Objective To study the characteristics and differential diagnosis of obsolete pulmonary tuberculosis accompanied withperipheral lung carcinoma.Methods CT findings of obsolete pulmonary tuberculosis accompanied with peripheral lung carcioma in 20 cases were retrospectively analysed.Results In 20 patients ,12 cases were diagnosed correctly because of them with typical CT findings of peripheral lung carcinoma,while 8 cases were misdiagnosed because of atypical CT findings of lung carcinoma.Conclusion Obsolete pulmonary tuberculosis accompained with peripheral lung carcinoma is common seen,atypical lung carcnioma is easily misdiagnosed.

OBJECTIVE: To investigate therapeutic progress of cerebral intravascular stent, and to evaluate biocompatlbility with host.METHODS: Articles were collected from CNKI and Medline database with the keywords of "cerebrovascular disease, stent, and therapy" in both Chinese and English from 1989 to 2009. Among 53 articles, 22 were included according to inclusion and exclusion criteria; while the included articles were summarized in the fields of therapeutic progress of cerebral intravascular stent,complication following cerebral intravascular stent implantation, and biocompatlbility of cerebral intravascular stent in order to investigate the biocompatibility of various stents.RESULTS: Cerebral intravascular stent was mainly used to treat cerebral artery stenosis, cerebral aneurysm, venous sinus stenosis, and thrombus. Complications following cerebral intravascular stent implantation included carotid sinus syndrome,hypertransfusion syndrome, cerebral angiospasm, thrombosis, and restenosis. Pre-enlargement prior to implantation in the stenotic region played an important role in avoiding deformation and displacement of stent. Restenosis correlated to stent types following cerebral intravascular stent implantation. For example, metal stent could promote thrombosis; however, polymer which had an excellent biocompatibility to vessel wall was superior to metal stent, thus it could prevent endomembrane proliferation following implantation. Metal-coated stent could inhibit aggregation of platelet; additionally, drug stent could effectively prevent restenosis via high-concentration drug release for a long term.CONCLUSION: Cerebral intravascular stent is considered as an ideal tool to treat cerebrovascular disease. Metal stent has a poor compatibility, but polymer stent, coating stent, and drug stent have a good compatibility.

Objective To evaluate the value of percutaneous transhepatic angioplasty in treatment of portal vein stenosis (PVS) after pediatric liver transplantation.Methods The data of 8 pediatric patients with PVS after liver transplantation were retrospectively evaluated.All cases were confirmed by portal vein angiography,and were treated with percutaneous transluminal angioplasty and/or percutaneous transluminal stent angioplasty.The effect of endovascular interventional therapy in 8 cases was analyzed.Results A total of 12 times of 8 patients received endovascular interventional therapy.The success rate was 66.67％ (8/12).The clinical success rate of the first treatment was 62.50％ (5/8).Three cases were treated with balloon dilation after the first balloon dilation,and there was no recurrence of PVS after operation in 2 cases.After the treatment of balloon dilation,stent angioplasty was performed in 1 case.There were no complications related to treatment in 8 cases.Conclusion Endovascular interventional treatment is a safe and effective way for PVS after pediatric liver transplantation.

Objective To study CT-guided localization of additional pulmonary nodules with microcoils prior to video-assisted thoracoscopic surgery (VATS) resection in patients with suspected lung cancer.Methods Eleven patients suspected lung cancer underwent preoperative microcoils localization towards additional small pulmonary nodules.The head of microcoil was pinpointed adjacent to the target nodule while its end tail remained above the visceral pleura.VATS were performed within 24 hours, and comprehensive assessments were conducted according to surgical and pathological outcomes of primary and additional lesions, and suitable surgical processes were followed.Results All 11 localizing pulmonary nodules (4-15 mm in diameter) were successfully removed after VATS, 9 microcoils'' end tails of which were placed above visceral pleural surface.There were no serious complications related with localizing procedure.Other 16 lesions including 11 primary ones were resected.The surgical and pathological outcomes for lung lesions were utterly assessed.Conclusion Microcoil preoperative localization provides helpful orientation for complete resection and assessment of multiple pulmonary lesions in patients with suspected lung cancer.

