Volume 90  ·   Issue 25  ·  2010

：Objective To discuss thelocalization diagnosis value of laparoscopic ultrasonography in laparoscopic surgery ofinsulinoma.Methods Retrospectively reviewed the results of laparoscopic uItrasonography in32 patients from Jan 2007 to Aug 2008 with insulinoma which confirmed after surgery,andanalyzed the detection rate of laparoscopic ultrasonography. Results Insulinoma tumolrswere success located in 31 patients among 32 patients by laparoscopic ultrasonography.Thedetection rate was 96.9% and the location accurate rate was 100%.Thirty-seven insulinomatumors were detected in 31 cases,including 29 solitary insulinoma and 2 multipleinsulinomas.One patient did not show a definite tumor in the pancresg and extrapancreaticorgan during the laparoscopic ultrasonography examination.Conclusion Laparoseopicultrasonography has a high detection rate in localizing diagnosis of insulinoma and canclear display the relationship between tumor and adjacent tissue.It is useful for surgeonto select the suitable operation modality.

Objective To evaluate the effect of positive end expiratory pressure on the bronchoalveolar lavage fluid (BALF) in pulmonary surfactant (PS) of patient during one lung ventilation anesthesia.Methods Patients undergoing Bullae resection were anesthetized with treatment (n=12) or control (n=12) combined anesthesia.Total phospholipid (TPL),saturated phesphatidylcholine (SatPC) and total protein (TP) in the bronchoalveolar lavage fluid (BALF) were measure.The ratio of SatPC/TPL% and SatPC/TP% represented the activity of PS.Results The thoracic surgery pulmonary surfactant significantly reduced,PEEP can prevent the decrease,but with decreased cardiac output Conclusion The end-expiratory pressure breathing can maintain the level of pulmonary surfactant to pmtect lung function.

Objective To explore the method and efficacy of microsurgery for anterior clinoidal meningiomas.Methods The clinical data of 53 patients with anterior clinoidal meningiomas treated from 1991-2009 were analyzed retrospectively.There were 15 males and 38 females.The age range was 33-65.5 years old (mean:45.5).All patients underwent micresurgery throush pterional,extended pterional,frontotemperal,frontotemperal and orbitozygomatic approaches.Results Of 53 patients,total,subtotal and partial resections were performed in 38,10 and 5 cases respectively.Postoperatively,48 patients recovered well,4 had mild disability,1 severe disability and no dead cage.Conclusion Mest anterior clinoidal meninglomas can be removed safely and effectively.Several approaches may be used to achieve the best resuIts.Microsurgical operation can offer a great aid in an effective resection of anterior clinoidal meningiomas and reduce the postoperative complications and mortality.Postoperative radiotherapy should be carried out for the residual tumor invading cavernous sinus or internal carotid artery.

Objective To evaluate the clinical characteristics of patients with depressive disorders at Department of Neurology in general hospitals.Methods A total of 596 consecutive patients with depressive symptoms,such as insomnia,or somatic symptoms were collected prospectively and those who were unable to answer the questionnaire were excluded.Data of demography and clinical characteristics were obtained from a questionnaire.The 17-item Hamilton depression rating scale (HDRS17) was used to identify the presence of depressive disorders. Case control method was employed to evaluate the clinical characteristics of patients with depressive disorders.Results Among all pailents,347 were diagnosed as depressive disorders (58.1%).The mean score of HDRS17 was 21.9±3.4.Fewer psychological symptoms were complained by patients with depressive disorder.The depressive mood was found in 146(41.2%),a loss of interost or pleasure 161 (46.4%) and depressive mood plus a loss of interest or pleasure 108 (31.3%).The factors of manual worker.lower education level.worse marital status.10wer economic statos,irregular lifestyle and coexisting medical conditions were associated with depressive disorders.The most frequent complaints of somatic symptoms were as follows:hard to fall asleep 254 (73.2%),early awakening 218(76.O%),poor memoory 219 (63.1%),fatigue 181(52.2%),palpitation 179(51.6%),dizziness 170(49.0%),headache 160(46.1%) and dyspnea 140 (40.3%).The mean number of somatic symptoms wag 6.87±2.78.The patients complaining of multiple somatic symptoms (≥4) was 322 (92.8%).The number of somatic symptoms was correlated with depressive disorders.Conclusions More minor depression and sonlatic symptoms are the main characteristics of patients with depressive disorder in general hospitals.

