Volume 88  ·   Issue 39  ·  2008

Minimally invasive medicine and biomedicine have become the two major trends and hotspots of medical development in the 21st century, and they are an important part of comprehensive tumor treatment. Modern minimally invasive tumor treatment is a modern tumor treatment method based on medical imaging, oriented and guided by medical imaging equipment and technology, integrating advanced medical imaging technology, drug therapy, biology, gene technology and high-tech medical technology (such as radiofrequency ablation, argon-helium cryoablation, particle implantation, laser, ultrasound focusing, endoscopy, endoscopy, photodynamic therapy, etc.), with the advantages of precise positioning, precise treatment, less trauma, less pain and exact curative effect.

Objective To investigate the efficacy and safety of radiofrequency ablation (RFA) intreatment of advanced lung cancer. Methods Seventy-eight patients with advanced local lung cancer weretreated with RFA at the temperature from 70 ℃ to 90 ℃ under local or intravenous anesthesia under CT scanfor 8 minutes to 26 minutes. 103 times of RFA were done in 78 patients , 19 of them being treated twice and2 treated tree times. Followed up was conducted for 1 -6 months. The outcomes were evaluated by plain andcontrast spiral CT scanning. Results During RFA 32 patients felt pain, and 18 patients experienced coughand hemoptysis. After RFA pneumothorax was seen in 18 of the patients, and contrast spiral CT scanningshowed devascularization and/or reduction of tumor size in 67 lesions. Conclusion Removing tumor loadrapidly and with excellent short-term outcome, percutaneous RAF is safe to treat advanced local lung cancer.

Objective To explore the value of CT guided radiofrequency ablation (RFA) intreatment of post-operational resectable liver metastatic tumors from colorectal carcinoma. Methods Thirty-seven patients with 52 resectable liver metastatic tumors from colorectal carcinoma underwent CT guidedRFA. CT, MRI, ultrasonography, and/or PET/CT were conducted after RFA every 2 months. Results of thisstudy were compared with data from literatures about surgical resection applied in liver metastases fromcolorectal carcinoma. Results Abdominal bleeding and abdominal infection occurred in 1 patientrespectively (2.7% ,1/37 ). No treatment-induced death occurred. The total complication rate was 5.4%.The median survival time of the patients treated by RFA was 39.8 months. The 3-year survival rate was42.6%. Conclusion With the clinical value similar to that of surgical resection, CT guided RFA can beone of the first choices for post-operational resectable liver metastatic tumors from colorectal carcinoma thanksto minimal invasion and low complication rate.

Objective To evaluate the long-term outcome and its relative influenced factors ofinterventional therapy in dealing malignant biliary obstruction (MBO). Method 109 MBO patients, 54males and 55 females, aged (71±12), underwent interventional therapy: 55 patients received percutaneoustranshepatic cholangiography and drainage (PTCD), and 54 underwent bile duct stent implantation. Oneweek later, total bilirubin (TB), direct bilirubin (DB), and alanine transaminase (ALT) were examined,and Child-Pugh scoring was conducted. 38 of the patient underwent transcatheter arterial chemo-embolization(TACE). Results One week after drainage the levels of ALT, TB, and DB of the patients undergoingPTCD and stent implantation all decreased in comparison with those before the treatment, the levels of thestent implantation group being significandy lower than those of the PTCD group ( P = 0. 019, 0.002, and0.002 respectively), but there was no significant difference in Child-Pugh scale between these 2 group (P =0.396). One week after TACE the levels of TB, DB, and Child-Pugh scale of the TACE group were allsignificantly lower than those of the patients without TACE ( P = 0.000, 0.002, and 0.002 respectively),however, there was no significant difference in ALT level between these 2 groups ( P = 0.834 ). Thecumulative mean survival time was 26.45 weeks [standard error (SE) 4.07], and the mean survival time ofthe PTCD group was 28.19 weeks( SE,6.54), not significantly different from that of the stenting groups were[21.38 weeks( SE,2.51 ) ,P = 0.713 ]. The mean survival time of the TACE group was 43.71 weeks ( SE,8.32), significantly longer than that of the patients without TACE [ 14.38 weeks ( SE,2.66) ,P =0.000].Conclusion Stenting is more effective than PTCD on relieving jaundice when the decreasing extent ofbilirubin level is concerned. TACE therapy following PTCD and stent implantation will significantly contributeto the survival time of MBO patients.

