Objective To investigate an ideal way to reconstruct the digestive canal after total gastrectomy. Methods The clinical data of 87 cases with gastric cancer confirmed by pathology were retrospectively analyzed between May 2003 and Jan 2009, and every patient was subjected to P style of total gastrectomy and digestive canal reconstruction by using jejunum. The diet,symptoms and the body weight were observed. Results In the 87 cases, there was no death causalgia behind sternum. During the follow-up period in the patients with the survival time more than one year, the meal habit was recovered. No reflux symptom was found. The body weight increased in all patients. Conclusions P style operation in gastric cancer is easy and safe to perform. Reflux esophagitis and dumping syndrome seldom developed. "P"jejunal ansa basically played the role in preservation and nutrition of stomach,so this was an ideal way to reconstruct the digestive canal after total gastrectomy.

Objective To study the effect and safety of modified Valdivia position and prone position in percutaneous nephrolithotomy(PCNL) on renal calculi.Methods The clinical data of 94 patients with solitary renal calculi admitted in our hospital from September 2015 to November 2016 were enrolled to this study,who were divided into control group and study group by surgery methods and body position,47 cases in each group.The control group received PCNL with prone position,and the study group were treated by PCNL with modified Valdivia position.The operative condition,postoperative condition,stone clearance rate and incidence of adverse reactions between the two groups between two groups were compared,and the levels of diastolic blood pressure(DBP),systolic blood pressure(SBP) and heart rate(HR) between the two groups were observed.Results After position placement,DBP and SBP level decreased in both groups,the level of DBP and SBP in study group were lower than the control group,the difference was significant(P<0.01).There was no significant difference in the level of HR between two groups(P>0.05).The operative time,intraoperative blood loss,hospitalization time,reoperation rate and blood transfusion rate in the study group were lower than those in control group,the differences were significant(P<0.05),the removal rate of stones was significantly higher than that of control group(χ2=9.55,P=0.00).The rate of chest stuffy and dysphoria in the study group were higher than those in control group(P<0.05).The incidence of infection,hemorrhage,pleural injury and renal injury were slightly lower than those of the control group,but there was no significant difference between two groups(P>0.05).Conclusion PCNL with modified Valdivia position has high safety and significant effect on patients with kidney stones,which can effectively remove stones,reduce operation time.

Objective Study the endobronchial ultrasound features of mediastinal tubercular lymphadenopathy and sarcoidosis to probe a new method for the differential diagnosis. Methods The endobronchial ultrasound features of 74 lymph nodes in 16 mediastinal tubercular lymphadenopathy and 30 sarcoidosis patients diagnosed in our department were studied retrospectively, and the sizes, borders, fusion and echo features of mediastinal tubercular lymphadenopathy were compared to sarcoidosis. Results Both of the long size and the short size of mediastinal tubercular lymphadenopathy were smaller than sarcoidosis [(15.77 ± 4.10) vs (19.76 ± 5.83), t = 3.28, P = 0.021;(12.67 ± 4.09) vs (16.81 ± 5.54), t = 3.56, P = 0.001]. And the following features were statistically significant of tubercular lymphadenopathy as compared to sarcodosis: indistinct borders, fusion of lymph nodes, hyperechoic echotexture and patchy anechoic/hypoechoic areas [50.0% (11/22) vs 17.3% (9/52), χ2 = 8.38, P = 0.004; 18.2%(4/22) vs 0.0% (0/52), P = 0.008; 50.0% (11/22) vs 0.0% (0/52), P = 0.000; 63.6% (14/22) vs 0.0% (0/52), P = 0.000, respectively). However, there was no significant difference in the existence of central hilar structure [9.1% (2/22) vs 19.2% (10/52), P = 0.491] between mediastinal tubercular lymphadenopathy and sarcoidosis. Conclusions The endobronchial ultrasound features of mediastinal lymph nodes, including sizes, borders, fusion, hyperechoic echotexture and patchy anechoic/hypoechoic areas are helpful in the differential diagnosis of mediastinal tubercular lymphadenopathy and sarcoidosis.

