteristics of the two diseases overlap. Hence attention should be paid to the size of the liver, proliferation of cells of diffuse liver carcinoma. In sonographic characteristics outside the liver, embolism of the portal vein and swelling of lymph nodes in the porta hepatis are particularly useful to identify diffuse liver cancer or diffuse liver cancer combined with liver cirrhosis in particular.

Background: Hepatitis C virus infection is a great issue in China; however, there is very little information on genotyping investigations based on sequence variability in the 5’untranslated (5’UTR) reported. The present study was to define the sequence variability based on the sequence divergences of the 5’UTR of the virus.
Methods: Sequences of 91 isolates from patients with chronic hepatitis C from Yunnan, southwest China, were sequenced and genotypes were defined according to the sequence divergences of the 5’UTR of the virus.
Results: Eighty-six isolates were classified into 3 clades (previously termed groups or major types) by the methods proposed by Chan et al in 1992 and phylogenetic analysis based on nucleotide sequence divergences within the 5’UTR. Fifty-six percent of the isolates were classified into clade 3, 35% into clade 1, and 34.9% into clade 2. New genotypes 1f, 2h, 3h and 3i were defined. In addition, 3 novel sequences were discovered, respectively with an 18-nt sequence deletion (corresponding to nucleotide position -173 to -156), a 28-nt sequence insertion, and a 40-nt sequence insertion, between -56 and -55. Of these isolates, 56% possessed a “G” at position -66 in place of the “T” that is present in all previously reported sequences.
Conclusions: These HCV variants, evolved or remained in this area, may be of great significance in diagnosis and treatment of hepatitis C patients.

Objective: To demonstrate the utility of DNA vaccines for the tailored methods, the efficacy of enhanced immune responses, and the types of increased immune responses.
Methods: Four recombinant plasmids constructed included the coding regions for the core protein (pC) and for the core, E1 and E2 together (pCE1E2), IL-12 p35 and p40. These plasmids were transfected into mammalian cells to test their protein expression and were injected into the quadriceps muscles of BALB/C mice for measurement of specific antibodies and cytotoxic T-lymphocyte (CTL) responses.
Results: All the recombinant plasmids were shown to express specific antigens stably in mammalian cells. Codelivery of pIL-12 expression cassettes with pC and pCE1E2 in mice resulted in the enhancement of Ag-dependent CTL responses and the reduction of specific Ab response. The CTL activity was: pC=18.65%±5.71%, pCE1E2=20.07%±11.11%, pC+pIL-12=60.11%±17.37%, pCE1E2+pIL-12=67.48%±15.57%, respectively. The average A values of anti-HCV were pC=0.415±0.127, pCE1E2=0.358±0.096, pC+pIL-12=0.210±0.086, pCE1E2+pIL-12=0.258±0.125.
Conclusion: Codelivery of pIL-12 with plasmid DNA can enhance the efficacy of immune responses and shift the type of immune responses.

Objective: To investigate the changes of scavenger receptor (SR) and CD14 in Kupffer cells in endotoxemia in order to uncover the mechanism of the liver to turn a defense organ into effector one in sepsis.
Methods: Mouse models of endotoxemia of different severity were reproduced by injection of different doses of lipopolysaccharide (LPS) via the tail vein. The expression of SR and CD14 in the liver was assayed by immunohistochemistry and was subsequently analyzed with an image analysis system. The levels of TNF-α and IL-6 in liver tissue were determined with ELISA.
Results: The expression of SR in the liver in the high-dose group was markedly decreased one hour after injection of LPS, and also in the low-dose group at 3 hours. The expression of SR in the liver in the two groups was shown to be progressively decreased with the time prolonged. There was significant difference in average optical density (OD) values of SR between the two groups. The expression of CD14 in the two groups was shown to be significantly increased one hour after injection of LPS, and more significantly with the time prolonged. But there was no significant difference in OD values of CD14 between the two groups. The contents of intra-hepatic proinflammatory mediators TNF-α, IL-6, ALT and TBIL were significantly increased after injection of LPS. Correlation analysis revealed that the changes of TNF-α, IL-6, ALT, and TBIL were negatively correlated with the expression of SR, and positively with the expression of CD14.
Conclusion: The up-regulation of CD14 expression and down-regulation of SR expression on Kupffer cells might be one of the important mechanisms for the conversion of Kupffer cells from immune defensive to inflammatory response cells in acute hepatic injury.