Objective To evaluate the clinical efficacy and minimal invasiveness of quadrant posterior distraction system in the posterior lumbar spondylolistbesis (LS) surgery.Methods Sixty-one LS paftients were randomly divided into two groups:quadrant posterior minimally invesive surgery system as invesive group (n=30) and traditional open surgery as open group (n=31).The clinical outcome of pain relief Was assessed by the scoring systems of visual analogue scale (VAS) and Oswestry disability index (ODI) for low back pain.Radiographic assessment:preoperative and 1-day,3-month and last follow-up (12 months) radiographs were analyzed including the index of relative posterior disc height. Results The scores of VAS and ODI of invasive group were less than open group at Months 3 and 12 post-operation (P<0.01).Relative posterior disc height of intra-operation and Month 3 was not significantly different (P>0.05).And there was only statistical significance difference within 12 months (P<0.05).At Month 12 post-operation.the fluctuating rate was slight. Condusion The minimally invasive operation with Quadrant is less traumatic to the patients traditional open operation in the protection of spinal stability,postoperative rehabilitation and radiographs.This new minimally invasive spine technique should be popularized.

Objective To compare several sequences of MRI and arthroscopy for detecting the ankle articular cartilage lesions and to evaluate the clinical outcome of special sequence of FS-3D-FISP.Methods Forty pailents (41 ankles) with iterative ankle pain who were scheduled for arthroseopy underwent MR scanning.including FS-3D-FISP.FSE T2WI and FSE PDWI sequences.The results of each sequence were then compared with the arthroseopic findings.Results Using arthroscopic results as the standard of reference,the FS-3D-FISP images had the higher sensitivity (92.86%) than the other two sequences.The FS-3D-FISP sequence wag well consistent with the result of arthroacopy. Kappa value (0.7590) was higher than the other two sequences (P<0.01).Conclusion As a favorable scanning sequence,FS-3D-FISP imaging can show the early-stage pathological changes of articular cartilage and it has an excellent correlation with the arthroseopic findings.A 3-D reconstruction is helpful to determine the location and the degree of lesion and obtain a more accurate classification to guide clinical decisions.

Objective To evaluate the complication rate and analyze its impact of multiple facts of CT-guided percutaneous lung automated cutting needle biopsies (ACNB) with extrapleural locating method (EPL).Methods Retrospective study where information was obtained from the department of medical imaging,the sign of complication after 480 cases CT-guided ACNB with EPL was observed and its relationship with multiple factors were analyzed by multiple logistic regression model.Results The diagnostic accuracy was made in 456 cages (95.0%).The length of the biopsy procedures was 16±2 min and the time of the biopsy needle in pulmonary parenchyma was <20 s.Senventy-one (14.8%) cases presented pneumothorax which include 7(1.5%) cases later pneumothorax,and 2 (0.4%) required chest tube insertions.The multivariate logistic regression analysis showed that emphysema,depth of intrapulmonal biopsy path and lesion size were sole effective factors of pneumothorax (OR=7.991,1.083,and 0.945 respectively).Lesions with emphysema,depth of intrapulmonal biopsy path and lesion size ≤10 mm had higher pneumothorax rates.Eight-seven (1 8.1%) cases presented pulmonary hemorrhage and twenty-six (5.4%) presented hemoptysis.The multivariate logistic regression analysis showed that depth of intrapulmonal biopsy path,emphysema,and number of pleural needle passes were sole effective factors (OR =1.143,0.712,and 0.521,respectively) of pulmonary hemorrhage.In patients with depth >10 mm or 20 mm.emphysema and number of pleural needle passes had higher hemorrhage rates.The multivariate logistic regression analysis showed that depth of intrapulmonal biopsy path and emphysema were sole effective factors (OR=1.077,and 0.578,respectively) of hemoptysis.Lesions with depth >20 mm had higher hemoptysis rate.One cage with pulmonary Cryptococcus presented pleural reaction,and three cases had the insistent pain.The total number of severe complications was 15 (3.1%) cases.Conclusion ACNB with EPL was a accurate method for diagnosing pulmonary lesions.ACNB can be safely performed,which reduces the rate of pneumothorax and hemorrhage.Pneumothorax rate was influenced by emphysema,depth of intrapulmonal biopsy path and lesion size ≤10 mm. Hemorrhage was related with depth > 10 mm or 20 mm,emphysema and number of pleural needle passes.Hemoptysis was related with depth of intrapulmonal biopsy path >20 mm.Later and severe complications should be considered in procedure.

