Objective To evaluate the application value of multi-slice spiral CT(MSCT)in D2 radical total gastrectomy for gastric carcinoma.Methods CT and clinical data of 353 cases with D2 radical total gastrectomy for gastric carcinoma was analyzed retro-spectively.Results Operative time was 236 (1 91-35 1)mins VS.245 (189-308)mins,no significant difference was observed be-tween the CT scan group and the non-CT scan group(P >0.05).The number of lymph nodes dissected was (27 ±3)VS.(20±2), there was significant difference between the CT group and the non-CT group (P <0.05).The blood loss in the CT group and no CT group was less 168 (110-600)mL and 280 (150-720)mL respectively(P<0.01).Postoperative hospital stay was shorter (11.2±2.1)days in CT group than no CT group (14.5±2.0)days (P <0.01).Postoperative complications developed in 1 7 patients in the CT group and in 29 patients in the non-CT group.The difference didn’t show statistically significant between the two groups (P >0.05).Conclusion Multi-slice computed tomography scanning has a great value in D2 radical total gastrectomy for gastric carcinoma.

Objective To determine the value and limitation of water enema spiral CT (WESCT) in staging of colorectal carcinoma.Methods Forty-eight patients with histologically proven rectum or colon carcinoma were included in this study. All of them were examined by SCT ,and the preoperative staging of TNM and Duke were used based on the findings of SCT.The results of WESCT were compared with those of surgical and pathological examination in all cases. Results All lesions in the 47 cases were demonstrated clearly by WESCT and the sensitivity was 97.9% ; 39 cases of 48 patients were correctly staged with TNM and 42 cases with Duke , the accuracy was 81.3% and 87.5% respectively, which were higher than the overall 50 % accuracy reported by references ;⑶The accuracy of WESCT was 89.6% (43/48) in T stage and 81.3% (39/48) in N stage. Three casas in M stage were all diagnosed correctly;Conclusion WESCT scan is a better method of depicting the colorectal carcinoma. It allows for accurate depiction and staging of colorectal carcinoma, especially detecting the invasion of adjacent tissues and distant metastasis. It is the best imaging method for staging the colorectal carcinoma . However the value of WESCT for early T staging in colorectal carcinoma and minute metastasis of lymph nodes or liver is limited.

Objective To evaluate the diagnostic value and clinical significance of preoperative staging in gastric cancer with induced pneumoperitoneum in spiral CT (SCTPP). Methods Both routine SCT and SCTPP were performed in 52 lean patients suffered from gastric cancers, and comparison was made between SCT findings and surgical and histopathologic findings. Results The accuracy of routine SCT and SCTPP in determining the T-staging was 72% and 96%, respectively (?2=8.0, P0.05). The sensitivity in determining M-staging was 61% and 100%, respectively (?2=0.04, P

Purpose　To evaluate the clinical safety of ionic contrast media made in china and compare with nonionic contrast media being imported. Methods　Among contrast-enhanced CT 1096 cases, 76% meglumine diatrizoate were administed in 864 cases and ultravist in 232 cases , comparative studies on adverse drug reactions(ADRs) and image quality were performed. Results　In 76% meglumine diatrizoate group , the prevalence of overall and mild -middle ADRs was higher than in the ultravist group , the prevalence of severe and potentially life-threatening ADRs was approximate in the ultravist group , the image quality was well than in the ultravist group.Preventive inoculation alleviated ADRs at all levels. Conclusion　Ionic contrast media made in china was safe and effective in patients without hyperthyroidism after preventive inoculation.

Objective To analyze the CT features of renal carcinoma associated with Xp11.2 translocations/TFE3 gene fusions (Xp11.2 RCC),and to improve the diagnostic accuracy.Methods Clinical data,CT imaging and pathological features of 12 cases with pathology proved Xp11.2 RCC were analyzed retrospectively.Results All the 12 cases were solid masses.11 cases were oval or quasi-circular,1 case was irregular.Tumors were iso-density or hyperdensity on CT plain scan images.The density was heterogene-ous,combined with necrosis in 11 cases and spotty or patchy calcification in 7 cases.After injection of contrast,moderate or obvious enhancement of tumors was found,1 case had retroperitoneal lymph node metastasis,1 case was found with mass formation in the re-nal hilus,1 case had adrenal metastasis.Another one was found with psoas major muscle and lumbar 5 invaded.Conclusion The Xp11 .2 RCC has certain CT characteristics.This disease should be considered when a renal tumor is iso-density or hyperdensity on the CT plain scan images and has moderate or obvious enhancement,combined with necrosis or calcification.

