Objective To investigate the correlation of the expression of p27 and Ki-67 with the clinicopathologic features in breast invasive ductal carcinoma. Methods S-P immunohistochemical staining was performed to examine the expression of p27 and Ki-67 in 60 specimens of breast invasive ductal carcinoma. Results The low p27 expression rate was 45.0 %(27/60), low expression in breast cancer was associated with larger tumor, nerve/vessel invasion, lymph node metastasis and histological grade(P

Objective To observe the clinical efficacy of peppermint oil capsules combined with domperi-done in the treatment of bile reflux gastritis(BRG)after gastric surgery.Methods Totally 47 patients with BRG after gastric surgery were treated with peppermint oil capsule (0.9g,tid)and domperidone(10mg,tid).Each patient's gas-troscopic manifestations and histopathology were rechecked after 4 weeks.The efficacy was observed on the improve-ment of symptoms and gastric mucosal injury,and on the reduction of bile reflux.Results 42 patients attained satis-factory therapeutic effect with the total efficiency rate of 89.4%.No adverse effects during the treatment period. Conclusion Peppermint oil capsules combined with domperidone shows better efficacy in treatment of BRG after gastric surgery.

Objective To study the indications of endoscopic treatment for carpal tunnel syndrome(CTS).Methods From July 2004 to September 2007,21 patients(24 wrists) with CTS received endoscopic treatment in our hospital.Under local anesthesia,an 1-cm incision was made at the level of the proximal transverse wrist crease ulnar to the palmaris longus tendon.A special cannula was inserted into the carpal tunnel,and then the transverse carpal ligment was cut and the median nerve was decompressed.All the patients were re-examined in 1,2,3,and 5 months postoperation.Results According to the criteria of Kelly,11 cases achieved excellent outcomes in 5 months,meanwhile 6 were good,2(3 wrists) were fair,and 2 were poor.One of the 2 poor cases received a second operation by traditional procedures(nerve release) 7 months after the first surgery,another case were treated by conservative therapy because of sympathetic symptoms.Conclusions ① Endoscopy is the first choice for idiopathic cases,while open surgery should be performed on secondary cases(rheumatic synovitis,fracture deformity,tumar,inflammation,gout,neurodegenerative desease etc.).② The carpal tunnel release should be used for patients with abnormal opponens function of the thumb,as well as advanced cases.③ Routine operation are the first choice for eldly patients but not for the younger ones.

Objective To investigate the necessity of releasing the distal holdfast fibers of the flexor retinaculum(DHFFR) during endoscopic carpal tunnel release(ECTR).Methods The Experiment Group included 16 cases.The operation was conducted under brachial plexus anesthesia without the use of tourniquet.A 1 cm skin incision was made.The USE system(Universal Subcutaneous Endoscope System) was employed.Both flexor retinaculum(FR) and distal holdfast fibers of the flexor retinaculum were cut off.Postoperative outcomes were compared with another 16 cases of flexor retinaculum release only(Control Group).Results Follow-up evaluation was carried out at 6 postoperative months.According to the Kelly's criteria,there were 13 cases of excellent results and 3 cases of good results in the Experiment Group,and 8 cases of excellent,5 cases of good,and 3 cases of fair results in the Control Group.Significant difference was obser red in flameda Ⅱ or Ⅲ grade patients between the two groups in carative effects(?~2=6.278,P=0.043).No serious complications or postoperative recurrence occurred.Conclusions Flexor retinaculum is not the only structure existing in the carpal canal to be released.More attention should be paid to complete decompression of both flexor retinaculum and distal holdfast fibers of the flexor retinaculum,especially in those who have serious symptoms.

Objective To study the ulnar nerve and its adjacent structures in the forearm and understand the anatomic basis for endoscopic harvesting of the ulnar nerve for the treatment of brachial plexus avulsion injury. Methods Ulnar nerves and their adjacent structures in 6 formaldehyde solution fixed upper limb specimen and 26 fresh upper limb specimens were carefully dissected and observed and measured. The entry path and implementation were designed according to the observations. Simulated operation was performed in 6 fresh autopsy specimens Results In the forearm, ulnar nerve passes through the flexor carpi ulnaris under the medial epicondyle of the humerus and the dorsal branch of the hand passes between the ulnar bone and flexor carpi ulnaris. Also the ulnar nerve descends through intermuscular space, accompaning the ulnar artery in the distant part of the forearm and the artery lies laterally along the nerve. The simulated operations were successfully done in all the 6 specimens. Conclusions The anatomy of the ulnar nerve in the forearm is fairly fixed with no crossing with important structures in its path, incisions of 1～2cm are made above the pisiform bone and under the medial epicondyle of the humerus 3～5cm respecitvely, After isolation of the ulnar nerve's two crosses from the muscle, the remaining part of the ulnar nerve and its adjacent structures are easily dissected. It is concluded that it is safe and reliable to harvest the ulnar nerve in the forearm with endoscopy.

