Objective To investigate rare etiological causes of giant gastric ulcers. Methods A retrospective investigation was made on 4986 endoscopically proved giant gastric ulcer in our hospital, from January 1976 to December 2000. The morphological features under endoscopy, pathology, diagnosis, treatment and prognosis were analyzed in 59 giant gastric ulcers with special causes. Results Thirty two cases of gastric eosinophilic granuloma,8 gastric carcinoid tumor,8 gastric schistosomiasis, 5 gastric Crohn's disease,4 gastric lymphoma and 2 gastric Behcet's disease were identified. Ten gastric eosinophilic granuloma,3 gastric carcinoid tumor,3 gastric schistosomiasis, 5 gastric Crohn's disease,3 gastric lymphoma , 1 gastric Behcet's disease were misdiagnosed at initial endoscopy.Conclusions Rare etiological causes of giant gastric ulcers could be divided into 3 categories: non-epithelium gastric tumor, gastric granulomatous disease and gastric vascular disease. Careful observation ulcer endoscopy, history inquiry, physical examination, comprehensive analysis and laboratory examination may provide useful information for the diagnosis. Biopsy may be falsely negative in some cases.

Objective To elucidate the pathogenesis of nodular duodenitis by investigating its endoscopic and histopathological characteristics. Methods One hundred and thirty-six patients were enrolled into study. Histopathological changes of duodenal tissue specimens were examined by H-E and AB/PAS staining. H.pylori was demonstrated by Giemsa staining and rapid urease test. Results Under endoscopy, all 136 patients with nodular duodenitis had nodular lesions (ranged from 0.2 cm to 1.0 cm), variant degrees of erythema and edema, among them 21 cases had erosion, and 30 cases had haemorrhagic spots and/or ecchymoses. The detecting rate of nodular duodenitis was 0.9%(136/15 820) of all the endoscopic examinations and 3.8%(136/3541) of duodenitis. There was 107 cases of nodular duodenitis identified by histopathological examination including 53 cases of chronic duodenitis and 54 cases of active duodenitis. The histopathological characteristics of chronic duodenitis were lymphocytes and plasmocytes infiltration and varied degrees of atrophic duodenal villi and glands. While in active duodenitis, there was neutrophilic granulocytes infiltration. There were 51 cases of Brunner's gland hyperplasia and 59 cases of gastric epithelial metaplasia. Among all patients, 7 cases were proved to be gastric heterotopia, 4 cases of schistosomiasis and 18 cases of normal tissue. Among 107 nodular duodenitis, the positive rate of H.pylori infection was 45.8% (49/107), the infection rate of H.pylori in active duodenitis(59.3%,32/54) was significantly higher than that in chronic duodenitis (32.1%,17/53) (P

Objective To study the significances of various gastroscopic findings in chronic atrophic gastritis.Methods To contrastively analyse various findings of CAG under gastroscopic direct vision and their corresponding pathologic diagnosis in 55 cases, and to calculate respectively the sensitivity and specificity of CAG, intestinal metaplasia (IM), atypical hyperplasia (ATP) through various gastroscopic expressions.Results Of the 55 patients CAG 30 cases, CAG and CSG 25 cases were diagnosed by endoscopy; the pathological diagnoses were CAG 36, CSG 8 and CAG plus CSG 11 cases. The coincidence rate of diagnosis between endoscopy and pathology was 85 45%. The sensitivities of gastroscopic findings in CAG to their pathology were about 12 77%～51 06%. Some manifestations in gastroscopy such as piebald change and flat protrusion in CAG have high specificity to pathology about 87 50% and 75 00% respectively. The dominated white phase, prominent vascular pattern with flat protrusion and piebald with erosive protrusion attained the specificity of 100% to the pathology. The asperous and granular changes had higher diagnostic value about IM, its sensitivity and specificity was 66 67% and 71 74% respectively. The dominated white phase and prominent vascular pattern had higher sensitivity, 71 74% in diagnosing ATP. Erosive protrusion had higher specificity, 68 89% in diagnosing ATP.Conclusion Piebald change, asperous and granular changes, dominated white phase and prominent vascular pattern under gastroscopy are highly helpful to the pathological diagnosis of CAG, IM and ATP. But the combination of gastroscopic and pathologic examination is the inevitable procedure in correct diagnosis of CAG, IM, and ATP.

