Objective To assess the effect of intraperitoneal interstitial implant of Sustained-release 5-Fluorouracil during operation for advanced rectal cancer. Methods One hundred and four cases with advanced rectal cancer were enrolled into the study and divided into 3 groups: treatment group 1(n = 37), underwent combined hypotonic peritoneal chemo-hyperthermia and Sustain-released 5-fluorouracil implantation treatment during operation; treatment group 2(n = 34), underwent combined intraoperative hypotonic peritoneal chemohyperthermia and early postoperatively intraperitoneal chemotherapy treatment; and control group(n = 33),underwent peritoneal lavage during radical resection alone. Results Digestive tract toxicity in group 1 was significantly lower than that in group 2(2. 70% vs. 20. 59%, x2 = 9. 104, P ＜ 0. 05). There were significant difference on 1 year survival rate among the three groups. The 2-year survival rate of group 1 was significantly higher than that in the control group (78. 37% vs. 48. 48%, x2 = 1. 297 ,P ＜ 0. 05). After two years follow-up the 2-year local recurrence rate of group 1 was significantly lower than that in the control group(21.62% vs 32. 35 %, x2 = 7. 001, P ＜ 0. 05). However, no significant difference was found compared to group 2, which was 32. 35%. Conclusion lntraperitoneal interstitial implant of Sustain-released 5-Fluorouracil during operation is an effective intraperitoneal chemotherapy with mild side effects for advanced rectal cancer.

Objective To evaluate the relationship between Helicobacter pylori (Hp) infection and pathohistological presentation of gastric and deuodenal mucosa.Methods The gastritis biopsies were taken through endoscopy from each gastric body,antrum and duodenum in 60 patients with gastritis and 22 patients with duodenal ulcer respectively for the examination of histology.Result The positive rate of Hp was nearly 100% in active chronic gastritis which was significantly higher than that of active duodenitis.The total detecting rate of Hp infection and incidence rate of active inflammation in antrum were obviously higher than that of gastric body and duodenal bulb.The detecting rate of Hp infection of duodenal bulb in 22 cases of duodenum ulcer was 54% which was significantly lower than that of antrum.Conclusion The Hp infection is a very important pathogenic factor of active inflammation in gastric mucosa on the basis of which the severe inflammation of mucosa and ulcer development.Therefore the early elimination of Hp is very important.

Objective To explore the value of serum procalcitonin (PCT) for early evaluation of the severity in bacterial infection, and compare it with C-reactive protein(CRP), white blood cell(WBC) and temperature to understand their strengths and weaknesses. Methods A sample of 139 impatients with bacterial infection from July 2009 to June 2010 in our hospital were divided into four groups, including local bacterial infection group(Group A, n = 50), sepsis group(Group B, n = 51), severe sepsis group(Group C, n = 21) and septic shock group (Group D, n = 17) according to ACCP/SCCM consensus conference and the clinical manifestation. Twenty noninfectious patients during the same time were recruited as control(Group E, n = 20)PCT, CRP,WBC and temperature were evaluated in all patients before treatment and PCT were measured 5 days after treatment. Results During the early period of the bacterial infection, PCT was highest in Group D ([42.36±48.49] × 10-6 g/L),which was higher than that of (4.66 ±2.46) × 10-6 g/L in Group C,( 1.08 ± 0. 68) × 10 -6 g/L in Group B and (0. 09 ± 0. 05) × 10 -6 g/L in Group A(Ps ＜ 0. 05), PCT in the four infectious groups were all higher than the control group([0. 05 ± 0. 01 ] × 10-6 g/L)(Ps ＜ 0. 05). No significant difference in CRP between Group D and Group C, neither did between Group C and Group B (Ps ＞0. 05). No significant difference was found in WBC between Group D and Group C,neither did between Group D and Group B (Ps ＞ 0. 05). Temperature in Group D was not significantly different to Group C(P ＞ 0. 05). After 5 days' treatment, PCT decreased in the four infectious groups than before. Conclusion The level of PCT can be used to evaluate the severity of infection during the early period of bacterial infection, which is better than CRP,WBC and temperature. PCT decreases after effective treatment,which can help monitor the patients' condition.

Objective To evaluate the feasibility of 153　Sm-EDTMP for multiple bone metastasis.Methods 32 patients with multiple bone metastases were treated with 153　Sm-EDTMP injected into the veins,0.4～1.0 mci/kg,of which 7 cases received therapy for 2～3 times.Results 53.1%(17/32)was relieved completely,25.0%(8/32)was relieved partially and 9.4%(3/32)was relieved slightly.No effects were found in 12.5%(4/32).The overall effective rate was 78.1%.Side effects that were the decreasing of WBC and PLT were found in 15.6%(5/32),which rose to the preoperative levels within 6～8 weeks.Conclusion Internal radiotherapy with 153　Sm-EDTMP is safe and effective in the treatment of multiple bone metastases.

