Twenty-four cases of carcinoma of biliary duct, 6 of carcinoma of gallbladder and 19 of carcinoma of Vater's ampulla are reported. All of those 49 cases were con- firmed by operation and/or pathology.The diagnostic accuracy by endoscopic retragra-de cholangiopancreatography(ERCP)was 85.7%.The radiological appearances of carcinoma of biliary tract under ERCP were described and classified into 3 types, namely obstruction,stricture and polypoid types. The stricture type was further divided into 3 subtypes of occlusive,annular and diffuse stenosis.The obstruction type and occlusive stenosis type were more common. Carcinoma of gallbladder manifested as a constant filling defect with a wide base in the gallbladder, while carcinoma of ampulla as an irregularly bordered space occupying lesion in it, which could obstruct the biliary duct and/or pancreatic duct. The soft rattan-form change in intrahepatic biliary ducts was the characteristic manifestation of malignant tumor of biliary tract.

Abandon of treatment and euthanasia is a hot topic on the medical ethics.The issue includes the ethical significance,the definition of criteria,the ethical disputes,the legislation,the basic procedure and so on.The paper comprehensive analyzes these issues in different respects and make the necessary explanation.

Personalized therapy has became a main method to break through efficacy of chemotherapy in lung cancer. At present, we have got a few progressions in personalized therapy, but which are very limited. This review discourses upon the dilemma and hope of individualized treatment from the following ways:limitation of based on histology type to determine treatment regimens, undecided sequential therapy after failure of TKI as front-line therapy for advanced NSCLC patients with EGFR mutation, clinical study of maintenance therapy and EGFR mutation detection based on peripheral blood being trap or surrogate for tumor tissue to direct personalized TKI therapy.

BACKGROUND: There are many reports on the entrance point of adult inferior thoracic spinal latero-anterior screw.Because of the differences in race,districts and the shape of vertebral body are various,and the choice of screw placement position is also varied.OBJECTIVE:To provide an anatomical reference for the implantation of clinical screws for inferior thoracic spinal latero-anterior fixation with the concave rib set as a reference.METHODS:Spinal specimens from 20 adult cadavers were observed,and anatomical data were colected from the concave ribs.One vernier caliper was used for the measurements.RESULTS AND CONCLUSION:The thoracic transverse diameters and the distance between the upper and the inferior edge of the concave rib and upper endplate increased gradualy as the vertebral number increased,whereas the distances between the upper and the inferior edge of the concave rib and inferior endplate and between the anterior edge of the concave rib and anterior edge of the vertebral canal decreased gradualy.Above findings suggested that the anatomical positions of the inferior thoracic concave ribs folowed a set of rules.The concave rib could be used as a simple,constant,and reliable reference point for inferior thoracic spinal latero-anterior fixation screw placement.

Objective To explore the diagnostic value of ultrasonography for the residual gallbladder after cholecystectomy.Methods Application of the ultrasound diagnostic apparatus in cholecystectomy patients was to be screened to find the residual gallbladder.Results Ultrasound resuts showed 18 cases of residual gallbladder,which combined stones in 12 cases(66.7％ ),polyps in 1 case(5.6％ ) ;Atrophic cholecystitis,acute cholecystitis,postoperative residual gallbladder probability were high,accounting for 83.0％.Conclusion Ultrasound for the preoperative prevention and postoperative diagnosis of the residual gallbladder has better value,and the cholecystectomy patients should be routinely review the ultrasound.

Ocular surface tissues are vulnerable to various stimuli from the external environment,including microbial invasion,mechanical damage,chemical stimulation,dust,UV light,and allergen stimulation.Conjunctival goblet cells play an important role in maintaining ocular surface self-homeostasis and health.These cells are the only unicellular glands in humans and mammals that are mainly distributed in the epithelium of the digestive tract,respiratory tract,and the ocular surface.Many factors affect goblet cell development and differentiation,especially the newly discovered molecule Spdef,which is a transcription factor found in the ETS family.The main function of conjunctival goblet cells is to secrete mucin to protect and lubricate the ocular surface;however,they also secrete a variety of other bioactive substances.Recent studies have demonstrated that goblet cells are involved in antigen presentation,regulation of dendritic cell phenotype differentiation,and induction of immune tolerance on the mucosa.Many ocular surface diseases,such as dry eye,will alter density and function of conjunctival goblet cells.Therefore,ophthalmologists should be concerned about the biological behavior of conjunctival goblet cells and the relationship between them and ocular surface diseases.

