Objective To evaluate the clinical efficacy of percutaneous nephrolithotomy (PNL) in combination with pneumatic and ultrasonic lithotripsy in the treatment of complex renal calculi. Methods Under general anesthesia,an ureteral stent was placed into the patient by cystoscopy. With the prone position,percutaneous access was established by inserting an access needle into the intended calix under the guidance of ultrasonography or fluoroscopy. Afterwards,combined pneumatic and ultrasonic probes were used by nephroscopy for lithotripsy. Results A single tract was used in 137 patients,while two or three tracts were created in the other patients (11 and 2 respectively). One-step procedure to remove the stones was achieved in 119 patients,while a second intervention was performed in 27,and three procedures was carried out in 4. The mean time of the operations were (88?34) min. After the operation,one patient developed infectious shock,and then was cured by anti-shock therapy;two patients showed secondary hemorrhage in two weeks postoperation,and was cured by conservative therapy. In this series,the rate of stone clearance was 84.7% (127/150);23 cases had residual stones,10 of them received ESWL (the stone was removed completely in 7 of the 10 cases),and the other 13 were treated by oral medicines. Six months after the operation,follow-up examination showed a stone-free rate of 89.3% (134/150). Conclusion Combination of ultrasonic and pneumatic intracorporeal lithotripsy is effective and safe for complex renal calculi,which is intractable by open surgery.

Objective To evaluate the indications,complications and efficacy of permanent interstitial brachytherapy in the treatment of clinically localized prostate cancer. Methods Five patients (mean age,73 years;range,59~84 years) with clinically localized stage T 2b to T 3 adenocarcinoma of the prostate were treated with iodine-125 brachytherapy using the transrectal ultrasound guided transperineal implantation technique and Prowess 2.42 treatment planning system.The follow-up period ranged from 12 to 18 months. Results After implantation,the PSA levels of the 5 patients were decreased significantly and were all less than 0.5 ng/ml at 12th post-implant month;and the prostate volume shrunk from the third month. In the early period after the implantation all the patients complained of some voiding problems and had a noticed increase of International Prostate Symptom Score (IPSS),with the decrease of urinary flow rate.But the conditions improved gradually from the third month. No serious complications such as hematuria, bloody stool and rectal ulcer were found in this group. Conclusions Permanent interstitial brachytherapy has better efficacy,fewer complications and more radiation safety in the treatment of clinically localized prostate cancer.

To investigate the influence of pressures change in gastric fundus in patients with reflux esophagitis (RE) to lower esophageal sphincter (LES) and motor function of lower esophagus. With gastro esophageal manometric catheter designed by the authors,the LESP and function of lower esophagus were synchronously measured,while the pressure in the gastric fundus was continuously increased, in 13 patients with RE and 8 healthy volunteers. The results showed that LESP and lower esophagus motor function of the RE group was significantly lower than that of the healthy group when the stomach was empty or when the pressure in the gastric fundus was increased.Whereas in the RE group, LES showed continuous relaxation,and frequent and transient lower esophageal sphincter relaxation (TLESR) were observed. It suggested that RE is an upper digestive tract motor disorder disease caused by various factors,the main mechanisms underlying RE are lower basic LES pressure and lower esophagus motor function. The LES showed continuous relaxafion and frequent and transient TLESR when the stomach is inflated.

To investigate the character of esophageal manometry in reflux esophagitis(RE) with or without sliding hiatus hernia(SHH). Ambulatory 24 hours esophageal pH metry and esophageal manometry were studied in 50 patients with RE, and 50 RE patients with SHH. Lower esophageal sphincter(LES) competence was significantly boorer in SHH groups as compared with RE group, esophageal sphincter length(LESL) was (1 31?0 33)cm in SHH groups and (2 10?0 86)cm in RE group, and lower esophageal sphincter pressure(LESP) was (1 17?0 53) kPa in SHH groups and (2 16?0 65) kPa in RE groups( P

To compare the diagnostic value of X ray and endoscopy in reflux esophagitis (RE) in patients with hiatus hernia(HH) and their option in clinical practice. Correlative data of X ray and endoscopic findings in 50 cases of RE with HH were analysed.The radiography showed that there was 78 57% with the reflux type of suck and 64 29% with the clearance type of passivity in HH1 group, 81 82% with the reflux type of dumpage and 90 91% with the clearance type of delay in HH2 group. X ray and endoscopic diagnoses were corresponded 60% identically. Both examination methods are suitable for diagnosis of RE with hiatus hernia, X ray is the modality of first choice. Endoscopic exemination is indicated in cases of reflux esophagitis or other complications.