Objective To investigate the clinical value of CT guided radioactive seed 125Iimplantation in treating bone metastasis. Methods 28 multiple bone metastatic tumor patients with 116metastatic lesions totally, adenocarcinoma of lung in 6 cases, squamous cell carcinoma of lung, renal clear-cell carcinoma, and carcinoma of prostate in 4 cases each, hepatocellular carcinoma and colon carcinoma in3 cases each, breast carcinoma in 2 cases, and malignant schwannoma and pancreatic cancer in 1 case each,13 males and 15 females, aged 49.8, underwent CT guided radioactive seed125I implantation into bonemetastatic lesions. Results In these 28 cases, complete pain relief (CR) was observed in 16 cases, partialrelief (PR) in 7 cases, and no change (NC) in 5 cases with an effective rate of 82. 1%. Among the 116lesions in these 28 cases local control (LC) was seen in 93 cases, NC in 17, and PD in 6. The responserate was 80. 2%. Conclusion CT guided radioactive seed 125I implantation procedure has good clinicaleffects in treating bone metastasis with minimal invasive and few complications.

Objective To investigate the clinical effects of total knee arthroplasty in treatment ofankylosed knee caused by various reasons. Methods Four patients with 7 ankylosed knees, caused byankylosing spondylitis in 1 case, septic arthritis with bony ankylosis in 1 case, and rheumatoid arthritis in 2cases, underwent artificial knee replacement. Before the operation joint activity was 0°, Knee Society score(KSS) was 42 (11 - 63), and the function score was 17. Follow-up was conducted for 5 - 27months. Results Follow-up showed that the average joint activity was raised to 83° (60° - 110°) ,KSSscore to 83 (64 -91) points,and function score to 77 points. No infectious case was found. Conclusion Totalknee arthroplasty has a satisfactory effect in treatment of ankylosed knee. Computer assisted navigationsystem is helpful in femoro-tibial osteotomy and soft tissue balance. Individualized and directed rehabilitationis a pivotal factor.

Objective To investigate the clinicopathologic characteristics of familiar gastric cancer(FGC) in Chinese. Methods A family with FGC was screened. China National Knowledge Infrastructurewas retrieved,and fifteen families with FGC were collected. Systematic literature review was carried out onthese sixteen families. Results There were 63 cases of FGC in these 16 families, 38 males and 25 females,aged 54 (30-72). The mean age of the parental patients was 61, older than that of the filial patients (43years ,Z = 3.494 ,P <0.01 ). There was a correlation between the ages of sibling patients (r5= 0.664, P <0.01 ). Among the 44 cases with clearly described tumor location, the tumor was located in the gastricantrum in 21 patients (47.7%). Among the 8 families with complete records of tumor location, 4 familiesshowed consistent tumor location. Accompanying other malignant tumors were seen in 7 families, 5 beingtumors in the alimentary canal. Conclusion The onset age of filial patients with FGC is younger than that ofthe parental patients in Chinese. The onset ages of the sibling cases are significantly correlated. In a specificfamily the tumor is nearly located at the same places. And most of tumors are located in gastric antrum. Mostof the accompanying tumors are alimentary canal tumors.