Objective To explore the relationship between children obesity and adiponectin(ADPN),leptin(LP),and high-sensitive C-reactive protein(hsCRP).Methods Seventy-one obese volunteers as obesity group and 30 normal volunteers who matched obese volunteers in age and sex as control group were selected from 13 702 children and adolescents of 2 to 18 years old in Xiangtan city by sampling survey.The body mass index(BMI),ADPN,LP,hsCRP,fasting blood-glucose(FBG),and fasting pure insulin(INS) were checked respectively.The homeostasis model assessment for insulin resistance(HOMA-IR) and the quantitative insulin-sensitivity check index(QUICKI) were calculated.The difference between the two groups was compared and the relationship of all indexes was analyzed.Results The values of ADPN and QUICKI in obesity group were significantly lower than those of control group(P

Background and purpose:It has been demonstrated that radical prostatectomy for patients with oligometastatic prostate cancer may contribute to improving local control of prostate cancer and overall survival by several retrospective studies. Perioperative complications play an important role in determining whether radical prostatectomy is appropriate for patients with oligometastatic prostate cancer. This study aimed to discuss the recurrence rate and the sever-ity of perioperative complications, and the primary curative effect of radical prostatectomy on oligometastatic prostate can-cer patients.Methods:A total number of 247 patients who received radical prostatectomy were recruited in the study from Jul. 2015 to Jan. 2016, including 25 patients with oligometastatic prostate cancer and 222 patients with localized prostate cancer. Patients with perioperative complications in both groups were graded with the Clavien-Dindo grading system. The proportion of PSA decline and the rates and severity of perioperative complications were analyzed in both groups.Results:The cases of prostate specific antigen (PSA) decline in the oligometastatic group were 21 (84.0%), lower than the localized group with 212 cases (95.5%). There were 6 cases (24.0%) with postoperative complications in the oligometastatic group, including serious complications (Ⅲ or above) 1 case (4.0%), and 49 cases (22.1%) with postoperative complications in the localized group, including serious complications (Ⅲ or above) 7 cases (3.2%). The differences between the groups reached no statistical significance (P>0.05).Conclusion:Radical prostatectomy for patients with oligometastatic prostate cancer could be safe, effective, and appropriate, the risk of perioperative complications should not be one of the limiting factors.

Objective To analyze prognosic factors for patients with hormone refractory prostate cancer (HRPC) after chemotherapy of docetaxel/mitoxantrone plus prednisone and to explore the relationship between prostate specific antigen (PSA) parameters and prognosis. Methods Data from 68 patients with CRPC after chemotherapy were collected and analyzed retrospectively.The median age of these patients were 65 years old with 28 cases of biopsy Gleason score ＜ 8 and 35 cases of ≥ 8.The median serum PSA at diagnosis,nadir and pre-chemotherapy baseline were 142 ng/ml,0.5 ng/ml and 33.0 ng/ml,respectively.There were 38 patients in docetaxel group and 30 in mitoxantrone group.PSA doubling time ( PSADT),progression free survival (PFS) and overall survival (OS) was calculated.Chi square test was used in analysis of chemotherapy effect and Cox proportional hazards regression model was applied to identify the predictors for PFS and OS.The median value of continuous variable as cutoff point was used to divide patients into two groups to compare.Risk ratio and 95％ confidence interval (CI) was calculated. Results 38 (55.9％)patients experienced effective chemotherapy. The effective rate were 33％ and 74％ for PSADT ＜ 1.6 months and ≥ 1.6 months group,85％ and 49％ for M0 and M1 stage group,and 69％ and 40％ for docetaxel and mitoxantrone group,(P ＜ 0.05).The median PFS was (3.5 ± 0.5) months for all patients,which were (2.7 ±0.4) months and (5.9 ±0.6) months for patients with PSADT ＜ 1.6 months and ≥ 1.6 months group,(5.0 ± 0.6) months and (2.7 ± 0.5 ) months for patients with docetaxel and mitoxantrone group,and (5.7 ± 0.8) months and ( 3.4 ± 0.6) months for patients with Gleason score ＜ 8 and ≥ 8 group (P ＜0.05).26 case died in the end and the median OS was (28.3 ± 2.6) months for these patients,which were (15.7 ± 3.4) months and (31.6 ± 1.2) months for patients with PSADT ＜ 1.6 months and ≥1.6 months group,(29 ± 4.1 ) months and (28 ± 3.2) months for patients with docetaxel and mitoxantrone group,and (28.7 ± 2.6) months and (24.3 ± 5.6) months for patients with Gleason score ＜ 8 and ≥ 8 group (P ＜ 0.05). Conclusions The effective rate of chemotherapy was related with PSADT,chemotherapy strategy and M stage.PSADT,chemotherapy strategy and Gleason score may be independent predictors for patients with HRPC taking chemotherapy.Patients with PSADT ≥ 1.6 months,docetaxel chemotherapy and Gleason score ＜ 8 will have longer PFS and OS.

