With the development of the population aging and the shifting of medical paradigm,as well as the deeply expansion of community health services,the importance of general medicine has become more and more evident.This paper describes the development history of general medicine and general medical education at home and abroad,analyzes the main problems of general medical education in China.By studying the characteristics of different models,we provided the basis of literature for the related policies.

Objective To evaluate the efficacy and adverse events of irinotecan (CPT-11) combined with 5-FU in treatment of patients with advanced rectal cancer. Methods 86 patients were randomly divided into FOLFIRI treatment group and IFL treatment group. The efficacy and adverse events were observed. Results There was no statistically significant difference between FOLFIRI treatment group and IFL treatment group in CR、PR、SD and RR(all P ＞ 0. 05). There was also no statistically significant difference between FOLFIRI treatment group and IFL treatment group in adverse events(all P ＞ 0.05). Conclusion Irinotecan in combination with 5-FU was effective and had some tolerable adverse events in treating patients with advanced rectal cancer in both FOLFIRI treatment group and IFL treatment group.

Objective　To optimize the oral contrast media in three-dimensional display of gastric lesions. Methods　41 cases were randomly divided into 3 groups according to different oral contrast media administered: No. 1 air contrast group (n=17), No. 2 fat emulsion group (n=7) and No. 3 positive contrast group (n=25). The 3D CT images were reconstructed using MPR, SSD, RaySum display and virtual endoscopic techniques, and compared with gastric endoscopy and/or conventional barium study.Results　The detectability of gastric lesions using fat emulsion and air contrast was 42.8%(3/7) and 80.0%(20/25), respectively, both were significantly lower than that using positive contrast (100%, 30/30) (χ2=19.22,P＜0.01;χ2=6.60, P＜0.05). The capability of showing the details of stomach lesions was significantly affected by the oral contrast media administered（χ2=17.04，P＜0.01）. Conclusion　It is very important to choose the appropriate oral contrast media for 3D display of gastric lesions in spiral CT, the positive contrast agent is the optimal choice.

Objective To investigate the value of CT in the diagnosis of dedifferentiated liposarcoma.Methods Fifteen surgical operations of dedifferentiated liposarcoma in 11 patients, confirmed by pathology, underwent plain (n=15) and contrast enhanced (n=12) CT scans. Two of the 12 lesions underwent dynamic multi-phase contrast scans. The CT features and the corresponding pathological basis were analyzed.Results The lesions were divided into 3 groups according to the fatty component and its distribution. The CT appearances were as follows: (1)a well delineated fatty component in the lesion and a closely apposed non-fatty region in 10 cases including 5 initial (5/5, 100%) and 5 recurrent (5/10, 50%), which depicted an abrupt transition from the well-differentiated area to the high-grade sarcoma component under microscope; (2)fatty component within the lesion was less than 10% in 3 recurrent (3/10, 30%); (3)fatty masses and non-fatty masses separately distributed in 2 recurrent cases (2/10, 20%). Contrast enhanced CT scan showed moderate to marked inhomogeneous enhancement in the early phase in all 12 lesions, and delay enhancement was also observed.Conclusion Dedifferentiated liposarcoma exhibited specific appearances as well delineated fatty component and closely apposed non-fatty region with apparent enhancement. Dynamic contrast CT scans play important roles in the diagnosis and differential diagnosis of dedifferentiated liposarcoma, and help pre-surgical grading and pathological sampling.

Objective To define the CT imaging characteristic of menetrier disease. Methods Four patients with proved Menetrier disease were retrospectively studied by means of CT performed with the water as oral contrast, hypotonic agent and dynamic or spiral CT technique. Results All cases showed that the enlarged rugae were seen projecting into the gastric lumen, but the gastric wall was otherwise normal. CT detected all lesions and made a confirmed diagnosis before pathology biopsy. Conclusion Our primary result revealed that the CT appearance of Menetrier disease was quite characteristic, CT is a very valuable tool for the diagnosis of Menetrier disease.

