Objective To assess the clinical application of microendoscopic discectomy (MED) system in the treatment of 36 cases of special lumbar disc herniation (LDH). Methods Laminectomy and decompression, and removal of fractured end plate or calcified herniated discs were performed by MED using self-made bone chisel, osteotome and L-shaped osteotome. Results Intraoperative dural laceration occurred in 2 cases, and no conversions to open surgery were required. Follow-up observation ranged (3～12) months (mean, 9.5 months). According to Macnab criteria, 28 patients had excellent, 5 had good, 2 had fair, and 1 had poor outcomes, with good or excellent results in 91.7% (33/36) of the patients. Conclusions MED may be carried out in patients in side position. Calcified herniated discs and fractured end plate can be excised by MED with self-made tools.

Objective To explore the angioarchitectrue characteristics and appropriate treatment strategies of dural arteriovenous fistula (DAVF) in foramen magnum region.Methods The clinical data of patients with DAVF diagnosed by digital subtraction angiography (DSA) were analyzed retrospectively.Results Thirteen patients intraoperative were found fistula and complete resection,patients discharged from hospital,DSA check showed that the DAVF fistula completely disappeared,all patients symptoms were improved to different extents.Conclusions The clinical features,prognosis and treatment methods of DAVF in forament magnum region depends on its angioarchitecture,especially the lesion site and venous drainage,surgical operation can usually find the fistula and can be completely removed.

The disc degeneration disease has been main research focus in spinal surgery,but the pathogenesis of disc degeneration is still not clear.Appropriate animal models are important for the study of pathogenesis of disc degeneration.Presently,models of disc degenetation are mainly classified into two categaries:vitro models and vivo models.The animal vitro models include disc cell models and disc tissue models.The vivo models include mechanics models and trauma models.This review tries to give a short introduction about the status and progress of animal model about disc degeneration.

Objective To investigate the clinical value of fetal echocardiography in prenatal diagnosis of fetal truncus artery. Methods Retrospective analysis was made in 10 cases with fetal truncus artery for their fetal echocardiography and follow-up findings. Echocardiographic characteristics was summed up in various fetal heart views. Results Truncus artery was confirmed by autopsy in 7 fetuses,and 3 cases were correspondingly verified by postnatal echocardiography. Echocardiographic characteristic images of fetal truncus artery was larger ventricular septal defect, only 1 great artery arising from heart, and pulmonary artery arising from truncus artery. Conclusions Echocardiography has important value in accurate diagnosis of fetal truncus artery and caution should be paid in differential diagnosis with other fetal complicated congenital heart diseases.

Objective To investigate the feasibility of thoracoscopic minimal access anterior surgery for thoracic spine. Methods Minimal access anterior thoracic surgery was conducted under thoracoscope in 14 patients in this hospital from October 2001 to October 2002.Six patients with thoracic vertebral metastasis underwent vertebral body excision, reconstruction by cement and steel plate, and anterior internal fixation with screw-rod system;4 patients with thoracic vertebral tuberculosis received focus resection,bone graft and anterior internal fixation with screw-rod system; 2 patients with of thoracic disc herniation received discectomy and fusion;2 patients with thoracic vertebral facture and dislocation received reduction, decompression, bone graft and anterior screw-rod internal fixation. Results Postoperative imageological analysis revealed that the focus had been cleaned completely and the internal fixation was excellent. Follow-up for 4～12 months in 14 patients showed that the pain on chest and back disappeared in all the patients. Of the 13 patients with spinal compression, muscle strength recovered from grade A～D preoperatively to grade C～E postoperatively. Conclusions Thoracoscopic minimal access anterior thoracic surgery is feasible. It offers satisfactory short-term effects.

