Resection of huge hepatic tumor located at segments Ⅶ and Ⅷ with reservation of segments Ⅴ and Ⅵ is difficult,because the right hepatic vein is easy to be injured during the operation.A male patient with huge hepatic tumor in the right lobe was admitted to the Cancer Hospital of Guangxi Medical University on July 26,2012.The tumor (diameter:14 cm) was located at segments Ⅶ and Ⅷ.The tumor and the whole structure of the liver were three dimensionally reconstructed by using digital medical technology and liver surgery planning system.The right hepatic vein was closely adjacent to the tumor.During the operation,the right Glisson pedicles were occluded intermittently,the liver parenchyma was dissected with cavitron ultrasonic surgical aspirator,and the right hepatic vein was occlued with non-invasive vascular clamp.The tumor was resected completely,with successful preservation of the trunk of right hepatic vein.No blood transfusion was needed,and the blood supply to segments Ⅴ and Ⅵ was not influenced.The patient recovered rapidly and was discharged on postoperative day 14.

Objective To study the effect of transcatheter arterial chemoembolizafion (TACE) on inhibitor apoptosis protein-Survivin, Survivin mRNA and proliferating cell nuclear antigen (PCNA). Methods Group A of hepatocelluar carcinoma with preoperative TACE (n = 26), group B of hepatocelluar carcinoma without any interven-tional therapy (n = 30) ,group C of Normal liver (n = 16) were divided. The expression of Survivin mRNA and the expression of Survivin and PCNA were detected. Result ①The positive Survivin mRNA expression in group A and the grey difference were lowere than that in group B (P < 0.05) ; ②The positive Survivin expression and the grey difference in group A were lower than that in group B (P < 0.05) ; ③The proliferating index (PI) of carcinoma tis-sure in group B was higher in group A and group C (P < 0.05 for each). Conclusion There is a high positive ex-pression of Survivin mRNA and Survivin, which may be decreased by TACE and then the proliferation of hepatocellu-lar carcinoma cell is surpressed.

BACKGROUND:Currently, it is stil controversial about the border, surrounding fascia, space of pelvic cavity, distribution of nerves and lymph nodes of the mesorectum, and the development of new technologies makes a progress in related anatomic research.
OBJECTIVE:To summarize the previous studies so as to describe clearly the progress of mesorectal anatomy and to discuss its clinical value.
METHODS: Using “rectum; mesentery; fascia; space; nerve; lymph node; total mesorectal excision (TME); clinical anatomy” as key words, a computer-based search of PubMed was done for articles related to the mesorectum and surrounding fasciae, space of pelvic cavity, distribution of nerves and lymph nodes.
RESULTS AND CONCLUSION:Fresh or frozen specimens are often used for studying the mesenterium, fascia, nerves and lymph nodes by using traditional pelvic and perineum anatomical methods. Computer-assisted anatomical dissection can combine immunostaining with computer imaging. A three-dimensional model can wel reflect the relationship among the different anatomical structures, as wel as nerve traveling and spatial location. Mesorectum is located behind the denonviliers and in the front of the sacral fascia of the rectum. Pelvic splanchnic nerve of the mesorectum is derived from the anterior sacral nerve root, runs through the presacral fascia, and enters into the neuro-fascial layervia the pesacral space, which is divided into the upper and lower parts according to the peritoneum. There are more folds in the rear of lymph nodes within the mesorectum within and near the peritoneum. There are stil a lot of controversies about anatomical relationship between the mesorectum and surrounding structures, and to elaborate these issues can provide an objective basis for guiding clinical work.

