Objective To study the diagnosis and treatment of duodenal papilla tumor (DPT). Methods Analyses were made on the clinical data of 22 patients with DPT proved by operation and pathology from 1977 to 1999. Results There were 17 patients with duodenal papillary carcinoma, 5 with duodenal papilloma in this series. Discomfort of the upper abdomen (16 cases) and jaundice (22 cases) were the main symptoms. Barium meal examination, BUS, CT and ERCP were very useful in the diagnosis of DPT. In this series, 19 of 22 patients received pancreaticoduodenctomy, and 3 received local reseciton, the resection rate was 100%. 15 patients (88.2%) were followed up, the 5 years survival rate was 73.3%, 7 years survival rate was 46.7%. Conclusions Duodenoscope and ERCP are credible methods for diagnosis of this disease, resection is the main way of treatment.

Objective To evaluate the impact of comorbidity and age on the tolerance of firstline single-agent chemotherapy in elderly patients with advanced non-small cell lung cancer(NSCLC).Methods Clinical data of 61 elderly patients with advanced NSCLC(aged over 70 years,median age 72 years) receiving first-line single agent chemotherapy were retrospectively analyzed in this study.Performance status(PS) between 0-1 score was in 52 patients,PS 2 score in the other 9 patents.Patients were treated with gemcitabine or docitaxel as the first line chemotherapy,and the median number of chemotherapy cycles was 3.4.Comorbidity was assessed by Charlson comorbidity index (CC1).Patients with CCI equal to 0 were classified as non comorbidity group(n=26),and patients with CCI≥1 were classified as comorbidity group(n=35).Adverse reactions were graded by using the criteria of NCI-CTC v3.0.Results Age and PS could not predict adverse effects of grade 3 or 4.The incidence of hematologic toxicity of grade 3 or 4 was higher in comorbidity group than in noncomorbidity group(40.0％ vs.15.4％,x2 =4.36,P=0.037).The incidences of febrile neutropenia,non hematologic toxicity of grade 3 or 4 and treatment suspension were higher in comorbidity group than in non-comorbidity group.The most common types of comorbidity were diabetes and chronic pulmonary disease.The incidence of non-hematologic toxicity of grade 3 or 4 was increased in patients with chronic pulmonary disease as compared with patients without chronic pulmonary disease(41.4 ％vs.11.5％,x2=6.061,P=0.032).Conclusions The incidences of adverse reactions,especially hematologic toxicity of grade 3 or 4 are significantly increased in patients with comorbidity after singleagent chemotherapy.Evaluation of comorbidity before treatment is helpful to predict the tolerance of single-agent chemotherapy in elderly NSCLC patients.

Through the integration of multiple types of information use hospital data resources to provide effective practice parameters for the hospital management decisions.Mainly includes the following aspects:First,the management of personnel files,personnel files to achieve the secure sharing of information and knowledge management in the information dossier on the basis of improving the efficiency of hospital management and scientific personnel.Secondly,the clinical aspects of digital information using the extended use of information technology to achieve information sharing medical imaging information systems and the medical doctors on the PACS station,nurse station systems,and computer management system,library networking integration and other modern IT networking,re sources to achieve the hospital image information sharing.In addition,play the role of information in the files of clinical teaching hospitals in major events,to carry out medical treatment,teaching,scientific research system for clinical teaching staff provide a basis.To enhance the scientific decisionmaking of the hospital management.

This paper presents a high voltage generator for the defibrillator.Its principle and design method are introduced.The high voltage generator is the core part of the defibrillator which is necessary toany hospital.There is nodomestic-patented defibrillator by now and published paper specialized in the principle and design method of the high voltage generator for the defibrillator.

Objective Discussing reoperative reasons and selection of operation for congenital bile duct cysts.Method Retrospectively analyzing 15 reoperative patients for congenital bile duct cysts.Result Reoperative reasons include unresected cysts canceraztion (3 cases);unresected cysts calculogenesis (4 cases);anastomotic stoma between gut and cyst or bile duct stenosis (6 cases);reflux cholangitis(1 case);recurrence cholecystitis (6 cases).There are two kinds of operations,the first is interposed jejunal choledochoduodenostomy,the second is Rou-en-Y choledochojejunostomy.Conclusion Cysts and gallbladder must be resected totally,Roux-en-Y choledochojejunostomy can enhance effect of operation and prevent reflux cholangitis,this operation is very important for avoiding reoperation.

Objective To evaluate the efficacy of imipenem-cilastin sodium as subsequent therapy on peritoneal dialysis(PD)-related peritonitis.Methods From January 2007 to December 2010,44 PD-related peritonitis patients in our hospital were enrolled in the study.These patients presented cloudy fluid after 3 days initial treatment,and bacterial culture was Gram-negative bacteria or negative.Thirteen peritonitis episodes were treated with ceftazidime,while 36 episodes with imipenem-cilastin sodium.Efficacy,outcome,pathogen and drug-resistance were analyzed retrospectively.Results The effective rates 2 d later of ceftazidime and imipenem-cilastin sodium were 23.1％ and 72.2％ respectively with significant difference (P＜0.05).Gram-negative bacteria of ceftazidime and imipenem-cilastin sodium groups were 69.4％ and 65.2％ respectively without significant difference (P＞0.05).The cure rates 3 weeks later of ceftazidime and imipenemcilastin sodium groups were 23.1％ and 72.2％ respectively with significant difference (P＜0.05).Conclusion As subsequent therapy for PD-related peritonitis,imipenem-cilastin sodium can improve the cure rate.

