Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a rare tumor which has malignant potential.Differentiating IPMN from other cystic lesions of the pancreas is difficult. Its clinical symptoms are nonspecific,including nausea,vomiting,abdominal pain,fever or jaundice,possibly accompanied by hyperamy lasemia of blood and urine.Some patients have acute pancreatitis or chronic cholecystitis.According to the result of a retrospective study on clinical and imaging data of 11 patients with IPMN,we drew a conclusion that cystic dilatation of the main or branch of pancreatic ducts and mural nodules,and cystic dilatation linked with the main pancreatic ducts are the characteristics of IPMN of the pancreas.Computed tomography diagnosis is feasible to provide important information for the diagnosis of IPMN of the pancreas.

ObjectiveTo explore a procedure to correct the multiple facial deformities by using the expanded frontal flap combined with the axial flaps.MethodsAccording to the face deformity we used the rectangle 100-350 ml expanders behind the frontal hairline,after finishing the tissue expanding,adopted two or three axial flaps based on the supraoribital,supratrochlear or temporal vessels. ResultsA total of 13 cases were treated with this approach.7 eases were nose and lip defect reconstruction after burn,in which temporal vessel-based flap was used in 2 cases and supraoribital or supratrochlear vessel-based flaps in 5 cases.The other 6 cases were nasal reconstruction combined with the frontal defect correction by using random flaps,including 2 cases of pigmented nevus,1 neurofibroma,and 3 burn scars.All the flaps survived and satisfactory appearance was obtained.Conclusions The expanded frontal flap combined with axial flap based on multiple vessels is a good approach to correct the multiple facial deformities.

Objective To investigate the value of video-assisted thoracoscopy in the diagnosis and treatment of pleural effusion with unknown causes.Methods Video-assisted thoracoscopic biopsy or pleurodesis was performed in 45 cases of pleural effusion unexplained by routine examinations from March 2002 to March 2005.Results The diagnosis was clarified in all the 45 cases.There were 3 cases of malignant effusion,38 cases of tuberculous pleurisy,3 cases of nonspecific effusion,and 1 case of idiopathic pleural effusion.No severe surgical complications occurred.Follow-up checkups for 2~36 months found no recurrence.Conclusions Video-assisted thoracoscopy is a safe,effective,and micro-traumatic approach for the diagnosis and treatment of pleural effusion.

Objective To explore the effects of static wrist on radial nerve palsies. Methods 60 patients with radial nerve palsies were devided into wrist group (n=20), acupuncture group (n=20) and intermediate-frequency (IF) group (n=20), who accepted static wrist wearing, electroacupuncture, and intermediate-frequency electro-stimulation respectively. Results The efficacy was not significantly different among these groups, but the time out of working and the cost for the management were the least in the wrist group. Conclusion Wearing static wrist is not only effective on radial nerve palsies, but also reduce the loss of working time and cost of treatment

BACKGROUND:Autologous peripheral blood hemopoietic stem cell transplantation(HSCT)in combination with high-dose chemotherapy significantly improves complete remission and survival rate of multiple myeloma patients.However,the relapse rate is high.Bortezomib is 26S proteasomes inhibitor,and effective on the primary treatment of multiple myeloma.OBJECTIVE:To evaluate the curative effect of HSCT in combination with bortezomib and high dose-melphalan for multiple myeloma.METHODS:A retrospective analysis of 3 patients with a stage-ITT multiple myeloma admitted to Department of Hematology,Affiliated Hospital of Guiyang Medical College from October 2006 to May 2007,was conducted.Chemotherapy and granulocyte colony-stimulating factor were used to mobilize autologous peripheral blood hemopoietic stem cells.All patients were pretreated with 200 mg/m2 melphalan via intravenous drip 3 days before transplantation,followed by HSCT 48 hours after drug termination.RESULTS AND CONCLUSION:All patients obtained prompt and sustained hematopoietic reconstitution,and bone marrow depression restored 30 days following HSCT.Case 1 and 2 obtained complete remission,and case 3 obtained partial remission.Results show that HSCT in combination with bortezomib and high-dose melphalan is a safe and feasible treatment on multiple myeloma.The patients have good tolerance to pretreatment.