Objective Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) has become a viable alternative to open surgical repair in the last decade.We report here our experience on the mid-term results of EVAR and analysis of the outcomes associated with endograft AAA repair.Methotis Between Nov 2002 and Mar 2007,26 patients with AAA were enrolled in a single institution.Indications for EVAR included unfavorable condition of body (eg.Heart,lung,or renal dysfunction,etc) for open surgery and maximum diameter of AAA>5.0 cm. Customized stent-grafts were Talent TM,Zenith and some of products made in China. All of the patients were followed up with ultrasonography or computed tomography angiography every 3 months first year after EVAR and every year after.Results The mean (SD) follow-up was 38.8+/-12.7 months (median,35.0 months;range,24 to 64 months), and no patients were lost to follow-up.All cause mortality was 15.4% (4/26),with all deaths occurring within the first 2 postoperative year;30-day mortality was 4.1%.No patient died during the operation.Completion angiography demonstrated successful sealing in 25 of 26 patients.There was no stent occlusion of renal atery.The mid term complication were observed including 2 type Ⅰ endoleak after 3 months of the operation, 2 sustained type Ⅱ endoleak caused by lumber artery,1 aneurysm of left fomoral artery after 16 months of operation.1 proximal neck dilation after 12 month of operation.The aneurysm sac size didn't increase significantly during follow time.except one of the type Ⅰ endoleak.Conclusions The mid-term results of EVAR support the continued use in patients with contraindications for traditional open surgery of AAA.Close surveillance is mandatory for endoleak.especially for type Ⅰ endoleak.Some proximal neck dilation can be caused by the stent-graft expansion,injury,and aortic pathological changes. Endoleak of type Ⅱ can not lead to enlargment of aneurysm sac probably.

