Objective To evaluate the efficacy and toxicity of navebine(NVB) given by continuous infusion plus cisplatin combination therapy in the treatment of advanced breast cancer.Methods 60 patients with advanced breast cancer were enrolled in this study.The type of his to pathologyis invasive ductal carcinoma.19 patients had no previous chemotherapy but 21 cases received chemotherapy containing ADM.26 patients had ≥2 metasta-ticsites.All the patients received vinorelbine according to the following doses chedule:10mg bolus followed by 10mg by continuous infusion over 24 hours every 5 days every 3 weeks.Results 60 patients were evaluable for response.A total of 131 cycles were administered.The lverall response rate was 41.6%(3 patients achieved a complete response and 22 patients achieved a partial response).The median over all survival was 35 weeks and the median duration of response was 19 weeks.The dose limiting toxicity was marrow-suppression.Neutropenia was in 43% patients(31% was grade Ⅲ and Ⅳ).Thrombo-cytopenia and anemia were mild.Conclusion A highe rsponse is obtained in advanced breast cancer treated by continuous intravenous NVB infusion with tolerable toxicity and deserve further revaluation.

Objective To compare the accuracy of endoscopic ultrasound (EUS) with double contrast enhanced ultrasound ( DCUS) in the preoperative staging of gastric malignancies. Methods This study included 162 patients with biopsy proven gastric cancer who underwent surgical resection as primary management of their malignancies. All patients underwent DCUS and EUS prior to surgical intervention with the results of the ultrasound findings compared with the pathological stages of the resected specimen. Results Among the 162 gastric cancer patients, there were 42 cases of T1, 49 cases of T2, 56 cases of T3, and 15 cases of T4 tumors. The overall accuracy of DCUS and EUS for the determination of loco-regional tumor infiltration ( T Staging) was 77. 2% and 74. 7% , (χ2 = 0. 273, P = 0. 603). Comparison of ultrasound techniques revealed that DCUS was superior to EUS only for a tumor depth of T3 (χ2 =5. 009, P = 0.025). Lymph nodes were correctly staged with DCUS and EUS in 78.4% and 57. 4% of cases, respectively ( χ2 = 16. 370,P =0.001). Using DCUS, the sensitivity of the technique was 78. 4% with a specificity of 78. 5%. In comparison, EUS had a sensitivity of 49. 5% with a specificity of 69. 2%. DCUS also detected a higher incidence of positive lymph nodes than EUS for poorly differentiated (81. 5% vs. 42. 6% ,χ2 =17. 338, P < 0. 01) and overall tumor types (78.4% vs. 49. 5% , χ2 = 17.523, P < 0. 01). Conclusions Double contrast-enhanced ultrasonography offers another noninvasive approach for the preoperative evaluation of gastric cancer. DCUS was comparable to EUS in tumor depth evaluation. DCUS offers an advantage in the detection of lymph node metastases, especially in poorly differentiated tumors.

Objective:To review the experience of closure of the left-main-bronchial stump fistula using endoscopic liner cutter staplers through the right thoracic approach and I stage or staged treatment for the left pyothorax.Methods:6 patients with the left-main-bronchial stump fistula after left pneumonectomy combined with pyothorax were treated by closing the left-main-bronchial stump using endoscopic liner cutter staplers through the right thoracic approach, and pleura was used to cover the distal and proximal incisional margin of the stump respectively. The thoracic T-tube drainage was used in the I stage or staged treatment for the left pyothorax.Results:All patients were survived without recurrence of the bronchopleural fistula. 4 patients were observed to have no recurrence of pyothorax when 1 patient had recurrence of pyothorax and was treated with intermittent T-tube drainage.1 patient operated with left-thoracic fenestration in the past was treated with drainage waiting for secondary operation.Conclusion:The right thoracic approach seemed to be a safer and more effective method than the transsternal transpericardial approach in cases with the left-main-bronchial stump fistula combined with pyothorax. The use of endoscopic liner cutter staplers reduced the risk of bleeding, infection and recurrence of fistula. The T-tube drainage in the I stage or staged treatment for the left pyothorax was considered to be an easier way for treatment.

Objective:To summarize the experience of surgical methods without repairing the fistula for 92 cases with gastrointestinal intrathoracic fistula.Methods:The surgical methods without repairing the fistula were performed through VATS, small incision assisted with VATS or thoracotomy. The focus of the surgery was to promote lung expansion, eliminate the residual cavity of chest cavity and keep effective drainage. After entering the chest cavity from the affected side, wash chest cavity with a large amount of warm normal saline and sterilize intermittently with iodophor to ensure the sterile environment in the pus cavity. Then completely remove the pleural cellulose or fiberboard on visceral pleura to promote lung expansion, eliminate the residual cavity of the chest cavity. The fistula was covered tightly and supported firmly by the visceral pleura on the lung. Multiple T-tubes were placed in thoracic cavity and fistula to keep effective postoperative drainage.Results:Among 92 cases, 85 cases were cured and the cure rate was 92.4% (85/92).7 cases died and the mortality rate was 7.61% (7/92). The 7 dead cases include 5 cases with esophagogastric anastomotic fistula (the death of 3 cases was cause by aortic esophagogastric fistula, the death of 1 case was cause by thoracic gastric tracheal fistula and 1 case was dead because of pulmonary infection and respiratory failure), 1 case with esophageal rupture (the cause of death was septic shock ), and 1 case with esophageal perforation(the cause of death was pulmonary infection and respiratory failure).Conclusion:Most of the surgeries without repairing gastrointestinal intrathoracic fistula are conducted simply through VATS or small incision assisted with VATS., which is safe and effective.