Objective To compare the treatment effect of laparoscopic appendectomy(LA) and open appendectomy (OA). Methods One hundred and forty-five cases of LA performed from May 2003 to May 2005, and 142 cases of OA performed from June 2001 to March 2003 were studied retrospectively. Results There was no difference in operative time between group LA and group OA. In the procedure of LA, some occult disease could be discovered and treated, while OA was not. The administration of analgesic, activity time, incidence of incision infection and hospital stay in group LA were better than those of OA group. While the cost of hospitalization in LA was higher than that of OA. Conclusion LA has significant advantages in treating appendicitis and it should be promoted.

ObjectiveTo investigate portal hemodynamic features and its changes following devascularization in cirrhotics. MethodsHemodynamics of portal trunk (PT), right anterior branch (RAB) and splenic vein (SV), including maximum cross-sectional velocity(CS-Vmax), flow volume and congestion index(CI), were assessed in 69 cirrhotics and 46 normal volunteers by using a recently-developed color Doppler velocity profile(CDVP). Of 28 patients undergone devascularization procedure, portal hemodynamics were studied and compared before and after operation. ResultsCSVmax of PT and RAB was significantly lower in cirrhotic group than normal group;PT and SV flow volume and the ratio of SV to PT flow volume(SV/PT)were significantly greater in cirrhotic group compared with those of normal group;CI of PT, RAB and SV was significantly higher in cirrhotic group than normal group. Postoperative PT flow volume was significantly reduced( P ＜0.01),and the reduction was closely related to preoperative SV flow volume( r = 0.65, P ＜0.001). CS-Vmax and flow volume in RAB were decreased significantly following operation( P ＜0.01), and the reduction of RAB flow volume was highly related to preoperative RAB flow volume( r =0.74, P ＜0.001). After operation, free portal pressure(FPP)was declined by (6 ± 5)cmH2O[ (0.59 ± 0.49)kPa] ( P ＜ 0.001 ). There were no significant changes in CS-Vmax, CI in PT and CI in RAB following operation. ConclusionIn cirrhotics with portal hypertension, portal venous system coexists the elevated vascular resistance and hyperdynamics, but with different redorainance at different portion. SV hyperdynamics is the main source of increased portal blood flow. Devascularization procedure could markedly relieve portal hyperdynamics by elimination of SV inflow, which is one of the main mechanisms in obmining therapeutic goal. But the operation has no favorable effects on the increased portal resistance,and portal perfusion to the liver would be further declined after relieving portal hyperdynamics, which is unfavorable to maintenance of liver function.

Objective To investigate the clinical value of intraoperative iodine-125 seed implanttation in treating pancreatic carcinoma. Methods Seventy-five patients (fourty-one men, thirty-four women;median age 54 years) with pancreatic adenocarcinoma were enrolled into the study. Thirty-one patients (group A) were accepted tumor resection,eighteen patients(group B) were implanted radioactive iodine-125 seeds into the tumors by a combination of bypass surgery, twenty-six patients(group C) were treated by bypass surgery.Results Sixty-seven patients were followed up. The median survival time was 19, 12 and 7 months in group A,B,C respectively, among which the difference was significant (P ＜ 0.05). The response rate(CR+PR) was 50 % and the effective rate of pain relieving was 80% in the group B. The 97.4 % of accordance rate of seed number was demonstrated by CT film, but the accordance rate of seed space distribution was only 56 %.Conclusion At present, the active resection of the pancreatic carcinoma, including the superior mesenteric vein and the retropancreatic fusion fascia, is essential for a curative resection. The combination of Intraoperative iodine-125 brachytherapy and bypass surgery is safe and effective for pancreatic carcinoma.The seed space distribution completed by seed computer therapeutic plan needs further study.