Objective The discussion of risk factors of affecting the long-term patency ratio of stent planted in arteriosclerosis subclavian artery.Methods To analyse the correlation between preprocedural white blood cell count,antiplatelet agents therapy,residual stenosis in the stent,the preprocedural lesion degree of subclavian artery,serum lipid,blood sugar,blood press et al,and long-term patency of stent by Logistic regression.To explore the significant difference in preprocedural white blood cell count (WBC),antiplatelet agents therapy,residual stenosis,the preprocedural lesion degree of subclavian artery,serum lipid,blood sugar,blood press and so on between non-patency group (15patients) and patency group (139 patients).To compare the significant difference of patency ratio of stent at the end of the survey between higher WBC(>7.08 × 109/L) group (45patients) and lower WBC (≤7.08×109/L) group (109 patients) by χ2-test.Results Among 154 stents planted in subclavian artery,the patency ratio of 1-year was 96.1% (148/154), and that of 3-year was 88.5% (69/78).The risk factors of the descended patency ratio of stent are respectively the increasing preprocedural white blood cell count,no antiplatelet agents therapy and residual stenosis[ OR 3.135 (P<0.001,95%CI 1.781-5.519);OR 5.818 (P=0.005,95%CI 1.688-20.057) and OR 5.253 (P=0.014,95%CI 1.391-19.838) ].There is the significant difference in preprocedural WBC between non-patency group and patency group (t=-5.008,P<0.001,(8.15±1.59)×109/L(5.25×109/L-10.75×109/L)V8(6.01±1.36)×109/L(4.07×109/L-8.11×109/L).And there ale the significant differences in antiplatelet agents therapy and residual stenosis between them (P=0.002 and P=0.025).At the end of the survey,the patency ratio of stent in subclavian artery of higher and lower WBC group is respectively 71.1% (32/45) and 98.2% (107/109) (P<0.01).Conclusion It's sustainable antiplatelet agents therapy and decreased residual stenosis the stent that key elements to improve the long-term patency ratio of stent planted in subclavian artery.In addition,pay attention to that increasing white blood cell disturbs the long-term patency ratio of stent.

：Objective To explore the pattern of benign gynecologicdiseases in patients treated with tamoxifen for breast cancer.Methods A total of 163 cageswith breast cancer were followed up by gynecologists.The incidence rates of several benigngynecologic conditions were determined and were compared among women receiving tamoxifenand those not taking it.Results For a follow-up of 12-96 months,the incidence rates ofleiomyomas requiring therapy Was 9.20%.Compared with women not taking tamoxifen,thepatients taking tamoxifen had a lower incidence rate of leiomyomas (17.59% vs 32.72%) (P<0.05),the menopausal women takingtamoxifen had a greater incidence of endometrial lesions (P<0.05) and the premenopausalwomen taking tamoxifen had a greater incidence of ovarian cysts (P<0.05).ConclusionTamoxifen is a high risk factor for an increased risk of endometrial lesions formenopausal women and ovarian cysts for premenopausal women.But it acts as a protectivefactor for decreasing the incidence rate of leiomyomas.

Objective To investigate the frequencies of combining loss ofheterozygosity (LOH) of chromosome 1p/19q in gliomas of different pathologies and analyze the clinical factors correlated withcombining LOH by logistic regression.Methods Tumor samples from 127 giioma patients were collected.The status of 1p and 19q was evaluated by fluorescence in situ hybridization (FISH) and the frequencies of combining 1p/19q LOH in gliomas of different pathologies were analyzed.Results The frequencies of combining 1p/19q LOH in agtrocytic,oligoagtrocytic and oligodendrnglial tumors were 19.30%,50.00% and 80.77%respectively.The frequencies of combining 1p/19q LOH in oligoagtrocytic and oligodendroglial tumors were hisher than those in agtrocytic tumors (P<0.01) and the frequencies of combining 1p/19q LOH in oligedendroglial tumors was higher than those in oligoagtrocytic tumors (P<0.05).The frequencies of 1p/19q LOH in agtrocytic,oligoagtrocytic and oligodendroglial tumors were 12.28%,11.36 and 0 respectively.There Wag no significant correlation between combining 1p/19q LOH and age,gender and grade by logistic regression.Conclusion In gliomas,combining 1p/19q LOH is proved to be the most common pattern of chromosome deletion involving 1p or 19q. It is significantly correlated with oligedendrogiial component.Combining 1p/19q LOH may be valuable in the diagnosis,treatment and prognostic prediction for glioma with oligodendroglial component.

Objective To study the infection status of hepatitis B virus in ovarian granulosa cells of female hepatitis B carriers.Methods The foilicular fluid of 6 female carriers of hepatitis B (HBsAg+,HBeAg+,HBcAb+) was used to extract granule cells and prepare smears.The samples were detected via in situ hybridization by digoxin-labeled HBV-DNA probe.The color reaction system of alkaline phosphates was used.And the positive hybridization signal was purple blue.Results Three granulose cell samples.located at the nuclei of gcanulose cells.were HBV-DNA positive.Conclusion HBV DNA exists in the granulosa cells of hepatitis B patients.Thus HBV infection may be vertically transmitted to the offspring via the infected reproductive cells.

