Esophageal cancer is one of the most common alimentary malignancy.Although drugs and radiation treatments for esophageal cancer are constantly improved,surgical resection is still recognized as the most effective treatment method at present.With the continuous development of esophageal surgical techniques,minimally invasive treatment of esophageal cancer surgery technology has bcen performed at home and abroad,for the purpose of reducing the complications or mortality and improving the post-operative quality of life.Minimally invasive surgical indications,surgical procedure selection,complications and prognosis compared with traditional surgery are reviewed in this article to explore the application and clinical significance of minimally invasive treatment in patients with esophageal carcinoma.

Objective To investigate the effects of celecoxib on apoptosis during acute rejection of cardiac allograft in rats.Methods Forty Wistar rats underwent heterotopic heart transplantation in the abdominal portion from disparate SD rats.The cardiac grafts were harvested at 3rd and 5th day after transplantation.The cardiac allograft sections were subjected to the HE staining and in situ terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling(TUN EL) for histopathological rejection grade and apoptotic index(AI).Results Apoptosis mainly occurred in cardiac myocytes throughout allograft rejection.Celecoxib could markedly reduce myocyte apoptosis and abate the damage to the graft tissue.The AI at 3rn and 5th day posttransplantation were(2.35)?(1.51) and(11.35)?(3.46) in control group,and (1.03)?(0.42) and(3.28)?(2.42) in celecoxib group respectively with the difference between them being significant.Conclusions Apoptosis is an important mechanism of cell death in acute cardiac allograft rejection in rats.Celecoxib can apparently inhibit the apoptosis of cardiac myocytes,which may be an important way of its immunosuppressive actions.

Objective To investigate the expressions and clinical significance of Ki-67,p53,and survivin in esophageal cancer and precancerosis.Methods The expressions of Ki-67,p53,and survivin proteins were detected by immunohistochemical staining in 40 normal esophageal mucosa,136 precancerosis (42 mild atypical hyperplasia,43 moderate atypical hyperplasia,and 51 severe atypical hyperplasia),and 68 esophageal cancer tissues.The correlation of three proteins expressed in esophageal carcinoma tissues was analyzed.Results The positive expression rate of Ki-67 was 0 (0/40)for normal epithelium,35.7％ (15/42) for mild dysplasia,51.2％ (22/43) for moderate dysplasia,74.5％ (38/51) for severe dysplasia,92.6％ (63/68) for squamous carcinoma,respectively.The positive expression rate of p53 protein was 0 (0/40) for normal epithelium,28.6％ (12/42) for mild dysplasia,46.5％ (20/43) for moderate dysplasia,52.9％ (27/51) for severe dysplasia,67.6％ (46/68) for squamous carcinoma,respectively.The positive expression rate of survivin protein was 0 (0/40) for normal epithelium,38.1％ (16/42) for mild dysplasia,55.8％ (24/43) for moderate dysplasia,64.7％ (33/51) for severe dysplasia,89.7％ (61/68) for squamous carcinoma,respectively.Rank correlation analysis showed that abnormal expressions of Ki-67,p53,and survivin were correlated significantly with the pathological grading of the lesions (r =0.637,0.454,0.590,P ＜0.01).The expressions of Ki-67,p53,and survivin were positively correlated in esophageal carcinoma (r =0.407,0.646,P ＜ 0.01).Conclusions The abnormal expressions of Ki67,p53,and survivin were associated with the processes of the esophageal canceration,and the joint detection with three parameters has important clinical value.

Objective To utilize the expert resource in central hospital for helping doctors in community hospital to make suitable diagnosis and treatment,improve the technical level of community medical care. Methods The Telemedicine Diagnosis System is developed based on B/S mode and Microsoft Visual Studio.net C#2005 in Windows platform. Results The Telemedicine Diagnosis System has been developed, and realized the function of interface display, information management, medical image transmission and telemedicine diagnosis. Conclusion The system has friendly interface, simple operation, more reliability and quick data transmission, and it can accurately realize the experts' telemedicine diagnosis in time.

Objective To investigate CT and MRI findings of giant cell tumors of the temporal bone(GCTTB).Methods CT and MRI features of 5 cases pathologically proven GCTTB were retrospectively reviewed.The lesion characteristics,including location, size,shape,margin,attenuation on CT scans,signal intensity on MR images,and enhancement pattern were documented and analyzed.Results In all 5 patients,the lesions were located adj acent to the mandibular fossa.These lesions were round or oval in shape,predominantly demonstrated as expansive lytic bone destruction containing hyperattenuating septa,calcifications,non-sclerotic borders,and discontinuous bony shells,with“boundary angle”sign.No soft tissue masses were found around the lesions.These lesions with different content demonstrated various MRI signal intensity,and the solid component enhanced intensely.Conclusion GCTTB is rare.Features such as expansive growing pattern,discontinuous bony shell,intralesional septa,calcification,and “boundary angle”sign are common,which may help in the radiographic diagnosis of giant cell tumor.

