Objective To evaluate the value of ultrasonic mini probe(UMP) in the diagnosis of lower digestive tract lesions . Methods one hundred and fifteen patients with lesions of lower digestive tract were undergone EUS with UMP (Olympus UM-3R, 20MHz; UM-2R, 12MHz). Results Eighty one cases with colorectal carcinoma appeared as a hypoechoic mass under UMP. UMP had an overall accuracy rate of 82. 7% (67/81) in the diagnosis of depth of infiltrative colorectal carcinoma. The sensitivity and specificity of UMP in the diagnosis of lymph node metastasis were 55. 4% and 68. 8% respectively. All 15 cases with submucosal tumors were diagnosed correctly under EUS except one leiomyoma misdiagnosed as leiomyosarcoma and other 10 and 9 cases were ulcerative colitis and Crohn's diseases respectively. Conclusions UMP has a high accuracy in determining the invasive depth of colorectal carcinoma and submucosal tumors. The preoperative UMP may provide much information and influence on the choice of therapy for colorectal carcinoma and submucosal tumors.

For the characteristics including minimal invasion,low incidence of complication and better postoperative prognosis,endoscopic therapy is widely accepted to be the first line therapy for most biliary strictures.At present,repeated progressive dilation combined with multiple plastic stents placement is the main therapy for benign biliary strictures.The long-term effective rate is relatively high in surgery related strictures,but in the non-surgery related strictures,its long-term effective rate is limited and the optimal therapy should be chosen cautiously according to patients' condition.In malignent biliary stricutes,dilation combined with metallic stents placement is recommended to treat both of preoperative long-term drainage in patients with resectable tumor and palliative treatment in patients with unresectable tumor,while nosobiliary drainage is recommended in preoperative short-term drainage. The choice of unilateral or bilateral drainage depends on patients' conditons in malignent hilar biliary strictures.The merits and demerits of stents should be mastered before they are placed in stricture sections.Recently,a lot of new endoscopic technologies and methods are applied in clinical practice,but their curative effect should be tested.Therefore,accumulative evidence-based data are needed to make them more rational and more standard.

Objective To evaluate the value of endoscopy in etiological diagnosis and treatment of post - cholecystectomy syndrome. Methods Three hundred and twenty - six patients with post -cholecystectomy syndrome received ERCP. To reveral the etiology of post - cholecystectomy syndrome. For those with choledocholithiasis and those with papillary inflammatory stricture EST or EPBD were given those with papillary diverticulum and SOD EPBD were given, those with papillary tumor and hepatobiliary carcinoma EMBE were given and for those with bililary stricture in middle part of bile duct, purulent cholangitis, chloedocholithiasis(stones not excluded in one time)and bile leakage ENBD were used. Results ERCP was succeeded in 315 cases(96. 6%), 24 cases had no abnormal endoscopic findings view. 191 cases of choledocholithiasis 186 were totally get rid of stone after one to three times of opretion EST or EPBD was successfully given to 39 cases of 39 had papillary inflammatory stricture. Nine had papillary diverticulum which oppressed the papillary orifice, 7 had SOD, all of them were dealt with EPBD. Sixteen had stricture in the middle portion of bile duct, 11 of which were treated with ENBD. In 6 cases of papillary tumor and 5 hepatobiliary carcinoma patients jaundice improved significantly after received EMBE. Residual stones in cholecystic duct were seen in 4 cases. In 2 cases of bile leakage after cholecystectomy, ENBD was successfully carried out to avoid another operation. Complications were noted in 15 cases(4. 8%) of them. pancreatitis 11 cases, cholangitis 3 eases and hemorrhage of upper gastrointestinal tract one ease. Conclusion ERCP can find out the defenite cause of post - cholecystectomy syndrome at early stage and take corresponding endoscopic therapeutic measures. The complications of ERCP can be avoided by skillful operator.

Objective To improve the successful rate of endoscopic biliary drainage. Methods The experience of biliary drainage with duodenoscope for biliary obstruction from January 1998 to September 2001 was reviewed retrospectively. Endoscopic naso -biliary drainage (ENBD) , endoscopic retrograde biliary drainage (ERBD) and endoscopic metal biliary endoprothesis (EMBE) were performed in 242 cases, 43 cases and 35 cases respectively. Results Of 320 cases with biliary obstruction, 305 received successful drainage under endoscopy and 15 cases failed. Ten cases with ENBD failed but got successful drainage after modulating the site of naso-biliary tube or reinserting another tube. For 3 cases failed with ERBD, we chose plastic stents with appropriate length for 2 cases to achieve fluent drainage and percutaneous transhepatic biliary drainage (PTBD) was managed for another case after endoscopic management failed. For 2 cases with EMBE failed, one stent couldn' t exceed the tumor stricture site and one was obstructed by tumor implantion at one month after EMBE. Either a metal stent or a plastic stent was replaced through previous prothesis in these two failed cases. Conclusions The effect of endoscopic biliary drainage for biliary obstruction is definite. Mostly the drainage failure can be avoided as early as possible by analyzing the causes and taking some corresponding measures to correct it.