Objective To evaluate the assistant medial approach used in the surgical management of intraarticular fractures of calcaneus.Methods From January 2005 to December 2009,33 patients with intraarticular fracture of calcaneus were treated by open reduction and internal fixation through the expanded lateral L-shape approach and the assisted medial approach.They were 27 men and 6 women,aged from 18 to 62 years (average,36 years).There were 15 left sides and 18 right sides.According to Sanders' classification system,there were 27 patients with type Ⅲ displaced calcaneal fracture and 6 with type IV.Four cases were complicated with fracture of lumbar vertebra,one with pilon fracture and one with fracture of acetahulun.Fracture healing was observed and the Bǒhler and Gissane angles were measured.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale system was used to evaluate the functional recovery.Results All patients were followed up postoperatively to assess their functional outcome.The follow-up duration was 6 to 24 months (mean,12 months).All incisions healed primarily and all fractures obtained bony union in an average of 8 weeks (from 6 to 24 months).All the Bǒhler and Gissane angles were corrected and AOFAS scores were improved.There were significant differences between preoperation and pestoperation in all indexes( P ＜ 0.05).Conclusion As the medial approach can be used to assist the expanded lateral L-shape approach in treatment of the intraarticular fractures of the calcaneus,the reduction and insertion of internal implants can be improved to achieve satisfactory functional outcome.

Objective To probe the CT findings of menisci in degenerative osteoarthrosis of knees joint.Methods CT features of meniscus damage in 151 cases with degenerative osteoarthrosis of knees joint collected randomly from 2003~2005 were retrospectively analysed.Results CT features included:abnormal outline of meniscus or its edge to be coarse in 16 cases(10.5%),local hypodense in the meniscus in 107 cases(70.8%),gap sign in 9 cases(5.9%) and vacuum sign in 19 cases(12.5%).Conclusion CT scan is of benefit for evaluating the meniscus damage in degenerative osteoarthrosis of knees joint,which can be used to plan the mode of treatment.

Objective To study the anatomical character of compartment syndrome of foot after calcaneal intra-articaular by experimental model. MethodSix intact human cadaver lower extremities were used to produce calcaneal intra-articular fracture models, fracture patterns of the model were observed with radiographical technique, and anatomical study was proceeded to observe the fractures and their effects on soft tissues and compartments in foot.ResultAll specimens were sustained calcaneal intra-articular fractures successfully, 4 were joint depression fracture in x-ray, 2 were tongue type; 3 were Sander Ⅱ type and others were Sander Ⅲ type in CT. the primary fracture line coursed from anterolateral to posteromedial, and from anterosuperior to posteroinferior. It damaged all the soft tissue arosed from fractures medially and laterally, included adductor hallucis,quadratus plantae, flexor digitorum brevis and abductor digiti minimi as well.ConclusionFrom anatomical view, soft tissues of many compartments in foot rather than of simple compartmen are injuried when calcaneal intra-articular fractures occur, decompressive fasciotomies should be performed in all compartments involved. The present experimental protocol is useful to reproduce calcaneal intra-articular fractures.

Objective: To improve recognition of radiologic manifestations, mechanism, classification and differential diagnosis with the gastric benign tumor prolapsing into duodenal bulb. Methods We retrospectively analyzed and studied gastric bengin tumor prolapsing into duodenal bulb,data 8 cases performed GI series and gastroscopic examination in our hospital which all were proved by surgery and pathology. Results Radiologic manifestations of the gastric benign tumor prolapsing into duodenal bulb included①filling defect in the duodenal bulb and in the duodenal descending segment;②pulling mucusal bridge sign and widened pyloric channal;③revealed smooth of tumor surface mucosa and/or niche shadowes - -"bull eyes" sign; ④changed of the entire gastric shape; ⑤manifestation of tumor prolapsing vs retured into stomach;⑥distribution of the primary gastric benign tumors:gastric antrum 6 cases, gastric body and fundus varied 1 case. Pathologic diagnosis the gastric benign tumors prolapsing into duodenal bulb,leiomyoma 4 cases,lipoma and neurolemmoma varied 1 case,prolapsing into duodenal decending segment,leiomyoma 2 cases. Conclusion Radiological diagnosing signs of the gastric benign tumor prolapsing into duodenal bulb include①filling defect in the duodenal bulb or duodenum;②pulling mucosal bridge sign;③widened pyloric channel:④ changed of the entire gastric shape.