Objective To compare the therapeutic result of endoscopic po lypectomy with colectomy for polypoid malignant colorectal tumor. Methods A tot al of 61 cases of polypoid malignant colorectal tumor including thirty－ nine pa tients treated by endoscopic polypectomy and surveillance,twenty－ two patients treated by colectomy.Follow－ up ranged from 28 to 168(mean 64) months. Results During the follow－ up period,one patient died relating to this disease,two rec urred at the original site,and one metastasized to the liver.The distribution of the adverse outcome had no significant statistical difference between the group of endoscopic polypectomy and colectomy;significant difference existed between the sessile and pedunculated malignant polyps (P=0.006),as well as between favou rable(carcinoma invading the muscularis mucosa or above,limited to the head of t he pedunculated polyp,polypectomy margin negative,and well and moderately differ entiated)and unfavourable(without those criteria) histologic characteristics(P=0 .002).Conclusion The polypoid malignant colorectal tumors with favourable his tologic characteristics could be treated by endoscopic polypectomy alone,tumors with unfavourable histologic characteristics should be treated by colectomy.

Objective: This study aimed to analyze the high medical expenses of hospitalized medical insurance patients for the first ten systemic diseases.Methods: We investigated the medical expenses for the first ten systemic diseases among 10 900 hospitalized medical insurance patients of a hospital,calculated the average expenses and total payment for the treatment of each of the systemic diseases that involved 5% of the total patients,computed their percentage in the total expenses,and compared them with those of all the other hospitalized cases.Results: The medical cost of the 5% of the first 10 hospitalized systemic diseases accounted for 21%-29.9% of the total expenses of all the hospitalized patients,4.3-6.0 times that of the average expenses,and 30.8%-54.9% paid by the patients themselves.In addition,the hospital stay of these patients was 1.5-4.7 times that of the average.Conclusion: The high medical expenses involving 5% of the hospitalized patients with the first 10 systemic diseases amounted to a quarter of those paid by all the hospitalized patients.Effective measures have to be taken to keep high hospitalization expenses at a reasonable level.

Objective To describe the characteristic endoscopic ultrasonography (EUS) features of gastric ectopic pancreas.Methods Totally 23 patients were diagnosed pathologically as having gastric ectopic pancreas.The EUS images of the lesions were retrospectively reviewed regarding layer of origin,size,growth pattern,margin,and internal echo pattern.Results The coincidence of EUS and pathologic diagnosis was 91%(21/23).EUS revealed that the lesions originated from the second,third,and/or fourth layers of the gastric wall.Most lesions were heterogenous,mainly isoechoic.The borders of the lesions were indistinct in 70%(16/23) patients. Anechoic cystic or tubular structures within the lesions appeared in 10 of the 23 lesions(43%).The mean longest/shortest diameter ratio of ectopic pancreas was 1.7.Conclusions Characteristic EUS features of gastric ectopic pancreases include:mural lateral growth pattern,third layer (submucosa) origin,indistinct margin,intermediate echogenecity,anechoic areas,and fourth-layer thickening.Careful assessment of the EUS findings may be a useful aid in the diagnosis of gastric ectopic pancreas.

Objectives: To investigate the affecting factors on expenditure in Medical insurant inpatients. Methods: 593 medical insurant inpatients, who were from Feb 1, 2001 to Feb 31, 2002 in Nanjing Jinling hospital, were enrolled in this study. The inpatient expenditure was analyzed from the aspect of operation or not, age, and payment mode, used the descriptive analysis and multi factor analysis on affecting factors of the total expense, self bearing expense, and self affording expense. Results: The hospitalized days, operation or not, severity of disease were important affecting factors. The self bearing expense of medical insurant inpatients was associated with hospitalized days, operation or not, and total expense. While the self affording expense of them was associated with expense of drug, hospital bunk, radiation and others. Conclusions: We can control these associated affected factors to lighten the economic weight of patients, and to reduce the ratio of individual payment.

It is an inevitable development tendency to build medical digital libraries. Our practice and results of digitalization of medical libraries explains the goal and idea of the construction of medical digital libraries.