BACKGROUND:The pelvic nerves innervate the pelvic viscera as wel as bring sensory information to the central nerve system, including splanchnic nerves and spinal nerves. Each of them comprises both motor fibers and sensitive fibers. Mostly, the key part of splanchnic plexus is pelvic plexus. Total mesorectal excision proposed by Heald in 1982 has been the “gold standard” for diagnosis and treatment of colorectal cancer. However, it carries a high risk of nerve damage during surgery, which results in urinary retention, sexual dysfunction and other complications. OBJECTIVE:To summarize the former researches so as to get a precise understanding of the pelvic fascia and nerve structure. METHODS:Using “splanchnic nerves, superior hypogastric plexus, pelvic plexus, pelvic splanchnic nerve, total mesorectal excision (TME), clinical anatomy” as key words, a computer-based search of PubMed was done for articles related to the pelvic nerves, including its pathway, consistent, ganglia, and reflection in pelvic viscera, published from 2000 to 2015. RESULTS AND CONCLUSION:The main splanchnic plexus in the pelvic cavity includes superior hypogastric plexus (it is located in the triangle formed by left and right common iliac artery and the sacral promontory), and pelvic plexus (hypogastric nerve, pelvic splanchnic nerve and sacral splanchnic nerve converge at the bottom of rectum, formed pelvic plexus, also known as the inferior hypogastric plexus). It is flattened against the lateral aspect of the rectum, the dorso-lateral bladder wal and the seminal vesicles. Nerves come from the plexus contain the sympathetic nerve, parasympathetic nerve and sensory nerve. They are in charge of the motions and sensations of the pelvic organs. The definite knowledge on the anatomy of pelvic fascia and nerve structures can avoid nerve damage during operation, which can help to improve the life quality of patients.

Objective To investigate the long-term effect of recombinate human growth hormone(rhGH) on the immune function in patients with liver cancer. Methods Fifty patients with hepatoma who underwent hepatectomy were randomly divided into two groups:(1)Control group;(2)rhGH treatment(GH) group. All patients were treated with TPN for five days postoperatively,and additionally the patients in the GH group received rhGH(8U/d IH) in the evening for seven days. Results IgG,IgM,CD3,CD4 in the control group and CD8 in the GH group were significantly lower on day 10 postoperatively than that on preoperative days. IgG in the GH group significantly increased on day 15. The 1 year and 3 year survival rate and recurrent rate were not different between the two groups. Conclusions rhGH therapy can improve the immune function of patients with hepatoma who underwent hepatectomy and has no side effect on the long term survival and recurrence.

Objective To analyze the clinicopathologic characteristics and prognosis in multinodular and multicentric occurrence of hepatocellular carcinoma (HCC). Methods Study group (multinodular HCCs) involved 42 multinodular HCCs patients with a total of 112 HCC nodules. 16 patients with single HCC nodule, and 4 patients with portal vein tumor embolus, 5 normal livers served as controls. MtDNA D-Loop sequences were compared among multinodular lesions in the study group, between inconsecutive tumor tissues and between tumor and embolus tissues in the study group with regard to their clinicopathologic characteristics. Results In study group, for the multinodular HCCs 20 cases were categorized as multicentric occurrence (MO) based on their variant mtDNA D-Loop sequences in each nodule from the same patient. 22 cases were characterized as intrahepatic metastasis (IM) based on the identical sequences found in each nodule from the same patient. In all 20 cases for the rest of the study group (16 patients with single HCC nodule and 4 patients with portal vein tumor embolus), the inconsecutive tumor tissues or the portal vein tumor embolus and original tumors shared identical sequences. HBeAg (P =0. 008), tumor size ( sizes of all nodules) ( P = 0. 029), position of nodules (P = 0. 040), cirrhosis ( P =0. 011 ), portal vein and microscopic tumor embolus ( P = 0. 023 ) and differentiation ( Edmondson grade) of the main nodule (P = 0. 027 ) were significantly different between the IM and MO HCCs, thus were considered to be the important factors in determinning the clonal origin of multinodular HCC. Positive HBeAg, cumulative diameter of all nodules ≤7 cm, nodules located in different lobes, cirrhosis, negative for portal vein or microscope tumor embolus and/or well/moderate differentiation of main nodular histopathology were found in high rate in MO. Tumor-free survival of the MO subjects was significantly longer than that of the IM subjects (21.6 ±4. 2) months vs. (8.7 ±2. 5) months, P =0. 031 ). Similarly, overall survival of the MO subjects was longer than that of the IM subjects (29. 6±4. 7) months vs. ( 14. 6 ±2. 9) months, P = 0. 034). Multivariate analysis revealed that the IM/MO characteristic was an independent factor influencing both tumor-free survival ( P = 0.012 ) and overall survival ( P = 0.011 ).Conclusions HBeAg, tumor size ( sizes of all nodules), position of nodules, cirrhosis, portal vein and microscopic tumor embolus and differentiation of the main nodule are important factors in differentiating IM and MO. Positive HBeAg, cumulative diameter of all nodules ≤ 7 cm, nodules located in different lobes, cirrhosis, negative for portal vein or microscopic tumor embolus and/or well/moderate differentiation of main nodular histopathology are frequent phenomena in MO. MO HCC patients might have a favorable outcome compared with IM patients.

