Objective To investigate the diagnostic value and safety of thoracoscopy routine pleural biopsy combined with frozen biopsy for pleural effusion. Methods A retrospective analysis was made on the pathological diagnosis rate of pleural effusion. Results 120 cases in thoracoscopy, 103 cases were confirmed with routine biopsy specimens (85.8%), 16 cases found in the lesions with conventional clamp not satisfactory tissue specimens, combined with frozen cut obtained satisfactory specimens, the diagnostic accuracy rate of 16 cases of cryobiopsy was 100.0%, and the total diagnostic accuracy rate of medical thoracoscopy combined with pleural biopsy and cryobiopsy was 95.0%. There was significant difference between conventional biopsy and cryobiopsy (P < 0.05). Conclusion Medical thoracoscopy combined with pleural biopsy and cryobiopsy can achieve a higher rate of pathological diagnosis, and the complications are mild, so it is worthy of clinical promoting.

Objective To investigate the indications for interventional therapy of Budd-Chiari syndrome((B-CS)) and surgical treatment after stent failure. Methods A retrospective analysis of the clinical data of 21 patients with mistakes in treatment of B-CS by stent placement in inferior vena cava(IVC).Results (Among) the 21 cases with mistakes, the indications were inappropriately selected in 6 cases, the main hepatic vein was obstructed by the stent in 1 case, dilated accessory veins were occluded in 10 cases, the stent was (displaced) in 3 cases, and the stent failed to unfold in 1 case. Nineteen cases were converted to operation; of these patients, a shunt was performed in 18 cases, and radical excision of diaphragmatic web of IVC was done in 1 case. Operation was successful in all 19 cases. After shunt procedure in the 18 cases, the free portal pressure significantly decreased(P

Objective To evaluate the possibility and clinical value of total spondylectomy for the treatment of spinal tumors and to investigate a reliable method of spinal reconstruction after total spondylectomy. Methods Twenty seven cases of spinal tumors which eroded both vertebral body and its attachments were treated with total spondylectomy and internal fixation as reconstruction techniques. There were benign, malignant and metastatic tumors, which involved different levels from upper cervical to lower lumbar spines. One to 3 spinal vertebrae were removed. Results Twenty three cases were followed up for 7 to 96 months (with an average of 25 months). Among them, 1 case of L 5 malignant neurofibroma and 1 case of C6,7 giant cells tumor recurred in 10 and 12 months after operation, but the patients refused further treatment. One case of C2-4 chordoma recurred 1 year after operation, after second surgery, the result was satisfactory. No recurrent signs were found in the rest of 20 cases. Among 25 cases with neurological lesions, obvious improvement were obtained in 23 after operation. Conclusion For patients with involvement of spinal vertebra eroded by tumors, total spondylectomy is an effective procedure. After total spondylectomy, spinal stability can be reconstructed by stable internal fixation system.

Objective To study the effect of small diameter graft (0.8 cm) splenocaval or mesocaval shunts combined with pericardial devascularization in the treatment of portal hypertensive variceal bleeding. Methods Splenocaval shunts were performed in 14 patients and mesocaval shunts were done in 24 patients, in combination with pericardial devascularization. Results The average decrease of free portal pressure was 6.6±1.2 cm. There was no significant changes in liver function postoperatively (P>0.05). Platelet counts and leukocyte counts were back to normal in splenocaval shunt patients postoperatively (P< 0.05). Operative mortality was 3%. Pyrexia developed in 4 patients, intractable ascites in 1 patient, chylons ascites in 1 patient, hepatic encephalopathy in 1 patient, intraabdominal infection in 1 patient and stress ulceration in 1 patient. All patients recovered after expectant treatment except one who died from severe intraabdominal infection. 35 patients received follow-up between 6 months and 3 years, total effective rate was 89%, 2 patients died from recurrent variceal bleeding, the shunt potency rate was 80% in 1 year and 75% in 3 years. Esophagogastric varices disappeared or alleviated as shown by endoscopy in 25 patients on 6 months postoperatively. Conclusions Small diameter portosystemic graft shunts combined with poricardial devascularization is an effective therapy for bleeding esophagogastric varices with a low rate of hepatic encephalopathy. Splenocaval shunt alleviates hypersplenism concurrently.

BACKGROUND: The changes in trabecular bone microarchitecture in osteoporosis have aroused much attention. The decrease in the number of trabecular nodes and increase in the number of free ends are found in osteoporosis, but the mechanism is still unclear.OBJECTIVE: To observe the trabecular remodeling process in ovariectomized rats as the osteoporosis models electron microscopically, and to explore the reasons for the decrease in the number of trabecular nodes and increase in the number of free ends.DESIGN: Randomized and controlled animal trial.SETTING: Department of Orthopedics, Third Hospital of Peking University.MATERIALS: The experiment was conducted in the Animal Laboratory, Third Hospital of Peking University from September 1999 to February 2000. Thirty-six female Wistar rats of 3 months old and 240-280 g were selected and randomly divided into ovariectomized group and control group with 18 rats in each group. The rats were observed at 4,8, and 12 weeks postoperatively with 6 rats at each time point.METHODS: The rats of ovariectomized group were subjected to ovariectomy 1 week after feeding, but the control group was not. The changes of proximal tibia trabecular microarchitecture was observed under scanning electron microscope at 4, 8 and 12 weeks, respectively, and the osteoclast, osteoblast, and structure of cell organs were observed under transmission electron microscope.MAIN OUTCOME MEASURES: [1]The re modeling process after ovariectomy by electron microscope; ②morphological changes of trabecular bone.RESULTS: [1]Scanning electron microscope observation showed that trabecular bone remodeling was distributed in every region of trabecular microarchitecture, especially St and Nd-St region. After ovariectomy, the transverse trabecular was easier to be perforated and broken; the trabecular network was almost intact at 4 weeks, but gradually damaged at weeks 8 and 12; moreover, the collagen fibers on the surface of trabecular bone were scrappy, disorder and thinner. ②By the transmission electron microscopic study, the tibial osteoclast were found active at 12 weeks. When absorbing cancellous bone, osteoclast closely adhered to its surface, and digitations stretched into the cancellous bone. The shape and size of digitations were significantly different, and around them, lucent area was observed. Osteoclast was polynucleation with abundant kytoplasm, and there were plenty of Golgi complex, smooth endoplasmic reticulum and mitochondrium. Lysosome inclusion compounds with different sizes and electron density were found in cells. Osteoblast was rarely found, and cell edge was rough, with bone lacuna.CONCLUSION: Bone remodeling is significantly active in St and Nd-St region of trabecular bone in ovariectomized rats.This may be the reason for the decrease in the number of trabecular nodes and increase in the number of free ends.