Gastroesophageal reflux(G), duodenoesophageal reflux(D) and duodeno gastroesophageal reflux(DG) model and control group(C) were reproduced by operations in rats. Their esophagi were harvested at 1, 2, and 4 weeks after operation. Epithelial cells were stained by PI and assessed with flow cytometry(FCM).The results of FCM were compared in terms of DNA index (DI, the ratio of the G0/G1 peak of the sample cells to that of the spleen lymphocyte of normal rat), proliferating index (PI, the percent of cells in S and G 2 /M in all cells) and aneuploidy (a distinct additional G0/G1peak).PI of D group increased at 2 weeks, and PIs of D and DG group were greater than G group and C group at 4 weeks.DIs and the rates of aneuploidy of all groups were similar at all time points. The results were in accord with the morphological changes. It is concluded that gastric and duodenal contents can induce abnormal proliferation of esophageal epithelium. This effect is obvious in groups with reflux of duodenal contents. Excessive proliferation of the esophageal epithelium might be one of the pathogenetic factors of reflux esophagitis or other relevant complications.

The aim is to study proliferation of esophageal epitheliun with reflux of different gastrointestin secretions to the esophagus and its role in carcinogenesis of esophagus. Gastroesophageal reflux(G), duodenoesophageal reflux(D) and duodenogastroesophageal reflux(DG) model and control group(C) were reproduced by operations. All rats were given carcinogen (methyl n amyl nitrosamine). Then their esophagi were harvested at 20, 26,and 40 weeks after the operation. With immunohistochemical staining of SABC method, PCNA labeling indexes(LI) were compared. Epithelial cells were stained with PI and assessed with flow cytometry(FCM).The results of FCM were compared in terms of DNA index(DI), proliferating index(PI) and aneuploidy. LIs increased with time of reflux and the administration of MANA. LIs in reflux groups, especially in D and DG group, were significantly greater than that in the C group with the same time interval. 3 indexes of FCM showed obvious changes in G, D and DG group, and they were greater than C group.The changes ware most marked in D and DG groups.It is concluded that all kinds of reflux into the esophagus can induce abnormal proliferation of esophageal epithelium and enhance carcinogenesis of the esophagus. The role of duodenoesophageal reflux may be more important than gastroesophageal reflux.

To study the relationship between gastric pH and bilirubin absorption value in bile reflux gastritis, we simultaneously assessed the changes in gastric pH and bilirubin absorption value during 24h in 22 patients with bile reflux gastritis using ambulatory 24h pH meter and bilirubin monitoring technique. There was no relationship between gastric pH and bilirubin absorption value,either with occurrence of bile reflux or elevation of gastric pH value. It is concluded that 24h intragastric bilirubin monitoring can not be replaced by pH monitoring, and monitoring bilirubin absorption as an index of bile reflux is very important in the diagnosis of bile reflux gastritis.

To observe the changes in mucosal blood flow and permeability after esophageal "Z"stenting, 12 adult healthy dogs were divided into two groups, and an esophageal stent was placed in each dog. Mucosal blood flow was measured with Dopplar blood flowmeter. Two hours after stenting PEG400 was instilled into the esophagus continuously under a constant pressure for two hours in the first group. The amount of PEG400 in the stented tissue was measured with gas liquid chromatography.In the second group the same experiment was carried out 24 hours after stenting. The mucosal structure was examined with electron microscope after stenting. It was found that the mucosal blood flow decreased evidently, and the amount of PEG400 was much greater in tissue after being stented as compared with that in normal esophagus. Electron microscopy revealed that the number of desmosome of epithelium decreased, and it was disrupted significantly after stenting. The interval epithelial cells were enlarged, basement membrane was damaged. Stenting might lead to evident decrease of esophageal mucosal blood flow, which significantly impaired the junction of epithelial cells and mucosal structure, and the permeability for PEG400 was increased significantly. All these findings demonstrate that stenting might impair the esophageal mucosa.

To assess the therapeutic value of endoscopic treatment in pancreas divisum(PD), 5 cases of PD from January 1993 to December 2001 were involved and analyzed retrospectively. Dilatation of minor papilla by passage of a balloon was used in one patient, and tapered catheter passed over guide wire was used in three patients, whereas endoscopic minor papilla sphincterotomy was used in one patient. Pancreatic stents were put into the accessory pancreatic duct in three patients after endoscopic minor papilla dilatation or sphincterotomy. The diameter of the stents was 7F and the length was 3 5cm, 5cm and 6cm. Severe pancreatitis, hemorrage or perforation was not found after endoscopic treatment, except in two patients the serum amylase level elevated within 24h and returned normal after 48h. After endoscopic treatment the remission rate of abdominal pain was up to 100%. By follow up for 5～36 months (average 18 months), no relapse of abdominal pain and complications were found except one patient who had stent occlusion and replaced by a new stent. So endoscopic treatment is a safe and effective therapeutic technique for symptomatic PD and should be used as the first choice.