Objective: To investigate the influence of Swiss ball exercises on clinical efficacy and stability of lumbar vertebra in patients with protrusion of lumber intervertebral disc. Method: Thirty patients with non-acute protrusion of lumber intervertebral disc were divided by gender and clinics orders into control and exercises group. Roland Morris questionaire(RMQ) and visual analogue seale(VAS) were selected as pain assessment. Pain, abdominal and back muscle strength were assessed respectively before treatment, 2 and 4 weeks after Swiss ball exercises. Both Swiss ball exercises and lumbar traction were used in exercises group. Lumbar traction was used in control group. Result: Compared with before treatment, RMQ and VAS scores decreased significantly after 4 weeks in control and exercises groups (P<0.05, P<0.01). Compared with control, RMQ and VAS scores in exercises group decreased significantly after 2 and 4 weeks respectively (P<0.05, P<0.01). Compared with control, abdominal and back muscle strength in exercises group increased significantly after 2 and 4 weeks respectively (P<0.05, P<0.01). Conclusion: The low back pain symptom of patients with protrusion of lumber intervertebral disc decreased significantly and abdominal and back muscle strength increased significantly by beth Swiss ball exercises and lumbar traction. The stability of lumbar vertebra of patients with protrusion of lumber intervertebral disc increased significantly.

Objective: To evaluate the prognostic factors of patients with stage Ⅳ gastric cancer. Meth-ods: A total of 138 patients with stage Ⅳ gastric cancer treated with platinum-based chemotherapy were ana-lyzed. Survival rate was estimated by Kaplan-Meier method. The prognostic factors were analyzed by univari-ate (Log rank) and multivariate (Cox model) analysis methods. Results: Univariate analysis and multivariate analysis showed that poor performance status (P=0.001), weight loss (P=0.001), depth of invasion (P=0.000), presence of peritoneal metastasis (P=0.005), more than 1 metastatic site (P=0.029) and elevated total biliru-bin (P=0.018) were independent prognostic factors. According to the outcomes of the Cox model analysis, a formula of the prognostic index was developed. According to the values of PI, 16 patients were categorized as the high-risk group (PI≤9.817), 28 patients were categorized as the moderate-risk group (9.817

Objective This study was designed to investigate the relationship between COX-2 and VEGF-C in human gastric carcinomas and discuss the significance of COX-2、VEGF-C in lymph mode metastasis.Methods Forty-two gastric carcinoma tissues and twenty adjacent noncancerous specimens were obtained from surgical resections.COX-2,VEGF-C protein expression was evaluated by immunohistochemical analysis.Results (1)COX-2 was overexpressed in 25 of 42 carcinoma tissues (59.5%) and VEGF-C was 27 of 42(64.3%),which were significantly higher than those in noncancerous tissues (P0.05).(3)There was positive correlation between the expression of COX-2 and VEGF-C(r=0.425,P

ObjectiveTo evaluate Fuji intelligent color enhancement (FICE) chromoendoscopy for diagnosis of early gastric cancer. MethodsFrom February 2010 to March 2011 ,a total of 67 patients with suspected gastric mucosal lesions were enrolled in this study. The lesions were observed with magnifying endoscopy, FICE, magnifying chromoendoscopy and indigo-carmine-magnifying-chromoendoscopy.Suspected gastric mucosal pit patterns and microvascular morphology were compared. Targeted biopsy was performed on suspected locations. Sensitivity, specificity and pathological consistency were compared between the 3 procedures. ResultsOut of 67 patients, 17 were diagnosed as having early gastric cancer.There was no difference among magnifying endoscopy, FICE magnifying chromoendoscopy and indigo-carmine-magnifying-chromoendoscopy in pit pattern findings,however, FICE magnifying chromoendoscopy was superior to other 2 procedures in displaying capillary loop. The sensibility, specificity and pathological accordance rate of FICE magnifying chromoendoscopy were 94. 1％ ( 16/17 ), 98. 0％ (49/50) and 97.0％(65/67), which were higher than those of the magnifying endoscopy [58.8％ ( 10/17), 84％ (42/50)and 77.6％ ( 52/67 )] ( P ＜ 0. 05 ), and were not different from those of indigo-carmine-magnifying-chromoendoscopy [88.2％ (15/17), 96％ (48/50) and 94.0％ (63/67)] (P ＞0.05). Conclusion FICE magnifying chromoendoscopy provides rather clear images of gastric mucosa and intrapapillary capillary, thereby improving the accuracy of endoscopic biopsy and then imporving the diagnosis rate of early gastric cancer.

