Objective To explore the value of combined biliary and duodenal stenting in the palliative treatment of pancreatic head carcinoma. Methods From August 2003 to July 2005, four patients who were diagnosed as pancreatic head carcinoma presenting obstructive jaundice were treated with biliary stenting. When duodenal obstruction occurred due to the growth of the carcinoma , duodenal stents were placed to relieve the obstruction. Results The biliary and duodenal stents were successfully positioned in all 4 patients. After biliary stents were inserted, the level of total bilirubin value of each patient decreased by 50% in 24 hours and returned to normal range within 1 week. When the biliary stents were occluded, stent replacement or restenting was performed, and relief of obstructive jaundice was thus achieved. After duodenal stents were inserted, the symptoms of duodenal obstruction were relieved and the patients were able to tolerate peroral solid food. When the duodenal obstruction recurred, a second coaxial duodenal stent was inserted. Three duodenal stents were placed in one patient because of rgrowth in size of the carcinoma. No complications related to stenting were observed. Two patients were followed up until their death with survival time of 24 months and 22 months, respectively, who were free of jaundice and duodenal obstruction at the end of their life. Two patients are still in follow-up period (16 months and 9months after stenting, respectively), who are now free of jaundice and duodenal obstruction. Conclusion Biliary stenting combined with duodenal stenting can improve the life quality of patients with pancreatic head carcinoma and is an effective palliative treatment for these patients.

Objective To evaluate the clinical efficacy, impacts on lung function and cytokines, and safety of azithromycin on the treatment for asthma. Methods Forty patients with asthma were randomized equally to receive azithromycin combined with inhaled cortisteroid (ICS) plus long-acting β_2-agonists (LABA), or only ICS plus LABA for 12 weeks. We evaluated the clinical efficacy including asthma control test scores and lung function, cytokines in induced-sputum including interleukin-4, interleukin-5 and interferon-γ, and the safety of azithromycin. Results After 12 weeks, asthma control test (ACT) scores and lung function were improved obviously, and concentrations of IL-4, IL-5 and IFN-γ in induced-sputum were reduced significantly in both groups. Comparing with the control group, the decline of cytokines in induced-sputum was much more significant in patients treated with azithromycin. No severe adverse events were found in both groups. Conclusions Azithromycin combined with ICS plus LABA is an effective and safe treatment for asthma, which could significantly reduce the level of cytokines elaborated from Th2-type cells in the airways.

Objective To evaluate the clinical application value of a new type of Bard Max-Core coaxial biopsy system and com-pare the effectiveness and safety of different diameter biopsy guns.Methods This retrospective study included 286 patients who re-ceived CT-guided percutaneous lung biopsy using Bard MC disposable biopsy system.We divided patients into three groups:1 6G, 18G,and 20G group.Then,we evaluated the biopsy effectiveness,histological diagnosis rate and complication incidence of this new type of Bard Max-Core coaxial biopsy system.Results All lung biopsy specimens were successfully obtained.The total histological diagnosis rate was 80.8%.Patients with malignant lesions had higher histological diagnosis rate than patients with benign lesions. The histological diagnosis rate in 1 6G group was the highest among three groups.There was no significant difference among three groups regarding to the rate of diagnosis of malignant lesions.Group with 1 6G had the highest histological diagnosis rate among three groups in diagnosing begin lesions.The incidences of pneumothorax in three groups had no significant difference.The incidence of bleeding in 1 6G group was the highest among three groups.Conclusion The new Bard MC disposable coaxial biopsy system is a safe and effective instrument for lung biopsy.We should select the biopsy needles with appropriate diameter according to the fully as-sessment of patients'preoperative conditions.

Objective To provide evidence for the application of nutritional intervention strategy by analyzing perioperative nutritional status of retroperitoneal liposarcoma patients.Methods 60retroperitoneal liposarcoma patients were divided into primary group (27 cases) and relapse group (33cases).These patients were put on nutritional risk evaluation using nutritional risk screening (2002)(NRS2002) within 24 hours of admission,and the serum albumin (ALB) value was recorded.Results Preoperative NRS2002 score showed that relapse group had a higher chance of cacotrophy.Serum albumin level from different time point showed that patients in relapse group were more prone to cacotrophy (respectively t =9.174,4.720,10.950,8.772,10.960,all P ＜ 0.05) and subject to slower recovery of gastrointestinal function [(86 ± 15) h vs.(61 ± 6) h] (t =7.903,P ＜ 0.05),prolonged antibiotic use [(15.5 ± 5.6) d vs.(7.3 ± 0.7) d],t =7.55,P ＜ 0.05),the average length of hospital stay was longer [(25.5±6.0) d vs.(14.1 ± 1.7)d] (t =9.571,P＜0.05),and higher inhospita cost [(13.2±5.6) × 104 yuan vs.(6.8 ± 0.9) × 104 yuan] (t =5.871,P ＜ 0.05).Though there was no difference between the two groups in incision complication rates (x2 =2.625,P ＞ 0.05)Conclusions Retroperitoneal liposarcoma patients has perioperative nutritional risk.Compared with the primary group,patients from relapse group have higher chance to got cacotrophy.NRS2002 scoring system is simple,it could be used in predicting nutritional risk for those patients.

