Objective To determine the effecting factors for diagnosis of binign or malignant in cystic lesions of pancreas(CLP).Methods One hundred twenty-six patients undergoing operations for CLP or suspected CLP in this hospital from January 1984 to June 2008 were reviewed.Patients were divided into two groups according to lesion's histological features after operation.The predictive effect of various preoperative factors on the malignant potential of CLP was evaluated.Results One hundred twenty-six patients underwent operations for suspected pancreatic cystic neoplasms.There were 89 benign and 37 malignant CLPs.The univariate analysis showed that gender, clinical symptoms(jaundice and weight loss), elevated serum CA199, and presence of one or more of three morphologic features such as solid component, nodule or septation were significantly different between benign and malignant cystic neoplasm of pancreas.The multivariate analysis indicated that imaging features and gender were independent predictors of malignancy.Conclusion In patients with suspected pancreatic cystic neoplasms, elevated serum CA199, clinical symptoms(jaundice and weight loss)and presence of suspicious morphologic features on imaging are predictors of malignant potential of CLP.Patients with a high likelihood of a potentially malignant or malignant lesion based on these three factors should undergo operation without additional investigations.

Objective To investigate the Effects of inflammatory response and postoperative analgesia on thoracic paravertebral nerve block in patients undergoing radical resection of lung cancer. Methods In this study, 68 patients with radical resection of lung cancer were divided into observation group(34 cases)and control group (34 cases)randomly. The anesthesia method of the observation group was general anesthesia combined with thorac-ic paravertebral nerve block ,and the anesthesia method of control group was general anesthesia. Serum IL-6 and IL-10 concentrations were measured before anesthesia(T0),30 min after surgery starts(T1),surgery end(T2),6h after surgery(T3). The visual analogue score of 2 h,12 h,24 h and 48 h postoperatively in two groups were re-corded. The postoperative 24h sufentanil dosage,the number of PCIA pump pressure and the total amount of back-ground infusion were measured. Results Compared with the control group,the serum IL-6 level of T2 and T3 in the observation group were significantly lower than those of the control group ,while the IL-10 concentration was significantly higher in the observation group(P<0.05). The VAS scores of 2 h,12 h and 24 h in the observation group were significantly lower than those in the control group(P<0.05). The 24h sufentanil dosage,PCIA pump pressure and the total amount of background infusion in the observation group were significantly lower than those in the control group(P < 0.05). Conclusions Preoperative thoracic paravertebral nerve block can significantly re-duce the inflammatory response and enhance postoperative analgesia.

Objective To summarize the diagnostic and therapeutic experiences for multiple insulinoma. Methods Clinical data of 34 cKsefl of multiple insulinoma treated in Peking Union Medical College Hospital between 1984 and 2007 were analyzed retrospectively. Results Multiple insulinoma was identified in these 34 cases for 37 instances.Malignant insulinoma was found in 2 cases.Three cases suffered from postoperative recurrent multipie tumors.35.3% cases belonged to MEN1;13.5% cases were of insulinoma combined with islet hyperplasia;43.2% cases had 3 or more than 3 insulinomas;Fifteen cases (40.5%)had had a misdiagnosis.45.2%tumors were smaller than 1 cm in diameter:88.9%multiple insulinonla located at the body and tail of the pancreas.Enucleation of multiple tumors was performed for 48.7 percent of cases. Conclusions Most multiple insulinomas were small,it was difficult for preoperative examination to locate all the tumors therefore.Being on the alert against multiple insulinoma and such measures as careful exploration,intraoperative blood glucose determination.fine needle aspiration biopsy,frozen sections helps to avoid missing multiple imuhnoma.

OBJECTIVETo compare the clinical efficacy on vascular cognitive impairment with no dementia (VCIND) between the combined therapy of auricular acupuncture and acupuncture and the simple acupuncture.

METHODSOne hundred patients of VCIND were randomized into a combined therapy of auricular acupuncture and acupuncture group (a combined therapy group) and an acupuncture group, 50 cases in each one. The basic internal medicine treatment was applied in the two groups. Additionally, in the combined therapy group, auricular acupuncture and's three needling therapy were used. pizhixia (AT), xin (CO), shen (CO), gan (CO), erzhong (HX) were selected in auricular acupuncture, once every Monday, Wednesday and Friday;,andwere selected in's three needling therapy, once a day. In the acupuncture group,'s three needling therapy was just provided, once a day. The treatment was given for 4 weeks in the two groups. Montreal cognitive assessment (MoCA) and social function activities questionnaire (FAQ) were adopted for the evaluation comparison before treatment and in 2 weeks and 4 weeks after treatment in patients of the two groups.

RESULTSCompared with those before treatment, the total scores of MoCA were improved in 2 and 4 weeks after treatment in the two groups (all<0.01). The score in the combined therapy group was improved more apparently as compared with that in the acupuncture group (<0.01). FAQ score was reduced in the two groups (all<0.05). The score in the combined therapy group was reduced more apparently as compared with that in the acupuncture group (<0.05). As compared with the result in 2 weeks of treatment, MoCA score was improved in the two groups in 4 weeks of treatment (both<0.01), the improvements in the combined therapygroup were more obvious than those in the acupuncture group (<0.05) and FAQ score was reduced in the two groups (<0.05), but the difference was not significant between the two groups (>0.05).

CONCLUSIONSThe combined therapy of auricular acupuncture and acupuncture effectively improve the cognitive function and social function, which are better than the effects of simple acupuncture in VCIND. The improvement of the combined therapy in social function is more advantageous in the treatment of the first two weeks.