Objective To summarize the experience of multiple primary colorectal carcinoma(MPCRC),to improve the level of diagnosis and treatment of MPCRC.Methods The clinical data of 14 cases of MPCRC seen over a 23-year period were retrospectively analysed.Results Amomg the 14 cases,9 cases were synchronous carcinomas and 5 cases were metachronous carcinomas.In the 14 patients,there were 37 carcinoma lesions and they were located as follows;8 lesions in the sigmoid colon,6 in the splenic flexure,6 in the transverse colon,5 in the hepatic flexure,3 in the ascending colon,9 in the desending colon,4 in the rectum and 3 in the cecum.Pathologic classification:19 were adenocarcinoma,7 were tubular adencarcinoma,7 were mucous adenocarcinoma,2 were papillary adenocarcinoma,1 was undifferentiated carcinoma,and 1 was polyp with malignant change.Duckes staging:stage B in 26 cancer lesions;stage C in 10 cancer lesions and stage D in 1 cancer lesion. A total of 21 operations were performed in the 14 patients,including hemicolectomy in 11 instances,extended hemicolectomy in 5,subtotal colectomy in 2,total colectomy in 2,and palliative resection in 1.There was no operative mortality.All 14 cases were followed up for 1～19 years;3 died of cerebral hemorrhage or natural causes.At present,11 patients have survived for 4～17 years. Conclusions The prognosis of MPCRC is good,provided that it is detected early and operation is zealous.Metachronous carcinoma has a better result compared to synchronous carcinoma.The main operation of choice is hemicolectomy or extended hemicolectomy.Total colectomy is considered only when absolutely necessary . Regular postoperative colonoscopy followup should be done.

Objectives: To investigate the characteristics and their functional significance of TMJ disc and its attachment. Methods: Each of the 23 TMJs from 12 cadavers were divided into quadrants sagitall y, and total 92 histological slices were obtained and stained with HE.The morpho logical characteristics of the samples was observed microscopically. Results: ①Both temporal posterior and anterior mandibualr attachment s were loose while mandibular posterior and anterior temporal attachments were d ense in which the fibers run anterior posteriorly. ②Fibers in the intermediate zone ran predominantly in anterior posterior direction while those in both ant erior and posterior bands were mixed with transverse fibers. ③At the posterior portion of disc there were 33 out of 92 slices from 6/12 cadavers (11/23 TMJs) s howed the structure of "the fourth band" which was featured by dense fibers alik e those of inner disc. There were 36 out of 92 slices from 6/12 cadavers (10/23 TMJs) showed the structure of "turned fibers" which was featured by a sudden tu rning of fibers from the thick posterior band back and downward, providing an angle like sign. Conclusions: There is great difference o f fiber direction in various parts of disc and its attachments, reflecting the functional demands.

Objective To summarize our experience in the diagnosis and treatment of right hemicolon carcinoma combined with acute appendicitis.Methods A respective analysis of clinical data of 51 cases of right colon cancer complicated with acute appendicitis and confirmed by surgical operation and pathology was made.Results In 2400 cases of right colon cancer,51 cases(2.1%)complicated with appendicitis.There were medical complications in 39 cases(76.5%).The diagnosis before operation was made in 13 cases(25.5%),and diagnosis of colon cancer was missed in 38 cases(74.5%).Colon adenocarcinoma was found in 40 cases,mucous adenocarcinoma 7 cases(13.7%),undifferentiated carcinoma 4 cases(7.8%);and Dukes B,C,D stages were in 2 cases(3.9%),29 cases(56.9%)and 20 cases(39.2%)respectively.The simple appendicitis,suppurative appendicitis,gangrenous appendicitis and phlegnomous appendicitis was found in 28 cases(54.9%),11 cases(21.6%),8 cases(15.7%)and 4 cases(7.8%)respectively.3-5-year survival was 95.2%,40.0%,respectively.Conclusions Occurrence rate of right colon cancer combined with appendicitis is low,but misdiagnosis rate is high,and 5-year survival rate is low.Middle and old age patients with appendicitis and accompanied with emaciation,anemia,digestive symptoms and right lower abdominal mass should have appropriate examination to avoid missing the diagnosis of right colon cancer.

