Objective　To evaluate the significance of combined therapy for advanced gastric carcinoma (AGC). Methods　To introduce the combined therapy for AGC based on home-and-abroad literalures review combiation with author's clinical experience.Results and Conclusions　 Most patients with gastric carcinoma are AGC in China, the 5-year survival rate after operation is 20% to 30%, and surgery along is not the satisfactory therapy of gastric carcinoma. Therefore, AGC must be treated with combined therapy which includes surgery, chemical therapy and biologic therapy, etc. The concept of radical operation AGC should be renewed: (1) Adequately resection of primary carcinoma and surounding tisusses; (2) resecting perigastric lymph nodes; (3) eliminating the cells falling away the tumor in abdominal cavity completely. The first two cases need standard operation, which should be introduced. Intraperitoneal chemotherapy should be carried out after operation in the third case. Palliative operation and surgery for perforated gastric carcinoma will prolong survival period of the patient with AGC.

Male breast cancer is rare,it mainly caused by the interaction of the genetic factors,hormone levels,way of life,and the environment.Its clinical manifestations are indolent tumors.The diagnosis method includes clinical medical examination and imaging examination,and pathology examination.The treatment is in reference to the female breast cancer treatment model,including surgery,chemoradiotherapy and endocrine therapy.Tumor size and axillary lymph nodes involvement are independent predictors of overall survival.

Objective:To summarize diagnosis and treatment of hashimoto's disease(HD) complicated with thyroid adenomas(TA) in 107 patients.Methods:Clinical data of 107 patients of HD complicated with TA were analysed retrospectively.Results:Complete serum immunologic examinations,B ultrasonography and fine needle aspiration biopsy were helpful for the diagnosis of HD with TA.Thirty-eight patients(35.5%) were diagnosed before operation.Misdiagnosis rate was 64.5%(69/107).Intraoperative frozen section diagnosis rate was 81.3%(87/107).Partial,large and total resection of thyroid gland can be selected according to frozen section and local disease focus.Afteroperation,87patients(81.3%)hada goodrecovery.Threepatients with total thyroid gland resection need thyroxin tablet.Thyroid hypofunction did not happented in 104 patients.Conclusions:HD with TA should be treated surgically.Intraoperation frozen section is helpful for selecting operationmethods.

Objective To investigate the etiology, pathology, diagnosis and management of patients with fat necrosis of breast (FNB). Method The clinical data of 50 cases of FNB confirmed pathologically in our hospital from 1966 to 2001 were analyzed retrospectively. Results All the patients in this series were females with the average age of 32.5 years and 56% of the patients over 30 years. The main clinical feature was breast lump and some of the patients had a trauma history. 48 patients were treated surgically and other 2 got an accurate diagnosis by biopsy and were treated by non operative therapy. Conclusions FNB is easily misdiagnosed and difficult to be differentiated from breast cancer, thus the surgery or needle biopsy is recommended.

Objective To investigate the diagnostic and theraputic problems in patients with smooth muscle tumors of the duodenum.Method The clinical data from 7 cases smooth muscle tumors were analyzed retrospectively which were treated surgically and confirmed pathologically in our hospital from 1987 to 2001.Results Of all the cases,4 had a leiomyoma in the duodenum and 3 leiomysarcoma.This disease is lack of pathognomonic sign and difficult for early diagnosis.All the cases were treated surgically and got good results.Conclusions Upper gastrointestinal bleeding is common in patients with this disease.Upper gastrointestinal tract examination and gastrduodenoscopy and CT scan are the main methods for diagnosis.Operation is the best choice for treatment.

OBJECTIVE: To evaluate the features and application of tissue engineered biomaterials in repairing femur defects, and to search an optimal femur substitution.METHODS: Papers published between January 1993 and October 2009 were searched using computer with key words of "tissue engineering, femur defect, mesenchymal stem cells, cytokines and materials" both in English and Chinese. Documents addressing biomaterials and tissue engineered bone in repairing femur defects were included. Repetitive research or Meta analysis was excluded. After that, 21 literatures were selected to discuss the features and application of tissue engineered biomaterials in repairing femur defects.RESULTS: Stem cells technology is obtaining seed cells from myeloid tissues, amplifying in vitro, combining with scaffold material, and in vitro constructing tissue engineered bones. The cultured cells could maintain osteoblast biological characteristics and fully fused with bone tissues at recipient sites, simultaneously, avoid immunological rejection. The combination of materials or modify the material surface could promote cells adhere to materials and increase the cellular biological activity. When transfecting seed cells to bone defect areas using certain carriers, the transplanted calls could form new bones and secret bone growth factor, induce determined osteogenic precursor cells differentiated into inducible ostegenic precursor cells, thereby, fasten the bone healing. The composite materials prepared by three-dimensional virtual surgical simulation and computer numerical control exhibited advantages of composite materials and histological anatomy conjunction, which had perfect appearance.CONCLUSION: Currently, there is no material can fully meet the requirement of bone tissue engineering. Thus, promoting adhesion between cells and materials, increasing cellular biological activity, and maintaining biological functions by combing materials or modifying material surface are the research focuses.

