Objective To determine the best position of the catheter to achieve a low recurrence rate during subdural drainage for chronic subdural hematoma (CSDH). Methods A retrospective study was done on 130 cases with CSDH in regard of preoperative thickness of CSDH, preoperative midline displacement, postoperative locations (forehead, temple, cupula and occiput) of the subdural drainage catheter, postoperative width of the subdural space and the relationship of the accumulated air in ipsilateral subdural space with postoperative relapse. Results The CSDH thickness and the midline displacement on preoperative CT scan had no correlation with the postoperative recurrence rate of CSDH. Seven days after operation, the width of the subdural space over 1 cm or the accumulated air of the subdural space exceeding 20% of the the subdural space volume would result in obvious increase of recurrence rate of CSDH. The catheter locating on the frontal lobe cortex postoperatively had the lowest recurrence rate of CSDH. Conclusions Postoperative recurrence of CSDH can be reduced by placing the tip of the drainage catheter on the frontal lobe cortex to remove subdural air during or after surgery. CT scanning at postoperative day 7 is helpful for determine recurrence rate.

OBJECTIVE To study the clinical manifestation and relationship of the pathologic type,clinical treatment and the prognosis of head and neck rhabdomyosarcoma. METHODS The clinical data of 28 cases with head and neck rhabdomyosarcoma were reviewed retrospectively. RESULTS Among these 28 cases, 10 cases were treated surgically accompanying with postoperative chemotherapy and radiotherapy, 6 cases were treated with operation and chemotherapy, 2 cases were treated with operation and radiotherapy, 2 cases were treated with radiotherapy and chemotherapy, 4 cases were treated with chemotherapy only, 2 cases were treated with radiotherapy only, and 2 cases were treated with palliative operation. The 3-year and 5-year total survival rates were 57.14 % and 28.57 % respectively.Two cases who were embryonal type in pathology and at stage Ⅰand treated with extensive dissection accompanied with chemotherapy survived more than 10 years. Among 8 cases survived more 5 years, 6 cases were embryonal type, one case was alveolar type, one case was pleomorphic type. CONCLUSION The combined treatment strategy can improve the survival rate of the patients.

Objective To evaluate the therapeutic results of neuroendoscopy for the treatmentof of patients with septated Chronic Subdural Hematoma(SCHS). Methods 45 patients with SCSH were operated on under endoscope through a burrhole approach.neomembranes were resected by small microscissors.A closed drainage system was applied temporarily to ensure the efflux of the remaining hematoma. Results Forty-five cases were treated successfully.All patients had a sufficient or complete hematoma evacuation whithout recurrence of subdural hematoma.There was no subdural infection,bleeding,brainedema and cranial aerocele. Conclusions Neuroendoscopy is minimally invasive technique and have the advantages ot simple,effective,safe,less complication,less expensive and shorter hospitalization in the treatment of SCSH.

Objectives:To investigate the morphologic changes of the colon in the rats after a total small bowel resection. Methods:Ten male Sprague Dawley(350～370 g) rats in the experimental group were undergone resection of total small bowel,and ten normal rats were randomly chosen as the control group.After supported by enteral nutrition for 3 months,rats were sacrificed and the colon harvested for morphologic parameters study. Results:The length,diameter,wet weight,crypt depth,mucosal thickness and kerckring height of the colon in the experimental group were significantly higher than those in the control group( P

Objective To explore the relationship between the status of the cervical lymphatic metastasis of papillary thyroid carcinoma(PTC)at cNo stage and tumor recurrence and the patient' s prognosis.Methods The clinical data of 498 cNo PTC patients admitted from 1986 to 1990 were retrospectively analyzed.Results All the patients were followed up for more than 10 years.16 patients died of PTC,among them 3 for metastasis,13 for local recurrence.The total cervical lymphatic metastasis rate in these 498 patients was 52.2％,in 260 cases in which detailed data were available: rate was 14.1％ in zone Ⅱ,27.1％ in zone Ⅲ,24.6％ in zone Ⅳ,12.5％ in zone Ⅴ,and 20.1％ in zone Ⅵ respectively.According to the appearances of microscopic pathology,the cervical lymphatic metastasis rates in 498 cases of cNo PTC were collected as following: uncapsuled group was 65.6％,extracapsular group was 64.5％,extralobal group was 56.5％,involved the surrounding tissue and structure group was 52.0％,focal cancerous focus group was 33.3％,latent sclerosis group was 26.9％,encapsuled and introcapsule group was 0.The cervical recurrence rate was only 2％ in the complete function neck dissection group and 9.9％ in the selective center neck dissection group.Conclusions In cNo PTC the most common cause of death was local recurrence.Prophylactic function complete neck dissection should be performed for cNo PTC cases of highly invasive type such as without tumor capsule,extracapsular,extralobal or surrounding tissue invasion.