Objectives: To quantitatively study the adhesive properties of hepatoma cells to collagen Ⅳ coated artificial basement membrane and to investigate the relevance of cell adhesive forces to the concentration of collagen Ⅳ.
Methods: Synchronous G1 and S phase cells were achieved using thymine-2-desoxyriboside and cochicine sequential blockage method and double thymine-2-desoxyriboside blockage method respectively. The adhesive forces of hepatoma cells were investigated by micropipette aspiration technique.
Results: The adhesive forces of hepatoma cells to artificial basement membrane were (107.78±65.44)×10-10N, (182.60±107.88)×10-10N, (298.91±144.13)×10-10N when the concentration of the membrane coated by 1, 2, 5 μg/ml collagen Ⅳrespectively (P<0.001). The adhesive forces of G1 and S phases hepatoma cells to artificial basement membrane were (275.86±232.80)×10-10N and (161.16±120.40)×10-10N respectively when the concentration of the membrane coated by 5 μg/ml collagen Ⅳ (P<0.001).
Conclusions: The adhesive forces of hepatoma cells to artifical basement membrane in direct proportion to the concentration of collagen Ⅳ suggests that the increase of basement membrane might be conducive to the chemotactic motion and adhesiveness of tumor cells. G1 phase cells are more capable of adhering to basement membrane than S phase cells. Hepatoma cells, especially G1 phase cells, may survive in blood circulation, and sequest and adhere in microcirculation, and get through basement membrane for remote metastasis.

Objective: To observe the expression of the A melanoma antigen (MAGE), G melanoma antigen (GAGE) and B melanoma antigen (BAGE) genes in human hepatocellular carcinoma cell lines.
Methods: The MAGE-1,MAGE-3,GAGE1-8,GAGE1-2 and BAGE mRNA lever in hepatocellular carcinoma cell lines SMMC-7721, QQY-7701, BEL-7402 were studied by reverse transcription polymerase chain reaction and were compared with biopsied liver tissues.
Results: MAGE-1 and BAGE mRNA were expressed in SMMC-7721, MAGE-3 and BAGE in QGY-7701, MAGE-1 and GAGE1-2 in BEL-7402. None of these genes was expressed in biopsied liver tissues.
Conclusions: MAGE-1, MAGE-3, GAGE1-8, GAGE1-2 and BAGE were expressed in hepatocellular carcinoma cell lines, respectively. These tumor-specific antigens can be used as molecular markers and possible targets of immunotherapy for patients with hepatocellular carcinoma.

Objective: To study relationship between apoptosis and invasive and metastatic potential of hepatocellular carcinoma(HCC).
Methods: Apoptotic rate (AR), proliferative index (PI) and S-phase fraction (SPF) were measured by flow cytometry, and p170, p21 and nucleoside diphosphate kinase (ndpk) by strept avidin-biotin complex immunohistochemical technique in 57 patients with HCC.
Results: In this group, AR was 1.77%±0.19%, SPF 12.55%±0.68%, and PI 20.91%±1.12% (r=-0.173). p170, p21 and ndpk positive rates were 61.36%, 68.18%, 52.27% respectively in patients with a mean AR of ≤1.77%, and 23.08%, 38.46%, 84.62% respectively in patients with a mean AR of >1.77% (all P<0.05). In patients with positive tumor invasiveness and metastasis, ndpk (+) was 43.75%, p21 (+) 75.00%, p170 (+) 65.63%, AR 1.12%±0.16%, PI 23.78%±1.48%, and SPF 13.90%±0.99%. In patients with negative invasiveness and metastasis, however, ndpk (+) was 80.00%, p21 (+) 44.00%, p170 (+) 36.00%, AR 2.32%±0.52%, PI 18.53%±0.82% and SPF 11.43%±0.70%.
Conclusion: Apoptosis of HCC is negatively correlated with its invasive and metastatic potential or other factors as proliferative activity, p21, p170 and ndpk.