ObjectiveTo determine the role of mammary ductoscopy in the evaluation and intraductal therapy for nipple discharge.MethodsIn this study 3280 patients with nipple discharge underwent mammary ductoscopy. Ductoscopy revealed space occupying lesions in 1018 patients who subsequently underwent surgery; 2260 patients with no-space occupying lesion underwent ductoscopically guided duct lavage.ResultsSpace occupying lesion was often seen in patients with bloody discharge,single duct nipple discharge,discharge in unilateral breast and lesions located in general or levelⅠ - Ⅱ duct.Non-bloody discharge,multiple duct with nipple discharge and bilateral breast involved and lesions at multi-level ducts were common in patients with no-space occupying lesions. Ductoscopically guided duct lavage was curative in 88.72％ among 2260 cases undergoing lavage.ConclusionsSpace occupying lesion should be suspected in patients with bloody discharge,single duct nipple discharge and unilateral breast involving lesion and lesions located in the general or level Ⅰ - Ⅱ duct system;Mammary ductoscopy is useful tool in the intraductal therapy for non-space occupying lesions.

Objective To compare the incidence of C5 nerve root palsy after laminoplasty and laminectomy with internal fixation for treating multilevel cervical spondylotic myelopathy (MCSM).Methods From January 2008 to August 2012,98 patients with MCSM were treated with laminoplasty (47 patients,group A) or laminectomy (51 patients,group B) with internal fixation.All the patients were followed up for 13-56(26.5 ± 7.9) months.In both groups,Cobb's method was applied to measure cervical lordotic angle,and Ishihara's method was conducted to measure cervical curvature index (CCI) before and after operation.The incidence of C5 nerveroot palsy was recorded and compared.Results The incidence of C5 nerve root palsy in group A was 2.1％ (1/47),while 21.6 ％ (11/51) in group B (x2 =5.430,P ＜ 0.05).The JOA scores in group A and group B before and after operation and improvement rate of JOA scores had no significant difference (P＞ 0.05).The cervical lordotic angle and CCI in group A and group B before and after operation had no significant difference (P ＞ 0.05).The improvement rate of CCI between two groups had no significant difference (P ＞ 0.05).All of 11 patients with C5 nerve root palsy were group B 1,and other 40 patients were group B2.The improvement rate of CCI in group B1 was significantly higher than that in group B2 [(38.7 ± 18.3)％ vs.(22.1 ± 12.1)％](t =1.772,P＜ 0.05).Conclusions Compared with laminoplasty,laminectomy with internal fixation has a higher incidence of C5 nerve root palsy.The C5 nerve root palsy may be associated with postoperative increase of cervical lordosis angle.Moreover,tethering of the C5 root may he one of its important pathomechanisms.

OBJECTIVE: To investigate the effects of Yinchen Shufu Decoction on hepatocyte apoptosis and the expression of its apoptosis-regulating gene Bcl-2 and Bax in Yin-jaundice rats. METHODS: Forty-eight rats were divided randomly into 4 groups: the normal control group, Yin-jaundice model group, Yang-jaundice model group, Yinchen Shufu Decoction treatment group. The TUNEL assay and the immunohistochemistry assay were used to detect the apoptosis of hepatocytes and the expression of Bcl-2 and Bax in hepatocytes respectively. RESULTS: The rate of apoptosis cells in Yin-jaundice model group was higher significantly than that in Yang-jaundice model group and normal control group (P<0.01), the expression of Bcl-2 in Yinchen Shufu Decoction treatment group was higher significantly than that in Yin-jaundice model group (P<0.01 or P<0.05), and the expression of Bax in it was lower significantly than that in Ying-jaundice model group (P<0.01 or P<0.05). CONCLUSION: Yinchen Shufu Decoction can prevent hepatocyte apoptosis perhaps by up-regulating the expression of Bcl-2 and down-regulating the expression of Bax. It is one of the mechanisms of its treatment on Yin-jaundice.

