Objective To study the clinical effect of minimally invasive treatment of 24 patients with hemor-rhagic moyamoya disease.Methods The clinical features of onset,bleeding location of the lesions and the type,ther-apeutic results of minimally invasive treatment were studied retrospectively.Results 24 patients with hemorrhagic moyamoya disease spontaneous intracerebral hematoma who need to acutely remove the hematoma were examined by CT angiography ( CTA) .Emergency minimal invasive puncture was performed according to the result of CTA,and the role of CTA in operation was analyzed.In all 24 patients,most of them were cerebral hemorrhage breaking into ventri-cles,5 cases with intracranial aneurysm.In all the hemisphere of hemorrhage,dilatation and abnormal branching of the AchA and P-CoM were observed in 9 patients,superficial temporal artery.Conclusion Minimally invasive treat-ment of hemorrhagic moyamoya disease scheme is simple,practical and effective,the maneuverability is strong.

The management of hilar cholangiocarcinoma was challenging to the surgeons due to difficult operations and low resection rate.Recently,a new mode of multidisciplinary team (MDT) is applied to the diagnosis and treatment of hilar cholangiocarcinoma,which leads to significant changes and development of the diagnosis and treatment for hilar cholangiocarcinoma.In this article,the authors first introduced the recent application of MDT treatment for hilar cholangiocarcinoma on diagnostic methods,staging systems,evaluation for resectability,radical resection,application of liver transplantation and other systematic therapies.Considering the complexity of hilar cholangiocarcinoma,a surgery-centered MDT for hilar cholangiocarcinoma is important and should be promoted.

The prognosis of hepatocellular carcinoma (HCC)is poor,and tumor thrombus in the portal vein or in the bile duct is an important influencing factor.Approximately 30%of HCC patients are found to have portal vein tumor thrombus (PVTT)when diagnosed,and their median survival time is about 2.7-4.0 months if they do not receive any treatment.The incidence of HCC complicated with bile duct tumor thrombus (BDTT)is less than 10%,while the prognosis is dismal.Once tumor thrombus extends to the major bile ducts,obstructive jaundice and subsequent hepatic dysfunction are inevitable.The survival time of patients with HCC complicated with BDTT is less than 4 months if they only receive palliative biliary stenting.The management of HCC complicated with PVTT or BDTT is challenging with controversy at present.Different treatment approaches and their benefits for patients with HCC complicated with PVTT or BDTT are introduced in this paper.

Objective To investigate glucose metabolism , insulin secretion and serum lipid in patients of nonalcoholic fatty liver disease (NAFLD) with hypertension. Methods A total of 100 subjects including NAFLD with hypertension (n = 50) and NAFLD without hypertension (n = 50), in our hospital during Jul. 2010 to Jul. 2012, were enrolled in this study. Records the following information of the two groups: The clinical data , oral glucose tolerance and insulin releasing test , serum lipid , serum uric acid and ALT were recorded. Results Compared with the NAFLD without hypertension group, impaired glucose regulation was significantly increased in patients in the NAFLD with hypertension group(P < 0.05).The insulin releasing was significantly increased at 30 min and was increased at 180 min in patients in the NAFLD with hypertension group (P < 0.05).The insulin releasing during 30 min to 120 min was descend gradually in patients in the NAFLD with hypertension group,with no significant difference between these two groups. TG was markedly elevated in patients in the NAFLD with hypertension group (P < 0.05). Conclusion Prevalence of impaired glucose regulation was elevated obviously in NAFLD with hypertension group,and early-phase insulin secretion were reduced and delayed.

Objective To evaluate the use of Mitrofanoff principle in the field of pediatric urology. Methods From May. 1997 to Dec.1999,the Mirtofanoff principle has been used in 7 children to achieve CIC and urinary continence.The mean age of the patients at operation was 8 years (range 3～14 years).A catheterisable conduit was created using the appendix.Either the cecum,ascending colon or plus the terminal ileum were used instead of the bladder or for augmentation of the bladder after detubularization.7 children consisted of an 8 years old boy has lost his bladder,right ureter and bilateral testis due to traffic accident, 4 children with congenital complete urinary incontinence (urogenital sinus abnormality 1,extrophy of bladder after failed reconstruction 1 and shortened urethra 2),and neurogenic bladder 2. Results Immediate success has been achieved in 5 children (70%),who were completely continent and practiced successful CIC via the Mitrofanoff stoma. Conclusions Use of the Mitrofanoff principle is a valuable procedure for urinary diversion in childhood.