Objective: To study the potential role of macrophage migration inhibitory factor (MIF), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the development of chronic virus hepatitis B (CH) and hepatitis cirrhosis (HC).
Methods: The serum concentrations of MIF, TNF-α and IL-6 in 18 patients with chronic virus hepatitis B and in 14 patients with hepatitis cirrhosis without ascitic fluid, and the serum and ascites cytokine concentrations in 22 HC patients with ascitic fluid were detected by enzyme linked immunity sorbed assay.
Results: The cytokine concentrations of the patients were significantly higher than those of the controls. The serum levels of MIF, TNF-α and IL-6 of the 22 patients with ascitic fluid were higer than those of 14 HC patients without ascites. In the 18 patients with CH, the serum cytokine concentrations were the lowest. The serum cytokine concentrations of the 22 HC patients with ascites were significantly higher than those of the 14 HC patients without ascites (P<0.01). Their serum cytokine concentrations were significantly higher than those in the 18 patients with CH (P<0.01). The concentration of IL-6 in ascites was the highest among all the groups. The serum le-vels of MIF, TNF-α and IL-6 are correlated with alanine aminotransferase (ALT) in the patients with CH, but not in those with HC with or without ascites.
Conclusions: These results indicated that MIF, TNF-α and IL-6 may participate in the pathological process of CH and cirrhosis, that IL-6 seems to play an important role in ascites formation, and that se-rum levels of MIF, TNF-α and IL-6 appear to reflect the severity of tissue injury in HBV disease.

Objectives: To analyze the clinical features of uncinate process carcinoma of the pancreas and to improve the resection rate.
Methods: From January 1990 to June 1999, 10 patients with pancreas uncinate process carcinoma received Whipple’s operation. Portal vein (PV) resection and reanastomosis were performed in 5 patients, and the resected length varied from 2.0 to 4.2 cm. Two patients underwent PV lateral wall partial resection.
Results: Among the 7 patients undergoing PV resection, 1 died of hepatic failure 3 days after operation. One patient suffered from postoperative chylous ascites. These 6 patients survived 13 to 29 months postoperatively. Among the 3 patients without PV resection, 2 survived 13 months and 14 months respectively. One patient was alive by the end of follow-up for 11.5 months postoperatively.
Conclusion: Although uncinate process carcinoma of the pancreas has a tendency to invade the adjacent PV and superior mesentery vein, it should not be simply regarded as a contraindication of radical resection.

Background: Portal biliopathy producing intrahepatic and extrahepatic biliary ductal abnormalities from portal hypertension, particularly with extrahepatic portal vein obstruction (EHPVO) is common. A majority of these patients are asymptomatic, but occasionally there is symptomatic biliary obstruction, and cholangitis and choledocholithiasis.
Objective: To explore the principles of diagnosis and treatment of portal biliopathy.
Data sources: To review the literature of portal biliopathy.
Conclusions: Endoscopic sphincterotomy, stone extraction and supportive drainage could effectively relieve cholangitis when jaundice is associated with common bile duct stones. Definitive decompressive portal-system vein shunting operation and choledocho-jejunostomy are sometimes required when biliary obstruction is recurrent and progressive.

Objective: To determine the role of mononuclear macrophages in the pathogenesis of acute lung injury during acute obstructive cholangitis.
Methods: Sixty Wistar rats were used to study the correlation between the behavior of mononuclear macrophages and acute pulmonary injury during acute obstructive cholangitis (AOC). Animal model of AOC was made according to the method that the common bile duct was injected with Escherichia coli and ligated. The rats were killed at 6 h, 12 h, 24 h and 48 h after operation. The phagocytic function of Kupffer cells (KCs), the number of alveolar macrophages (AMs) in bronchoalveolar lavage liquid, and the extravascular water content of lung tissue were measured. The levels of lipid peroxide (LPO) and supperoxide dismutase (SOD) were determined too. Pathological alterations of liver and lung tissue were observed under light and electron microscopes.
Results: KCs phagocytic function was significantly elevated at the 6th hour but markedly decreased from the 24th hour to the 48th hour in the AOC group as compared with the control (P<0.05). From the 12th to the 48th hour, the number of AMs, the extravascular water content of lung tissue, and the content of LPO significantly increased, but the SOD level of lung tissue decreased greatly (P<0.05). Morphologically, KCs proliferated diffusely in the early period in livers of the AOC group, but decreased markedly in the late period. Mitochondria of KCs were swollen or even vacuolated; focal cytoplasmic degeneration and many myeli like figures could be seen in the cytoplasm. The changes of injury such as disturbance of pulmonary capillary blood circulation, degeneration and/or necrosis of the lung tissue and endothelium, and inflammatory reactions could be observed. In other two groups, no evident morphological changes were observed.
Conclusions: KCs phagocytic function is decreased, whereas AM is activated by the invading bacteria to release such inflammatory mediators as free radicals, resulting in acute pulmonary injury. It seems that there is a close relationship between the functional status of mononuclear macrophages and the development of acute lung injury. The dysfunction of mononuclear macrophages may play an important role in the pathogenesis of multiple organ damage, especially acute pulmonary injury.

