Objective To study the clinicopathologic classification,and methods of individualized treatment of Budd-Chiari syndrome (B-CS).Methods Analysed the clinical data of 42 cases of B-CS in our hospital from March 2006 to August 2010.Results The 42 patients were divided into three types,including 5 subtypes,which of them underwent operation or the interventional therapy,All kinds of bypass,a total of 20 cases.After operation,1 case appeared hepatic encephalopathy and die from it,the others all recovered well.Radical lesion resection and thrombosis was taken out in 7 cases; a balloon catheter in 5 cases and postoperative recovered well.The spleen-lung fixation in 6 cases were cured after operation.The three cavity two capsule tube was used oppression hemostasis for 4 patients with emergency bleeding,three cases was cured of joint spleen cut + cutoff,1 case with conservative treatment is invalid,died.The 41 cases received follow-up,during the follow up period of 3 months to 3 years,2 patients had recurrence (4.9％),and the other patients recovered satisfactorily.Conclutions According to different the clinicopathologic classification of B-CS,Taking individualized treatment may further improve the clinical curative effect.

Objective:To discuss treatment of complete response cases after neoadjuvant radiotherapy in rectal cancer. Methods:This retrospective study analyzed clinical data of 84 rectal cancer cases with pre-operative neoadjuvant chemoradiotherapy in our hospital from January 2010 to Augnst 2014. Results:After neoadjuvant chemoradiotherapy, 33 patients presented clinically complete response at a rate of 39.3%. After post-operative pathologic examination, among clinically complete response cases, six cases exhibited patho-logically complete responses at a rate of 18.2%. No recurrence or disease progression occurred within 12-36 months of post-operative follow up. Conclusion:Neoadjuvant chemoradiotherapy can significantly lower tumor stage and promote clinically complete remission of some patients. However, for clinically complete remission cases, further radical surgery should be provided.

Objective To investigate curative efficacy of transurethral endoscopic surgery for foreign body-induced lower urinary tract injury. Methods A retrospective case series study was conducted to analyze the clinical data of 31 patients with foreign body-induced lower urinary tract injury admitted to Henan Provincial People's Hospital from January 1998 to January 2018. There were 27 males and four females, aged 6-68 years [(27. 1 ± 16. 3)years]. Foreign bodies were located at the bladder in 12 patients, at urethra in 16, and at bladder and urethra in three. The foreign bodies were placed into the body by patients themselves in 23 patients, by other people in one, iatrogenic implantation in six, and by unknown approach in one. All patients underwent urethral surgeries, and individualized treatment plan was formulated according to the specific conditions such as the foreign body type, size, shape, location,activity and combined injury. The success rate, operation time and hospitalization time were recorded. The sexual function of the married males was evaluated by international index of erectile function-5 (IIEF-5) (IIEF-5 score≥22 points as normal) before and after the operation. The urination after the operation was evaluated by the maximum urinary flow rate ( Qmax) ( Qmax<15 ml/s as abnormal) and the complications were recorded. Results All the patients underwent successful surgeries and the foreign bodies were removed, including 26 patients who underwent transurethral endoscopic surgery alone with success rate of 84％ and five patients underwent open surgery due to failed transurethral endoscopic removal. All patients were followed up for 6-36 months [(27. 0 ± 7. 7)months]. The operation lasted for 20-72 minutes [(42. 0 ± 21. 7) minutes]. The hospitalization time was 2-7 days [(4. 0 ± 1. 7) days]. During the follow-up, 11 married males obtained normal sexual function after surgery [ postoperative IIEF-5:(23. 4 ± 1. 1) points vs. preoperative IIEF-5: (23. 8 ± 0. 9) points]. Twenty-nine patients had normal urination [Qmax=(21. 7 ± 5. 9)ml/s]. Two patients had narrow urinary tract (Qmax<15 ml/s), of whom one patient received regular urethral dilatation and another received resection and anastomosis of urethral stricture, both with satisfactory improvement of urination. Three patients had fever caused by urinary tract infection and recovered within 2 weeks after anti-infection treatment. There were no serious complications such as male sexual dysfunction, complex urethral stricture or septic shock. Conclusions Transurethral endoscopic surgery for foreign body-induced lower urinary tract injury has high success rate, minor impact on the sexual function of male patients and low incidence of complications, which is worthy of clinical practice.

Objective To summarize the epidemiological features,diagnosis and treatment of the penile fractures in single clinical center in recent 25 years so as to improve the treatment level.Methods A retrospective case series study was conducted on 23 patients with penile fractures from January 1993 to June 2017.The average age of patients was 37.78 years (range,21-66 years).Nineteen patients were married and four were not.Fourteen patients had penile fractures in summer,five in winter,three in spring and one in autumn.Three patients had Bachelor's degree or above,while 20 had less than university education.There were nine urban and 14 rural residents.Nineteen patients were caused by violent intercourse,two by violent masturbation,one by oral sex and one without willing explanation.All patients were unilateral rupture of albuginea penis,including five with urethral rupture.No misdiagnosis or missed diagnosis occurred.The time from injury to surgery was average 32 h (1993-2002),10.5 h (2003-2012),and 3.8 h (2013-2017),respectively.Emergency operations were performed using the degloved distal foreskin to repair the albuginea penis.The penile erectile function,urination and complications were recorded.Results All patients were followed up for 6-62 months (mean,26 months).In all patients,morning erection was restored at days 1 to 3 after operation,and normal urination was attained after the removal of urethral catheter.Normal sexual life was restored within 3 months after the operation.Penis elephantiasis combined with poor postoperative skin healing was seen in one patient,and mild penile erection pain was reported by one patient.No obvious erectile dysfunction,abnormal urination or other severe complications were reported.Conclusions The epidemiological features of penile fractures include low incidence,relatively concentrated region and age of onset,diversity of causes,and patients with insufficient education.Penile fractures can be diagnosed based on medical history and body examination.Emergency surgery is the first choice for penile fracture,with satisfactory outcomes and few postoperative complications.

