Objective To evaluate the efficacy and priority of laparoscopy in the diagnosis and treatment of acute peritonitis. Methods Clinical data of 133 cases of acute peritonitis diagnosed and treated under laparoscope between April 2001 and October 2004 were retrospectively reviewed. Results Of the 133 cases, there were 60 cases of gastroduodenal perforation, 15 cases of acute cholecystitis, 8 cases of gallbladder perforation, 2 cases of sigmoid colon perforation, 35 cases of acute perforated appendicitis, 3 cases of jejunal diverticulum perforation, 1 case of foramen of Winslow hernia, 4 cases of acute pancreatitis, and 5 cases of primary peritonitis. The diagnostic accuracy was 100%. All the patients were treated laparoscopically without complications. Conclusions Laparoscopy gives a high diagnostic accuracy for acute peritonitis. The rationale for the use of it lies in the possibility of avoiding time- consuming preoperative B-ultrasonography or CT scans and performing minimally invasive surgical interventions directly.

Objective To investigate the clinical feas ib ility of endoscopic resection of benign mammary tumors. Methods A total of 22 cases were detected as benign mammary tumors by molybdenum targe t X-ray examinations from March 2002 to August 2003, including 15 cases of fibro ma and 7 cases of cystoid adenoma. The tumor was 2~4 cm in diameter (mean, 2.8 c m). A two-port transaxillary endoscopic resection using the electrotome and harm onic scalpel was carried out. Results The resection was comple ted endoscopically in all the 22 cases. The operation time was 28~68 min (mean, 42 min). A drainage tube was maintained for 1 day. Except for 1 case of subcutan eous effusion, no skin necrosis and other complications happened. The patients r ecovered uneventfully and stayed in hospital for 2~4 d (mean, 3 d) postoperative ly. There were no scars on the breast. Conclusions Transaxilla ry endoscopic resection of benign mammary tumors is safe and feasible and gives good cosmetic results.

This article provides the possible mechanism of acupuncture-moxibustion repair of gastric mucosal injury from central regulation and puts it forward that the nucleus of solitary tract is the primary regulation center for the injury repair and has the effect of collecting and integrating information. In addition, it is put forward that neural regulation is a main regulatory mechanism for the injury repair and besides, endocrine, immune and humoral regulations participates in the modulation and gastric mucosal repair involves a composite regulatory mechanism in which the central nervous system, neuroendocrine-immune network and neurohumoral regulation take part.

AIM: To evaluate the effects and safety of intravitreal injection of triamcinolone acetonide ( TA ) or conbercept combined with macular laser grid photocoagulation in the treatment of macular edema secondary to retinal vein occlusion( RVO) . ·METHODS: Fifty cases ( 50 eyes ) with macular edema secondary to retinal vein occlusion were selected and assigned to 2 groups: intravitreal injection of TA or conbercept, and laser photocoagulation after 7d. Best corrected visual acuity ( BCVA ) , fundus examination, optical coherence tomography ( OCT ) and intraocular pressure ( IOP ) were examined before intravitreous injection and 14d, 1 and 3mo after laser, fundus fluorescein angiography(FFA) were examined 3mo after treatment. The postoperative results at each time point were compared with preoperative values. · RESULTS: Two kinds of treatment compared with preoperative, the BCVA all increased in various degrees. At 14d after intravitreous injection, 1 and 3mo after laser, the ratio of vision improved in TA group was 76%, 80%, 68%, conbercept group was 88%, 92%, 88%, BCVA of two groups in each period all had varying degrees of increase than preoperative. The best BCVA acquired at 1mo after treatment. The macular thickness after treatment was significantly lower than preoperative in two groups. At preoperative, 14d, 1 and 3mo after treatment, the macular thickness in TA group was 557. 5 ± 150. 9,301. 7±120. 1, 262. 7 ± 131. 2, 338. 1 ± 146. 5μm; the macular thickness in conbercept group was 569. 4 ± 135. 9, 282. 3 ± 133. 5, 259. 5 ± 116. 4, 307. 8 ± 122. 6μm. The macular thickness of the two groups were significantly different between preoperative and postoperative. · CONCLUSION: The combination of intravitreous injection of TA or conbercept with macular laser grid photocoagulation can be an effective method in the treatment of macular edema secondary to RVO, conbercept treatment is more effective and security.

Objective To investigate the prognostic factors of gastrointestinal stromal tumors.Methods From Nov.1999 to Dec.2006,a total of 85 patients were diagnosed by postoperative pathology as gastrointestinal stromal tumors.The relationship between the prognosis of GIST and demographic factors、tumor location、operation style、preoperative metastasis、lymphadenectomy、grading of Fletcher were analyzed retrospectively.Results The 1 year、3 year and 5 year survival rate of these 85 patients were 94%,60%,57%respectively,Univariate analysis indicated that tumor location、operation style、grading of Fletcher and preoperative metastasis were significant predictors of survival(P<0.05),while demographics and lymphadenectomy were not statistically related with prognosis.Multivariate analysis showed that preoperative metastasis was the independent factor predicting the prognosis(P=0.020,β=4.226).Conclusion Radical surgical excision is still the therapy of choice for primary gastrointestinal stromal tumors.Preoperative metastasis is the independent factor predicting poor prognosis,therefore early diagnosis and treatment are very important for GIST.Fletcher grading is also a simple recalls to predict the prognosis of GIST.