Objective: To evaluate the relation of laparotomy timing to the prognosis in patients with acute necrotizing pancreatitis (ANP).
Methods: The laparotomy timing, morbidity, mortality and reoperation rate were reviewed in 78 patients with ANP at our hospital from 1988 to 2001.
Results: The morbidity rates of early operation, delayed operation and non-operation groups were 68.7%, 34.2% and 29.1%, respectively, and their mortality rates were 37.5%, 10.5% and 12.5%. The reoperation rates in early operation and delayed operation groups were 87.5% and 18.4%, respectively.
Conclusions: The strategy for the management of ANP is an important factor influencing the prognosis of ANP patients. For ANP, delayed operation if necessary is more preferable than early operation in terms of better prognosis, and surgery should be simple and free from severe trauma.

Objective: To probe the potential use of duodenoscopy in the diagnosis and treatment of acute gallstone pancreatitis (GP).
Methods: Fourty-five patients with acute GP were randomly divided into endoscopic retrograde cholangiopancreatography (ERCP) group (n=20) and non-ERCP group (n=25). Each group was subdivided into mild and severe groups according to APACHE II scores. They were given supportive treatment combined with traditional Chinese medicine. The patients in the ERCP group received ERCP within 24 hours after admission. If there were stones in the common bile duct with stenosis of the inferior extremity or ampulla, endoscopic sphincterotomy (ES) was performed to extract the stones by basket. If no calculi were identified or multiple stones were large, endoscopic naso-biliary drainage (ENBD) was carried out.
Results: The incidence of complication, length of hospitalization and cost were markedly lower in patients with severe acute GP in the ERCP group than those in the non-ERCP group (P<0.05), in contrast to the 2 mild subgroups of the ERCP and non-ERCP groups (P>0.05).
Conclusion: It is feasible, effective and safe to apply duodenoscopy in the treatment of severe acute GP.

Objective: To explore the way to lower the morbidity and mortality of patients after pancreaticoduodenectomy.
Methods: Between March 1998 and March 2001, 26 patients with periampullary tumors received pancreaticoduodenectomy (PD) with Roux-Y anastomosis to reconstruct the digestive tract. Of these patients, 6 had ductal cell carcinoma at the head of the pancreas, 8 distal common bile duct carcinoma, 5 ampullar adenocarcinoma of the Vater, 6 duodenal adenocarcinoma, and 1 duodenal malignant lynphoma. A 30-40 cm free vascularized segment of the proximal jejunum was taken and pulled up to the bed of the duodenum for end-to-end pancreaticojejunostomy, end-to-side choledocojejunostomy or side-to-side jejunojejunostomy by a single loop.
Results: The operative mortality was zero. Postoperative intraabdominal hemorrhage occurred in 2 patients, but no leakage during pancreaticojejunostomy or choledocojejunostomy as well as abdominal infection. The patients were discharged from the hospital on the tenth to fourteenth day after operation. Follow-up for 5 to 36 months (mean 21 months) revealed chronic steatorrhea and malnutrition in one patient (3.85%), and good digestive function and normal nutritional status in 25 (96.15%). No bile reflux gastritis, retrograde infection, anastomotic ulcer, and dumping syndrome were observed.
Conclusion: Our results show that this procedure can effectively reduce the morbidity and mortality of patients after PD.

