Objective To investigate the difference of clinical features between primary colorectal malignant T cell lymphoma and primary colorectal malignant B cell lymphoma.Methods Forty cases diagnosed as primary eolorectal malignant lymphoma (PCML) between Jan 1999 and May 2008 were studied retrospectively.Results The average age of 40 patients with PCML was (41.0±11.2) years old.Twenty-seven cases (67.5%) were diagnosed as B-cell lymphoma.Thirteen cases (32.5%) were diagnosed as T-cell lymphoma.Patients with T-cell lymphoma in PCML had more symptoms such as fever,night sweat and hematochezia,and was easier to perforate than those with B-cell lymphoma.Protrude type and single-focus and right-colon type were common in B-cell lymphoma under colonoscopy,but ulcerative type and multi-focus and fulbcolon were common in T-cell lymphoma.B-cell lymphoma had an earlier diagnosis,and more opportunities for surgery than T-cell lymphoma.Conclusions The misdiagnostic rate for PCML was high.Protrude type and single-focus and right-colon type were common in B-cell lymphoma under eolonoscopy,but ulcerative type and multi-focus and full-colon were common in T-cell lymphoma.B-cell lymphoma could be diagnosed earlier.

Objective To study the safety and efficacy of endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) in the treatment for extrahepatic bile duct stones.Methods A total of 164 patients underwent endoscopic treatment for extrahepatic bile duct stones.Seventy eight underwent EST and EPBD (the EST + EPBD group),86 others underwent EST only (the EST group).The complication rate,complete stone clearance rate and gravel incidence rate were compared between the two groups.Results Hyperamylasemia occurred in 3 cases,mild acute pancreatitis in 2 cases of the EST and EPBD group,while hyperamylasemia occurred in 5 cases,mild acute pancreatitis in 3 and hemorrhage in 2 of the EST group.There were no severe complications like severe acute pancreatitis or intestinal perforation.The complication rate of the EST + EPBD group ( 6.4％,5/78 ) was slightly lower than that of the EST group ( 11.6％,10/86),(x2 =1.340,P =0.288),so was gravel incidence (33.3％ vs.60.5％,x2 =12.073,P =0.001 ).While complete stone clearance rate of this group was obviously higher than that of the EST group (100.0％ vs.93.0％ ),(x2 =5.649,P=0.030).Conclusion EST combined with EPBD is safe and effective for extrahepatic bile duct stone removal,especially for large stones or poor duodenal papilla.

ObjectiveTo evaluate the learning curve of utilizing the full endoscopic technique for the surgical treatment of lumbar disc herniation.MethodsFrom August 2008 to February 2009,30 patients with lumbar disc herniation underwent lumbar discectomy by the full endoscopic-only approach were retrospectively analyzed.The patients were divided into three groups of 10 sequential cases each.Group of early time consisted of the first 10 cases,Group of medium term the subsequent 10 cases,and Group of later time the last 10 cases.The clinical evaluation data included operative time,length of hospital stay,leg and back pain visual analogue scale (VAS),and complications.ResultsAll patients were observed prospectively for (1.61±0.22) years.There was no measurable intraoperative bleeding,no postoperative infections and symptomatic recurrences in the three groups.Compared to group of early time,the operative time in group of medium term was significantly decreased(P＜0.05).The patients in group of later time had much less operative time than that in group medium term(P＜0.05).There was no significant difference with length of hospital stay between the three groups (P＞0.05).The improvement of leg and back VAS in each group was similar:there was a significant improvement 3 months post-operation compared with pre-operation (P ＜0.05),but no statistical difference between 3 months post-operation and final foliow-up(P＞0.05).The complication rate was 12.5％ for group of early time,10％ for group of medium term,and 0 for group of later time.There were two cases conversed to an open procedure for group of early time compared with 0 cases in both other groups.ConclusionExcellent clinical and minimally invasive outcomes can be obtained in the surgical treatment of lumbar disc herniation via the interlaminar approach assisted by full endoscopic technique.However,attention must be paid to the steep learning curve with use of this complex technique.Obtaining microsurgical experience and suitable patient selection can help shorten the learning curve and decrease the complications.