Objective To discuss the value of endoscopy in the diagnosis and treatment of Dieulafoy disease. Methods Twenty-one patients with upper gastrointestinal bleeding caused by Dieulafoy disease from June 1994 to June 2002 were analyzed retrospectively with regard to endoscopic features, therapeutic methods and outcomes. Results Of the 21 cases, diagnosis was confirmed in the first endoscopic examination in 15 cases (71.4%), and in two or more examinations in 6 cases. The bleeding was successfully stopped under endoscope in 17 cases: after the initial treatment in 14 cases (66.7%) and after the second treatment in 3 cases (14.3%), while the open surgery was required in 4 cases (19.0%). Conclusions Endoscopy is the alternative of the first choice in the diagnosis and treatment of Dieulafoy disease.

Objective To assess the clinical efficacy and safety of endoscopic submucosal dissection(ESD) for submucosal tumor(SMT) of the gastrointestinal(GI) tract.Methods A total of 19 patients with SMT of the GI tract diagnosed by endoscopy(6 in the esophagus,6 the stomach,1 the duodenum,1 the sigmoid,and 5 the rectum),were examined using endoscopic ultrasonography(EUS).Among the cases,18 lesions were within the submucosa and 1 in the muscularis propria.The SMTs were managed by ESD with a needle knife.After injection of physiological saline solution into the submucosal layer to separate the lesion from the muscle layer,the mucosa surrounding the lesion was pre-cut,and the connective tissues of the submucosa beneath the lesion were dissected.Then,the lesion was resected completely.Results The resected lesions sized 0.5-3.0 cm in diameter(mean,1.6 cm).Among the 19 lesions,18 were successfully resected with ESD.The mean ESD procedure time was 45 min(ranged from 15 to 105 min).Two patients had massive hemorrhage during ESD,which could not be controlled under a gastroscope.One of them was treated with balloon compression,and the other was managed surgically.None of the patients had delayed bleeding after ESD.Perforation of the GI tract occurred in 2 cases(the duodenal ball in one,and the gastric fundus in another) during the procedure,and was closed with endoclips without surgical treatment.One patient with rectal carcinoid developed subcutaneous emphysema after the operation owning to deep tearing of the muscle layer,and recovered after several days' conservative treatment.Histological evaluation showed that the tunica of the tumors was intact,and both the lateral and basal margins of the specimens were free of tumor cells.Conclusions ESD is an efficacious and safe procedure for the treatment of SMT of the GI tract.It is possible to completely resect submucosal lesions and provide sufficient pathological information.For the SMT originated from the muscularis propria,ESD should be performed cautiously.

Objective To investigate the effect of thrombin and hemoglobin on aquaporin (AQP) and the correlation between AQP and hydrocephalus.Methods Eighty-four clean grade healthy male SD rats were randomly divided into 3 groups:a control group,a thrombin group,and a hemoglobin group using the random number table method.A hydrocephalus model was induced by injecting isotonic saline (0.3 ml),thrombin (0.3 ml[10,U/ml]) and hemoglobin (0.3 ml[150 mg/ml]),respectively into the cisterna magna.According to the deficiency and complement way,each group maintained 24 rats.The relative area of the lateral ventricles,the expression of AQP1 and AQP4,and the correlation between AQP and the area of the lateral ventricles were observed at 1,3,7,and 14 d after molding.Results (1) Compared with the control group,both the thrombin group and hemoglobin group showed hydrocephalus at 1 ,3 ,7 and 14 d,and they were most obvious at 1 day (6.94±0.19% and 6.58±0.15% vs.3.40±0.13%,6.06±0.12% and 5.79±0.09% vs.3.55±0.15%,5.80±0.13% and 5.58±0.08% vs.3.78±0.18%,5.66±0.14% and 5.47±0.13% vs.3.52±0.18 %,respectively).There were significant differences (all P<0.01).(2) The increase of AQP1 was mainly in the basal membrane and apical membrane of ventricular choroid plexus epithelial cells,and the increase of AQP4 was mainly in the ependymal cell of ventricle.The relative expression levels of AQP1 and AQP4 at 1,3,7,and 14 d in the control group were 1.09±0.07 and 1.30±0.15,0.91±0.06 and 1.18±0.12,1.33±0.17 and 1.16±0.08,1.22±0.11 and 1.00±0.10,respectively;the thrombin group were 4.40±0.14 and 3.69±0.11,3.88±0.11 and 3.17±0.07,3.55±0.07 and 2.86±0.13,and 3.36±0.07 and 2.70±0.07,respectively,the hemoglobin group were 4.24±0.07 and 3.55±0.10,3.77±0.08 and 3.04±0.09,3.46±0.07 and 2.76±0.08,and 3.31±0.10 and 2.62±0.08,respectively;the relative expression levels of AQP1 and AQP4 of the thrombin group and hemoglobin group at each time point were significantly higher than those of the control group.There were significant differences among the groups (all P<0.01).There were no significant differences in the relative expression levels of AQP1 and AQP4 mRNAs in the hemoglobin group at each time point (P>0.05);in the thrombin group and hemoglobin group,compared with those at 1 d,the expression levels of AQP1 and AQP4 at 3,7,and 14 d were significantly decreased (all P<0.01);compared with those at 3 d,AQP1 was decreased significantly at 7 and 14 d (P<0.05).The differences were statistically significant (P<0.05).(3) The relative expression levels of AQP1 (r=0.983,P<0.01) and AQP4 (r=0.987,P<0.01) in the thrombin group at each time point were positively correlated with the contralateral ventricular area;and the relative expression levels of AQP1 (r=0.964,P<0.01) and AQP4 (r=0.962,P<0.01) in the hemoglobin group at each time point were positively correlated with the contralateral ventricular area Conclusions After injecting thrombin and hemoglobin into subarachnoid space,it could cause the increased expression levels of AQP1 and AQP4 of ventricles and their surrounding areas.Thrombin and hemoglobin may be the important mediating factors of hydrocephalus after subarachnoid hemorrhage.