Background and purpose:Parotid gland is rich in fat and has obvious contrast with bone and muscle in CT image.The preoperative examination of CT could help to evaluate the scale of tumor invasion and the relationship between tumor and normal tissues so that the proper therapy could be properly designed.The purpose of this study was to evaluate the roles of computer tomography(CT)in differential diagnosis of benign and malignant parotid tumors and to improve the diagnostic accuracy.Methods:CT images of 17 patients with benign parotid tumors and 15 patients with malignant parotid tumors proved by pathology were analyzed retrospectively.All patients underwent CT contrast-enhanced examination preoperatively.Images of all patients were retrospectively reviewed by two experienced radiologists in the diagnosis of head and neck tumors.Results:14 of 17 cases of benign tumors had round shapes and 9 of 15 cases of malignant tumors exhibited lobular or irregular masses(P

Purpose:To evaluate the role of CT in diagnosing local recurrence after surgery of gastric carcinoma. Methods:Two groups of 51 patients after surgery of gastric carcinoma were prospectively studied by means of CT performed with the water as oral contrast,hypotonic agent and dynamic or spiral CT technique. 15 patients proved to be without local recurrence measured the thickness and observed the CT findings of anastomosis stoma ,36 patients proved to have local recurrence ,those patients included male 21 and female 15.Results:90.19%(46/51)anastomosis stoma was clearly demonstrated ,and 32 lesions was detected and confirmed the diagnosis in 29 of 32 cases . The CT findings of local recurrence after gastric resection for gastric cancer were irregular gastric wall thickening ( n =14),local mass ( n =6) and mixed lesions ( n =9).Conclusions:Using the optimal technique can improve the detectability and accuracy of CT for diagnosing the local recurrence after surgery for gastric carcinoma.

Purpose:To investigate the values of three newer contrast enhanced MRI sequences including gadolinium-enhanced FLAIR MRI(CE FLAIR), dynamic contrast-enhanced MRI (DCE MRI) and perfusion- weighted MRI(PWI) by comparing their advantages and disadvantages respectively in the diagnosis of intracranial tumors. Methods:43 patients with intracranial tumors underwent DCE MRI, CE FLAIR and PWI respectively. The gadolinium-enhanced FLAIR, dynamic enhanced MR and perfusion-weighted MR images were evaluated independently by two radiologists for the number of examinations with one or more enhancing lesions, the number and location of enhancing lesions per examination, the detectability for different lesions in different locations, size and extent of the lesions. Results:Perfusion-weighted MR images showed poor quality and could not give a diagnosis in 5 of 43 cases because of heavy susceptibility artifacts. There were 47 lesions in the 38 cases. However, 41 lesions were found on CE FLAIR MR images and 42 on DCE MRI and 45 on PWI. 3 lesions(2 located in the subcortical area and 1 in paraventricle) were only revealed on the CE FLAIR images. 4 lesions in the basal ganglia area were only found on dynamic enhanced images. 7 lesions in the cerebral hemisphere were only found on perfusion-weighted images. So there were significant differences in revealing lesions of different locations with the three MR modalities(P

5 mm) in 4 cases, and polypoid mass in 3.[WT5”HZ] Conclusion[WT5”BZ] CT is a new non invasive technique, evaluable in the diagnosis of chololedochal cyst complicated with carcinoma. [WT5”HZ]

Computed tomography colonography (CTC) is a well-established technique for evaluation of colorectal cancer (CRC). Signiifcant advances have been made in the technique of CTC since its inception. Besides being an excellent tool for detection of CRC, it is minimally invasive, less time-consuming and well tolerated by patients. Furthermore, it has fewer complications than conventional colonoscopy (CC) or barium enema (BE). The application of new technologies, such as electronic cleansing (EC) and dual-energy CT (DECT), enriches the examination of CTC. In 2005, a standardized reporting scheme, CT colonography reporting and data system (C-RADS), was put forward by the working group on virtual colonoscopy. They proposed that the report should include lesion size, number, morphology, location, attenuation and recommendations for lesion surveillance. New research progress and clinical applications of CTC in CRC are reviewed in this article. In addition, the paper also brielfy touches upon technique, indications, contraindications, safety and risk of CTC.