Objective: To investigate the effective of Sanhua decotion(三化汤) on early brain water content,penetration of blood brain-barrier and the expression of aquaporin4(AQP4) in rats with acute cerebral ischemia/reperfusion(I/R).Methods: The string inserting method was employed to reproduce the rat model of focal cerebral I/R SD rats were randomly divided into sham operation group,model group and Sanhua decotion group.After I/R,each group was then divided into 6 hours,12 hours,24 hours,48 hours and 72 hours five subgroups.The brain water content was detected by the ratio of wet/dry weight to evaluate cerebral edema and the blood-brain barrier(BBB) damage was observed by Evan′s blue(EB) staining.The AQP4 mRNA and protein expressions were measured by reverse transcription-polymerase chain reaction(RTPCR) and immunohistochemistry respectively.Results: Compared with sham operation group,the brain water content,EB content,AQP4 protein and AQP4 mRNA expressions were increased at every time point after I/R in the model group(P

Objective To study the application of fusion of CT and MRI images in X-knife treatment for intracranial lesions.Methods Total 25 patients included:3 gliomas,3 acoustic neuroma,2 pituitary adenoma,one craniopharygioma to be remained or recurred postoperatily,2 pituitary micro-adenoma,5 AVM,4 cavernous angioma,3 metastatic tumour,one neoplasm located pituitary stem and midbrain respectively.Before the fusion of CT and MRI images MRI scan and CT scan for location of X-knife were performed respectively,then MR and CT image were transferred to workstation for the fusion of images.Results All lesions were showed clearly on fusional images and more nodules were observed in 3 metastatic tumour.Skull,soft tissue constructures and the profile of lesions were completely overlaped on overlaped images of CT and MR with an error less 1.0 mm.Conclusion CT and MRI images of head can be accurately registered.The images can show the radiologic informations more clearly than conventional CT image.It provides a safe,effective and little harmful method for X-knife treatment of intracranial lesions.

Primary central nervous system T-cell lymphomas (PCNSTL) are rare, the clinical symptoms and radiographic imaging of which are unspecific, and the pathological morphology is antypical, leading to misdiagnosis and delays in treatment. A 45-year-old male patient with diplopia accompanied by numbness and dysarthria was reported in this paper, which was considered as "lymphoma or lymphoproliferative lesions" on magnetic resonance imaging (MRI) while no typical tumor cells in brain biopsy. The clinical symptoms worsened one month later and the reexamined MRI showed that the scope of the lesion was enlarged and the enhancement was more obvious than before, which was still considered as lymphoma or lymphoproliferative lesion. The second biopsy was performed and still no typical tumor lymphocytes were seen. Finally, gene rearrangement was carried out and showed the β and γ chains both present positive mutations in T cell receptor (TCR) gene rearrangement. Combined with cell morphology, immunophenotype and TCR gene rearrangement results, the patient was finally diagnosed as PCNSTL. This article reviewed the clinical symptoms, imaging features, laboratory examinations, pathological characteristics, diagnosis and differential diagnosis of PCNSTL, so as to improve the understanding of this rare disease.

Hemangioma of the penile head is rare. This paper reported a patient, 16 years old, who was admitted to hospital due to the discovery of multiple masses on the head of the penis for more than two years. Physical examination showed that three vascular mass-like masses were distributed along the coronal sulcus at the 3, 9, and 12 points of the penile head, and the larger one was about 10 mm×5 mm size, blue-purple, soft, and painless. Ultrasound examination suggested that the patient had a penile head hemangioma. Surgical resection was performed, and the postoperative pathological diagnosis was penile head hemangioma.The follow-up of 3 months showed that the wound healed well without recurrence, and the penile head appearance was not obviously deform.

Objective To evaluate the clinical efficacy oftemozolomide (TMZ) and whole brain radiotherapy (WBRT) in the treatment of leptomeningeal metastases (LM) from non-small cell lung cancer (NSCLC).Methods The clinical data were retrospectively analyzed of the 19 patients with LM from NSCLC who had been treated from October 2007 to June 2016 at Guangdong Sanjiu Brain Hospital.Of them,10 were treated by a combination of TMZ+WBRT,and 9 by other therapies.The survival rate was determined by the Kaplan-Meier method and analyzed using the log-rank test.Results After treatment for 2 weeks,the illness was alleviated in 8,stable in 2 and progressive in 0 of the 10 patients receiving TMZ+WBRT,yielding a remission rate of 80％;the illness was alleviated in 5,stable in 3 and progressive in one of the 9 patients receiving other therapies,yielding a remission rate of 55.6％.The median overall survival was 8 months,the survival rate was 56.3％ at 6 months and 33.8％ at one year for those receiving TMZ+WBRT;the median overall survival was 7 months,the survival rate was 55.6％ at 6 months and 14.8％ at one year for those receiving other therapies.Conclusion Temozolomide and whole brain radiotherapy may prolong the survival time and improve the prognosis of patients with LM from NSCLC.