Through the doctor group, the questionnaire survey to understand what the doctor online habits situ-ation of network communication, doctors and patients, the effect of the real network environment for medical diag-nosis and treatment, news media under the network environment on the influence of the doctor and the doctor group about web development comprehensive view of the impact of the doctor-patient relationship.Points out that the current network environment brings to the doctor-patient relationship: the influence of the Internet become some doctors information update and the accumulated knowledge source, network has become an important platform inter-action some doctors and patients, doctors need to deal with an increasing number of network patients, the doctor-shave reactive shifts to the media negative reports.

Objective To observe the prevalence of anionic trypsinogen (PRSS2) gene G191R mutation in patients with acute pancreatitis (AP) and chronic pancreatitis (CP),and to investigate the effect of PRSS2 gene G191R mutation on susceptibility to pancreatitis.Methods The blood samples of 82 patients with acute pancreatitis,73 patients with chronic pancreatitis and 138 healthy subjects were collected,and genomic DNA was extracted.Nest PCR were performed to amplify PRSS2 gene and restriction fragment length polymorphism (RFLP) was followed by using Hpy188Ⅲ to distinguish the G191R mutation.DNA sequencing analysis was performed to confirm the mutation status.Results The size of nest PCR products was 436 bp.RFLP2 produced 309 bp and 127 bp fragments,which were resulted from PRSS2 gene G191R mutation (GGA →AGA).DNA sequencing analysis of the PCR products further confirmed the PRSS2 gene G191R mutation.Five of eighty-two(6.1％) patients with acute pancreatitis had PRSS2 gene G191R mutation (OR=0.682,95％ CI 0.231 ～ 2.010); one of seventy-three (1.4％) patients with chronic pancreatitis had the mutation (OR =0.145,95％ CI 0.019 ～ 1.145),and the corresponding value in healthy group was 8.7％ (12/138).The G191R mutation rate in patients with chronic pancreatitis was significantly lower than that in healthy group (x2 =0.432,P =0.035),but the G191R mutation rates were not significantly different between AP group and healthy group (x2 =0.487,P =0.485).Conclusions PRSS2 gene G191R mutation facilitates the degradation of anionic trypsin,and may reduce the incidence of chronic pancreatitis.

Objective: To explore the potential influencing factors of the quality guidelines for medical treatment by factor analysis.Method: We analyzed with the SPSS package 9 quality guidelines for medical treatment in the department of integrated TCM and Western medicine of a hospital,including the out-patient person-time,the number of discharges,the average days of hospitalization,the rate of bed utilization,the frequency of bed rotation,the rate of cure and improvement,the case fatality rate,the coincidence rate of diagnoses at admission and discharge,and the success rate of emergency treatment.Results: Four common factors were extracted,namely,the quantifiable factor,determined by the out-patient person-time,the number of discharges,the average days of hospitalization and the frequency of bed rotation;the treatment factor,determined by the cure and improvement rate and case fatality rate;the diagnostic factor,determined mainly by the rate of bed utilization and the coincidence rate of diagnoses at admission and discharge;and the emergency treatment factor,determined by the success rate of emergency treatment.The cumulative contribution rate of the 4 factors was 85.1%.Conclusion: The amount of medical work,the techniques of treatment,the ability of diagnosis and the efficiency of emergency rescue are the main influencing factors of quality guidelines for medical treatment.

Disciplinary construction plays a significant role in the building of a hospital.Based on the developmental trend of and existing problems in the disciplinary construction in modern hospitals and in view of the requirements of medical development,the authors proposed some specific measures for building up brand-name specialties,accelerating technological innovations and strengthening personnel training,so as to promote the competitiveness and sustainable development of the hospital.

Objective:TO introduces the construction of digital resources in medical library of Nanjing General Hospital of Nanjing Command, PLA. Methods and results:How to utilize digital resources in the library through local area network and how to utilize PLA medical library through Internet.To achieve the full utilization of digital resource in library. Conclusion:The management and serve of digital resources is the direction of digital resources development of hospital library.