Objective To investigate the value of the dynamic susceptibility contrast enhanced MRI (DSC-MRI) in differential diagnosis of glioblastoma,solitary cerebral metastatic tumors and cerebral lymphoma.Methods Seventeen patients with glioblastoma,15 cases with solitary cerebral metastatic tumor and 17 cases with cerebral lymphoma were analyzed retrospectively.All patients underwent conventional MR imaging,contrast enhancement and DSC-MRI preoperatively.Pseudo color pictures of cerebral blood volume (CBV) and the time signal intensity curve were obtained from the raw data of DSC MRI.The relative CBV (rCBV)were measured from regions of enhanced solid parts of the tumors,peritumoral region and contralateral normal white matter regions respectively.The percentage of signal intensity recovery (PSR) of enhanced solid parts of the tumors were measured.ROC curve analysis was performed to determine optimum indicator in differential diagnosis of three types of tumors,and the sensitivity and specificity were calculated.Results Three types of tumors all showed enhancement of solid area with obvious peritumoral edema.Besides the no difference between glioblastoma and metastasis in rCBV of solid parts of the tumors,there were statistically significant differences in comparisons of two types of tumors (all P＜0.05).Besides the no difference between single brain metastases and lymphoma in rCBV of peritumoral regions,there were statistically significant differences in comparisons of two types of tumors (all P＜0.05).The PSR of the solid parts of the tumors had no difference between glioblastoma and single brain metastases,while there were statistically significant differences in comparisons of two types of tumors (all P＜0.05).ROC curve analysis showed sensitivity and specificity of the PSR values of solid parts of the tumors in differentiating lymphoma and non lymphoma were 100 ％and 81.3 ％.The rCBV of peritumoral regions was the optimum indicator for differentiating glioblastoma and solitary brain metastasis,the sensitivity and specificity were respectively 94.1％ and 86.7％.Conclusion The combination of rCBV and PSR can improve the efficiency for diagnosing the three types of brain tumors.

1 313 patients who received renal transplantations at Department of Urology, Research Institute of Field Surgery, Daping Hospital, Third Military Medical University of Chinese PLA from December 1993 to October 2008 were selected in the experiment. Urinary fistula occurred in 68 patients of them after renal transplantation. In order to make diagnosis more standard, 68 patients was classified in accordance with diagnostic classification standards after renal transplantation. The 68 patients were divided into simple and complex urinary fistulas in accordance with lesion degree. They were divided into low, high and multiple fistulas in accordance with the position and etiology. 47 (69.1%) of 68 cases were simple urinary fistulas: 42 cases were because of terminal ureteral necrosis; 4 cases were because the anastomosis was mended unsuitably; 1 case was because of poor healing of anastomosis due to infections. 21(30.9 %) cases were complex urinary fistulas. The position of orificium fistula: orificium fistula located at renal pelvis, ureter and anastomosis were 2, 2 and 11 cases, respectively. 6 cases had ureteral necrosis longer than 2 cm. The times of repair: 11 cases had 1 time, 5 cases had 3 times, 3 cases had 3 times and 2 cases had 4 times. 2 cases (2.9%) died because of severe pulmonary infection caused by urinary fistula. Result suggests that there are two advantages of dividing urinary fistula into the simple and complex types after renal transplantation: one is that the diagnosis of urinary fistula is more carefully and standardized, and the other is that doctors can make the best choice for treatment in order to get the best efficacy.

Objective To establish the standards for classification of urinary fistula after kidney transplantation. Methods From December 1993 to February 2009, 1313 cases of renal transplanta-tions were operated, out of which 102 cases of urinary fistulas occurred (7.8%). Based on the princi-ple of the urethral injury classification method, we divide urinary fistula into simple and complex clas-ses by the cause, location, and the severity of the disease. Results There were 81 cases (79.4%) of simple urinary fistulas, of those 76 cases were ureteral end necrosis,4 cases were due to ureter blad-der anastomosis suture,1 case was anastomotic problem caused by wound infection. There were 21 ca-ses(20.6%) of complex urinary fistulas, of these 2 cases had fistulas at renal pelvis, 11 cases at ure-ter-bladder interface and 6 cases had ureteral necrosis longer than 2 cm. For the 81 cases urinary fistu-las patients, 34 patients conservative treatments were cured and 47 patients need surgeries. For all complex urinary fistulas need surgeries: 11 cases had surgery once, 5 cases had 2 times, 3 cases had 3 times and 2 cases had 4 times. Among the 2 groups, three patients (2.9%) died of urinary fistulas which led to severe lung infection. Conclusions A "Five Steps Procedure" could be used for diagno-sis and treatment of post renal transplantation fistula. The urinary fistulas are divided into simple and complex types after renal transplantation. This provides a guidance for the best choice of treatment.

Objective To introduce a new method of trans-superior limb of cerebellopontine fissure approach for exploring and managing superomedial responsible vessels of facial nerve of patients with hemifacial spasm.Methods Clinical data of 21 patients with hemifacial spasm among 183 consecutive patients were analyzed retrospectively in our hospital from February 2009 to December 2013.Dissection of the superior limb of the cerebellopontine fissure was performed to explore the distribution and the severity of compression of the superomedial responsible vessels of the facial nerve,and microvascular decompression was performed.Results Neurovascular compression was found in all of the patients,primary responsible vessels were found in 13 patients,and secondary responsible vessels were found in 8 patients.Complete spasm alleviation was achieved immediately after operation in 18 patients,and complete spasm alleviation was achieved in all of the patients 3 months after operation.No severn complications occurred and no patient died.No recurrence was noted after an average 56 months of follow-up.Conclusion The trants-superior limb of cerebellopontine fissure approach could avoid the defects of standard suboccipital retrosigrnoidal approach,which allows easy identification and management of the superomedial responsible vessels of the facial nerve of patients with hemifacial spasm;thus,high consistent successful rate and low complication rate could be found.