Objective To investigate the causes of and prophylactic measure for complications of minilaparotomy cholecystectomy (MC).Methods The clinical data of 10 200 patients receiving MC from Apri1 1991 to March 2006 were analyzed.Results MC was successful in 9 835 cases(96.4%), and in 365 cases(3.6%) the incision was lengthened. Serious complications were 12 cases(0.12%)of bi1e duct injury, 4 cases(0.04%)of colon injury, 8 cases(0.08%)of massive haemorrhage, and 25 cases (0.25%)of bile leakage. Four 4 cases(0.04%) died. Conclusions The key to prevention of complications is a strict selection of MC indications,careful identification of the anatomical structures of Calot's triangle,use of suture ligation of the mesentery of gallbladder triangle and the technique of deep knot-tying and the timely use of extension of the incision.

Objective To explore the operative procedure and perioperative management of gastric cancer with liver cirrhosis.Methods Clinical data of 28 cases of gastric cancer with liver cirrhosis who were surgically treated in our hospital during the last seven years were retrospectively analyzed.Preoperatively,a detailed examination,and improvement of their nutritional status,liver function,and prothrombin time were aggressively made,and the possibility of tumor removal was estimated.Seven patients underwent radical proximal subtotal gastrectomy,and 4 of these cases underwent splenectomy and pericardial devascularizaion simultaneously.Five cases underwent total gastrectomy,and 3 of them had splenectomy and pericardial devascularizaion simultaneously.Twelve patients underwent radical distal subtotal gastrectomy,and 5 of these cases had splenectomy and suture of pericardial varices simultaneously.Four patients had palliative distal subtotal gastrectomy.The support of liver function and intense monitoring and management of complications were carried out postoperatively.Results Varying degrees of ascites occurred in all the 28 patients postoperatively,and other complications such as early liver coma occurred in five patients,extensive wound bleeding in three patients,left subdiaphragmatic abscess in one patient and wound infection in two patients.The morbidity rate was 100%(28/28).However,all the complications were recovered by non-surgical treatment.There were no perioperative deaths in this series.Conclusions Gastric cancer patients with liver cirrhosis are at a significant risk of developing postoperative complications.The surgical procedure should the "individual" principle based on liver function,history of upper gastrointestinal bleeding and the location of gastric carcinoma.Good hepatic reserve and perioperative care,meticulous hemostasis during operation,and prevention and treatment of postoperative complications are the likely determinants of operative prognosis.

Objective To determine the value of ERCP and EST after Billroth gastroenterostomy. Methods ERCP was used in 31 patients after Billroth- Ⅰ gastroenterostomy, 12 of whom received EST. It was in 137 patients after Billroth-Ⅱ gastroenterostomy, of the 34 received EST and 4 EPBD.Results Billroth- Ⅰ gastroenterostomy ERCP was successfully performed in 28 out of the 31 patients and EST in 11 out of the 12 patients. Billroth- Ⅱ gastroenterostomy ERCP was successfully performed in 109 out of the 137 patients and EST in 31 out of the 38 patients. There were no serious complications in patients receiving endoscopic treatments. Concluasion The success rates of ERCP and EST are high in patients with bile duct lithiasis after Billroth-gastroenterostomy. Endoscopic treatment or cholangioduodenostomy has good therapeutic effects.

Objective To investigate the early diagnosis value of MR by detecting spinal inflammatory lesions in ankylosing spon-dylitis (AS).Methods Forty patients were involved in this study,including 20 cases with short inflammatory back pain (IBP)histo-ry (duration ≤18 months)and 20 cases with long IBP history (duration ≥24 months).MR images were analyzed retrospectively. Results Patients with a short history of IBP had 7 lesions in vertebral bodies (anterior/posterior spondylitis and spondylodiscitis) and 33 lesions in posterior spinal structures (arthritis of costovertebral joints,costotransversal joints,zygapophyseal joints and en-thesitis of spinal ligaments).Patients with a long history of IBP had 27 lesions in vertebral bodies and 24 lesions in posterior spinal structures.Patients with a short history of IBP had significantly more lesions in posterior spinal structures than in vertebral bodies with 82.5% (33/40)vs 1 7.5% (7/40),respectively (P <0.01).In contrast,patients with a long history of IBP had significantly more inflammation in vertebral bodies with 79.4% (27/34)vs 20.6% (7/34),respectively (P <0.01).Conclusion Inflammatory spinal lesions in patients with a short history of IBP are seen more often in the posterior structures.Early detection of inflammatory spinal lesions by MRI is useful for early diagnosis of AS.

OBJECTIVETo analyze the risk factors of postoperative complications in gastric carcinoma patients complicated with liver cirrhosis.

METHODSA retrospective research of 41 gastric cancer patients with liver cirrhosis who underwent surgical therapy was performed. The multivariate Logistic regression analysis was carried out to determine risk factors of postoperative complications.

RESULTSThere were no postoperative death in this cohort. Twenty-seven(65.9%) patients developed postoperative complications. As determined by the Logistic regression analysis, Child-Pugh score(OR=27.96, 95% CI:1.16-672.23), albumin level(OR=17.98, 95% CI:1.28-253.36) and intraoperative blood loss(OR=10.60, 95% CI:1.21-92.82) were independent risk factors of postoperative complications.

CONCLUSIONAs for gastric cancer patients with liver cirrhosis, positive perioperative management, adjustment of Child-Pugh classifications score, following damage control principle during operation and reducing the intraoperative bleeding may decrease the morbidity of postoperative complications.