Objective To investigate the safety and feasibility of laparoscopic hepatectomy and cystectomy for hepatic cystic echinococcosis.Methods Between September 2015 and May 2016,patients with hepatic cystic echinococcosis indicated for surgery were evaluate.Selective hemihepatic inflow inclusion or non-selective hepatic inflow inclusion was adopted to control the bleeding.Laparoscopic multifuctional operative dissector (LPMOD) was applied for liver parenchymal transection.Laparoscopic hepatectomy and cystectomy was applied for hepatic cystic echinococcosis in eight cases,including one case of mesohepatectomy,two cases of right posterior sectionectomy,two cases of right partial hepatectomy,one case of left hepatectomy,one case of left lateral sectionectomy and one case of cystectomy in the left hepatic lobe.Results 8 patients received laparoscopic hepatectomy and cystectomy for hepatic cystic echinococcosis.Seven cases were performed totally laparoscopically and one case required a conversion.The maximum size of the lesion was 10 cm.Operating time was 150-260 min (mean,200 ± 35);Blood loss was 100-1 000 ml (313 ±290).One patient received intraoperative transfusion.Postoperative hospital stay was 6-9 days (mean,7.6 ± 1.3).One patient developed postoperative pleural effusion that resolved after medical treatment.One patient developed biliary leak in postoperative five days and recovered after drainage for twelve days.No remaining cavity infection,postoperative abdominal bleeding,liver failure occurred.No hospital death occurred.Conclusions Laparoscopic hepatectomy and cystectomy for hepatic cystic echinococcosis is technically safe and feasible.

valuating the unilateral renal function of hydronephresis.

Objective To evaluate the value of MSCT perfusion imaging in assessment of single renal function of hydronephrotic kidney.Methods 64-slice spiral CT perfusion was performed in 36 obstructive nephrohydrosis patients whose split renal glomerular filtration rate(GFR) was measured by SPECT renal dynamic imaging. ①The perfusion parameters of the renal cortex and renal medulla of the hydronephrotic kidney were compared with the normal kidney studied by contrast group. ②The 72 kidneys were divided into normal renal function, mild and severe renal impairment groups according to renal function. Differences between the groups respect to all the mean perfusion parameters of the renal cortex and renal medulla were assesses by ANOVA. ③Using Pearsons correlation test, the correlations between all the mean perfusion parameters of the renal cortex and renal medulla and renal GFR were examined.Results ① The time-density curves of bilateral normal renal cortex and medulla were not symmetric. The mean BF, BV, PS, PBV of renal cortex were (203. 2±44.9)ml·100 ml~(-1)·min~(-1), (27.6±3.9)ml/100 ml, (30.7±6.5)ml·100 ml~(-1)· min~(-1), (46.5±10. 9)ml/100 ml; and the mean BF, BV, PS, PBV of renal medulla were (99.9±24.1)ml·100 ml~(-1)·min~(-1) ,(18. 3±4.3)ml/100 ml, (51.8±12.1)ml · 100 ml~(-1)· min~(-1) , (21.3±3.0)ml/100 ml. The mean perfusion parameters of the cortex and medulla of obstructed kidney were lower compared to that of normal kidney. ②There were significant differences of all the perfusion parameters of the renal cortex and me-dulla between 3 groups (P<0. 05). ③The perfusion parameters of the renal cortex and medulla had positive linear correlation with GFR. The best correlation was the blood flow of the cortex of kidney. The correlation coefficient r=0.852.Conclusions64-slice spiral CT perfusion imaging can quantita-tively evaluate the haemodynamic condition and functional lesion of the kidney, classify the impaired kidney function. The perfusion parameters of the renal cortex and medulla had positive linear correlation with GFR.

Objective To study the relationship of the antepartum foramen ovale (FO),the ratios of foramen ovale and aorta (FO/AO) and postpartum ostium secundum atrial septal defect (ASD).Methods Nine hundred fifty-eight fetuses were divided into 5 groups by gestational age,18-22 weeks,23-26 weeks,27-30 weeks,31-34 weeks,35-40 weeks.The diameter of FO and aortic (AO) and FO/AO were measured by fetal echocardiography,the postpartum echocardiography were followed up more than 12 months after birth.ANOVA was used to compare FO,AO,FO/AO with different gestational age.Regression equation estimate was used to compare the relationship of FO and AO with gestational age.Independent sample T test was used to compare FO and FO/AO with postpartum ostium secundum ASD and postpartum normal heart.Results There was significant difference in FO and AO among 5 groups(P =0.000),FO and AO increased with increasing gestational age.There was significant difference in antepartum FO,FO/AO between postpartum ostium secundum ASD and postpartum normal heart (P =0.000).Conclusions Antepartum FO and FO/AO provide clinical value in observing postpartum ostium secundum ASD.