Objective To discuss the application of pelvic lymph node dissection during radical prostatectomy.Methods The data of 239 patients with prostate cancer which had been done radical prostatectomy and pelvic lymph node dissection were retrospectively reviewed,with the patients'median age of 68 (48-79) years.148 patients(61.9%) had either a Gleason score of>7 or a PSA of>20 ng/ml.All patients were diagnosed as clinical localized prostate cancer preoperatively.The extent of pelvic lymph node dissection included bilateral obturator fossa and region of the external iliac artery.Patients with positive lymph nodes were advised to receive maximal androgen blockade therapy and were followed up until biochemical recurrence.Results It took an average operation time of 20(15-35)min with the average blood loss of 20(5-45) ml for bilateral lymphadenectomy. There was no injury of big vessels and nerves. The total number of lymph node dissected was 1-23 with a median of 7.The median postoperative hospital stay was 16 days.The time of drainage was 4-36 days with a median of 7 days.74.5%(178 cases)of patients had drainage less than 8 days and 9.4%(20 cases)patients were more than 14 days. Positive nodes were found in 29 cases with the positive rate of 12.1%. The median number of positive lymph nodes was 1.Early postoperative complications related to pelvic lymphadenectomy included deep venous thrombosis,lymphocele,lymph leakage,pelvic infection. Patients with positive lymph nodes had a median progression free time of 10 months.Conclusions Pelvic lymph node dissection could detect lymph node metastasis which might be difficult to find through other means. It could facilitate the accurate staging of prostate cancer and bring potential benefits to patients. It does not significantly prolong the operation time and the incidence of complications should decrease gradually with the improvement of the surgeons'experience and surgical techniques.

Objective To investigate the efficacy and toxicity of sorafenib dose escalation in treating patients with advanced renal cell carcinoma who progressed after rutine dosage of sorafenib.Methods Twenty-four patients with advanced renal cell carcinoma who progressed after 4-22 months' rutine sorafenib treatment(400 mg bid po.) received dose escalation therapy.Nineteen cases were male,5 were female,with the average age of 52 years.Ten cases added their doses to 600 mg bid,and 14 cases escalated to 800 mg bid.Results Four cases(16.7%) progressed after one month's treatment of sorafenib dose escalation,and quited the study.In the other 20 cases,1(4.2%) reached partial remission with a tumor shrinkage of 42.5% and 19(79.2%) maintained stable disease for more than 12 weeks.To Jul 2009,another 10 cases progressed,and the median progression free survival(PFS) for the PR and SD patients was 7 months(3-14 months).The disease control rate was 79.2%,and the median PFS was 5 months(0-14 months) for the entire group of 24 cases.Common toxicities after dose escalation of sorafenib were similar to those of rutine dosage.Although the grade of hand-foot reaction,diarrhea,fatigue,and neutropenia were more severe,no grade 4 toxicities were observed during the treatment.Grade of toxicities would decrease when the time of treatment prolonged.Conclusions Sofafenib dose escalation is a feasible and effective treatment for the patients with advanced renal cell carcinoma who failed to rutine dosage of sorafenib.The disease control rate of this therapy is relatively high.The toxicities do not increase much,and could be well tolerated by most patients.