Objective To investigate the clinical effect of multi-point aspiration combined withcontinuous irrigation with urokinase in treating great hematoma as the result of brain hemorrhage due tohypertension. Methods Ninety-four patients with great hematoma as the result of brain hemorrhage due tohypertension, aged 70, were randomly divided into 2 equal groups: one point puncture group and muhi-pointpuncture group. Both groups underwent puncture under local or general anesthesia and were irrigated withurokinase continually. The outcomes were recorded and analyzed. Results The case-fatality rate of the multi-point puncture group was 10. 87, significantly lower than that of the one-point puncture group (20.83, P <0.05 ). The superiority rate of recovery of the multi-point group was 78.26%, significantly higher than thatof the one-point puncture group (64.58% ,P <0.05). In 15 days, the resolution rate of brain hematoma ofthe multi-point group was 67.43%, significantly higher than that of the one point puncture group (23.68%,P <0.01 ). The re-hemorrhage rate of the muhi-peint puncture group was 8.95%, significantly lower thanthat of the one-point puncture group ( 12.5% ,P < 0.05 ). Conclusion Multi-point puncture and continuousirrigation decrease the intracranial pressure quickly and suck the hematoma more effectively, especially forthe great and irregular hematoma of brain. Continuous urokinase irrigation-drainage is able to keep theconcentration of urokinase at an effective level, thus continuously washing, liquefying, draining, andresolving the brain hematoma.

Objective To investigate the expression level of Galectin-9 (Gal-9) in the serum ofcervical cancer patients and analyze the clinic significance of it. Methods Collected sera from 29 patientswith cervical cancer, 45 patients with cervical inter-epithelial lesion (CIN) and 26 normal females.Determination of Gal-9 was performed by ELISA, and in the group of patients with cervical cancer, theseresults were compared with the serum vascular endothelial growth factor (VEGF)and C-reactive protein(CRP). Then selecting four patients from the invasive cervical cancer group performed Gai-9 retrospectiveimmuno-staining analysis. Results Gal-9 concentration was 27.15 ng/L in the group of patients withcervical cancer that was significantly higher compared with the patients with CIN (21.20 ng/L) and thenormal females( 17.43 ng/L), and the Gal-9 concentration was significantly correlated with both VEGF andCRP in cervical cancer group. Two of these patients, who had a higher Gal-9 serum level, shown moreintense staining and the other two patients, with lower serum level of Gal-9, had moderate immunostaining,suggesting that at least part of serum Gal-9 might be produced by cervical cancer tissue. Conclusions Gai-9 might play a role in the progression and invasion of cervical cancer and warrants further study.

Objective To compare the enhancement pattern of low mechanicalindex contrast-enhanced ultrasonography (CEUS) in peripheral lung carcinoma with contrast-enhanced helical CT (CECT).Methods Thirty-five patients with peripheral lung carcinoma underwent CEUS performed with the contrastagent SonoVue at a low mechanical index contrast specific mode and CECT performed with the contrast agentUltravist at a standard biphasic helical CT scaning protocol. The enhancement pattern related to tumorvascularity was analyzed. Results By using contrast-enhanced sonography, hyper-enhancement patterns weremanifested in 57.1% (20/35) of the lesions and hypo-enhancement in 40% (14/35); both notsignificantly different from those manifested by using CECT [42.9% (15/35) and 54. 3% (19/35) of thelesions respectively, both P > 0.05 ]. By using CEUS, inhomogenous enhancement pattern rate in the lesionswas 68.6% (24/35) and the homogeneous enhancement rate was 28.6% (10/35), both not significantlydifferent from those of the CECT group [74.3% (26/35) and 22.9% (8/35) respectively, both P> 0.05 ].The non-enhancement rates of CEUS and CECT groupd were both 2.9% (1/35). The enhancement intensitydB value of the CEUS group was positively correlated with the CT value of the CECT tumors ( r = 0.836,P <0.001 ). Conclusion The diagnotic value of contrast-enhanced sonography is similar to that ofenhancement CT in detecting peripheral lung carcinoma's vascularity.