Objective Discussing reoperative reasons and selection of operation for congenital bile duct cysts.Method Retrospectively analyzing 15 reoperative patients for congenital bile duct cysts.Result Reoperative reasons include unresected cysts canceraztion (3 cases);unresected cysts calculogenesis (4 cases);anastomotic stoma between gut and cyst or bile duct stenosis (6 cases);reflux cholangitis(1 case);recurrence cholecystitis (6 cases).There are two kinds of operations,the first is interposed jejunal choledochoduodenostomy,the second is Rou-en-Y choledochojejunostomy.Conclusion Cysts and gallbladder must be resected totally,Roux-en-Y choledochojejunostomy can enhance effect of operation and prevent reflux cholangitis,this operation is very important for avoiding reoperation.

Objective To compare extramedullary fixation (EF), intramedullary fixation (IF) and dipolar femoral replacement(DFR) in the treatment of intertrochanteric fractures in the elderly patients. Methods From July 1999 to December 2008, 172 old patients with intertrochanteric fractures were treated by either EF, or IF or DFR. The operative procedures, complications and therapeutic effects were compared between the 3 methods. Results The patients included in the present study were followed up for 8 to 36 months (average, 19. 6 months). There were significant differences ( P<0. 05) in incision length, operation time, intraoperative blood loss, functional recovery and complications between the 3 methods. IF had the shortest incision length and the least intraoperative blood loss. DFR had less blood loss than EF. IF had the least operation time, followed by DFR. DFR had the best functional recovery one year postoperatively. IF had shorter rehabilitation and healing time than EF. Conclusions EF is the first choice for intertrochanteric fractures of A 1.1, A 1.2, A 1.3 and A2. 1. IF is more appropriate for the aged and unhealthy patients with intertrochanteric fractures of A1. 1, A1. 2, A1. 3, A2. 1, A2. 2, A3. 1 and A3.2. DFR is fit for the elderly patients with severe comminuted fractures and osteoporosis.

Objective To sum up the problems should be taking care in operations for huge goitres. Methods Retrospectively analyzed the clinical data of 295 cases of huge goitres was made. Results All of the 295 cases had some degree of compress, replacement and bend of trachea by the goitre comfirmed by X ray examination .Among the 295 cases,162(54.9%) had trachea constriction.51(17.3%) had obvious dyspnea. Retrosternal goitres was found in 21 cases.12 complicated with secondary hyperthyroidism. All the 295 cases underwent subtotal or total thyroidectomy. Postoperative pathological diagnosis: nodular goitres was diagnosed in all the 259 cases (100%),including 11 cases(3.7%) with malignancy, 12 cases( 4.1% ) with secondary hyperthyroidism,and 39(15.1%) with adenomas. Conclusions Operation of huge goitres should choice appropriate anaesthetic method.For the main vessels of thyroid, very high position of the upper pole of thyroid, retrosternal goitres, malignancy of goitres etc,appropriate operative measures shoudd be adopted to prevent introoperative massive bleeding and damage of recurrent laryngeal nerve. If the indications of tracheostomy presents,a tracheostomy must be done.

Objective To study the diagnosis and treatment of duodenal papilla tumor (DPT). Methods Analyses were made on the clinical data of 22 patients with DPT proved by operation and pathology from 1977 to 1999. Results There were 17 patients with duodenal papillary carcinoma, 5 with duodenal papilloma in this series. Discomfort of the upper abdomen (16 cases) and jaundice (22 cases) were the main symptoms. Barium meal examination, BUS, CT and ERCP were very useful in the diagnosis of DPT. In this series, 19 of 22 patients received pancreaticoduodenctomy, and 3 received local reseciton, the resection rate was 100%. 15 patients (88.2%) were followed up, the 5 years survival rate was 73.3%, 7 years survival rate was 46.7%. Conclusions Duodenoscope and ERCP are credible methods for diagnosis of this disease, resection is the main way of treatment.