The initiation and development of gastric cancer is due to the effects from both external and internal factors.Recent researches show that external environment factors regulate and control the key genes expression during the process of cell's growth and development through epigenetic modification such as DNA methylation or demethylation,histone modification and small RNA,thus playing an important role in gastric cancer's occurrence and development.

Objective To evaluate the therapeutic effects of low tension,anti-reflux Roux-y sigmoid neobladder. Methods Using modified ureterocolostomy and colorectostomy,low tension Roux-y sigmoid neobladders were formed on 12 cases of bladder cancer and 1 case of vesicovaginal fistula.The surgical procedures involved making an “inversive valve” into the bowel lumen about 1.5 cm above the Roux-y anastomotic stoma and anastomosing the ureter and colon by Leadbetter method;then the reservoir was made by detubularization of sigmoid.Postoperatively,blood electrolytes and acid-base balance, and urination were monitored. Results During the follow-up of 0.5~5 years,only 2 cases had occasional fever;no hydronephrosis, no disorder of acid-base balance occurred.The blood electrolytes were within the normal range.And no one had incontinence. Conclusions The low tension,anti-reflux Roux-y sigmoid neobladder is a surgical technique of less trauma and with less complications.

Objective To study the diagnosis and treatment of adrenal tumors. Methods 1 006 cases of adrenal tumors treated from 1957 to 2000 were reviewed. Results Of the 1 006 cases of adrenal tumors,845(84.0%) were functional with 12(1.4%) malignant and 161(16%) nonfunctional with 11( 6.8%) malignant.There were 180 incidentaloma including 19 pheochromocytoma.A total of 996 tumors have been surgically removed and 10 cases underwent surgical exploration only.The total mortality rate was 0.3%. Conclusions Adrenal tumors occurred mostly in patients of 30～50 years of age.The prevalence of Cushing syndrome was more in females than in males.Ultrasonography and CT are the method of choice for the localization of the tumor whereas hormone levels should be determined both in the symtomatic and asymtomatic patients with adrenal tumors.Functional adrenal tumors and solid incidentaloma of large size should be surgically removed while asymtomatic incidentaloma less than 3 cm in size could be observed and followed up and surgery might be undertaken when indicated.

Objective To improve the diagnosis and treatment for malignant adrenal tumors. Methods Clinical data of 50 cases of malignant adrenal tumors were retrospectively analyzed.Of them 7 cases of corticoadrenal carcinoma with endocrine function presented with relevant symptoms and endocrine abnormality.Among 23 cases of malignant pheochromocytoma high blood pressure existed in 19 and 18 had a high level of urinary catecholamine.Fifteen cases had corticoadrenal carcinoma without endocrine function and 5 cases developed adrenal metastic carcinoma.All of the patients underwent endocrinological and image examination before operation. Results Among the 27 cases of corticoadrenal carcinoma or metastasis,25 were confirmed by pathology and 2 were confirmed during follow-up.Of the 23 patients who were diagnosed as malignant pheochromocytoma,11 were confirmed to have extensive tumorous infiltration or metastasis by imaging procedures and operations and 12 were detected by follow-up to have metastasis.Tumors were resected in 14 cases of corticoadrenal carcinoma,8 of whom survived for 1～5 years.Twelve cases of malignant pheochromocytoma underwent radical operations with a survival of 1～14 years. Conclusions Most cases of corticoadrenal carcinoma can be diagnosed by pathology or image findings of metastasis.Pheochromocytoma is more likely to be malignant when it recurs,expecially for the extro-adrenal pheochromocytoma.The diagnosis of malignant pheochromocytoma must depend on the evidence of tumorous infiltration or invasion of the tissue without para ganglions found by imaging procedures or pathology.The prognosis of the late-stage corticoadrenal carcinoma is poor.For the cases of late-stage malignant pheochromocytoma dibenzyline or 131 I-MIBG treatment can extend their lives.

Objective To summarize the experience of microsurgery for repair on urethrovaginal and vesicovaginal fistula. Methods Five cases of complex urethrovaginal or vesicovaginal fistula underwent repair procedure with thin suture under surgical magnifier.The defect of vesical neck was sutured in several layers and the urethra was renovated by using vaginal wall tissue. Results The operations were successful in all the 5 cases with no obvious incontinence.Their course of coition was not influenced. Conclusions Suturing the defect of the vesical neck in several layers can restore the function of the sphincter.Microsurgery may align the tissue well and cause less tissue reaction,thus it is beneficial to the concrescence of the fistula.

Objective To improve the diagnostic level of on pelvic nodal metastases of prostate cancer. Methods Thirty-three cases of prostate cancer underwent instep lymphangiography to find out if there were pelvic nodal metastases.The results of lymphangiography were compared with the pathologic results of fine needle aspiration biopsy of lymph nodes. Results In the 9 cases testing positive for nodal metastases 7 were identified by cytology of fine needle aspiration biopsy and 6 were confirmed by pathology;while in the 24 cases with negative results,4 were false negative(17%). Conclusions The lymphangiography plays an important role in diagnosis of nodal metastases of prostate cancer.Fine needle aspiration for suspected lymph nodes can minimize false positive result,nevertheless there is still false negative result in lymphangiography.