Objective To assess the value of endoscopic submucosal dissection(ESD)for the treatment of early tumors located at the esophagogastric junction.Methods The clinical data of 57 patients with early tumors located at the esophagogastric junction who received ESD at the Zhongshan Hospital from November 2006to March 2011 were retrospectively analyzed.The operation time,blood loss,resection of tumor and perioperative complications were observed.The pre-and postoperative pathological findings were analyzed.Results ESD was successfully completed on the 57 patients.The median operation time was 55 minutes(range,25-95 minutes),and the median volume of blood loss was 74 ml(range,20-300 ml).En-bloc and piecemeal resections were carried out on 39 and 18 patients,respectively.The operative complication rate was 25%(14/57),including 5 patients complicated with perforation and 9 with bleeding.The postoperative complication rate was 16%(9/57),including 6 patients complicated with delayed hemorrhage and 3 with stricture of the esophagogastric junction.Of the 39 patients who were diagnosed as with high-level intraepithelial neoplasia preoperatively.3 were confirmed as with intramucosal carcinoma;of the 18 patients who were diagnosed as with intramucosal carcinoma preoperatively,4 were confirmed ag with adenocarcinoma.All patients were followed up for 9-27 months,no recurrence or metastasis was found.Conclusion ESD is effective and safe for the treatment of early tumors located at the esopha gogastric junction.

Objective To study if the dose verification technique for three dimensional conformal radiation therapy ( 3 DCRT) can be applied for simplified intensity modulation radiation therapy ( sIM RT). Methods From 1988 patients treated by sIMRT in our department,12 were chosen randomly for the study. For each case,3 differert plans of 3DCRT,sIMRT,and IMRT were worked out with Pinnacle TPS,and the dose verification for each plan was carried out with Elekta Precise LA by using 2D diode-matrix of MapCHECK Model 1175. Results For slMRT,the overall average percentages of pass points for DD(DTA) 2% (2 mm) ,3% (3 mm)and 4% (4 mm) were 90.5% ,94.8% and 98.2% reapectively,which were slightly worse when comparing with those of 3DCRT with deterioration of 1.9% (t=2.19,P=0.040) ,1.0% (t= 1.52,P=0.144) and 0.2% (t=0.05,P=0.623), but slightly better comparing with those of IMRT with increment of 2.1% (t=2.17,P=0.041) ,1.5% (t=2.62,P=0.016) and 1.5% (t=3.68,P=0.001) for 2% (2 mm) ,3% (3 mm) and 4% (4 mm) ,respectively. Conclusions The sIMRT technique simplifies the complicated dose verification procedure of I MRT. When the sIMRT technique is formally used, the procedure of dose distribution verification for 3DCRT can be used directly for slMRT.

Objective To investigate the diagnostic and predictive value of spasticity in shunting patients with normal pressure hydrocephalus (NPH).Methods Twenty-three secondary NPH patients who received ventriculo-peritoneal shunt were retrospected. Increased muscular tension were quantified pre and post-shunting by modified Ashworth scale. The dilatated ventricle was measured by Evans' index.Results Four weeks after shunting, spasticity was relieved to some extent on all the identical limbs side of the primary impairment cerebral and 78% cases was improved to zero scale. on the contralateral side limbs, the relieved rate was 86% and 46% cases improved to normal scale. Evans' index improved 35%.Conclusion Increased muscle tonus could be measurement quantified and is readily available and sensitive as a diagnostic criteria in secondary NPH.