Objectives: To evaluate the specific manifestations of pancreatic carcinoma on spiral multi-phase CT and its resectability before operation.
Methods: Ninety-seven patients were confirmed operatively and pathologically. Enhanced CT scan was performed with intravenous injection bolus of approximately 75-120 ml (1-1.5 ml/kg body weight) contrast medium at a rate of 2.5-3 ml/s. In 68 patients receiving dual-phase scan, the delayed scan time of arterial and venous phases was 18-20 s and 60-70 s, respectively, and in 29 patients receiving three-phase scan, the delayed scan time of arterial, pancreatic and portal venous phases was 18 s, 40 s and 75 s, respectively, with a slice of 3-5 mm thickness, a pitch of 1-1.5, and a reconstruction interval of 2.5-4.8 mm.
Results: Positive and negative predictive values of unresectable tumors were 97.65% and 75.86%, respectively. The sensitivity and accuracy were 90.67% and 90.72%, respectively. Positive predictive values of dual-phase and three-phase were 95.83% and 100%, respectively; negative predictive values were 75% and 77.78%, respectively.
Conclusions: Spiral multi-phase CT is superior in revealing the involvement of peripancreatic vessels, the invasion of the neighboring organs, the size, shape and range of carcinoma, and the metastasis of liver and lymph node. The predictability of resection is obviously increased for patients with pancreatic carcinoma.

Objective: To detect the relations of c-erbB-2 oncogene protein, epidermal growth factor receptor (EGFR) and transforming growth factor-β1 (TGF-β1) to the progression or metastasis of pancreatic carcinoma.
Methods: Using streptavidinbiotin complex (SABC) method, c-erbB-2 oncongene protein, we examined immunohistochemically EGFR and TGF-β1 expressions in wax-tissue sections from 10 individuals with normal pancreas (NP), 13 patients with chronic pancreatitis (CP) and 36 patients with pancreatic ductal adenocarcinoma (PC).
Results: The positive expression rates of c-cerbB-2 oncogene protein, EGFR and TGF-β1 in the NP, CP and PC groups were 0, 0, 10%; 7.7%, 7.7%, 7.7%; and 41.7%, 50.0%, 44.4%, respectively. The positive expression rates of the three specific proteins increased more significantly in the PC group than in the NP and CP groups (P <0.05). The individual expression of c-erbB-2, EGFR and TGF-β1 was not related to the age and sex of the patients as well as the site, size and histopathological grade of tumors (P >0.05), but to the clinical stage of tumors (P <0.01). The coexpression rate of the three proteins was 27.8% (10/36). This coexpression in the PC group was correlated with the histopathological grades and clinical stages of tumors (P <0.01).
Conclusion: Detection of c-erbB-2 oncogene protein, EGFR, and TGF-β1 expressions in pancreatic tissue is helpful to judge the malignancy, progression, and metastasis of PC.

Objective: To clarify the relationship between loss of DPC4 gene expression and pathogenesis of pancreatobiliary carcinoma.
Methods: 75 slides of normal duct (20), hyperplasia (15), dysplasia (15), invasive carcinoma (25) from patients with pancreatic diseases including pancreatic carcinoma (25 patients), chronic pancreatitis (6), pancreas injury (2) and 71 slides of common bile duct (CBD) carcinoma (38), gallbladder carcinoma (18), hilar bile duct (HBD) carcinoma (15) from patients with primary biliary tract carcinoma were analyzed for the expression of DPC4 protein by immunohistochemical staining.
Results: All specimens from 20 cases of normal duct and 15 cases of hyperplasia showed marked expression of DPC4 protein. The frequency of loss expression of the DPC4 gene was 33% in dysplasia, and 48% in invasive carcinoma. There was a significant statistical difference between hyperplasia and dysplasia (P<0.01) and in dysplasia vs invasive carcinoma (P<0.05). The frequency of loss expression of the DPC4 gene was 47.3% in CBD carcinoma, 11% in gallbladder carcinoma, and 13% in HBD carcinoma. The frequency of loss expression of the DPC4 gene was significantly different in CBD carcinoma vs gallbladder carcinoma and HBD carcinoma (P<0.01).
Conclusions: Inactivation of the DPC4 gene occurs late in the neoplastic progression of pancreatic carcinoma. The frequency of DPC4 gene alternation was different in various locations of biliary tract carcinoma. In CBD carcinoma, this frequency is similar to that in pancreatic carcinoma, indicating their similar molecular alternations.