BACKGROUND: Rituximab single or in combination with CHOP regimen for treatment of CD20-positive non-Hodgkin lymphoma has achieved good curative effects. Autologous hematopoietic stem cell transplantation (AHSCT) has been shown to improve the curative effects and increase survival rate of patients with non-Hodgkin lymphoma. However, the curative effects of these two methods remain disputed. OBJECTIVE: To investigate the efficiency of rituximab in combination with AHSCT on CD 20-positive non-Hodgkin lymphoma. METHODS: Six patients with CD 20-positive non-Hodgkin lymphoma (stage IV) underwent AHSCT and rituximab administration. 375 mg/m~2 rituximab was intravenously administered 2-4 times prior to AHSCT, twice prior to and after peripheral blood stem cells mobilization and preprocessing, respectively, as well as once every 3 months after AHSCT. RESULTS AND CONCLUSION: The mean number of mononuclear cells and CD 34-positive cells was 5.13×10~(-8)/kg and 4.75×10~(-6)/kg, respectively. Following AHSCT, all 6 patients presented normal hematopoietic functions, neutrophils exceeded 0.5×10~(-9)/L at 9-15 days and blood platelet counts exceeded 20×10~(-9)/L at 12-19 days. Hemorrhagic cystitis, interstitial pneumonia, cytomegalovirus infection, or hepatic venous obstruction was not observed during the whole process of AHSCT in each patient. At 6-32 months, patients completely recovered. These results indicate that rituximab in combination with AHSCT is a good method for treatment of CD20-positive non-Hodgkin lymphoma and rituximab maintenance therapy could prevent disease recurrence.

BACKGROUND: As a kind of unwounded biomagnetism technique, magnetoencephalography (MEG) relfects immediate information of cerebral function by using magnetic source imaging through recording changes of magnetic field of neurocytes under different functional status.OBJECTIVE: To investigate the practicability of magnetoencephalography (MEG) imaging in localizing sensory-motor cortex for brain tumour surgery in 36 patients.DESIGN: Observational study.SETTING: Department of Neurosurgery, Guangdong Provincial Hospital of Traditional Chinese Medicine.PARTICTPANTS: From Janury 2003 to April 2006, 36 patients (17 male and 19 female) with brain tumors selected from Deparment of Neurosurgery, Guangdong 999 Brain Hospital underwent surgery with MEG-guided neuronavigation in the region of the sensory and motor cortex. Ages of the patients ranged from 13 to 70 years. Among the 36 patients, 14 with gliomas (including 5 highly malignant gliomas), 19 with meningomas, 1 with spongy angioma and 2 with adenocarcinoma (due to the metastasis of brain tumor). All patients and relatives provided the confirmed consent and the experiment provided by the local ethics committee.METHODS: A 148-channel biomagnetometer (4-D Neuroimaging, USA) was used to determine motor and/or senory cortex with sampling rate 678.17 Hz, high-pass filter 1.0 Hz and bandwith 200 Hz. MRI images were acquired using a Philips Gyroscan Intera 1.5T MR tomography. And then, the functional maps were transfered to the neuronavigation system for the treatment of brain tumor. All patietns followed up by further consultation and telephone call in 2-26 months after operation.MAIN OUTCOME MEASURES : Operative outcome and prognosis.RESULTS: MEG demonstrated that the tumor lesion changed the sensory-motor cortex in various degrees for the 36 patients. Brain tumors were resected completely in 34 cases. At 2-26 months after surgery, neurological deficits fully recovered in 19 cases, unchanged in 15 cases and deteriorated in 2 cases.CONCLUSION: MEG was found to be practical and useful in localizing sensory-motor cortex and brain tumor. It is a valuable non-invasive method for presurgical planning in the treatment of brain tumors.