Objective To elevate ability of diagnosing adrenal tumors. Methods B-ultrasonography were performed on 385 cases;CT scanning were on 385 cases;IVU were on 380 cases;MRI were on 180 cases;Doppler were on 63 cases;DSA were on 16 cases;MRA were on 28 cases;MIBG were on 34 cases;3 cases were performed tumors biopsy directed through CT. Results The accurate localization rate of APA,Cushing tumors,Pheo,myelolipoma with B-ultrasonography were 92.7%,88.3%,100.0%,100.0% respectively.The accurate qualitative rate of diagnosis were 83.2%,86.7%,83.4%,100.0% respectively.With CT scanning were 98.2%,98.7%,100.0%,100.0% and 90.5%,92.3%,83.4%,100.0% respectively.With MRI were 90.4%,96.5%,100.0%,100.0% and 72.8%?93.5%?85.8%?100.0% respectively. Conclusions The overall data of imaging is helpful in diagnosis of adrenal tumors.Correct localization of the tumors is the key step for the treatment.

Objective To study the diagnosis and treatment of adrenocorticotrophic hormone (ACTH) independent Cushing syndrome. Methods A retrospective review was done on 89 patients with ACTH independent Cushing syndrome, including 85 cases of adrenal tumors with hypercorticism, 2 cases of adrenocortical adenocarcinoma and 2 cases with ACTH independent macronodular adrenal hyperplasia. Results Favorable results were observed from the surgery for 85 cases of adrenal tumors combined with hypercorticism.Two cases with ACTH independent macronodular adrenal hyperplasia were cured by bilateral adrenolectomy. Adrenal cortical adenocarcinoma was unresectable for both the patients who survived 7 and 9 months respectively. Plasma ACTH,dexamethasone suppression test,B ultrasonography and CT scan were useful for the diagnosis and differentiated diagnosis of ACTH independent Cushing syndrome. Conclusions Prognosis of adrenal tumors with hypercorticism and ACTH independent macronodular adrenal hyperplasia is favorable after surgery,whereas the prognosis of adrenal cortical adenocarcinoma is poor.

Objective To study the diagnosis and treatment of primary aldosteronism. Method 507 cases of primary aldosteronism were reviewed. Result Serum potassium was lower in aldosterone producing adenoma (APA) as compared to idiopathic hypersteronism (IHA) (2.35?0.53) mmol/L vs ( 2.94 ? 0.55 ) mmol/L.Aldosterone in serum and 24h urine were higher in APA than in IHA ( 1 027.67 ? 531.84 )pmol/L and (69.25?43.77) mmol/L vs (781.14?310.24)pmol/L and (37.12?9.99) mmol/L.The diagnosis rate on B ultrasonography was 83.9% and on CT 93.1%.The postural stimulation test was more sensitive in IHA and on imaging procedures both the adenals were increased in size or with small nodule.In aldosterone producing adrenocortical carcinoma (APC),there were pronounce increase of cortisol and dehydroisoandrosterone and the tumor size was usually greater than 5cm.APA and APC should be treated surgically but the prognosis was only favorable for APA not for APC.IHA should be treated medically. Conclusion Serum and urine aldosterone were significantly higher in APA and serum potassium lower than in IHA.Postural stimulation test,B ultrasonography and CT were helpful to the diagnosis of APA.In patients with a single APA especially complicated by adrenal atrophy,partial adnalectomy of the affectd side is indicated whereas total adrenalectomy of the affected side is mandatory if the APA is multiple or there is adrenal hyperplasia.

BACKGROUND:As a kind of stressor, exercise-induced fatigue surely can lead to the material and functional changes of certain nerve nucleus within brain.It is still uncertain on what kind of nucleus closely relate to exer-cise-induced fatigue and what materials induce the functional or/and structural changes of tired central nerve.OBJECTIVE:To study the relationship between nitric oxide synthase (NOS) in ventromedial hypothalamic nucleus(VMH),dorsomedial hypothalamic nucleus(DMH) and exercise-induced fatigue.DESIGN:Randomized controlled study.MATERIALS:The experiment was completed in the Department of Human Anatomy of North University of China and Shanxi Medical University during October 2003 to January 2004.Twenty male Wister rats of clean class were selected.INTERVENTIONS:The rats were randomly divided into experimental group and control group with each of 10 rats.The rats in experimental group were made exercise-induced fatigue animal model by doing heavy load swimming until they were exhausted for 4 consecutive weeks. After the model was built,ABC immunohistochemical method was used to observe the expression of neuronal NOS (nNOS) in neurons of VMH ,and DMH and image analysis and statistic process were conducted.MAIN OUTCOME MEASURES:Number of nNOS positive cells in per unit visual field; Area and gray of positive substance.RESULTS:The number of nNOS positive cells in VMH of fatigue group was (25.25±7.35)/visual field which was much greater than that of control group (9.70±3.20)/visual field(P＜ 0.001).The area of nNOS positive substance was (3 867.75±1 940.41)μm2/visual field which was greater than that of control group(750.13±579.88)μm2/visual field(P ＜ 0.001). The number of nNOS positive cells in DMH of fatigue group was (30.25±7.87) /visual field which was much greater than that of control group (14.00±4.99) /visual field. And the area of nNOS positive substance was (4 512.06±1 243.93) μm2/visual field that was much greater than that of control group(782.46±711.46)μm2/visual field(P ＜ 0.001).CONCLUSION:The nNOS positive neurons in VMH and DMH neurons are closely related to the occurrence of central exercise-induced fatigue.Nitric oxide may play an important role in regulation of VMH and DMH to stress caused by fatigue.