Objective To investigate the difference between the spiral tibial shaft fracture combinedwith ipsilateral posterior malleolar fracture. (TSPMF) and simple ipsilateral posterior malleolar fracture inankle joint fracture in adults. Methods The sex, age, and type and mechanism of fracture of 82 patientswith tibial shaft fracture associated with ankle joint fracture (TAF) and 28 patients with tibial shaft spiralfracture associated with ipsilateral posterior malleolar fracture (TSPMF) among 1685 cases of adult tibial andfibular shaft fracture and 330 patients with posterior malleolar fracture among 1871 cases of simple ankle jointfracture were analyzed. Results The mean age of the 28 cases with TSPMF, 24 males and 4 females, was(41.1±11.8 ). The mean age of the 330 cases with simple posterior malleolar fracture, 187 males and 143females, was (42.6±15.9). The incidence of posterior malleolar fracture in the TAF patients was 34. 1%(28/82), significantly higher than that of the simple ankle joint fracture [ 17.6%, 330/1871 ,P =0. 000].The rate of combined external malleolus and posterior maileolus in the TSPMF patients was 17.9% (5/28),significantly that in the patients with simple ankle joint fracture (73. 7%, 159/330, P =0. 000). The fibularfracture line of 75.0% (21/28) of the TSPMF patients was located over the level of the lower tibiofibularligament union, a rate significantly higher than that in the simple melleolus fracture (24. 8%, 82/330,P =0.000). Conclusion Spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture is aspecial kind of fracture; the cause and mechanism of TSPMF are difference from those of the ankle jointfracture.

Objective To study the electrophysiological and pathological features of Kennedydisease (KD) and to make sure the functional and anatomical change of the sensory nerve of KDpatients. Methods Electrophysiological and pathological tests were performed in 14 KD patients, includingelectromyogram, conduction velocities of median, ulnar, peroneal, tibial, and sural nerves, trigemino-cervical reflex(TCR), contact heat evoked potential(CHEP) , and biopsy of the sural nerves. During TCR,the patients lay on the back, holding the heads slightly raised to make the sternocleidomastoid musclescontract slightly. Electrical stimuli were applied to the infraorbital nerves and recording electrodes wereplaced in the sternocleidomastoid muscles. For CHEP, contact heat was delivered via a circular thermode toexcite selectively nociceptors with a rapid rising time at 70℃/s to elicit pain and CHEP. Thermal stimuliwere sent at 54.5℃ to three body sites: skin of back of hand, proximal volar forarm, and C7. The CHEPswere recorded from Cz and Pz. Results The sensory conduction velocity and latency were almost normal,while the amplitude of the sensory nerve action potential(SNAP) declined to O. 65 -2. 85 μV. The latency oftrigemino-cervical reflex was longer than normal with the onset peak latency of (38.9±7.0 ) ms. Theconfiguration was asymmetric. The onset peak latencies when the skin of the back of hand, volar surface offorearm, and C7 were stimulated were (613±57), (595±32), and (489±37) ms respectively. Biopsy ofthe sural nerves showed that the large myelinated nerve fiber was decreased. Conclusion Sensory nerve isinvolved in the patients with Kennedy disease, including the large and small fibers.

Objective To investigate the value of abnormal muscle response (AMR) monitoringduring microvascular decompression (MVD) for hemifacial spasm (HFS) and compare the outcomes of thepatients undergoing AMR or not. Methods 234 HFS patients, aged (45.2±12.5) (25 -76), undergoingMVD were randomly divided into 2 groups:199 of them underwent AMR monitoring intra-operatively and 35not. No muscle relaxant was used. The zygomatic branch of the facial nerve was stimulated electrically and theAMR of the ipsilateral mental muscle was recorded. The relationship between AMR monitoring results andfinal surgical outcome was analyzed. Results Before incision of dura mater, all patients showedcharacteristic AMR of HFS. AMR disappeared in 165 patients ( 82.9% ) after MVD of the facial nerveroot. HFS disappeared shordy after operation in 144 of the 165 patients with disappearance of AMR, and onlyin 8 of the 34 patients with persistent AMR. Follow-up lasting for more than 1 year showed that HFSdisappeared in 157 of the 181 patients of the AMR group, and in 24 of the 35 patients who had notundergone AMR monitoring during operation. Conclusion Helping differentiate the responsible vessel, toassess the effect of decompression, and to predict the postoperative course of MVD, AMR monitoringimproves the long-term outcome of HFS treated with MVD.

