Objective:To study the treatment result of the unresectable advanced pancreatic cancer by radiotherapy. Methods: A total of 16 patients with unresectable advanced pancreatic cancer were treated by radiotherapy from March 1996 to December 2001. According to TNM staging system, there are 5 patients in stage II, 6 in stage Ⅲ and 5 in stage Ⅳ. Karnofsky score were ranged from 30～70. Eight patients were treated by the conventional fractionation (1.8～2.0 cGy/f, 5f/w), and eight patients treated by non-conventional fractionation(1.2～1.8Gy/f,2～3f/d).The radiation dose was70Gy for 3 cases. Results:The remission rate was 85.7 percent. The median survival course was 9.2 months(3～30months). 1-year survival rate was 31.25 percent. The pretreatment performance status and TNM stage were important prognostic factors. Both groups of Karnofsky score 60～70 and stageⅡ,Ⅲ showed a highly significantsurvival improvement when compared with groups of Karnofsky score 30～50and stage IV ( P

Objective To investigate the early diagnostic value of high‐sensitivity C‐reactive protein(hs‐CRP) ,D‐dimer and cTnI in ACS .Methods All the 83 blood samples of patients with chest pain in the emergency department of our hospital were enrolled in the study ,and 30 healthy people were recruited as the control group .According to the final clinical diagnosis ,29 patients were grouped into non‐ischemic chest pain(NICP) group and 54 patients were grouped into ACS group .Venous blood samples were col‐lected and the concentrations of serum hs‐CRP ,cTnI ,plasma D‐dimer were measured .The diagnostic value of the 3 indicators and their combined test for ACS was evaluated by using the receiver operating characteristic(ROC) curve and Youden index .Results The levels of hs‐CRP ,cTnI and D‐dimer in ACS group were significantly higher than those of the control group and the NICP group (P<0 .05) .The levels of hs‐CRP and D‐dimer in ACS group were significantly higher than those of the NICP group(P<0 .05) . ROC showed that the area under urve of hs‐CRP ,D‐dimer and cTnI were 0 .564 ,0 .631 and 0 .639 respectively .The sensitivity ,spe‐cificity and accuracy of the combined detection of hs‐CRP ,cTnI and D‐dimer were 88 .1% ,58 .7% ,53 .2% respectively . Conclusion To some extent ,the levels of hs‐CRP ,cTnI and D‐dimer all could be used as indicators in the diagnosis of ACS .But combined detection of hs‐CRP ,cTnI and D‐dimer could improve the sensitivity and specificity ,and had value to guide clinical diagno‐sis of ACS in the early stage .

Objective To evaluate the use of spiral enteroscopy in diagnosis and treatment of smallbowel diseases.Methods The data of 8 patients who underwent spiral enteroscopy from July to September 2009 were retrospectively studied.The variables including maximal insertion depth,total procedure time,complications,and outcome were evaluated.Results The average maximal depth of intubation was 2.2 m beyond the Ligament of Triez (0-3.6 m beyond Ligament of Triez),with a mean procedure time at 41 min (25 to 77 min).Small bowel Crohn's disease was diagnosed in 2 cases with biopsy suggesting active inflammation and granular formation.Small intestinal tumor was detected in 1 patient with pathological finding of high grade dysplasia.Jejunal ulcer was detected in 1 patient.Multiple polyps were found in 1 patient after jejunal anastomosis,which were then treated with endoscopic argon plasma coagulation (APC).No abnormalities were found in 3 other patients.No complications occurred during and after the procedure.The maneuver of spiral enteroscopy and APC were same as that of balloon enteroscopy.Conclusion Spiral enteroscopy is simple and convenient to operate,which is of great potential in clinical use.

lem and direct necessary intervention to improve the completion rate of whole small intestine examination.