AIM: To investigate the homing effect of immature dendritic cells (iDC) after injection of iDC into the mouse hepatoma treated by microwave ablation and the possibility of stimulating tumor immunity after thermal ablation. METHODS: The model of hepatoma was established with Hepa 1-6 cells injected into the subcutaneous tissue of C57BL/6J mice. The tumors were treated by microwave ablation under different temperatures, and then fluorescent-labeled iDCs (PKH26-DC) were injected into the ablated tumor tissues. The influences of ablation to homing of PKH26-DC, maturation and excitation ability towards T-cell were observed. RESULTS: There were no homing PKH26-DCs and expression of CCR7 in draining lymph nodes in (65?5)℃ and (90?5)℃ ablation groups after intratumoral injection of iDCs. The number of homing PKH26-DCs was 32?8 in (50?5)℃ ablation group vs 21?6 in un-ablated group, and the expression rate of CCR7 was 100% vs 90%. The number of clusters with immunological synapsis was 8-12 in (50?5)℃ ablation group vs 4-6 in un-ablated group under 100-magnification visual field, and the number of lymphocytes in each cluster was 12-25 vs 3-10. CONCLUSION: Thermal ablation of hepatoma under an appropriate temperature level may promote maturing and homing of iDCs and stimulate immunity of lymphocytes.

Objective To investigate the changes of tumor necrosis factor-?(TNF-?) and platelet-derived growth factor(PDGF) in gallbladder carcinoma (GA) patients with cell wall-deficient bacleria(L-form) infection .Methods The levels of TNF-? in gallbladder mucosa were detected by radioimmunoassay and the activity of PDGF was detected by bioactivity assay in patients with GA or cholecystitis and normal gallbladder(control group).Results The positive detection rates of L-forms in gallbladder mucosa of gallbladder carcinoma , chronic cholecystitis, and control group were 80.0%(16/20),82.5%(33/40) and 0(0/20), respectively.The TNF-? and PDGF levels in patients with L-form infection-positive gallbladder carcinoma were significantly higher than those in patients without L-form infection and in control group.The levels of TNF-a and PDGF in patients with L-form infection positive chronic cholecystitis were significantly higher than those in patients without L-form infection and in control group.Conclusions L-form may be one of the direct factors leading to the increase in PDGF during gallbladder oncogenesis,and there is positive correlation between PDGF and gallbladder oncogenesis when L-form induces inflammatory reaction and predisposes gallbladder mucosa to develope neoplasms.

Objective To investigate the efficacy and toxicity of low dose of docetaxel and cisplatin (TP) combined with radiotherapy in the treatment of elderly patients with esophageal cancer.Methods The data of 65 elderly patients with esophageal cancer were studied retrospectively, including 33 patients treated by TP combined with radiotherapy (chemoradiotherapy group) and 32 patients by radiotherapy only (radiotherapy group).Patients in both groups received 3D conventional radiotherapy (3D-CRT).In chemoradiotherapy group, 40 mg/1f docetaxel and 40 mg/1f cisplatin were administered once a week on the 1st, 8th, 15th, 22th, 36th day of five successive weeks.Results In chemoradiotherapy group and radiotherapy group, the response (CR+RR) rates were 87.8 ％ (29/33) and 65.6 ％ (21/32), respectively (P ＜ 0.05), the median TTPs were 5.5 months and 4.3 months, and the difference had statistically significant (P ＜ 0.05).The 1-year survival rate was 69.6 ％ and 59.3 ％ in chemoradiotherapy group and radiotherapy group, respectively, and there was no statistically significant difference between both groups (P ＞ 0.05).The incidences of esophagitis and gastrointestinal tract were slightly higher in chemoradiotherapy group than those in radiotherapy group (P ＜ 0.05).Conclusion Concurrent radiotherapy and chemotherapy with low dose TP can treat effectively esophageal cancer in elderly patients with the tolerable toxic reactions.

The high incidence of postoperative recurrence of hepatocellular carcinoma ( HCC) is a most difficult obstacle for improving the prognosis of patients.Several adjuvant modalities have been developed to prevent recurrence in patients after surgery; nevertheless , there is no consensus regarding the standardized adjuvant therapy in terms of indications , clinical efficacy and interactions.In this article we review the currently available evidence in the medical literature on adjuvant therapy in HCC after radical resection.