Objective To approach the value of perfusion-weighed and diffusion-weighted imaging at high field intensity (7.0 T) MR in research of the ischemic penumbra in acute cerebral infarction of rats.Methods Acute cerebral infarction of rat was induced by octluding middie cerebral artery (MCAO) with suture.Sixty SD rats were divided into six groups randomly of ten including sham operation group.and groups of MCAO for 0.5,1.5,3.6,24 h.Then all rats were examined by PWI,T1WI,T2WI and MRA at corresponding time point.Regional cerebral blood volume (rCBV),relative cerebral blood flow (rCBF),mean transit time (MTT) topographical maps were reconstructed and the relative values of rCBV,rCBF,MTT,DWI-derived (rVD) and PWI-derived (rVP) lesion volume were calculated.The outcomes of serial MRI were compared with TTC stain and pathological findings.Results Neither abnormal sisnal of MBI nor TTC stain or pathological changes were found in sham operation group.The rCBV.rCBF was significantly decreased but rMTT obviously extended of the area of middle cerebral artery blood-supply of each group of MCAO.The core of infarction was more serious than the edge of infarction. Abnormal signals were found in the MCA-supplying regions in the DWI and PWI of all of the groups of MCAO.The size of rVD became bigger with the time going on but no significant difference of rVP The size of rVP was larger than rVD before MCAO of 6h(P<0.05).There was no significant difference between PWI and DWI after 6 h (P>0.05) and also between TTC at 24 h and DWI after 3 h (P>0.05).Conclusion Perfusion-weighed and diffusion-weighted imaging at high field intensity (7.0 T) MR dynamic displaying the existence and the process of ischemic penumbra in acute cerebral infarction of rats provides a basis for further study.

Primary esophageal malignant melanoma is a rare malignant tumor derived from the basal cell layer of esophageal mucosa. From January 2008 to December 2008, there were 168 patients with esophageal malignant tumor operated on in the Department of Thoracic Surgery of Beijing Friendship Hospital affiliated to Capital Medical University, of which 3 were primary esophageal malignant melanoma. Based on this group of cases and combined with literature, the clinical and pathological characteristics of esophageal malignant melanoma were discussed, so as to provide help for clinical diagnosis, treatment and prognosis.

A 30-year-old female was admitted to the hospital on October 12, 2009 due to hematemesis, melena for 2 weeks and abdominal distension for 10 days. The patient vomited blood without inducement 2 weeks ago, with unknown amount, accompanied by melena, 2-3 times/d, about 300 ml each time, accompanied by palpitations, shortness of breath and fatigue; 10 days ago, I felt abdominal distension, consciously increased abdominal circumference, and there was no fever, anorexia, abdominal pain and diarrhea.

Clinical data A 28-year-old female was admitted to Peking Union Medical College Hospital on July 8, 2009 due to 36+6 weeks of pregnancy, polydipsia and polyuria for 20 days, and abnormal liver and kidney function for 3 days.

Less than 1% of patients with spinal cord injury (SCI) can recover their neurological function completely, and most of them leave serious sequela.Recent studies on the pathophysiology of spinal cord injury have found that the secondary injury leads to inflammatory infiltration, progressive ischemic necrosis and demyelination around the lesion, which plays an extremely adverse effect on neuronal regeneration and functional recovery. How to promote the repair and regeneration of injured neurons and restore the neurological function of the body has become the focus of SCI treatment.

Case 1: A 36-year-old female was admitted to hospital on August 9th, 2007 because she had no contraception and no pregnancy 6 years after induced abortion. The patient was 13 years old with menarche, regular menstruation, moderate amount and no pain.