Objective To investigate the changes of perioperative right ventricular function after pulmonary resction. Methods 45 cases of pulmonary resection were divided into four groups.Group Ⅰwas wedge resection(n = 10), GroupⅡ was lobectomy(n = 19), Group Ⅲ was double lobectomy(n=7)and Group Ⅳ was pneumonectomy(n=9). The changes of CVP, PAMP, PEP/ET, Sa, VTIs, RVSP, Ea/Aa, and Tel were evaluated by traditional ultrasonic and tissue Doppler ultrasonic techniques at different time inter- vals (pre-operation, 5-7 days orland 1 month post-operation), Results Compared with the pre-operation CVP, the indexes of all groups have no significant changes post-operatively. Wedge resection didn' t obviously influence right cardiac after load and systolic function/diastolic function. No evidet changes detected in Tei pre-and post-operatively. However, the indexes (PAMP, RVSP and PEP/ET ratio) reflecting right cardiac afterload evidently increased at post-pneumonectomy or lobectomy group5- 7 days post-opera- tive. All these reflect the decrease of Tei, which was more obvious in pneumonectomy than in lobectomy group. Right cardiac after- load, systolic/diastolic function and Tel index recovered to pre-operative level 1 month post-operation in single lobectomy group. But the above indicators, especially the Tel, were still high in double lobectomy and pmeunonectomy groups 1 morth post-operation.Tei index is positively correlated with PAMP and is weakly correlated with PET/ET ratio and Ea/Aa ratio. Conclusion Pulmonary wedge resection doesn't evidently influence right cardiac function. However, right cardiac diastolic function evidently decreases temporarily at lobectomy group. The systolic function and diastolic funetions decrease after double-lobectomy and pneumonectomy and it's more evident in pneumonectomy group. Though the right cardiac afterloads of lobectomy, double lobectomy and pneumonectomy groupa all increase significantly post-operativlye, only the former recover to pre-operative level 1 month after surgery.

ObjectiveTo evaluate the role of nitric oxide (NO) in ischemia reperfusion injury (IRI) and acute rejection (AR) of intestinal transplantation in rats.MethodsThe rat orthotopic intestinal transplantation was performed. Animals were assigned to the following 4 groups with random methods:transplant control group,L-arginine (L-Arg) group,NG-Nitro-L-arginine methyl ester (L-NAME) Ⅰ group (group Ⅰ ) and L-NAME Ⅱ group (group Ⅱ ).The rats in different group were given saline,L-Arg (150 mg· kg-1 · d-1 ),L-NAME (4 and 8 mg· kg-1 · d-1 ) injection respectively from the operative day.The recipient survival time was observed.The pathologic changes were observed by HE staining.The activity of nitric oxide synthases (NOS) was measured by using immunohistochemistry.The abilities of glucose absorption and serum NO levels were tested.Results The recipient survival timein transplant control group,L-Arg group,group Ⅰ and group Ⅱ were (11.7 ± 1.2),(10.2 ± 1.0),( 12.3 ± 1.5) and ( 17.3 ± 1.9) days respectively,and the survival in group Ⅱ was prolonged significantly (P＜0.01).As compared with control group,the Park scores in L-Arg group and group Ⅰ were reduced,and IRI were attenuated; the Park score in group Ⅱ was increased (P＜0.01),the IRI was aggravated,but the AR was attenuated.As compared with control group,during the IRI period,the iNOS staining in group Ⅰ was decreased,and both iNOS and nNOS staining in group Ⅱ was decreased; during the AR period,the iNOS staining in group Ⅱ was decreased obviously.The serum NO levels were increased gradually in all groups.As compared with control group,the increase of serum NO level in group Ⅱ was delayed.As compared with control group,the glucose absorption levels in L-Arg group were increased significantly from 30 min after reperfusion to POD-3 (P＜0.01),and the postoperative glucose absorption levels in groups Ⅰ and Ⅱ maintained the low levels.ConclusionNO may play a dual role as both cytotoxic and cytoprotective effects in IRI,and aggravate mucosal damage in AR in rats intestinal transplantation.The glucose absorptive capacity of graft is promoted by supplementation of LArg at early postoperative period.

Objective To explore the influence of modified Lawrence's reconstuction procedures following total gastrectomy for gastric cancer to alimentation of patients. Methods Retrospective analysis of nutritional status and symptoms of digestive tract in 76 patiens of total gastrectomy for gastric cancer while 3 and 6 month after modified Lawrence's reconstuction procedure. Results Examination was given in 48 patients 3 month after operation. Emptying time of barium was 60-100 min, barium meal backflowing to esophagus was not observed in all patients when they were in erect or decubitus position, no sign of narrow of anastomotic stoma. The hemoglobin, total protein, body weight and food-intake of patients 3 or 6 months after operation was as same as them before operation. Conclusion The patients undergoing this reconstuction procedure will recover normal food habits soon after operation, Lawrence's reconstuction procedures is a satisfactory choice in patients of total gastrectomy for gastric cancer because of its safety and convenient.

Objective To explore the effect of radio frequency ablation (RFA) combined with transcatherterarterial chemo embolization (TACE) and percutaneous puncture hydrochloric acid injection(PHI) for hepatic tumors unable to resection. Methods The clinical data of 40 cases of patients with unable resection liver cancer (URLC) treated by RFA combined with TACE and PEI were analyzed retrospectively.Results There were 30 cases of primary hepatic tumor(PHT) and 10 cases of metastasis hepatic tumor(MPT) , in this series. Examination of ultrasound, CT and MRI showed the tumors shrink or steady in 39 patients.Among 30 patients with damage by ethanol, 18 cases were AFP positive before treatment and 16 cases of them AFP decreased to normal level after operation. No severe complication was seen in the series. Conclusion RFA combined with TACE and PEI is a safe, well tolerable and effective method for hepatic cancer, and may improve the treatment efficacy of URLC.