Objective To compare the immediate effects of extracorporeal shock wave therapy with that of joint mobilization plus short wave therapy in treating scapulohumeral periarthritis, and to elucidate the mechanism of extracorporeal shock wave therapy and how it should be used. Methods Forty-seven patients diagnosed with scapulohumeral periarthritis were selected and randomized into two groups, a treatment group (n = 26) treated with extracorporeal shock wave therapy, and a control group ( n = 21 ) treated with joint mobilization plus short wave therapy. The short form of the McGill pain questionnaire (SF-MPQ) and range of motion (ROM) measurements were used to evaluate shoulder function. Results Compared with baseline, both groups improved significantly af-ter treatment, but the immediate effect in the treatment group was superior to that in the control group. Concln-sions As a safe, time-saving and effective therapy, extracorpnreal shock waves could be used to treat scapulo-humeral periarthritis.

Objective To determine the effect of combination of chest physiotherapy (CPT) and intermittent non-invasive ventilation for chronic obstructive pulmonary disease (COPD) patients with respiratory failure. Methods Ninety COPD patients with intermittent bi-level positive airway pressure (BiPAP) ventilation were randomly divided into 2 groups : control group (n=45) received BiPAP treatment after conventional anti-infection, phlegm treatment and support treatment; CPT group (n=45) received CPT before BiPAP treatment. Clinical symptoms, chest signs, chest X-ray, time of BiPAP therapy, PaO2, and PaCO2 after the treatment were evaluated. Results Compared with with the control group, patients in the CPT group significantly improved in clinical symptoms, chest signs, chest X-ray absorption as well as shorter BiPAP therapy time, PaO2 increase and PaCO2 decrease(P<0.05). Conclusion For COPD patients who need intermittent non-invasive BiPAP ventilation, receiving CPT can effectively improve the therapeutic effect. CPT and intermittent non in-vasive BiPAP ventilation cooperate in the treatment of COPD patients with respirstory failure.

Objective Brain metastasis(BM) is unusual in colorectal carcinoma(CRC) patients.This study was to evaluate the characteristics and prognosis of brain metastasis of colorectal carcinoma patients.Methods Twenty-eight consecutive CRC patients underwent surgical resection for BM between January 2001 and December 2008.The clinical data were analyzed by univariate (logrank) and Cox regression test.Results The median age at BM diagnosis from CRC was 57 years(41-75 years).Median survival after neurosurgical intervention was 9.4 months.The 1-year and 5-year survival rates were 28.9%and 7.1%,respectively.Seventeen patients(61%)had concurrent systemic metastasis.All patients were symptomatic with neurologic deficits and symptoms.On multivariate analysis,gender,infratentorial location of lesions and characteristics of primary CRC had no significant impact on survival.Two factors were signitlcandy associated with better survival:single brain metastases and absence of extracranial metastases.Perioperative mortality was zero.There were no difference of survival among patients undergoing resection alone and resection combined with whole brain radiotherapy (WBRT) or stereotactic radiosurgery(SRS). Conclusions Brain metastases from colorectal cancer is an evil omen of poor prognosis of CRC patients.Sursical resection of symptomatic brain metastases from colorectal cancer is relatively safe and provides the opportunity for prolonged survival.

ObjectiveTo investigate the effect of propofol repeated anesthesia on the expression of CaMK Ⅱ α in the hippocampus in neonatal rats.MethodsThirty-two SD rats aged 7 days weighing 12-16 g were randomly divided into 2 groups (n =16 each): group C received intraperitoneal 0.9％ normal saline 7.5 ml/kg once a day for 7 days and group P received propofol 75 mg/kg once a day for 7 days.Learning and memory function were assessed using Morris warier maze at 28 days old of rats.The animals were sacrificed at 24 h after the tests and brain tissues were removed.The expression of CaMK Ⅱ α and phosphorylated CaMK Ⅱ α (pCaMK Ⅱ α) in hippocampal CAI region were determined by immunochemistry and Western bolt.ResultsCompared with group C,the escape latency was significantly prolonged,space exploration time shortened and expression of CaMK Ⅱ α and pCaMK Ⅱ α down-rugulated in group P than in group C( P ＜ 0.01 ).ConclusionPropofol repeated anesthesia decreases congnitive function through down-regulating the expression and inhibiting the activity of CaMK Ⅱ α in hippocampus in neonatal rats.

OBJECTIVE: To study the effect of continuous renal replacement therapy on acute renal failure and multiple organ dysfunction syndrome following simultaneous pancreas-kidney transplantation. METHODS: A patient was complicated with acute renal failure, severe acute pancreatitis, lung infection, bleeding in anastomosisbetween duodenum and jejunum, and peritonitis following simultaneous pancreas-kidney transplantation. He was treated with immunosuppressor, antibiotics, amylopsin inhibitor, haemostatic and alimentation; at the same time, he was treated with continuous renal replacement therapy for 22 days. The Baxter system was used for continuous venovenous hemofiltration. RESULTS: The vital signs and hemodynamic indicators were stable during continuous renal replacement therapy. Pulmonary edema was well controlled, and acid-base equilibrium of water electrolyte was maintained. The function of vital organs was stableand graft function was normal following continuous renal replacement therapy for 22 days. He was completely cured and out of hospital on day 40. CONCLUSION: Continuous renal replacement therapy plays an important role in treating acute renal failure and multiple organ dysfunction syndrome following simultaneous pancreas-kidney transplantation. Thus, it is a well kidney support for ultaneous pancreas-kidney transplantation.