ObjectiveTo evaluate the Fuji intelligent chromo endoscopy (FICE) in the diagnosis of Barrett esophagus (BE).MethodsFrom September 2010 to March 2011,a total of 180 patients with suspected reflux esophagitis were examined successively by FICE,magnifying FICE,acetic dyeing endoscopy and magnifying acetic dyeing endoscopy.The diagnosis was made out under the observation of lesion extensions,superficial mucosa contrast ratio,pit patterns and capillary forms of BE.The endoscopic diagnosis was made and compared with the pathologic diagnosis,and the consistency of the diagnosis was evaluated by Kappa value.ResultsBE was confirmed in 35 patients ( 19.4％ ) pathologically.The consistency rates of diagnosis under FICE and acetic dyeing endoscopy were 81.7％ and 72.8％ ( P ＜ 0.05 ).The consistency rates of diagnosis under magnifying FICE and magnifying acetic dyeing endoscopy were 97.8％ and 85.6％,respectively (P ＜ 0.05).FICE magnifying endoscopy revealed better mucosal structures of capillaries than magnifying acetic dyeing endoscopy did ( P ＜ 0.05 ),but there was no significant difference in revealing of duct openings (P ＞ 0.05).The specificity,sensitivity,positive predictive value,negative predictive value and Kappa value of FICE in diagnosis of BE were 82.1％,80.0％,51.9％,94.4％ and 0.52,respectively,which were 73.2％,71.4％,39.1％,91.4％ and 0.34 of acetic dyeing endoscopy,98.6％,94.3％,94.3％,98.6％ and 0.93 of magnifying FICE,and 88.3％,74.3％,60.5％,93.4％ and 0.58 for magnifying acetic dyeing endoscopy.ConclusionAs a neotypical endoscopic system,magnifying FICE could exhibit clearly the pit patterns and microvascular structures of esophagus mucosa,and it can capture the optimal images of Barrett's epithelium.FICE could improve the diagnosis of BE in vivo.

Objective To investigate the relationship between the staging of endoscopic ultrasonography(EUS) and the expression of carcinoma metastasis associated genic in the patients with gastric carcinoma.Methods Sixty-three patients with gastric cancer were diagnosed by electric gastroscopy and EUS.The preoperative staging of gastric cancer was measured by EUS and compared by pathologic staging and MMP-9 expression.MMP9 level of peripheral serum was measured by enzyme-linked immunosorbent assay,while the expression of MMP-9 protein was tested by immunohistochemistry and hybridization in situ in the gastric carcinoma tissue.Results The total accuracy rate of EUS in estimating invasive depth of gastric cancer was(80.95)%,while that of lymphatic metastasis was(73.02)%.The expression level of MMP-9 in serum was consistent with the expression of MMP-9 protein and MMP-9 mRNA in tissue,which was closely correlative with invasive degree,staging with EUS,lymphatic metastasis in gastric cancer(P

Objective To evaluate endoscopic ultrasonography in preoperative diagnosis and staging of gastric cancer, and to study the molecular biologic basis of its ultrasonic manifestation. Methods Gastric cancer patients were diagnosed by electric gastroscopy and endoscopic ultrasonography. Gastric cancer was preoperatively staged by EUS and results were compared with pathologic staging and VEGF expression. Results The diagnostic accuracy of gastric cancer by gastroendoscopy combined with biopsy in 63 patients was 94%,the accuracy of EUS was 92%,while that of gastroendoscopy combined with EUS was 100%.The total diagnostic accuracy of EUS in estimatating invasive deepth of gastric cancer was 81%,that for stage T_1,T_2,T_3,T_4 was 78%,79%,82%,83%,respectively.The total diagnostic accuracy of lymphaden metastasis was 73%.The positive expression rate of VEGF protein in cancer tissue was 56%,which was closely associated with EUS staging and lymphatic metastasis. Conclusions The accuracy of gastroendoscopy combined with EUS in the diagnosis of gastric cancer was high. The preoperative staging with EUS has a high correspondence with postoperative pathological staging. The VEGF protein expression is positively correlated with preoperative EUS staging.