Objective To study the independent risk factors of early rebleeding after endoscopic variceal ligation (EVL) and/or endoscopic injection of fibrin tissue adhesive.Methods Data of 370 patients who had cirrhosis and accepted 396 procedures of EVL and/or endoscopic injection of fibrin tissue adhesive were retrospectively studied.Independent risk factors for early rebleeding were determined by Logistic regression analysis.Results Results of all the factors that were significantly different between the re-bleeding and non-rebleeding patients,the portal vein diameter,ascites volume,Child-Pugh score and serum albumin were independent ones of early rebleeding after EVL and/or endoscopic injection of fibrin tissue adhesive ( P ＜ 0.05).Larger volume of ascites,wider portal vein diameter,reduced albumin,Child-Pugh score greater than 10 were indicative factors of rebleeding.Conclusion The early rebleeding rate after EVL and/or endoscopic injection of fibrin tissue adhesive is determined by portal vein diameter,ascites volume,ChildPugh score,and serum albumin.

Objective To assess the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary diseases in children. Methods Data of 9 patients younger than 14 years who underwent ERCP at between November 2004 and May 2010 were indentified through a computer database search. Therapeutic methods, success rate and procedure-related complications were evaluated.Results A total of 9 patients underwent 17 ERCP procedures under anesthesia, including 16 therapeutic and 1 diagnostic procedure. The success rate was 94. 1% (16/17) and the complication rate was 11.8%(2/17), including 1 mild pancreatitis and 1 peri-pancreatic infection. Conclusion ERCP is an important tool with high safety and efficacy for diagnosis and treatment of pancreaticobiliary diseases in children.

Objective To investigate the value of combination of B-flow imaging and spatio-temporal image correlation in prenatal diagnosis of congenital heart diseases. Methods Volume images of 50 normal fetuses and 14 fetuses with congenital heart diseases were recruited in the study. Surface mode was used to reconstruct the volume images. Results Sixty-three and twenty-six qualified volume images were obtained in 50 normal fetuses and 14 fetuses with congenital heart diseases respectively. All volume images were reconstructed successfully and showed the spacial relationship of cardiac blood vessel directly. Conclusions The combination of B-flow imaging and spatio-temporal image correlation was feasible and useful in prenatal diagnosis of congenital heart diseases.

Objective To explore the safety and efficacy of endoscopic retrograde cholangiopancreatography(ERCP)by using carbon dioxide for malignant biliary obstruction.Methods A total of 60 patients with malignant biliary obstruction, hospitalized from September 2008 to February 2010, were randomly divided into 3 groups to receive ERCP by using carbon dioxide, contrast agent or magnetic resonance cholangiopancreatography(MRCP)without any agent.The safety and efficacy of 3 contrast methods were compared.Results Successful stent or drainage tube insertion was achieved in all patients.Carbon dioxide was superior to contrast agent in terms of lowering postoperative infection rate(P ＜ 0.05), and it was also superior to MRCP for more effective drainage(P ＜ 0.05).There was no significant difference in occurrence of postoperative pancreatitis and hyperamylasemia between 3 groups.Conclusion Using carbon dioxide during ERCP, safe and effective, is superior to use of contrast agent in less leukocyte increase, and to MRCP in more adequate drainage in patients with malignant biliary obstruction.Furthermore, there is no more risk of pancreatitis and hyperamylasemia.

Objective To determine the sensitivity of autofluorescence bronchoscopy (AFB) in the assessment of tumor size and therapeutic strategy.Methods Patients with imaging suspected of malignancy were examined with both white light bronchoscopy (WLB) and AFB.The area of tumor infiltration,imaging information and pathological results were analyzed.Results A total of 212 patients were enrolled,including 180 male and 32 female.In 24 patients (13.2％),greater tumor volume was revealed by AFB than by WLB alone.In these patients,the median diameter of tumor was ＞ 1 cm wider on AFB examination than on WLB.Therapeutic strategy was changed in 18 patients (9.9％) after receiving AFB,including 15 patients with expanded scope of removal and 3 patients with avoidance of surgery.In the univariate analysis,the pathological type of squamous cell carcinoma and tumor invasion in two or more segments of bronchus were independent predictive factors.Diagnostic sensitivity of AFB group was 85.7％,specificity 73.3％,positive predictive value 95.1％,false predictive value 45.8％.Diagnostic sensitivity of WLB group was 72.5％,specificity 60.0％,positive predictive value 91.7％,false predictive value 26.5％.Conclusion Our study suggests that compared with WLB alone,autofluorescence bronchoscopy plus WLB significantly improves the diagnostic value and treatment outcome of central lung cancer.