Objective To analyze the neurological complications in treatment of severe thoracolumbar spinal deformity with one stage posterior vertebral column resection (pVCR) and discuss the related risk factors. Methods There were 67 patients with severe thoracolumbar spinal deformity who underwent one-stage pVCR from February 2000 to September 2010.There were 29 males and 38 females at an average age of 31.4 years old(range,14-62 years).There were 21 patients at age less than 18 years old and 46 at age more than 18 years old.Patients were divided into four pathological types:severe scoliosis group(n=11,mean Cobb angle 90.4°),kyphoscoliosis group(n=25,mean scoliosis 94.5°,and mean kyphosis 65.5°),angular kyphosis group(n=28,mean kyphosis 74.3°)and global kyphosis group(n=3,mean kyphosis 91.1°).of all the patients,59 patients underwent primary surgery and eight underwent revision surgery.Surgical methods included posterior apex vertebral column resection,segemental pedicle screw fixation and correction as well as 360° bone fusion.Neurological complication was statistically analyzed. Results The average follow-up was 14 months (range,3-69 months),which showed severe neurologic complication in eight patients(11.9%)after surgery.Severe neurologic complication occurred in three patients (4.5%),among whom one patient presented delayed complete paraplegia 23 hours after surgery.Five patients had mild neurologic deficits(7.5%),the incidence of which was higher than 23.1%for thoracic osteotomy (P<0.05).Multilevel pVCR had high rate of neurological complications (P<0.05).The incidence rate was 33.3% for patients with preoperative neurologic compromise and 7.3%for patients mthom preoperative neuroiogic compromise (P<0.05).The incidence rate was increased in the revision surgery (P<0.05).Eight patients with neurological deficits had kyphotic angle of raore than 60°although there was no statistical difference (P>0.05). Conclusions pVCR is an effective surgical method for the correction of severe thoracolumbar spinal deformity.The neurological complications,however,should be paid attention to the surgeons.The risk factors for neurologic complications include improper manipulation,massive blood losing,preoperative neurologic compromise,osteotomy at thoracic rein,multi-level vertebrectomy,revision surgery and severe kyphosis.

Objective To verify the feasibility of eryoablation on rabbit brain tumor under interventional MRI guidance.Methods The procedures were performed under general anaesthesia.Twenty-two New Zealand white rabbit'S brains were inoculated with VX,tumor tissue through cranial holes. MR-guided cryoablation were conducted as preliminary experiment when diameter of brain tumor grew up to 0.8 cm in size.Cryoablation lasted two cycles of 5 minutes freezing, in 2 rabbits.and of 10 minutes freezing in another 2 rabbits.After procedure and MR scanning.rabbits were executed.Specimens of rabbit'S brain showed complete necrosis pathologically after cryoablation of cycles of 10 minutes freezing.The optimal parameters of eryoablation were defined.Except for the two rabbits that died of infection,the other 16 rabbits were divided into control group and therapeutic group.According to the optimal parameters of cryoablation,cryoablation of 10 minutes freezing were performed for rabbit brain tumors in therapeutic group.Venous injeetion of 20%mannitol and subcutaneous injection of dexamethasone were used for dehydration.None of rabbit brain tumors in the control group were treated.After cryoablation,MRI scanning Was performed immediately,7 days later,14 days later and 60 days later,to observe the ablative area and the pathologic changes.The survival time wag recorded.Resuits Brain tumors could be found in all New Zealand white rabbits after inoculation except two died of inflammation.The maximum diameter of brain tumors Was from 0.7 to 1.0 elEL The tumors showed slight low signal on T1WI and slight high signal on T2WI as well as comrast enhancement after injection of Gd-DTPA.Pathologically coagulative necrosis were observed after cryoablation immediately,7 days and 14 days later,and liquefactive necrosis was found 60 days later.The correlation between MRI and pathologic appearance of tmnors are consistent.The therapeutic area ranged from 1.0 to 1.5 em.,The maximium diameter of ice ball ranged from 1.5 to 2.0 cm Conclusion CiToablation for brain tumor iS a safe and feasible therapy.

OBJECTIVE: To analyze the accuracy of free-hand thoracic pedicle screw placement in severe idiopathic scoliosis via CT scan. METHODS: Twenty patients with complete CT data were chosen out of 58 patients of severe idiopathic scoliosis from June 1996 to December 2006. The Cobb angle of the main thoracic curve was from 82 degree to 142 degree (96.3 degree +/- 14.3 degree). The kyphotic angle in the main curve was 66.2 degree +/- 12.4 degree. The placement of thoracic pedicle screw was completed free-handedly, and the accuracy of screws placement was evaluated with CT thin-slice scan postoperatively. RESULTS: Altogether 174 thoracic pedicle screws were inserted, 157 (90.2%) of which were fully contained within the cortical boundaries of the pedicle.The other 17 screws (9.8%) were misplaced in 9 patients: 11 screws (6.8%) were lateral, 9 of which had a breach 0.05). There was no neural complication in all patients. CONCLUSION It is fairly accurate place thoracic pedicle screw in severe idiopathic scoliosis free-handedly, with some misplacements.
Adolescent ; Bone Screws ; Female ; Humans ; Male ; Orthopedic Procedures ; methods ; Scoliosis ; diagnostic imaging ; pathology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult