Objective Surgical treatment is the first choice for treatment in pituitary adenomas except for prolactinomas?In part of patients after operation would occur hypopituitarism,which with acute adrenal crisis is the most serious, and chronic adrenal insufficiency is different degree affects the patient's quality of life?Therefore,it is very important to accurately assess the hypothalamic pituitary adrenal( HPA) axis in patients with pituitary adenoma?But there is still a lack of reliable methods for evaluating adrenal axis?We reviewed the harm of adrenal insufficiency,HPA axis evaluation method of the new progress and postoperative glucocorticoid replacement treatment of new ideas, cleared the importance of reassessment and regular follow?up and the development of individual programs.

Arm Injuries ; etiology ; Autonomic Pathways ; pathology ; Central Nervous System ; pathology ; China ; Humans ; Occupational Diseases ; etiology ; Temperature ; Vibration ; adverse effects

Impotence is one of the more common and serious symptom type of male sexual disturbance.It demonstrates by domestic sampling investigation that about more than 10% of male adult have impotence,and the incidence of impotence goes higher with the growing of age.Warming and invigorating kidney-yang has been the main therapy method for treating impotence.Through years of clinic practices,the treatment for impotence from liver has achieved satisfied effects.

Objective:To study the CT and PET/CT features of pleural mesothelioma and the value of CT and PET/CT imaging in the diagnosis of the disease.Methods:We retrospectively analyzed the spiral CT images of 23 patients and PET/CT images of 7 patients with pleural mesothelioma,all histologically confirmed.Results:Of the 23 cases detected by spiral CT,7 were benign and 16 malignant;local nodular pleural thickening was found in 9 cases,7 benign and 2 malignant;diffuse pleural thickening was observed in 14 cases,all malignant.Of the 7 cases diagnosed by PET/CT,5 were excluded from surgery.Conclusion:CT imaging helps determine the location,shape,extent of the pleural lesion and its relation to the surrounding tissues,while PET/CT is better in the differentiation of pleural mesothelioma and staging of malignancy,and therefore plays an important guiding role in the treatment of the disease.

Objective: To discuss the imaging features of esophageal fistula and the value of intervention.Methods: We retrospectively analyzed the complete clinical data of 12 cases of esophageal fistula treated from June 2000 to May 2008,of whom,2 developed esophago-thoracis fistula and esophago-mediastinum fistula respectively after conservative radiotherapy,and 10 developed esophageal fistula after surgery for esophageal cancer.All the patients received iodine-based oral contrast,spiral CT scanning and intraperitoneal stent implantation for fistula closure.Results: Iodine-based oral contrast showed that the contrast agent overflowed into the chest in 8 cases,into the airway in 3 and into the mediastinum in 1.Spiral CT scanning revealed 8 cases of pleural fistula and 2 cases of remnant stomach-airway fistula,but failed to display the other 2 because of the small size.Intraperitoneal stent implantation was successfully accomplished in all the cases,which helped to close the fistula,take in food,stop bucking,control lung,mediastinum and other infections,and improve the patients' quality of life.Conclusion: Esophageal fistula can be effectively diagnosed based on the findings of iodine-based oral contrast and spiral CT scanning.As a novel technique,intraperitoneal stent implantation for fistula closure,simple,safe and with obvious immediate effect,is well worth promoting.

Objective To evaluate the clinical effects in treating periprosthetic femoral fractures classified Vancouver B2 with a cementless modular revision femoral prosthesis.Methods Twenty-six patients (7 males and 19 females with mean age of 66.5 years,range 60-69 years) who suffered from periprosthetic femoral fractures classified Vancouver B2 were treated with a cementless modular revision femoral prosthesis in hip revision and open reduction and internal fixation with cables or plates from March 2007 to February 2014.The previous femoral prostheses included 21 cementless and 5 cemented hip stems.The period from former procedures to fractures was 16 months,range from 7 to 32 months.Harris hip scores and numerical rating scales were analyzed statistically.Time of leaving bed,discharging,fracture union postoperative complications and radiographic imaging were also recorded.Results The operation duration were 143 (range 105-165) minutes.Blood loss volume was 450 (range 270-780) ml.Blood transfusion volume were 330 (range 0-800) ml.All patients were followed up at least two years,averagely 3.5 years after surgeries.All fractures healed at 6.5 (range 3-12) months averagely after surgeries.Harris hip scores improved significantly from 11.8±2.5 before surgeries to 80.3±5.3 one month and to 91.4±7.3 six months after surgeries separately (F=0.715,P=0.001).Numerical rating scales were 9.6±0.3,9.4±0.4 and 9.1±0.7 points averagely in aspect of information acquisition,postoperative pain control and function recovery respectively one month after surgeries.Average time of leaving bed and discharging from surgeries was 68.3 (range 51-75) hours and 6.5 (range 5-9) days respectively.No postoperative complications was found except dislocation in 1 hip,lower limb discrepancy in 1 hip,DVT in 1 hip,and heterotopic ossification in 3 hips.Conclusion Due to achieving prosthetic stability and fracture union,periprosthetic femoral fractures classified Vancouver B2 treated with a cementless modular revision femoral prosthesis combined with open reduction and internal fixation with cables or plates can reach good clinical outcomes.

Objective:Percutaneous fluoroscopic gastrostomy(PFG) is an alterative method for the patients who were not suitable for percutaneous endoscopic gastrostomy(PEG) and stent.This is a study to report the clinical experience of PFG in 25 patients. Methods:Twenty-five patients could not have oral intake due to obstruction of the oesophagus and depended on long-term parenteral nutrition.They contraindicated for percutaneous endoscopic gastrostomy.Results:The procedures all were successful completed without complication.The patients could use home enteral nutrition and get rid of parenteral nutrition.The patients' quality of life was improved significantly.Conclusion:PFG is a useful,convenient and less complication method for patients who are contraindication for PEG.

Obiective To discuss the diagnosis value, limitations and mutual complement of MRI and TDUI in the fetus. Methods, TDUI and MRI was performed in 24 cases pregnant women that suspected fetus congenital malformation by Ultrasound examination, the examination results were compared by MR1 and TDUI with the clinical results.Results The 9 cases congenital malformation of 24 cases pregnant women were found by MRI. The 9 cases were confirmed and 3 cases were more sufficient by MRI. The one case examined by MRI was normal other than Ultrasound examination. Conclusion MRI is superior to Ultrasound in diagnosing malformation of nervous system. The Ultrasound and the TDUI in particular is better in finding the surface malformation than MRI. In clinical application, MRI and Ultrasound must be connected to make up the limitation and have a definite diagnosis.

Purpose:Evaluate the operation methods and prognosis following Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy for carcinoma of the middle and lower third of the oesophagus. Methods:From March 1997 to March 2001, A total of 356 consecutive patients underwent Ivor Lewis esophagogastrectomy with two-field radical lymphadenectomy for carcinoma of the middle and lower third of the oesophagus ,The patients received cupula of pleura or cervical esophagogastroanastomosis with mechanical methods through two incisions (right posterolateral thoracotomy and upper abdominal).Results:The post-operative mortality was 0. anastomotic leakages occurred in 3 patients(0.8%). Gastric leaks for stress gastric ulcer occurred in 2 patients (0.6%). Chylothorax occurred in 2 patients(0.6%). Hoarseness occurred in 5 patients(1.4%),4 cases recuperated after 3 months. Barium swallowed postsurgery through anastomosis and pylorus went through smoothly.Full follow-up was 97.2%. Median survival for operative survivors was 2.6 years (range,61 days to 5 years). The overall 3-year survival rate was 74.5% .The overall 5-year survival rate was 55.49%,it was 94.2% for those in stage Ⅰ,81.5% for those in stage Ⅱa,78.3% for patients in stage Ⅱb,36% for those in stage Ⅲ and 0% for patients in stage Ⅳ. Conclusions:Ivor Lewis esophagogastrectomy with two-field radical lymphadenectomy for carcinoma of the middle and lower third of the oesophagus is a safe operation. There is the low post-operative morbidity. Long-term survival have been improved.

Objective To explore the changes of thyroid hormone and TNF-α in severe patients which occurring under critical illness and to explore the interrelation of these endocrine factors in order to direct clinical therapy. Methods Serum thyroid hormone and TNF-αin 102 severe patients and 80 healthy volunteers were detected by radioimmunoassay and enzymoimmunoassay. The results were analyzed and compared with normal subjects,groups of different prognosis,MODS group and no MODS group. Results TT3,FT4,FT3 levels in severe pa-tients were lower than that in normal subjects(P <0. 01),By contrast,TNF-α level were significantly higher than that of control group (P<0. 01). As the situation became worse,the above changes were more obvious in severe patients as compared with normal subjects. For TT3 and TNF-α level,the differences in the early stages of the disease (3 ~7rd) in the survival group and death group were significant (P<0. 05). Compared with non-MODS group,TT3,FT4,FT3 and TNF-α changed significantly in MODS group(P<0. 05). Conclusion TNF-α and thyroid hormone levels play important roles in the severe patients. The changes of TNF-αand thyroid hormone levels can be used for severe patients prediction and treatment.