Objective To study the relationship between the CT features and pathological grade of malignancy of the gastric stro-mal tumors (GST).Methods A retrospective review was performed based on the database of 80 consecutive patients with GST.Age and gender of the patients were recorded,and the CT findings of GST including growth pattern,morphology,tumor site,boundary, mucosa,serosa,ulcer,volume and maximum diameter of the tumor were also measured.The patients were divided into three groups:very low and low risk group,intermediate risk one and high risk one according to the pathology.All parameters were ana-lyzed by one-way ANOVA or Fisher’s exact test.Results The patients in 3 groups (from low risk to high one)were 30,30 and 20 respectively.There were no significant differences in age,gender,location and mucosa among 3 groups(P>0.05).However,the growth pattern,morphology,boundary,serosa,ulcer,volume and maximum diameter of the tumor were significantly different (P<0.05).Conclusion The CT features including growth pattern,morphology,boundary,serosa,ulcer,volume and maximum diameter of the tumor can be used to evaluate the grades of malignancy in GST.

Objective To investigate the value and usefulness of optimized multislice CT enterography (MSCTE) with orally administered isosmotic mannitol (2. 5%) as negative contrast in demonstrating the small bowel and its abnormality. Methods Forty patients suspected of intestinal tumors were randomly divided into two groups and underwent conventional or optimized MSCTE. The expansion degree of bowel lumen and the thickness of bowel wall were evaluated for the six segments of the small intestine. The other 20 patients suspected of gastrointestinal diseases underwent gastrointestinal CT imaging.The expansion degree of bowel lumen and the wall thickness of bowel wall were statistically analyzed with Chi-Square test and t test. Results The wall thickness of the stomach, ileum and colon were (2. 56 ±0.52) ,(1.41 ±0. 15),(1.46 ±0. 13),(1.91 ±0. 25), (1.97 ±0.26),(2.01 ±0. 19), (2. 04 ±0.24)and (2. 05 ±0. 18)mm. Optimized method was superior to conventional method in the expansion degree of the second and third segments of the small intestine (P ＜ 0. 05) . There was no significant differences between two groups in the expansion degree and depiction of mucosa for the other segments of small intestine (P ＞ 0. 05). The gastrointestinal CT imaging was poor in the depiction of the duodenum and jejunum, but stomach, ileum and colon were fully illustrated. Conclusion Optimized MSCTE was superior to conventional method in demonstrating the small bowel, and gastrointestinal CT imaging can expand diagnostic scope because of good observation of whole gastrointestinal tract.

Objective To analyze the value of multi-slice spiral CT (SCT) scan in staging and subtyping of renal cell carcinoma (RCC). Methods The preoperative kidney SCT data and postoperative pathology results of 64 patients with RCC were retrospectively analyzed. The patients′ ages ranged from 33-78 years (average 54 years). There were 44 males and 20 females in the study group. According to the CUA Guidelines, the staging and subtyping of RCC were performed through the combined information of preoperative SCT attenuation in unenhanced, corticomedullary phase and enhancement pattern. The results were compared with the postoperative histopathological results. Results The SCT results showed 38 cases were clear cell RCC, 14 cases were papillary RCC and 12 cases were chromophobic cell RCC. Histopathological results showed that 40 cases were clear cell RCC, 16 cases were papillary RCC and 8 cases were chromophobic cell RCC. According to the standard of 40 HU of CT attenuation value, the sensitivity, specificity and accuracy were 75%, 79% and 78% for diagnosis of papillary RCC in the unenhanced phase. The sensitivity, specificity and accuracy by the standard of 90 HU of CT attenuation value was 90%, 88% and 89% for diagnosis of clear cell RCC in the corticomedullary phase. In chromophobic RCC, homogeneous enhancement was more common than in papillary RCC and clear cell RCC. There was no significant difference of staging and subtyping of RCC between SCT and pathological results (P>0.05). The accuracy of SCT in staging and subtyping of RCC was 88% in staging, and 89% in subtyping. Conclusions SCT is a useful preoperative tool to stage and subtype RCC