BACKGROUND:Cataract is not the necessary symptom for myotonic dystrophy(DM).But it may be the early and even only clinical symptom of DM.Molecular diagnosis can provide the important evidence for the diagnosis of DM.OBJECTIVE:To explore the characteristics of cataract in 26 patients with myotonic dystrophy of 3 pedigrees from Shanghai Songjiang area.DESIGN:Analysis on the Genealogy of Pedigree.SETTING:Department of Neurology,Shanghai Changhai Hospital.PARTICIPANTS:Twenty-six patients of 3 pedigrees,aged 7 to 71 years old,which were preliminarily diagnosed as DM patients or were suspicious DM patients,admitted to Department of Neurology,Shanghai Changhai Hospital between May 2001 and August 2003,were recruited in this study.Among the involved patients,13 corresponded to the clinical diagnosis standard from Practical Neurology,and the other 13 patients have adverse symptoms and (or) body signs of partial or mild DM,suspecting with DM patients.METHODS:①Peripheral blood of 1 mL was taken and genome DNA was extracted.By using a thermocycler,a polymerase chain reaction (PCR) was carried out to examine the CTG repeats according to criteria of molecular diagnosis (CTG repeats from 80-3350).②In addition,slit-lamp examination for specific lens opacity was carried out and the association between DM and cataract was analyzed.MAIN OUTCOME MEASURES:①CTG trinucleotide repeat numbers.②Association between DM and cataract.RESULTS:Of the 26 patients,25 participated in the final analysis except 1 who suffered from sterility clinically.①25 patients were consistent with the molecular diagnostic criteria of DM (CTG repeats from 80-3 350).The remaining 1 with CTG repeats of 13 was clinically sterility and therefore belonged to the normal individual.The (CTG)n triplet repeats of 17 patients with cataract were 2380±80,while 8 patients with cataract were 2298±105(P＞0.05).②Cataract was characterized as iridescent lens opacity or blue posterior cortical lens opacity in 17 patients.Among the 17 patients,cataract in 8 patients was the only early clinical sign whose(CTG) n triplet repeats were higher than the normal ones.CONCLUSION:In the pedigrees with DM patients,characteristic cataract,as a main and even only early clinical sign,will provide important clinical evidence for the early diagnosis of DM.

Objective To investigate the effect of methylprednisolone pretreatment on cardiopulmonary bypass(CPB)-induced intestinal barrier injury in patients undergoing cardiac surgery.Methods Ninety NYHA Ⅰor Ⅱ patients,aged 30-50 yr,weighing 50-75 kg,scheduled for elective cardiac surgery with CPB,were randomly divided into 3 gnoups(n =30 each):control group without CPB(group Ⅰ),control group with CPB(group Ⅱ)and administration of methylprednisolone before CPB group(group Ⅲ).Anesthesia was induced with midszolam,fentanyl,etomidate and rocuronium and maintained with intravenous infusion of propofol and intermittent iv boluses of fentanyl and rocuronium.The patients were mechanically ventilated after tracheal intubation.In group Ⅲ,methylprednisolone 10 mg/kg was injected intravenously before operation and CPB.While in groups Ⅰ and Ⅱ,the equal volume of normal saline was injected instead.The blood samples were taken from the central vein before induetion of anesthesia(T1),before CPB(T2),at 30 min after the beginning of CPB(T3),at 30 rin afier the end of CPB(T4)and at 120 min after operation(T5)for determination of the plasma endotoxin concentration.Infection was recorded within 7 days after operation.Results The plasma endotoxin concentrations at T1 were within the normal range in all groups,without significant difference among the three gnoups(P ＞0.05).The plasma endotoxin concentration at T3-5 and incidence of postoperative infection in group Ⅲ were significantly lower than those in group Ⅱ,while higher than those in group Ⅰ(P ＜ 0.05).Conclusion Methylprednisolone pretreatment can reduce CPB-induced impairment of the intestinal harrier function in patients undergoing cardiac surgery.

AIM: To observe the change of insulin receptor in rabbit kidney with acute ischemic-reperfusion injury. METHODS: 15 Japanese white rabbits were allocated randomly into control group, ischemic-reperfusion group(IR group). IR group received clamping for 1 h followed by 2 h or 48 h of reperfusion. At 2 h or 48 h after reperfusion, glucose and insulin in serum were determined. Insulin receptor in renal tissue was analyzed by radioligand binging assay(BAD). RESULTS: The level of serum glucose increased after 2 h reperfusion in 2 groups, but in IR group the value increased much more higher than those in control groups(P