Objective To investigate the utility of virtual endoscopy ultrasound Fly-Thru in the diagnosis of obstructive bile duct diseases.Methods One-hundred patients with obstructed bile duct diseases underwent Fly-Thru examination.All Fly-Thru images were reviewed by two radiologists with different experience.The capabilities of Fly-Thru for bile duct obstructive degree evaluation and distinguishing malignant lesion from benign one were assessed respectively.Results The accuracy and sensitivity of Fly-Thru image in obstruction degree evaluation were 70.59％ and 89.2％ (95％CI 74.6％-96.9％).The diagnosis accuracy of 2DUS for lesion characteristics increased from 80％ to 84％,accompany with Fly-Thru images,especially for lesions in common bile duct from 77.2％ to 86.0％ (x2 =14.399,P =0.001).Conclusions The virtual endoscopy ultrasound Fly-Thru is only partly capable to display the obstructed degree of some bile ducts,but it can improve the diagnostic accuracy of common bile duct diseases.

Objective To evaluate the correlation between the imaging features on contrast-enhanced ultrasound (CEUS) and pathological characteristics of combined hepatocellular-cholangiocarcinoma (CHC).Methods Forty patients with pathologically proven hepatic CHC were evaluated,the CEUS imaging findings and pathological characteristics of CHC were retrospectively analyzed.Results On CEUS,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 13(32.5 ％),21 (52.5 ％) and 6(15.0％) lesions,respectively.Pathological findings showed that HCC-predominance,CC-predominant,and similar proportions of the two components were illustrated in 16 (40.0 ％),19 (47.5 ％) and 5 (12.5 ％) cases,respectively.The presence of necrosis were illustrated in 28 (70.0％) cases.On CEUS,when the enhancement pattern was peripheral irregular rim-like enhancement,CC-predominance and necrosis were presented in 11(84.6％) and 10(76.9％) cases,respectively.When the enhancement pattern was diffuse heterogeneous enhancement,CC-predominance and necrosis were presented in 11(52.4％) and 18(85.7％) cases,respectively.When the enhancement pattern was diffuse homogeneous enhancement,HCC-predominance and necrosis were presented in 4(66.6％) and 0 (0％) cases,respectively.There were significant differences in relative proportion of HCC,CC components and tumor necrosis among the three types of enhancement pattern on CEUS (P =0.009 and P ＜ 0.001).When CHCs were ≤ 5 cm,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 5,3 and 5 cases,respectively.When CHCs were ＞5 cm,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 8,18 and 1 cases,respectively.There were significant differences in the three types of enhancement pattern between lesion size of ≤5 cm and ＞5 cm on CEUS (P =0.006).Conclusions The imaging findings of CHC on CEUS depends on the relative proportions of HCC and CC component and on size-dependent patterns.

Objective To comparatively analyze CEUS features of hepatitis B virus (HBV)-related combined hepatocellular-cholangiocarcinoma (CHC) and hepatocellular carcinoma (HCC).Methods Thirty-one patients with HBV-related CHC and 31 patients with HBV-related HCC confirmed by pathology were enrolled and CEUS features were compared.Results On CEUS,HBV-related CHC and HBV-related HCC mainly manifested as hyper-enhanced in arterial phase and hypo-enhanced in portal phase and delayed phase.No significant differences of enhancement level on CEUS were found between HBV-related CHC and HBV-related HCC.When the maximum diameter of tumor ≤3.0 cm,both HBV-related CHC and HBV-related HCC were mainly homogeneous enhancement (P=1.000).When the maximum diameter of tumor more than 3.0 cm,diffuse heterogeneous enhancement and peripheral irregular rim-like enhancement were more commonly observed in HBV-related CHC,while diffuse heterogeneous enhancement was more commonly noted in HBV-related HCC (P=0.001).Conclusion The enhancement pattern of HBV-related CHC ＞3.0 cm has relative specific performance.