Objective To observe the extent of injury in esophageal mucosa resulted from Argon plasma coagulation (APC). Methods The injuries from APC were observed in 55 sites of esophageal normal mucosa in 11 patients with esophageal cancer. APC powers in 45 W,60 W and 90 W were selected with exposure times of 1 sec and 3 sec respectively. The probe of APC was hold approximately at 30?and 2 mm from the mucosa. The histological changes of esophageal wall injured by APC were examined under light and electric microscopy. Results The injuries in 46 out of 55 sites were merely restricted in the mucosa or sub-mucosa,7 out of 55 extended into the muscularis propria.and 2 of 9 sites extended to the whole depth of e-sophageal wall. The depth of injury increased in relation with the elevating of APC power (P 0. 05). Conclusion APC is a safe way for treating esophageal diseases if its power is limited in an appropriate range.

Objective To study the diagnostic value of double-balloon endoscopy (DBE) and capsule endoscopy (CE) for small intestinal bleeding. Methods Overall detection rates of small intestinal bleeding with DBE, CE and the whole alimentary tract barium meal were compared. Positive rates of bleeding detection with DBE and CE were compared within the same patients. Influence of CE on one-procedure rate of DBE was analyzed. Results In 105 cases of small intestine bleeding, DBE detected 24 cases of Crohn's disease, 15 adenocarcinoma, 12 chronic nonspecific inflammation, 10 small intestinal ulcer of unknown reason, 8 entero-mesenchymoma, 8 polypus, 6 vascular deformation hemorrhage, 5 ancylostomiasis, 5 Mechel's diverticula ( including multiple diverticula), 3 lymphoma and 9 of no evident abnormalities. The positive detection rate of DBE is 91.4% (96/105). Disease detection rates of CE and whole alimentary tract barium meal were 75.0% (30/40) and 33.3% (25/75), respectively. The one-procedure rate of DBE is 90% (36/40) based on CE results, but it was only 69. 2% (45/65) according to clinic features and the whole alimentary tract barium meal. Conclusion The main causes of small intestinal bleeding are benign ulcers (including Crohn's disease) and tumor, as well as chronic inflammation. Polyps, vascular deformation, parasitosis, Mechel's diverticulum and lymphoma are the secondary causes.DBE is superior to CE in diagnosis of small intestine bleeding, but CE can increase the one-procedure rate of DBE.

Objective To observe the morphological changes of pancreatic tissue of thoracic duct ligated rats in fine and ultrastructural levels, and to determine whether lymph block animal model can affect pancreatic islet amyloid polypeptide(PIAP)deposit in rat pancreas. Methods At the 6th month after the operation, some pancreatic tissue sections of 16-month-old experimental rats were embedded in paraffin wax and stained with HE and Congo red;immunohistochemical staining was performed on some frozen sections, which were then observed with light microscope;transmission electron microscope (TEM) specimen preparation and observation were performed on other samples. Results HE and Congo red stained sections showed that the pancreatic glandular lobule space was widened, with significant connective tissue hyperplasia, and fat accumulation when the islet was stained indistinctly or vermeil and tissue space was broadened. The sections with immunohistochemical staining displayed the pancreatic islet as well as the tissues around it were stained into dark brown being positive with PIAP antigen. TEM observation showed the pancreatic glandular interlobule space was widened, while blood vessels and enlarged lymphatic vessels were visible;within widened pancreatic islet interstitial space, a great quantity of lipid droplets and some collagen fibril structures could be seen.Conclusion The ligation of thoracic duct can contribute to pancreatic lymph draining block, lymphagiectasis, connective tissue space and interstitial space widening, fat accumulation, and PIAP deposit in rat pancreas. These structural changes may affect the function of pancreatic islets.

Objective To evaluate the efficacy of biliary tract prosthesis and pancreatic duct stents for advanced periampullary carcinoma. Methods A total of 36 patients were diagnosed as advanced periampullary carcinoma pathologically or clinically, with strictures both in pancreatic and biliary ducts confirmed by imaging. Teflon stents were firstly implanted through endoscopy to the narrowed pancreatic ducts, expansible metal prosthesis were then implanted to the biliary tract. If failed, the metal stents were given through percutaneous transhepatic biliary drainage (PTCD) pathway. Serum levels of liver enzymes, amylase and clinical manifestations were observed before and after operation. Results Teflon stents were successfully implanted into pancreatic ducts in all patients. Metal prostheses into bile ducts were endoscopically implanted in 29 cases, and via PTCD in 7, including 2 cases of Billroth Ⅱ gastrectomy. The levels of liver enzymes significantly decreased (P<0.01) after stents implacement. The levels of amylase (plasma and urine) and lipase increased in 15 cases, but they were corrected to normal levels after adequate treatments. Rates of abdominal pain relieving and diahhrea improvement were 82.4% (28/34) and 88.2% (15/17), respectively. Conclusion The combined implacement of biliary tract prosthesis and pancreatic duct stents is safe and effective in relieving malignant obstruction in periampullary carcinoma.

Objective To evaluate the efficacy of computed tomography ( CT ) and diffusion?weighted magnetic resonance imaging ( DWMRI ) in the diagnosis of regional lymph node metastasis in thoracic carcinoma, and to figure out the methods and thresholds for delineation of lymph nodes with higher reasonability and accuracy. Methods A total of 43 patients with thoracic carcinoma, including 35 patients with esophageal cancer and 8 patients with non?small cell lung cancer, were enrolled as subjects from 2012 to 2013. All patients received abdominal CT scan and DWMRI examination one week before surgery, and regional lymph node metastasis was diagnosed based on the images of CT scan or DWMRI. With the postoperative pathology as the gold standard, the diagnostic efficacy was evaluated and compared between the two methods. The two sets of obtained images were analyzed using the χ2?test. Results The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden’ s index of CT versus DWMRI in the diagnosis of regional lymph node metastasis were 57?1% vs. 60?0%, 96?3% vs. 98?9%, 93?8% vs. 96?5%, 50?0% vs. 77?8%, 97?2% vs. 97?4%, and 53?4% vs. 58?9%, respectively;the specificity, accuracy, and positive predictive value of DWMRI were significantly superior to those of CT ( P=0?005,0?038,0?022) . Twenty out of forty lymph nodes diagnosed by CT scan were false positive, and 15( 75%) of them could be corrected by DWMRI. Fifteen out of forty lymph nodes diagnosed by CT scan were false negative, and 3 ( 20%) of them could be recognized by DWMRI. In all 35 metastatic lymph nodes, 5 lymph nodes had no apparent swelling on images, and 13(43?3%) out of the other 30 lymph nodes had a short diameter less than 1?0 cm. Conclusions CT scan has apparent limitation in the diagnosis of regional lymph node metastasis. Many metastatic lymph nodes would be missed if a short diameter not less than 1? 0 cm is the only standard for target volume delineation . With superior specificity , accuracy , and positive predictive value to CT in the diagnosis of regional lymph node metastasis, DWMRI can effectively rule out non?cancerous intumescent lymph nodes and recognize some of small metastatic lymph nodes.