Objective To improve the understandazation of manifestation of lung metastases and awareness of characteristics. Methods 21 cases of lung metastases were collected by the clinical diagnosis during Jan 2005 to Dec 2008, and its manifestation of chest X -ray and CT imaging was analysed to explore the characteristics. Results The chest X - ray was a conventional method for lung metastases .CT, especially HRCT, can provide more comprehensive and accurate image information. 21 cases of lung metastases included 17 cases of hematogenic metastasis, accounting for 80% , 2 cases of lymphatic metastasis and 2 cases of direct metastasis, each accounting for 10% . Primary tumor + lung typical manifestation can help to make more precise diagnosis. Conclusion Chest X - ray and CT are an important for lung metastases in the clinical diagnosis, treatment, program settings, and efficacy of assessment.

Objective To summarize surgical experience for the treatment of substernal goiter.Methods 102 cases of substernal goiter underwent surgical resection,in 74 by low collar incision,12 cases by larger low collar incision and pillowing the shoulder pad about 20 degrees for neck hyperextension,8 cases by unilateral or bilateral infrahyoid muscles transection,8 cases by low collar and up-mid-sternal incision plus horizontal sawing in 2 and 3 ribs.Results Resection was performed successfully in all cases.Hoarseness occurred in 7 cases,4 cases recovered after one month,3 cases did not improve because of tumor invasion of laryngeal recurrent nerve.Postoperative transient hypocalcemia in 9 cases recovered after 2 to 3 months.102 patients were followed up for 1 to 3 years without recurrence.Conclusions Substernal goiter can be resected successfully through a transcervical approach or mid-sternal incision.CT scanning and chest X radiograph are decisive for the surgical approach.

Objective To explore the diagnosis and treatment of cystic dilatation of the cystic duct in adults.Method Clinical data of 25 cases of the cystic dilatation of cystic duct in adults in 3 hospitals in Songhuajiang river drainage area from 1991 to 2012 confirmed by surgery were analyzed retrospectively.Results The 25 cases were with manifestations of chronic cholecystitis,and 14 patients with right upper quadrant recurrent biliary colic and nausea,vomiting and other gastrointestinal symptoms,9 patients with yellowish discoloration of sclera and skin,and fever.Ultrasonography was done in 25 cases,ERCP in 16 cases and MRCP in 9 cases,displaying liquid dark area of diameter from 1.6 cm × 1.6 cm to 2.5 cm ×2.5 cm in the gallbladder tube suspective of calculi,and characteristic dumbbell shape image.Preoperative diagnosis was cystic duct cyst with stones or gallstones which was confirmed by surgery.Gallbladder and cyst resection was performed in all 25 cases,and bile duct jejunum Roux-en-Y anastomosis was done in 2 of these cases because of introgenic bile duct injury.Conclusions Cysts of the cystic duct is the special type (Ⅵ type) of choledochocele,and its prognosis is good after surgical treatment.

Objective　Analyze and summarize the clinical and EEG characteristics of 3.0 T MRI-negative adult patients with epilepsy，to provide a basis for improving the etiology of MRI-negative adult patients with epilepsy. Methods　Review the clinical data of patients with epilepsy diagnosed and treated in our hospital from September 2016 to June 2019，aged ≥16 years old and with a cranial 3.0T MRI result normal，combined with relevant literature，to summarize and analyze MRI-negative adult epilepsy patients Clinical and EEG characteristics，to explore possible potential causes. Results　134 MRI-negative adult epilepsy patients had the most common onset at 18～60 years old，accounting for 64.18%，37.31% of patients had a traceable etiology；50.75% of patients had clear aura symptoms before onset，and the specific aura symptoms were significantly higher than non-specific aura symptoms. The seizure type was most common with focal origin；82.10% of patients were treated with standardized AEDs，and the effective rate was 67.27%；68.18% of them were monotherapy，with a total effective rate of 54.54%. The positive rate of epilepsy detected by video-EEG was 62.69%. Intermittent abnormal discharges were most common in the temporal region，accounting for 40.48%，and were mostly were unilateral. Conclusion　MRI-negative adult epilepsy is more common in young and middle-aged patients，and it is mostly of focal origin. The temporal lobe epilepsy has the highest proportion. The potential etiology is complex and diverse. regular anti-epileptic treatment should be used，and immunization and multimodal imaging should be completed as soon as possible to find the cause of intervention.