Objective To discuss the sensitization effect of celecoxib in the radiotherapy and chemotherapy of patients with esophageal cancer,and its clinical application value.Methods According to the digital table,60 patients with esophageal cancer were randomly divided into observation group and control group,30 cases in ecah group.The control group was given conventional radiation and chemotherapy,the observation group received combination with celecoxib for radiotherapy sensitization.The clinical effect was compared between the two groups.Results The total effective rate of the observation group was 46.67％ (14/30),which was higher than 20.00％ (6/30) of the control group,the difference between the two groups was statistically significant (x2 =4.343,P ＜ 0.05).In the observation group,radioactive pneumonia occurred in 1 case,radioactive esophagitis in 2 cases,radioactive myocarditis in 1 case.In the control group,radioactive pneumonia occurred in 2 cases,radioactive esophagitis in 1 case,radioactive myocarditis in 2 cases,the differences between the two groups were statistically significant (x2 =0.350,0.350,0.350,all P ＞0.05).In the observation group,7 cases occurred nausea and vomiting,diarrhea in 1 case,bone marrow suppression in 5 cases,renal toxicity in 2 cases.In the control group,8 cases had nausea and vomiting,diarrhea happened in 2 cases,bone marrow suppression in 3 cases,renal toxicity in 1 case,there were no statistically significant differences between the two groups (x2 =0.088,0.350,0.576,0.350,all P ＞ 0.05).Conclusion Application of celecoxib in patients with esophageal cancer during the process of radiation and chemotherapy has sensitization effect,it can promote the esophageal cancer treatment effect,without increase in adverse reactions,it is worthy of popularization and application in clinic.

Objective:To analyze the clinical and pathological features and gene mutations of pancreatic acinar cell carcinoma (PACC).Methods:Clinical data of 34 patients with PACC admitted to the Department of Pancreatic Surgery of the First Affiliated Hospital of Naval Medical University from December 2009 to July 2018 were retrospectively analyzed to summarize its clinical characteristics, and the expressions of α1-ACT, CaM5.2, Syn and CgA in pancreatic tumor tissues were detected by immunohistochemistry. Next-generation gene sequencing technology was used to detect gene mutations in tumor specimens.Results:Among the 34 PACC patients, 23(68%) were males and 11(32%) were females; the age ranged from 25 to 75 years, with an average age of 54 years. The first symptom was abdominal pain or distension in 21 cases (62%), skin or scleral yellow staining in 4 cases(12%), and 9 cases(26%) were found in routine physical examination. BMI was 17.6-34.0 kg/m 2, of which 3 cases (9%) were <18.5 kg/m 2, 23 cases (68%) were 18.5-24.0 kg/m 2, and 8 cases (23%) were >24.0 kg/m 2. Preoperative examination showed elevated CA19-9 in 7 cases (20.6%), elevated CEA in 3 cases (8.8%), and elevated AFP in 7 cases (20.6%). Blood amylase was 16-247 U/L, with an average of 80 U/L. Enhanced CT showed that the lesion was irregular in shape, showing inhomogeneity and slightly low density, with areas of cystic degeneration and necrosis. The tumor was located in the head of the pancreas in 14 cases (41%), the body and tail of the pancreas in 19 cases (56%), and the neck of the pancreas in 1 case (3%). The largest tumor diameter was 1.5-15.5 cm, with an average of 5.4 cm. Postoperative pathologic stage I was confirmed in 4 cases (12%), stage Ⅱ in 14 cases (41%), stage Ⅲ in 14 cases (41%) and stage Ⅳ in 2 cases (6%). Immunohistochemical results showed that both α1-ACT and CaM5.2 were positively expressed (100%). Syn was positive in 8 cases (23.5%) and CgA was positive in 6 cases (17.6%). Ki-67 index was from 9% to 70%, with an average of 41%. Gene sequencing of pancreatic tumor tissue from 6 patients showed BRCA2 mutation in 2 patients (7155C>G), K-ras mutation in 1 patient (35G>T), RET mutation in 1 patient (200G>A), and LKB1 mutation (234G>T) in 1 patient, and one double mutation of K-ras and RET (35G>A, 1 798C>T). 30 patients were followed up, and the median survival was 38.3 months. Conclusions:PACC was a rare pancreatic tumor with no specific clinical manifestations. The positive expression rates of α1-ACT and CAM5.2 in tumor tissues were 100%. BRCA2, K-ras, RET and LKB1 were common gene mutations.

As a new direction of pancreatic cancer treatment, neoadjuvant therapy for pancreatic cancer has been confirmed to be able to improve the prognosis of the patients. Under multidisciplinary treatment (MDT) mode, neoadjuvant therapy combines multidisciplinary advantages to solve patients′ problems of diagnosis and treatment, provides accurate, comprehensive and individual treatments, and maximizes the clinical benefit for patients. In this article, we summarize the present problems of neoadjuvant therapy for pancreatic cancer in patient selection, treatment regimen selection, treatment response evaluation and surgical selection, and explore the direction of clinical research and neoadjuvant therapy for pancreatic cancer under MDT mode.