Objective To present experience on the management of traumatic posterior urethral stricture or obliteration in boys. Methods Treatment included transurethral resection (TUR) in 112 cases,combined perineal-transpubic urethral repair in 44,via perineal approach for urethral repair in 32,perineal urethrostomy performed either transpubicaly or(and) via perineal approach or interposition of a segment of pediculated skin tube of scrotum in 20 cases,Mitrofanoff in one,urethra anastomotic repair through rectal and perineal approach in one. Results The whole series have been followed up for 6 months to 14 years.Normal urination was achieved in 187(89%),incomplete urinary incontinence in 17,still with perineal urethrostomy in 5,and intermittent catheterization needed in 1.Posterior urethral diverticulum with chronic epididymitis persisted in one. Conclusions Appropriate initial treatment is important for the management of traumatic posterior urethral injury.In fresh cases simple cystostomy was only carried out for incomplete urethral disruption,end to end anastomosis via suprapubic combined with perineal approach is indicated in complete urethral disruption.For old urethral injury,internal urethrotomy is good for the majority of simple stricture.Transpubic combined with perineal approach is indicated for the length of posterior urethral stricture or obliteration longer than 2 cm.If the proximal urethral end is long enough for exposure the urethra can be repaired via perineal approach alone. Perineal urethrostomy should be reserved for patients with long segment of urethral obliteration.

Objective To explore the effects of formaldehyde (FA) on the contents of CD3, CD4, CD8 and the activity of SOD and the contents of MDA in the spleen and thymus of mice. Methods 30 Kunming mice were randomly divided into 5 groups, 6 in each and treated with FA: the negative control group, 1 mg/m3, 3 mg/m3, 5 mg/m3 and the positive control group (treated with cyclophosphamide, CP). The mice were exposed to FA by static state inhalation in a chamber for 14 days, then the contents of CD3, CD4, CD8, MDA and the activity of SOD in the liver, spleen and thymus were determined. Results The contents of CD3, CD4, CD8 in the spleen and thymus showed a significant decreasing as the exposure dose increasing, an obvious dose-response relation was seen and there were significant differences between FA exposed groups and the control group (P

Objective Misdiagnosis of benign hepatic mass as malignancy is not infrequent. This study was to improve the clinical diagnosis by reviewing our clinical data for space occupying hepatic lesions. Methods In this study 545 patients undergoing hepatic resection for suspected malignant hepatic lesions were retrospectively studied from Jan 1998 to Jun 2004. All patients were pre-operatively assessed with plasma tumor makers, ultrasonography, computed tomography or magnetic resornance imaging. Percutaneous liver biopsy was employed in selected patients. Final pathological data was reviewed to evaluate preoperative diagnosis. Results Twenty-four out of 545 patients were pathologically diagnosed as with benign lesion. Preoperative misdiagnosis involved atypical radiological characteristics, incomprehensive clinical data and inexperienced recognition for liver lesions. Two of 24 cases suffered from minor post-operative complications, and there was no mortality. No recurrence was found by a mean follow-up of 3 years and 1 month. Conclusions Some benign hepatic lesions are easily misdiagnosed as malignant tumor. Appropriate use of multimodality examination in combination with correct algorithm of diagnostic protocol could improve diagnostic accuracy in cases of benign solid space occupying lesions of the liver.

Hepatolithiasis is still a common biliary disease in China with unknown pathogenesis and poor long-term outcomes.Surgery is probably the only curative treatment to hepatolithiasis.However,surgeons and patients cannot keep trouble from high recurrence and reoperation rates after surgery.Hepatolithiasis is a serious disease,which can cause cholangitis,liver abscess,liver cirrhosis,and even cholangiocarcinoma.Sphincter of Oddi,which controls the unidirectional outflow of bile and separates the bile duct from the bacteria-filled intestinal tract,is thought to be a gatekeeper of the almost-sterile biliary tract.Dysfunction of sphincter of Oddi,including stenosis,spasm and laxity,is closely associated with biliary disease,A lax sphincter of Oddi will aggravate bilioenteric reflux,leading to biliary infection and calculi development eventually.This issue has gradually gained enough attention.How to evaluate sphincter of Oddi function reliably and restore or replace its function,which is key to treat hepatolithiasis and prevent its recurrence,remain unclear.

Pancreatic adenocarcinoma is a highly lethal disease with a high morbidity and dismal prognosis.A multidisciplinary consultation based on evidence-based medicine has become the main modality for treatment of pancreatic adenocarcinoma.National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology has been widely recognized and implemented.Recently,the guidelines (version 1.2017) in oncology have been published by NCCN.This article will summarize and interpret the updates of the new version of the NCCN guideline for pancreatic adenocarcinoma.