Objective To assess the survival of patients receiving high intensity focused ultrasound(HIFU) and investigate the prognostic factors for primary hepatocellular carcinoma(PHCC) victims with HIFU application.Methods One hundred and eighty-seven patients with PHCC undergoing HIFU treatment in our department were enrolled into this study from June 2004 to June 2007.Among them,101 patients were males and 86 were females(mean age: 47.7 years old,range: 19-79 years old).The average tumor size was 5.7 cm(range: 0.5-18.0 cm).Of these 187 patients,numbers according to Child-Pugh grade of A,B and C were 104,52 and 31,respectively.According to TNM system,45,111 and 31 patients were in stage Ⅱb,Ⅲa and Ⅲb respectively.Kaplan-Meier model and log-rank test were used in univariate analysis and Cox regression model was used in multivariate analysis to identify prognostic factors for survival.Results Survival period was(17.3?2.5) months after HIFU treatment of PHCC.The overall survival rate of 3-month,6-month,1-year and 2-year were 79.1%,60.1%,35.7%,and 29.3%,respectively.It was significant that tumor number(P=0.02),size(P=0.04),AFP(P=0.04),Child-Pugh grade(P=0.00),TNM stage(P=0.01),tumor metastasis(P=0.03) before HIFU,and tumor recurrence after HIFU(P=0.02) and standard treatment(P=0.02) were prognostic factors by single factor analysis.The following factors were identified as independent prognostic factors for overall survival by multivariate model: standard treatment protocol(P=0.000),and TNM stage(P=0.004) and Child-Pugh grade(P=0.009) before HIFU.Conclusion It is used for improving overall survival rate to found PHCC early,protect liver function,examine comprehensively before HIFU treatment,focus on standard treatment and auxiliary treatment.

Objective To investigate the feasibility and safety of reoperation of laparoscopic common bile duct exploration in the management of choledocholithiasis in patients with biliary surgical history. Methods Thirty-one patients with choledocholithiasis and biliary surgical history were performed by reoperation of laparoscopic common bile duct exploration between January 2012 and January 2014 in our hospital.The adhesion was disconnected under the laparoscopy, and then the common bile duct was opened to introduce an endoscope for stone removal.A T-tube was placed for drainage. Results The operations were successfully completed in all the 31 cases, without conversion to open surgery.The vital signs of those patients were smooth during the operation.The operation time was 65-125 min, with a mean of (118 ±21) min.The volume of blood loss was 10-75 ml during operations, with a mean of (39 ±19) ml.The patients could take food normally 24-48 h after operation, with a mean of (27 ±13) h.The drainage tubes were pulled out 48 -72 hours after operation.No severe complications, such as residual stones, bleeding, gastrointestinal leakage, or pancreatitis happened during hospitalization, except for 1 case of biliary leakage and 1 case of incision infection.The patients stayed in hospital for 6-9 days after operation, with a mean of (7.0 ±1.5) days.No biliary stricture or recurrence was found during a 3-24 months of follow-up (mean, 15.6 months) in 31 cases. Conclusion Reoperation of laparoscopic common bile duct exploration by experienced laparoscopic specialists for choledocholithiasis in patients with biliary surgical history is relatively safe and effective.

OBJECTIVE: To summarize the clinical features of epistaxis in the posterior fornix of inferior meatus and its comprehensive treatment measures. METHOD: We collected and retrospectively analyzed the clinical data of 212 cases of epistaxis hospitalized in our department, among which 23 cases were diagnosed as epistaxis in the posterior fornix of inferior meatus. They underwent nasal endoscopic exploration and coagulation surgery with one case under general anesthesia and the other 22 under local anesthesia. The bleeding from olfactory cleft, spheno-ethmoidal recess and the middle nasal meatus were excluded for all the patients during the surgery. After shifting the inferior turbinate inward by fracture, the active bleeding was found in the posterior fornix of inferior meatus, which was stopped immediately by bipolar coagulation. The areas of coagulation and nasal mucosa erosion were packed with nasopore after operation. RESULT: For all the patients, bleeding spots were definitely located during the operation and successfully coagulated. None of them suffered from recurrent-bleeding within 1 week postoperatively. Followed up for 6 to 12 months, there was no epstaxis recurrence or nasal cavity adhesion at the bled side in all patients. CONCLUSION For intractable epistaxis patient, after excluding the bleeding in olfactory cleft, sphenoethmoidal recess and the middle nasal meatus, it should be considered that the bleeding might come from posterior fornix of inferior meatus. It is the key point to thoroughly expose the posterior fornix of inferior meatus by shifting the inferior turbinate inward by fracture and explore for the bleeding spot carefully.
Adult ; Aged ; Epistaxis ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