Objective To discuss the clinical value of immunofecal occult blood test in screening of colorectal cancer and its precancerous lesions in a large series of health checkup population. Methods Colorectal cancer and its precancerous lesions in 5919 subjects undergoing health checkup in our hospital were screened out by using immunofecal occult blood test from July 2006 to June 2007; positive cases with the test were subjected to colorectal endoscopy or X-ray barium enema examination. Relevant results were analyzed in combination with clinical and pathological data. Results Positive result was obtained in 314 out of the 5919 subjects undergoing health checkup with immunofecal occult blood test; the positive rate was 5.30%. 241 cases(76.75% )of them accepted colorectal endoscopic examination and 23 cases(7.32%) accepted X-ray barium enema examination. The total follow up rate was 84.08% with 50 cases out of contact. After excluding the cases out of cantact, 16 cases of colorectal cancer were found morbidity 2.37‰ including 8(50.00% )cases of Dukes A,7 cases (43.75%)of Dukes B and 1 case of Dukes C (6 .25%).The detection rate of colorectal cancer with postive imunofecal occult blood test was 6.06% (16/264). 94 cases (16.01‰) of adenomatous polyps were found including 55 cases (58.51%) of tubular adenoma, 23 cases (24.47% )of villiform- tubular adenoma and 16 cases(17.02%) of villfform adenoma. Among these cases 55 (58.51%)were solitary and 39(41.49%) multiple. In addition, 6 cases of ulcerative colitis in active phase were found. Altogether 116 (43.94%)of the 264 cases with positive immunofecal blood test and not out of contact were found to have colorectal cancer or its precancerous lesions. Conclusion Immunofecal occult blood test is suitable for screening of colorectal cancer and its precancerous lesions in large series of population. Colorectal cancer and its precancerous lesions may be found in relatively early phase and be eradicated in curable stage, thus to reduce the morbidity and mortality.

Objective To evaluate the diagnostic value of hysterosalpingography in infertility caused by salpingian obstraction.Methods 892 cases of femiles infertility were reported in the group,ranged in age from 20 to 36 years and the mean age was 26 years.The hysterosalpingography was taken under fluoroscopic guidance during third to 7th day after menstruction,the radiographes were taken and analysed.The different segments and shapes of salpingian obstruction were correspondently divided into 3 levels and 3 degrees respectively according to the different therapeatic methods for infertility.Results There were total 776 cases with salpingian obstructional infertility,of them,both side involved in 582 cases,and one side in 194 cases,the total of abnormal fallopian were 1358 tubes including 1 st level 423,2nd level 561;3rd level 374,1 st degree 263,2nd degree 553 and 3rd degree 542.Conclusion Hysterosalpingography plays an important role in the therapy and diagnosis of the inferility caused by salpingian obstraction.

Objective To evaluate whether the comparability of 3 automatic blood cell analyzers meet the clinical requirements by conducting the comparative study on the detection results of these instruments.Methods With the Sysmex 2100 automatic blood cell analyzer as the reference instrument,Sysmex 1000i and Abbott 1800 as the experimental instrument,the original quality control provided by the instrument factory and the patient′s fresh anticoagulant blood samples in the laboratory were adopted to monitor for continuous 40 d by these three instruments and the detection results of WBC,RBC,HGB,HCT and PLT were analyzed.Results The detection results of these 3 instruments were statistically tested by the F test,the differences showed no statistical significance (P >0.05)and the bias was in 1/2 of the maximum permissible error range in America department clinical test revised regulations (CLIA′88).Conclusion The detection results by these 3 instruments are comparable and can meet the clinical requirements.