Objective To introduce a new technique--Carpal tunnel release by Okutsu's technique Methods A 1cm skin incision was made under local anaesthesia without tourniquet. The procedure was performed by system (Universal Subcutaneous Endoscope System). Postoperative functional assessment was done by Kelly's standards. Follow-up was conducted in the first, third and twelve month after the operation. Results One hundred and forty-nine sides of 126 cases of CTS were treated with this method. And seventy eight sides of 69 cases of CTS were followed up. 54 cases were excellent; 19 cases good; 3 cases fair; 2 cases poor. The average time of the operation was ten minutes. There was less blood lost in the procedure. Complication occurred in one case. Conclusions As compared with open procedure, the method has advantage of minimal incision,less tissue damage, shorter operation time, less skin scar and no postoperatioven plastic splint. The therapeutic results was as efficient as routine procedure.

Objective To evaluate the endoscopic tendon sheath release for stenosing tenovaginitis (trigger finger). Methods Five patients with stenosing tenovaginitis (2 in thumbs, 1 in middle finger, and 2 in ring fingers) underwent operations by Smith & Nephew Endoscopic Trigger Finger Release system. After two 3.0mm transverse incisions were made, the window cannula assembly was inserted subcutaneously along the sheath from the proximal portal and advanced until it passed through the distal portal. Then a 2.7 mm endoscope was passed into from the proximal portal and a retrograde knife was introduced into the operative site from the distal portal. Finally the entire length of sheath was sectioned under direct endoscopic vision. Results All operations were successfully completed. Finger's flexion and extension function recovered immediately after the operations. All the patients restarted their employment one week postoperatively. There were no complications such as distinct pain or delayed wound healing in these patients. Conclusions This method has the advantages of minimal invasion, safety, effectiveness and quick recovery, especially suited to diabetic patients or multiple trigger fingers.

Objective To introduce our surgical experience and techniques of endoscopic carpal tunnel release (ECTR) by Chow technique (two-portal technique). Methods A total of 30 endoscopic procedures in 25 patients with carpal tunnel syndrome (CTR) were performed. Results Follow-up evaluations for 1～12 months were made in all the patients. The sensibility of radial 3 fingers and a half returned to normal at postoperative 4～6 weeks in 20 sides of 18 patients. The greater thenar atrophy and opposition dysfunction in 10 sides of 7 patients disappeared at 8～12 postoperative weeks. No serious complications occurred in this series. Conclusions ECTR by Chow method has advantages of short incision, minimal invasion and rapid recovery, being an easy, safe and reliable minimally invasive procedure.

Objective To report carpal tunnel release using Universal Subcutaneous Endoscope System from anatomical and clinical point of view for the purpose of avoiding operative complication and improving clinical efficacy. Methods Operation approach and adjacent structures were observed and measured on 18 fresh upper limb specimens and 26 formaldehyde solution fixed upper limb specimens. Nineteen patients with 21 carpal tunnel syndrome (CTS) were treated with this method under local anaesthesia without tourniquet. The incision is made in the wrist just 2-3 cm superior to palmar crease of the wrist at the medial border of the palmaris longus. The operation plane is just under the deeper layer of deep fascia. The instrument points to the third web. The median nerve and its branches, flexor retinaculum and superficial palmar arch were carefully observed. Results The results were satisfactory in all patients. Conclusion Single wrist portal arthroscopic procedure is a safe, simple and efficient approach if the anatomic structures of the wrist are perfectly clear to the opeator.

Objective To investigate the feasibility of endoscopy in diagnosis and treatment of compressed peripheral nerves. Methods An 1.5 cm transverse incision posterior to the margin of pectoralis major along the second rib was made in 2 old and 9 fresh cadaver specimens. The distance from the incision to the insertions of anterior and middle scalene muscle on the first rib was measured at various angles. The structures surrounding the approach was observed and measured to find a safer approach for endoscopic treatment of brachial plexus compression syndrome. Results With the upper limb hyperabducted at 120 degrees, anteriorly tilting at 30 degrees, through an 1.5 cm transverse incision made posteriorly to the margin of pectoralis major and along the second rib, the apparatus was inserted toward the point 6.5 cm laterally apart from the sternoclavicular articulation and 7.8 cm in depth, reaching the insertions of the anterior and middle scalene muscle on the first rib without injury to the nerves and vessels. Conclusion The approach is safe for endoscopic apparatus reaching the insertions of the anterior and middle scalene muscles on the first rib. It also provides a basis for further investigation of cutting anterior and middle scalene muscles through endoscope.