AIM: To observe the expression of transforming growth factor ? 1 (TGF-? 1), MAPK 1/3 and fibronectin (FN) in the development of renal tubulointerstitial disease. METHODS: Wistar male rats were randomly divided into normal control group, diabetic group of 1week, 2 weeks, 4 weeks and 8 weeks. Diabetic model was induced by peritoneal injection of streptozotocin. Immunohistochemistry was employed to detect the expression of TGF-? 1, MAPK 1/3 and FN in the kidney. TGF-? 1 protein in the renal cortex was checked by Western blot. BG, Scr and UP were analysed by biochemical methods, and the morphological changes in renal tubulointerstitium were also examined under microscopy on sections stained with HE and PAS. RESULTS: The expression of MAPK 1/3 and FN was observed, but not the expression of TGF-? 1 in normal renal tissue. Positive staining of TGF-? 1 was observed in the renal tubulo-interstitium in 1-week diabetic group and thereafter it increased in the course of diabetes. A continuous increase in the expression of MAPK 1/3 and FN was also observed in two - week diabetic rats. Chronologically the expression of TGF-? 1,MAPK 1/3 and FN and the ratio of KW/BW were positively correlative with each other in diabetic animals except one -week diabetic rats. There was also a positive correlation between MAPK 1/3 and FN in l -week diabetic rats. CONCLUSION: Our data suggest that TGF-? 1 appears in the renal tubulointerstitium in early period of diabetes and then its signal is mediated by MAPK 1/3 cascades to accelerate production of FN ,and in turn leads to renal hypertrophy and tubulointerstitial fibrosis. [

Objective: To explore the clinical characteristics, imaging feature, surgical outcomes, and prognosis of recurrent aneurysmal bone cysts (RABC) of the extremities. Methods: Between January 2008 and January 2016, 29 patients histopathologically diagnosed with RABC were treated at our hospital. These patients included 15 males and 14 females. The mean age at the time of diagnosis was 17.4 years(range 4-42 years). The most common site of the RABC was the proximal tibia (12 cases), followed by the distal femur (11 cases), and 3 cases each with involvement of the proximal humerus and the proximal femur. Recurrence was most commonly ob-served within 24 months following the initial treatment. Intralesional re-curettage was performed in 24 patients and en bloc resection of the tumor and reconstruction in 5 patients. The medial tibial stress syndrome (MTSS) score was used to evaluate postoperative func-tion of the affected limb, and the comprehensive clinical efficacy was evaluated on the basis of the Mankin criteria. Results: The mean follow-up duration was 64 months (range 24-90 months). Re-recurrence occurred in 1 patient with a total re-recurrence rate of 3.4%. The postoperative MTSS score was 26-30 points (mean 29.1 points) in the intralesional re-curettage group and 21-27 points (mean 23.0 points) in the tumor resection group. Based on the Mankin criteria, excellent and good clinical outcomes were observed in 95.8% of patients in the intralesional and 60% of the patients in the tumor resection and reconstruction groups. Conclusions: Regular follow-up is essential for the early diagnosis of RABC. The re-recurrence rate following intralesional re-curettage was within an acceptable range, and postoperative limb function was satisfactory; therefore, intralesional re-curettage is the treatment of choice for RABC in-volving the extremities. Tumor resection can be performed in patients with severe articular surface destruction and repeated recur-rence, although long-term complications may occur.

Objective To investigate the clinical treatment strategy of large and giant pituitary adenomas invading the cavernous sinus.Methods One hundred and nine patients with large and giant pituitary adenomas invading the cavernous sinus,admitted to our hospital from January 2010 to December 2018,were chosen in our study.Four patients with prolactin-type pituitary adenomas received oral treatment with bromocriptine;the remaining 105 patients received surgical treatment,and choices of surgical approach were based on classification of pituitary adenomas.The clinical data and efficacies of these patients accepted different treatment approach were retrospectively analyzed.Results Of the 105 patients with pituitary adenomas,63 (60％) were of type Ⅰ,15 (14.3％) were of type Ⅱ,18 (17.1％)were of type Ⅲ,and 9 (8.6％) were of type Ⅳ.Single extended transsphenoidal approach was used in 75 patients,transcranial approach was used in 26 patients,and combined extended transsphenoidal and transcranial approach was used in 4 patients.Gross total tumor resection was achieved in 86 patients,subtotal resection in 17 patients,and partial resection in two patients.Ten patients had new cranial nerve palsy after surgery,including 7 with oculomotor nerve palsy and three with abductor nerve palsy;two patients with preoperative neurological paralysis were aggravated,and both of them were oculomotor nerves;transient insipidus was noted in 19 patients and electrolyte disorder was noted in 23 patients;no permanent insipidus,cerebrospinal fluid leakage or intracranial infection,and no new or aggravated visual field vision disorder were noted.Conclusion Reasonable clinical treatment strategies and appropriate microsurgical approaches can achieve good therapeutic effect in patients with large and giant pituitary adenomas invading the cavernous sinus.