Primary hepatic carcinoma (PHC) is one of the most common cancers worldwide and is the leading cause of death in China. Multidisciplinary treatment is widely accepted as the way to improve the prognosis of PHC, and non-surgical therapy now plays a more and more important role. The purpose of this article is to review the current status and progress of non-surgical treatments of PHC, such as TACE, local ablation, radiotherapy and systemic therapy.

Objective:Through the discussion on the purchasing mode of hospital equipment in China, fully understand the advantages and disadvantages of various procurement ways, choose reasonable acquisition method, optimize acquisition method, standardize the procurement management objective.Methods: By using the method of analogy, comparison of the four main acquisition methods. By the comparative analysis, the scope of each purchase way was confirmed. Results: Public bidding was better for more than 500000 yuan or the treasury payment items, competitive negotiation approach applies to 50000 yuan-500000 yuan purchase project. Consultation approach can be applied to 50000 yuan purchase project. Information project procurement preferred to methods of government procurement.Conclusion: Reasonable choices of purchasing and proper optimization has significant meaning for equipment purchasing and management in hospital.

[Objective]To investigate new methods of the management of closed rupture of Achilles tendon surgery to reduce postoperative skin necrosis.[Method]Small incisions and Absorbable sutures were used to manage 39 cases of closed Achilles tendon rupture,with proximal stump a Bunnell-type suture and remote stump percutaneous repair.[Result]In the 39 cases,three developed slight skin necrosis,of which two healed by changing dressings,the other one healed by debriding and sutureing.Follow-up of 10 months to 36 months was available for 35 cases.According to Arner-Lindholm efficacy evaluation standard,29 cases (82.9%) had excellent result,4(11.4%) had good result,with the good to excellent result of 94.3%.[Conclusion]Small incisions and Absorbable sutures used to manage the closed Achilles tendon rupture,with proximal stump a Bunnell-type suture and remote stump percutaneous repair is an effective and reliable methord for closed Achilles tendon repture,with small invasion,less impact on the skin blood supply,less skin necrosis,less re-rupture reinfection,and faster recovery.

Objective To investigate the effects of different surgical modalities on primary anorectal malignant melanoma. Methods Clinical data of 60 primary anorectal malignant melanoma cases who were admitted between 1965 and 2007 were collected, summarized and analyzed. Multivariate analysis was performed using the COX proportional hazards regression method. Results Tumors located in the rectum in 50 cases, in the anal canal in 10 cases. The overall survival rates were not significantly different between the 23 cases who received tumor resection only and those 30 cases receiving postoperative adjuvant therapy (X2=0. 078, P>0.05). Among these 53 surgical cases of anorectal malignant melanoma, 37underwent abdominoperineal resection, 16 underwent wide local excisions, There was no significant difference of the survival rates between the two groups (X2=1.464,P>0.05). Risk factors analysis revealed that the depth of tumor invasion is a risk factor (P<0.05), the modality of treatment is a protective factor (P<0.05). Conclusions Surgical operation is the principal effective management for anorectal malignant melanoma, Wide local excision is the principal therapeutic choice for localized well-circumferential anorectal malignant melanomas.

Objective To study the clinical feature,diagnosis,treatment and prognosis of hepatocellular adenoma(HA).Methods The clinical data of 10 patients confirmed pathologically with HA,were retrospectively analyzed.Results There were four females and six males,aging from 25 to 71 years(mean:42.6 years).Among these 10 patients,6 cases were discovered to have no clinical symptom.Tumors were located in the right lobe of the liver in 4 cases,and in the left lobe in 6 cases.Uhrasonography was performed in all cases.Six cases underwent CT examination and three cases experienced MRI as well as angiography was conducted in one case.All cases were confirmed by complete excision and pathology.All of them were followed up for 5 months to 9 years without tumor recurrence.Conclusion The combination of imaging data is helpful in the diagnosis of HA.Surgery is the best treatment with satisfactory results,and its prognosis is fairly good.

Objective To investigate the effectiveness of surgical resection for metastatic liver cancer in patients of gastric carcinoma, and evaluate the prognosis. Methods Clinical data of 24 gastric cancer cases undergoing hepatectomy for hepatic metastatic tumor were collected retrospectively. There were 18 cases of synchronous resection and 6 cases of heterochronous resection. The prognostic values of clinicopathological factors were assessed by univariate and multivariate analyses. Results Postoperatively all cases were followed up until the death of the patietns. Counting from the time of liver resection the 1-,3- and 5-year survival rate was 67%, 21% and 13% respectively. Univariate analysis showed lymph node involved, tumor size of hepatic metastases, vascular invasion and R0 margin as significant prognostic factors;Multivariate analysis indicated that tumor size of hepatic metastases and vascular invasion were independent prognostic factors influencing the survival. Conclusion These results suggest that for patients with liver metastasia from gastric cancer, better prognosis can be obtained by surgical treatment.

Objective To establish the diagnosis of am niotic fluid em bolismwith blood sam ples by liq-uid-based cytology technique and to study the validity of m ethod. Methods The blood sam ples were collected from patients who suffered from am niotic fluid em bolism. The com ponents of am niotic fluid in blood samples were examined with blood smear by two direct smear methods(supernatant smear, sedi-ment smear) and two liquid-based cytology methods(autom atic smear, manual smear). The positive de-tection rate of each m ethod was calculated. Results The positive detection rates of two liquid-based cy-tology methods(84.6% and 92.3%, respectively) were m uch higher than those of two direct methods(53.8% and 61.5%, respectively). Conclusion The liquid-based cytology technique could im prove the positive detection rate of am niotic fluid em bolism.

The clinical data of 147 patients with carcinoma of ampulla of Vatar at our hospital from January 1998 to December 2012 were retrospectively analyzed.The neutrophil-to-lymphocyte ratio ( NLR) was calculated from pre-operative complete blood count.They were divided into low NLR group (NLR<5,n=121) and high NLR group (NLR≥5,n=26).The 5-year survival rates of two groups were compared and the prognostic risk factors examined by univariate analysis and Cox model.The 5-year free survival rates of low and high NLR groups were 57.9%and 27.6%respectively ( P=0.005 ).Univariate analysis revealed that depth of invasion (P=0.006),pancreatic invasion (P=0.002),lymph nodal metastasis (P=0.008), poor differentiation ( P =0.008 ) , tumor stage ( P =0.003 ) and per-operative NLR ( P =0.005 ) were significant prognostic factors.Multivariate analysis showed that per-operative NLR significantly increased the risk of recurrence (P<0.05).Pre-operative NLR represents a significant independent prognostic indicator for patients with carcinoma of ampulla of Vatar.

10.3969/j.issn.1000-8179.2013.12.012

Objective To discuss the cause and means of prevention of postoperative acute renal failure(ARF) in patients with malignant tumors.Methods Clinical data of 32 patients with malignant tumors who suffered postoperative ARF were retrospectively studied.Results 13 patients(40.6%)suffered ARF because of hemorrhea or hypovolemia shock in or after operation, 10 patients(31.3%)suffered ARF because of fistula or sepsis after operation, 2 patients(6.3%)because of chemotherapy and other 7 patients(21.9%)with no evident causes. Conclusions ARF is a severe postoperative complication with high mortality. Maintaining adequate circulating volume before operation, carefully operating to decrease complication, avoiding nephrotoxins are key strategies to prevent the patients from ARF and improve prognosis.