A reverse phase HPLC-ELSD method for the determination of ginsenoside Rg1 in the rootof Panaa pseudo-ginseng var. notoginseng (Burkill) Hoo et Tseng was reported. Chromatographic condi-tions: Shim-pack CLC-ODS column (6.0 mm×150 mm)； acetonitrile-water (30: 70) as the mobilephase； Shimadzu LC-6A with SEDEX-55 ELSD detector. The method was found to be simple and accuratewith recovery rate of 100. 50％ and RSD= 1.82 %. The established UV spectrophotometric determinationof total saponins in P. pseudo-ginseng var. notoginseng was also tried and gave an accurate result coinci-dental with that of the HPLC results. The recovery rate was 101.50%， and RSD=1. 44%. It seemed thatboth methods can be used reliably for the quality control of P. pseudo-ginseng var. notoginseng.

A strain producing eggshell membrane protease (ESM protease) was isolated from the soil and identified as Pseudomonas aeruginosa. The enzyme isolated from the fermentation liquid of this strain and purified by ammonium sulfate precipitation, quadratic anion-exchange chromatography exhibited eggshell membrane degrading activity of 304.5 U/mg. By SDS-PAGE, the protein molecular mass is 32 kD. The N-terminal amino acid sequence of this protease is: Ala, Glu, Ala, Gly, Gly, Val, Ala, Gly, Lys, Glu, Asp, Ala, Ala, Glu, Leu.

Objective To investigate the causes,prevention and management principles of postoperative recurrence of Budd Chiari syndrome(BCS).Methods The clinical data of 223 postoperative recurrence BCS patients were analyzed retrospectively,including type Ia in 66 cases,type Ib in 48 cases,type II in 57 cases , type IIIa in 28 cases,and type IIIb in 24 cases. Of them,36 patients underwent two or more operations .Results Secondary operations were all successful.No patient died in the perioperative period. One hundred and eighty two patients were followed up for 6 months to 10 years.In 89.6% of the patients,the results were successful,but the recurrence rate after the reoperation was 6.0%,and 8 patients died postoperatively .Conclusions The main recurrent causes are that indications are not correctly selected and the operative technique is not correct. Correct classification,reasonable selection of the operation method, and adopting an interruptive,matress,and eversive suture for blood vessels anastomosis in the operation are important to prevent the recurrence of BCS.

Objective To investigate the diagnosis and treatment of portal hypertension caused by cavernous transformation of the portal vein (CTPV) in adults Methods A retrospective study was made on clinical data of 31 adult upper GI bleeding patients with CTPV The diagnosis of CTPV in all cases were confirmed by B ultrasonography or ultrasonic Doppler and by percutaneous splenoportography or selective arteriography Splenic artery and coronary vein ligation plus C graft mesocaval shunt was performed in 12 cases Splenorenal graft shunt was performed in 1 In 8 post splenectomy rebleeding, cases 6 underwent C graft mesocaval shunt, one inferior meso caval shunt and one jejunectomy due to ictopic variceal hemorrhage Six cases received splenocaval shunt 2 splenopneumopexy 1 splenorenal shunt 1 portocaval shunt 1 pericardial devascularization ResultsPostoperativelly varices disappeared or ameliorated in all patients There was no rebleeding and hepatoencephalopathy occurred in follow up of 6 months to 4 years Conclusion Ultrasonic Doppler and percutaneous splenoportography are diagnostic for CTPV in adults Portasystemic shunt plus porta azygous devascularization is the choice of treatment

Objective To observe the adipocytic differentiation potential of bone marrow stromal cells (BMS), and the effect of simvastatin on adipocytic differentiation of bone marrow stromal cells in vitro, and to elucidate the mechanisms of anabolic effect of simvastatin on bone formation. Methods BMS from femur and tibia of adult female BALB C mice were cultured in vitro. Changes of alkaline phosphatase (ALP) activity were determined after treatment with adipogenetic agonist (hydrocortisone 0 5 ?mol/L and indomethacin 60 ?mol/L, HI) for 6 days. Thenexpression of lipoprotein lipase (LPL) mRNA was detected by RT PCR after treatment with HI and different concentration of simvastatin for 72 h. Adipogenetic differentiation were also observed with Oil Red O staining and fluorescence activated cell sorting (FACS) after treatment with HI and different concentration of simvastatin or 100 ?g/L rhBMP 2 for 12 days. Results After BMS were treated with HI for 6 days, ALP activity was significantly decreased ( P