Objective To explore the effect of stereotactic resection of small intracerebral lesionslocated in the motor cortex using blood oxygen level depended functional magnetic resonance imaging(BOLD-fMRI) and diffusion tensor imaging (DTI) fusion guidance. Methods Fifteen patients with lesionsin posterior frontal lobe to anterior central gyms, 1.5 - 3 cm in diameter, underwent combined three-dimensional (3D) enhancement MRI with BOLD-fMRI, and DTI. Computer procedure was used to performthe images fusion to show directly the lesions, motor cortex, and corticospinal tract, and to confirm theirposition relationship and design the operative approach so as to guide the stereotactic resection of the smallintracerebral lesions. Results The images fusion demonstrated that the motor cortex and corticospinal tractwere located in the lateral-posterior side of the lesions, and were both compressed, deformated anddisplaced. Total removal of the lesions under microscope was achieved in 12 cases, and subtotal removal in 3cases. Histological examination showed 3 cases of meningeoma, 3 cases of astrocytoma of grade Ⅱ , 2 casesof astrocytoma of grade Ⅲ, 2 cases of abscess, and 2 cases of cavernous angioma. No complication wasfound postoperatively. Conclusion Mutual complementarity can be achieved by combining 3D-enhancementMRI,BOLD-fMRI, and DTI. Stereotactic resection of the small intracerebral lesions is safe, accurate andeffective under the images fusion guidance.

Objective To study the effects of demographic variables, surgery-related uncertaintyand other related variables on preoperative anxiety and depression in patients undergoing selective cardiacsurgery. Methods 103 patients who were scheduled for cardiac surgery were investigated by using HospitalAnxiety and Depression Scale (HADS) and a self-made questionnaire, and the related influencing factorswere analyzed. Results The positive rates of anxiety, depression, and both anxiety and depression were27%, 20%, and 14% respectively. The anxiety score of the female patients was (7.3±3.8), significantlyhigher than that of the male patients [ (4.3±3.2), T(97) =3.41 ,P <0.01 ]. The depression score of thefemale patients was (6.4±3.4), significantly higher than that of the male patients [ (4.3±3.2) ,T(97) =2.98 ,P <0.01 ]. The education background had no significant influence on anxiety score [ F(3,98) = 1.06,P = 0.37 ]while had significant difference on depression score [ F ( 3, 98 ) = 4. 10, P < 0.01 ]. The threefactors reflecting the recognition of surgery-related uncertainty, "what I thought is all about the surgery","I'm worrying about the possible failure of surgery" and "I'm worrying about the possible unsatisfiedconvalescence", showed very significant effects on the anxiety and depression scores (all P<0.01).Conclusion The state of preoperative anxiety and depression of the cardiac surgical patients are influencedby multiple factors, which should be considered in clinical practice. Recognition of surgery-relateduncertainty is one of the most important influencing factors that can predict the state of preoperative anxietyand depression.

Objective To detect the expression patterns of Notch, and Jagged1 in the hippocampusof focal ischemia and find out whether the Notch pathway is involved in the regulation of the differentiation ofthe proliferated neural precursor cells in the dentate gyms under ischemic conditions. Methods 42 SD ratswere randomly divided into 3 equal groups: middle cerebral artery occlusion (MCAO) group undergoingMCAO by intraluminal thread technique so as to cause focal cerebral infarction, sham operation group, andnormal control group. 19 and 28 days after the operation 6 rats in each group were killed with theirhippocampuses taken out. The protein and mRNA levels of Notch1 and Jagged1 in hippocampus were assayedrespectively by Western blotting and real-time reverse-transcription PCR. Results The protein and mRNAexpression levels of Notch1 on the 19th day of the MCAO group were up-regulated, both significantly higherthan those of the sham operation and control groups ( all P < 0.05 ). The protein and mRNA expressionlevels of Notch, on the 28th day of the MCAO group were both significantly lower than those of the samegroup on the 19th day ( both P < 0.01 ), and were lower than those of the sham operation and control groupson the 28th day, however, not significantly ( all P > 0.05 ). The protein and mRNA expression levels ofJagged1 on the 19th and 28th days of the MCAO group were significantly higher than those of the sham andcontrol groups ( all P < 0.05 ), however, there were not significant differences in the protein and mRNAexpression levels of Jagged1 on the 19th and 28th days of the MCAO group (all P >0.05). Conclusion Theprotein and gnne expression of Notch, and Jagged, vary dynamically in the hippocampus of focal ischemia,which suggests that the Notch pathway may be a potential mechanism in the regulation of the neurogenesis inthe dentate gyrus of hippocampus.