Objective To compare anatomic resection (AR) and non-anatomic resection (NAR)for hepatocellular carcinoma (HCC) as a factor in preventing intra-hepatic recurrence and local recurrence after the initial surgical procedure.Methods A systematic review and Meta-analysis of nonrandomized trials comparing anatomic resection with non-anatomic resection for HCC published from 1990to 2010 in PubMed and Medline,Coehrane Library,Embase,and Science Citation Index were searched.Intra-hepatic recurrence,including early and late recurrence,and local recurrence were primary outcomes.5-year survival and 5-year disease-free survival were secondary outcomes.Pooled effect was calculated by utilizing either fixed effects model or random effects model.Result Eleven nonrandomized studies including 1576 patients were identified and analyzed.810 patients were in the AR group and 766 were in the NAR group.Patients in the AR group were characterized by lower prevalence of cirrhosis,more favorable hepatic function,and larger tumor size and higher prevalence of macrovascular invasion compared with patients in the NAR group.Anatomic resection significantly reduced the risks of local recurrence (OR,0.27; 95％ CI,-0.17～0.43; P＜0.001) and achieved a better 5-year disease-free survival (OR,2.10; 95％ CI,-1.41 ～3.12; P=0.001) in HCC patients.Also,anatomic resection was marginally effective in decreasing early intra-hepatic recurrence.However,anatomic resection was not advantageous in preventing late intra-hepatic recurrence.No significant differences were found between the AR and NAR groups with respect to postoperative morbidity,mortality,and length of hospitalization.Conclusion Anatomic resection was recommended to be superior to non-anatomic resection in reducing the risks of local recurrence,early intra-hepatic recurrence and achieving a better 5-year disease-free survival in HCC patients.

Forty-five patients with peritonsillar abscesses(PA) were treated by needle aspiration. Pus was drawn in 89%(40/45) of the cases at the first aspiration and repeated aspiration was necessary in 33%(15/45) of the patients. All of the patients were cured by needle aspiration without further invasive therapy and no serious complication was observed. 32 out of 45 patients were available for follow-up. Among them, three had another recurrent PA in situ and the other ten(31%) had recurrent tonsillitis. However, analysis showed that the patients under 35 years of age had higher recurreuce rate of PA of recurrent tonsillitis than those over 35 years old(P

OBJECTIVE： To develop a HPLC method for the determination of the contents of lidocaine and prilocaine in compound lidocaine cream as a quality control means.METHODS： Lidocaine and prilocaine in compound lidocaine cream were determined by high-performance liquid chromatography on C18 column with the detection wavelength at 254nm.The mobile phase was 0.5％ ammonium dihydrogen phosphate(pH=7)-methanol(20∶ 80).RESULTS： The calibration curves of both lidocaine and prilocaine were linear within the concentration range of 130～250μ g/ml(r=0.9 996).The recovery rates of lidocaine and prilocaine were 99.05％ and 99.27％ respectively， RSDs were 0.67％ and 1.15％ ， intra-day RSDs 0.81％ and 1.45％ ， inter-day RSDs 0.55％ and 0.63％ respectively.CONCLUSION： The method was sensitive， stable and accurate.It can be used to determine and control the quality of compound lidocaine cream.

OBJECTIVE:To prepare indapamide capsules and study the quality control methods METHODS:The content of indapamide in capsules was determined by UV-spectrophotometry The other ingredients were determined by HPLC RES_ULTS:The calibration curve was linear within the concentration range of 3 7～11 1?g/ml(r=0 9 997);the recovery of indapamide was 99 50%,RSD=0 43% The RSDs of indapamide and other ingredients were 0 43% and 0 1% respectively The relative percentage contents of 3 batches of sample were 99 07%,99 34%,99 58% respectively The uniformity A+1 80S of contents of indapamide in all samples detected was