Objective To study the clinical characteristics,diagnosis and differential diagnosis of myelodysplastic syndrome.Methods The clinical features,routine hematological tests and morphology of medullary cells were analyzed in 49 cases.Results Of 49 cases,there were 36.7% of RA,8.2% of RAS,20.4% of RAEB,30.6% of RAEBT and 4.0% of CMML,respectively ,which showed the positive pathosis hemogenesis ,and had a trend of transforming to leukemia.Conclusion MDS(especially RA)is difficult to diagnose,which should be diagnosed according to pathosis hemogensis.The detection of blasts in peripheral blood will help to differentiate RA and CAA,but more researches should be made on the differentiation of MDS/AML and AML-TMDS.

Objective To evaluate the effects of preventing and treating delayed gastric emptying (DGE)in the patients with pylorus preserving pancreaticoduodenostomy(PPPD).Methods The clinical data about PPPD from 1992～2000 were analyzed retrospectively.Results The incidence rate of DGE was 50%,among which gastrostomy was performed in 2/2 cases and not performed in four tenths.Comparing gastric decompression through noses with gastrostomy,the function of gastric wriggle recovered ahead of seven to fifteen days in the former group.Conclusion The incidence rate of DGE in the patients with PPPD is very high.Preventive jejunostomy should routinely be taken and the application of the thin silicon rubber tube through nose is very effective to gastric decompression,combining the traditional Chinese medicine with western medicine.

Objective To explore the diagnosis and surgical treatment for rupture of small intestine.Methods Diagnostic methods and surgical treartment of 78 closed rupture of small intestine were analyzed retrospectively.Results The positive rates of abdominal puncture and abdominal X-ray were 89.7% and 32.0%,respectively 30.7% cases were complicated with other organs injured.All the patients were performed on the surgical operation,among which repairment for the small intestine rupture was performed in 58 cases(74.4%),partial resection of small intestine was performed in 18 cases (23.1%) and anastomsis of small intestine performed in 2 cases (2.5%).4 cases were reoperated because of delayed rupture of small intestine.3 cases died of MODS.Conclusion Diagnostic abdominal puncture plays an important role in the early diagnosis of closed rupture of small intestine.The selection of operative method is based on the degree of rupture.Suitable application of antibiotics is the key to reducing the complications.

Objective To evaluate the application of fast track surgery (FTS) in the rib internal fixation of multiple rib fractures. Methods Forty-eight chest trauma with multiple rib fractures patients from March 2008 to March 2010 were divided into FTS group and traditional care group randomly. Meanwhile two groups accepted FTS and conventional management of perioperative period respectively. The degree and duration of the chest pain, early exercise tolerance, intravenous infusion time, the length of postoperative hospital stay,chest scar and postoperative complications were observed and compared between the two groups. Results The duration of chest pain was significantly shorter in FTS group than in the traditional care group([ 112. 46 ±23. 24 ] mins vs [ 180. 23 ± 51.56 ] mins, t = 4. 23 ,P ＜ 0. 05); the early exercise tolerance was longer([ 68. 35 ±9. 30 ] mins vs [ 33.48± 5. 18 ] mins,t = 2. 87, P ＜ 0. 05) ;the intravenous infusion time was shorter ([ 10. 83 ±1.87 ] d vs [ 13. 30 ± 2. 12 ] d, t = 2. 38, P ＜ 0. 05); the length of postoperative hospital stay was shorter([ 12. 35 ± 2.03 ] d vs [ 16. 48 ± 3. 18 ] d, t = 3.04, P ＜ 0. 05); the less postoperative complications(8.3% vs 37. 5 %, x2 = 5. 005,P ＜ 0. 05); chest pain was relieved([ 3.43 ± 0. 45 ] cm vs. [ 6. 62 ± 0. 62 ] cm, P ＜ 0. 05);the scar healed well. All patients were successfully discharged. Conclusion The perioperative idea of fast track surgery was feasible and effective in the chest trauma with multiple rib fractures patients. FTS can improve the patients long term living quality.

Objective To study the common aetiology and the principle of treatment of neonatal hyponatremia.MethodsThe clinical data of 48 neonatal hyponatremia cases,admitted to our hospital from June 2006 to January 2010,were analyzed retrospectively. ResultsThe main manifestations of neonatal hyponatremia were poor response ( 37.5％ ) and anorexia ( 31.3％ ).The common causes included anoxic diseases during perinatal period,improper feeding,effects of specific diseases,premature birth et al.After active treatment,the serum sodium returned to normal in 47 neonate within three days,except for 1 premature infants died of serious respiratory distress syndrome.Conclusion Neonatal hyponatremia shows no special clinical manifestation.The aetiologies are complicated,which should be treated in different methods correspondingly.The inquiry of feeding history,the treatment of primary illness,the early detection of serum sodium levels and timely correction of the serum sodium levels are very important to improve the successful rate and reduce sequela.

ObjectiveTo retrospectively analyze the experience in the treatment of cardiac rupture caused by blunt chest trauma and to explore the approaches and methods to improve patient survival.Methods From 2004 to 2010,16 cases of closed chest trauma caused by cardiac rupture,who were treated in our hospital,were treated by heart repair using median sternotomy incision approach.Results Except for 1 patient occurred cardiac arrest before the establishment of CPB,who was failed for cardiopulmonary resuscitation after surgical repair,the remaining 15 patients were all successfully treated.Conclusion The diagnosis of cardiac rupture should be made as soon as possible once it occurs.Timely and decisive rescue and emergency surgery should be given.Heart repair can greatly improve the patient's survival.