Objective To research the changes of cisplatin sensitivity by RNA interfering theexcision repair cross-complementing (ERCC) 1 gene in lung cancer cell lines. Methods The smallinterference RNA (siRNA) targeting ERCC1 gene was designed and synthesized by transcription in vitro, andtransfected to lung cancer cell line A549. The mRNA and protein of ERCCI were evaluated by means of RT-PCR, Western blot and immunocytochemistry. The changes of cisplatin sensitivity after interference wereexamined by methyl thiazolyl tetrazolium(MTT) assay. Results In A549 cell, the mRNA and protein levelsof ERCC1 were dramatically decreased 24, 48 and 72 hours after transfection. The sensitivity to cisplatin ofA549 cell line was increased by 3.07 times after disturbing the ERCCI gene. Conclusions The sensitivityto cisplatin of lung cancer cell lines A549 could be enhanced by RNA interfering ERCC1 gene.

Objective To investigate the changes of structure and metabolism of the cartilage offemoral head overlying the bone defect in animal model and analyse the possible effect of the necrotic area ofthe femoral head on the cartilage overlying there. Methods 18 adult hybrid dogs was applied for bone defectmodel of femoral head. Of the femoral heads, the left was applied for bone defect model , the right for shame-operation. 5, 5, and 8 animals were sacreficed respectively 4, 12 and 24 weeks after operation and thefemoral heads were received for examinations. The X-rays films were taken just before the animals weresaereficed. After the cartilage specimens were decalcified, dehydrated and embedded, sections 6, u thickwere made. They were stained with hematoxylin-eosin, sirius-red and toilude blue. The biochemical assaywere performed. Results 12 and 24 weeks after operation of bone defect, cartilage histology andbiochemistry demonstrated the signs of articular cartilage pathological changes. The arrangement ofchondrocytes were disorder. The number of cbondrocytes decreased. The cartilage surface lost its smoothness,and these kinds of changes were more severe in the area next to the bone defect. Fibrosis and vasiformationwere found. Tidemark had the changes of discontinuation and veil. Glycosaminoglycansdecreased. Conclusion The bone defect, whose damaged structure strength and decreased blood supply issimilar, had effect on the structure and metabolism of the articular cartilage near the bone defect, and sugestosteonecrosis at the stage of pro- collapse may affect the cartilage overlying it.

Invasive hydatidiform mole is a common malignant tumor in women of gestational age, and its diagnostic value of MRI has not been reported. Noonan et al. [1] concluded that MRI has high value in the diagnosis and staging of trophoblastic tumors through magnetic resonance imaging of retention products of conception.

A 40-year-old female developed right lower abdominal pain without obvious trigger 10 days ago, persistent, accompanied by radiation to right shoulder and back. Physical examination showed no yellowing stain on the skin sclera, mild tenderness in the right upper abdomen, and no fever. Laboratory examination: urine routine (-), blood routine (-), AFP2.61, CEA 3.6, hepatitis B three-line negative. CT examination: plain scan showed a 93mm ×77mm ×66mm cystic-solid low density focus in the right liver, up to the parietal level of the diaphragm and down to the level of the first hepatic hilum.