Objective To explore the characteristics and risk factors of type 2 diabetes mellitus (T2DM) onset in pedigrees. Methods A total of 865 subjects were screened and diagnosed by oral glucose tolerance test (OGTT) based on American Diabetes Association (ADA) criteria. Type 1 diabetes mellitus (T1DM) , maturity onset diabetes of the young (MODY) and chondriosome diabetes were excluded by clinical features and laboratory test of insulin and autoantibodies including glutamic acid decarboxylase antibody, insular cellular antibody and insulin autoantibody. A total of 182 pedigrees of T2DM were obtained. Results No gender difference was found in the prevalence of T2DM (42. 59% in male and 48. 18% in female respectively, P ＞0. 05) , nor was the newly diagnosed rate(9. 89% in male and 11. 82%in female, P ＞ 0. 05). The onset age was (63. 3 ± 12. 4) years old in the first generation [(64. 4 ± 12. 5)years in male and (62. 3 ± 10. 3) years in female] , (47. 1 ± 8. 7) years old in the second generation [(48. 2 ±9. 3)years in male and (46. 1 ± 8. 1) years in female] , (29. 6 ± 10. 2) years old in the third generation [(28. 9 ±9. 5)years in male and (30. 0 ± 10. 4)years in female]. Compared with normal glucose tolerance (NGT) subjects , newly diagnosed T2DM and impaired glucose regulation (IGR) subjects had higher prevalence of hypertension, hyperlipidemia and smoking but less physical activities. Statistical differences were shown in body weight five years before diagnosis, one years before diagnosis and at diagnosis in newly diagnosed T2DM[(68. 4 ±12. 4)kg, (69. 5 ± 11. 0)kg and (69. 1 ±9. 6)kg] and IGR[(66. 1 ±10.7)kg, (65.9 ± 10.7) kg and(65.7 ± 10.4) kg] , when compared with NGT [(61.0 ± 10.2) kg,(59. 5 ±11.0) kg and (60. 1 ± 10. 4) kg, all P ＜ 0. 05] . The same results were obtained with waist circumference and waist-hip ratio [(4. 1 ± 12. 5) cm and 0. 92 ± 0. 36 in newly diagnosed T2DM while (89. 1 ± 10. 7) cm and 0. 90 ± 0. 64 in IGR] , when compared with NGT[(82. 5 ± 10. 1) cm and 0. 82 ±0. 25] , all P ＜0. 05. Conclusions No gender difference was found in the onset characteristics of T2DM.High prevalence of obesity, hypertension, hyperlipidemia and smoking with less physical activities were associated with T2DM.

Objective To explore the early diagnosis, option of the surgical procedures, preven-tion and treatment of the complications in patients with pancreatic trauma.Methods All patients with pancreatic trauma during the past 20 years were studied retrospectively in respect of sex, age, cause of injury, grade by AAST, style of operation, therapeutic efficacy, complications and factors for death etc.Statistical analysis was made with Chi-square test.Results In all 148 cases of the present series, 132 underwent surgical interventions including simple suture or external drainage alone, distal pancre-atectomy, distal pancreaticojejunostomy or other internal drainage, diverticularization, Whipple's pro-cedure, and Damage Control Surgery (DCS) etc.Postoperative morbidity was 27.83% with a signifi-cant difference of the incidence of pancreatic fistula between pancreas grade Ⅲ-Ⅴ injuries and grade Ⅰ-Ⅱ(P＜0.01).The mortality rate was 11.49%.The cause of the deaths was mainly massive bleed-ing due to severe associated injuries(76.47%).Among various grades, the difference of the mortality was not significant (P＞0.05).Conclusion To improve the survival rate, it is important to control massive hemorrhage from associated injuries precedes dealing with pancreas trauma.Selection of surgi-cal procedures should be based on whether the main duct is injured.The removing of devitalized tis-sue, adequate external and internal drainage are essential for treatment of pancreatic injuries.Early recognition of pancreatic injury and correct choice of surgical procedures may obviously decrease the in-cidence of postoperative complications.