Objective To evaluate the clinical effect of capsule endoscopy(CE)followed by a directed double-balloon enteroscopy(DBE)in diagnosis of patients with suspected small bowel disease.Methods Two hundred and ninety-nine consecutive patients with obscure gastrointestinal bleeding or other various indications for CE examination were analyzed.DBE was recommended after negative or indeterminate evaluation on CE.The diagnostic and follow-up data were collected and analyzed.Resails A total of 296 patients completed CE examination.Of whorn,138(46.6%)cases had positive findings,68(23.0%)cases were suspected for small bowel disease and 90(30.4%)cases had negative finding,Those who were suspected(45 cases)and negative(7 cases)for CE examination were performed DBE examination and small bowel lesions were found in 31 cases and 1 case,respectively.The false-negative diagnosis was probably made by DBE in 8 patients,whereas no false-positive case was found by DBE.The false-negative diagnosis was probably made by CE in 2 patients,whereas 8 false-positive cases were found by CE.With the results of CE examination,lesions were found by only one-side procedure of DBE in 90.3%(28/31)of patients.The results that followed up for median 17 months indicated that 93.5% of patients with positive findings by DBE were received optimal therapy.Both CE and DBE procedures were well tolerated and no severe complications occurred.Conclusions The detection rate of sinall bowel lesions with CE was high,whereas the indetermination of CE findings was also significant.Majority of suspected findings by CE may be further confirmed by DBE.The strategy that start with CE and followed by DBE may increase diagnostic yield in patients with suspected small bowel disease and improve the prognosis.

Objective To evaluate the guiding role of capsule endoscopy (CE) in choosing the access route of double-balloon enteroscopy (DBE) for small bowel diseases. Methods Patients with complete CE and with small bowel diseases confirmed by DBE were enrolled. The lesion location found on CE was represented by the time index, which was the ratio of access time from pylorus to lesion over access time from pylorus to ileocecal valve. Based on our previous retrospective evaluation, oral approach was selected when the index was ≤0. 6, otherwise the anal access would be chosen. Accuracy of time index predicting DBE access rout was evaluated. Results Data of 60 patients undergoing both CE and DBE were evaluated. All lesions detected by CE were confirmed by DBE, with 41 via oral route and 19 via anus. Based on the time index with threshold of 0.6, the accuracy of selecting the insertion route of DBE was 100%. Conclusion DBE is an effective approach to confirm CE results. In patients with complete small bowel investigation by CE, the insertion route for DBE can be reliably indicated with time index based on the CE results.

Objective To determine the detection rate of duodenal papilla and the diagnostic rate of small bowel diseases by capsule endoscopy(CE)and its possible influencing factors.Methods A total of 369 cases with suspected small bowel disease who had undergone CE were retrospectively reviewed. The de- tection rate of duodenal papilla and that of small bowel disease were calculated respectively. The detection rate of duodenal papilla in another 369 patients having received gastroscopy was also counted in order to findout the miss detection rate of forward-viewing endoscopy. The CE findings were reviewed at the rate of 1 im-age and 15 images per second by hand-motion respectively. The detection rate of duodenal papilla was calcu-lated,and the number of frames showing duodenal papilla was counted. Differences of detection rate of duo-denal papilla were also analyzed by different age and gender groups. In addition,the potential difference in detection rate of duodenal papilla between different bowel preparations before CE of two different reviewing approaches was also investigated respectively. Results The miss detection rate of duodenal papilla with for-ward-viewing gastroscopy was 22. 0%. The detection rate of duodenal papilla reviewed at the rate of 1 image by hand-motion,where less frames were needed to visualize duodenal papilla(3. 7vs7. 0),was significantly higher than that at the rate of 15 images per second(32. 2%vs13. 6%,P=0. 001). The diagnostic rate of small bowel diseases was also significantly higher than that of duodenal papilla by CE(67. 2%vs32. 2%,P=0. 000). Age and gender were not significantly correlated with the detection rate of duodenal papilla. No significant correlation was found between various kinds of bowel preparation before CE at different viewing rate and the detection rate of duodenal papilla. Conclusion It iS relatively difficult to identify duodenal pa- pilla by CE,as they are peculiarly positioned in anatomy,so the detection of duodenal papilla does not nec- essarily represent the detection rate of small bowel diseases. The major factors that influencing the detection of duodenal papilla by CE include local anatomy,viewing rate and technical limitations of CE.