Objecfive To explore pathological mechanism and treatment of central hyponatrem-ia. Methods Synchronous assay was made to detect changes of atrial natriuretic peptide(ANP),brain natriuretic peptide(BNP),endogenous digitalis-like substance(EDLS),antideuretic hormone (ADH),Na+ concentrations in blood and urine as well as osmotic pressure of plasma and urine in 68 pa-tients with traumatic brain injury(TBI). Results Of all,there were 27 patients with hyponatremia,mostly in patients with severe or critical TBI.There found syndrome of inappropriate secretion of antidi-uretic hormone(SIADH)in 7 patients and cerebral salt wasting syndrome(CSWS)in 20. Conclu-sions The central hyponatremia in patients with TBI may be related to the increased secretion of EDLS and ADH.The decrease of ANP and BNP in blood has no direct effect on Na+ concentration in blood.In-travenous injection of extrinsic thyrotropin releasing hormone(TRH)may inhibit dilutional hyponatremia resulted from increased secretion of ADH in TBI patients.

Objective To investigate the characteristic,diagnosis,clinical staging, treatment and clinical prognosis of occult breast carcinoma (OBC). Method Forty-six cases of OBC were analyzed retrospectively with the clinical and follow-up information that were confirmed by postoperative pathologic diagnosis from November 1981 to November 2005. Results All patients showed axillary node enlargement as the first sign and were operated.The operation included axillary node excision in 2 patients,radical mastec-tomy or modified radical mastectomy in 44 patients. Forty-five cases got follow-up for 1-22 years,33 cases had existed 3 years,18 cases had existed 5 years,8 cases had existed 10 years. Conclusions For axillary mass which causes are uncertain ,the possibility of OBC should be considered .Meanwhile excision and pathological examination is necessary.The metastatic histological structure and immunohistochemical index of the axillary nodes usually provide important clue for the source of this tumor.Radical or modified mastectomy is the best method, and pest-operative chemotherapy and/or radiotherapy should be done. It has been showed that targeted therapy is very important to breast cancer with C-erbB-2 positive recently.To the cases that neck lymphatic metastasis is M4G3 positive by immunohistochemical examination and no primary focus clinically, the diagnosis of OBC should be considered. The cases without primary focus have better prognosis than those with primary focus.

Diabetic lower extremity lesions (DLEL) occur as lower extremity pain, sensory and motor disturbance, ulcers, destruction of deep tissues and subsequent infections related to lower extremity vasculopathy and neuropathy in diabetes. The disease affects multiple organ systems, leading to complicated pathogenesis and difficulty in treatment. This article reviews the pathogenesis and treatments of diabetic lower extremity lesions, hoping to expand new ideas for the multi-disciplinary treatment of DLEL.

Pancreatic malignant tumor with more complex diagnosis and treatment is one of digestive system tmnors,especially pancreatic cancer (PC) continues to have high malignancy and poor curative effect and prognosis."Pancreas" conference is currently held every.two years,and it is acknowledgedas a distinguished gathering of the pancreatic tumor field through showing abundant leading-edge achievements.Authors summarized contents and features of the Pancreas 2018 conference sponsored by Johns Hopkins Hospital,and made some analyses based on translational medicine,evidence-based medicine,multidisciplinary team,new surgical technology and domestic teams' harvests,meanwhile,they also will disseminate and share leading-edge information with domestic doctors,and provide new ideas for diagnosis and treatment of PC and basic and clinical researches.

Objective To analyze the difference among the 3 guidehnes used to make surgical decision for branch duct intraductal papillary mucinous neoplasm (BD-IPMN),then the guidelines were combined with neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) respectively for further analysis.Methods Clinical data of 51 appropriate BD-IPMN patients who underwent surgical resection from January 2008 to December 2015 was retrospectively analyzed.Results The significant difference was exist in the consensus for followup criterion (P ＜ 0.05).The preoperative NLR and PLR were helpful for the differential diagnosis between malignant and benign BD-IPMN,because the receiver operating characteristic curve (ROC) of NLR and PLR for prediction were 0.686 and 0.692,and the best boundary values were 2.64,92.56 respectively.The consensus combined with PLR could improve the specificity and positive predictive value (PPV),besides,the specificity and PPV could achieve 70.3％,54.2％ respectively while the sensitivity (92.9％) still remained at an ideal level after international consensus guideline combined with PLR.Conclusions NLR ≥ 2.64 and PLR ≥ 92.56 were predictive markers for the presence of BD-IPMN associated invasive tumor.The addition of PLR as a criterion to the international consensus guideline improved the accuracy of international consensus guidelines in estimating invasive BD-IPMN.