Objective To observe the external morphology of Histiostoma feroniarum hypopus under a light microscope. Methods The samples were collected in a mushroom cultivation base,and the H. feroniarum hypopus was isolated and puri?fied. The slide samples were prepared and observed under an optical microscope. Results The back body of the H. feroniarum hypopus was flat with tiny bristles,the epidermis was of significant ossification,the ventral had four pairs of slender feet stretched,the sucker plate was prosperous in the end of the body,and the sucker plate had eight suckers. The gnathosoma was thin,long and highly specialized. Conclusion The light microscopy shows the morphological characteristics of H. feroniarum hypopus,providing the basis for identifying and life cycle study.

Objective To investigate the Histiostomas apromyzarum breeding in traditional Chinese medicine Rhizoma Bletillae. Methods The scurf and dust of R. bletillae were obtained by brushing,and the mites samples were separated and identified. Results Totally 520 g samples were collected,and 56 adult mites(female?male ratio 0.12)and 18 dormant bodies were obtained from the samples,and they were identified as H. apromyzarum with an average breeding density of 0.14/g. Con?clusion H. apromyzarum could breed on the traditional Chinese medicine R. bletillae,and the corresponding control mea?sures should be strengthened.

Objective To evaluate the efficacy and prognostic factors of combined medical thera-py with amitriptyline, cimetidine and intravesical resiniferatoxin post-hydrodistention for patients with painful bladder syndrome/interstitial cystitis (PBS/IC). Methods Twenty-nine patients with PBS/ IC according to NIDDK criteria were enrolled. There were 6 males and 23 females with average age of 52±14 years and average duration of symptoms of 3.7±1.9 years before diagnosis. The patients were divided into 2 groups. Non-concomitant disease group included 10 cases without concomitant disease and 7 cases with unrelated diseases such as hypertension and diabetes mellitus. Concomitant disease group included 5 cases with history of bladder neck incision, 3 cases with history of transurethral re-section of the prostate, 2 cases with history of gynecologic disease and 2 cases with history of gyneco-logic operation. Patients of concomitant disease group still had the painful bladder syndrome after 3 months when the primary disease had been cured. All patients were treated with amitriptyline (25 mg twice a day), cimetidine (800 mg per day) and intravesical resiniferatoxin (1-2 times) post-hydrodis-tention. The primary assessment index was O'Leary-Sant score. The secondary assessment index was pelvic pain score, mean voiding times per day and mean volume of each micturating. The data of pa-tients before treatment and after follow-up≥9 months were collected to evaluate the efficacy and prog-nostic factors of the combined treatment. Results The mean follow-up for all patients was 9.2±6.0 months. Patients were followed up at month 1 and month 6 after discharge. Then, patients would be followed up at each 6 months interval. The overall remission rate was 65.5% (19/29). Complete re-mission rate was 41.4% (12/29). Partial remission was 24. 1% (7/29). Non-remission rate was 34.5% (10/29). For all patients, the pre-treatment mean voiding times per day were 29±15, voiding volume each time was 64±36 ml, average O'Leary Sant score was 23. 8±4.8, and they were signifi-cantly improved post-treatment (17±12 times, 172±108 ml, 13. 3±10.4, respectively, P<0.001). O' Leary-Sant score of concomitant disease group was lower than that of non-concomitant disease group (21.5±4.7 vs 25.4±4.3, P=0.030). However, complete remission (8.3%, 1/12) of con-comitant disease group was lower than that(64. 7%, 11/17) of non-concomitant disease group (P= 0. 003). In independent variables of patients age, sex, duration of symptom, O'Leary Sant score pre-treatment, and whether or not with concomitant disease, according to the results of Logistic Regres-sion, patients with concomitant disease would have poor prognosis (P-0.008, partial regression coef-ficient was -3. 899, OR was 0. 020). Conclusions Treating PBS/IC patients with amitriptyline, ci-metidine and intravesical resiniferatoxin post-hydrodistention is effective. However, concomitant dis-eases such as gynecologic disease or urethra operation history can impair the effectiveness of these treatment.

Objective To explore the immunophenotype of chronic lymphocytic leukemia (CLL). Methods The immunophenotypes of 31 patients with CLL were determined by immunocytometry. Results Among 31 cases with CLL, the positive expression rates of CD19,HLA-DR, CD5, CD23, CD20, CD22, CD38, FMC7 and CD10 were 100%, 96.8%, 90.3%,90.3%, 83.9%, 54.8%, 32.3%, 6.5% and 0.0%, respectively. Conclusions The imrnunophenotype analysis is very important for diagnosing CLL and it can early detect monoclonal B-cell lymphocytosis of CLL, which is the early phase of CLL, and provide early warning for patients.

Objective To summarize the experience in prevention and management of delayed-diagnosed injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 5 patients with injury in chole-docho-pancreatico-duodenal junction who had received surgery from 2000 to 2007 in Peking Union Hospital was summarized and analyzed retrospectively. All the 5 patients were diagnosed 24 hours after the injury. The injury was caused after endoscopic retrograde cholangiopancreatography (or endoscopic sphincterotomy) +endovascular stent placement in 4 patients and by vehicle accident in 1 patient. Results All the patients were treated conserva-tively for 24-72 hours, and peritonitis was not alleviated, and were subsequently transferred to surgery. Three patients received gastrostomy +choledochostomy +jejunostomy. The abdominal pain was alleviated in 1 patient, and 2 died of multiple organ dysfunction syndrome 5-6 weeks later. Two patients received duodenal diverticulariza-tion + gastrostomy + jejunostomy + Roux-en-Y choledachojejunostomy + Roux-en-Y gastrojejunostomy, and had good prognosis. Conclusion Duodenal diverticularization is a proper choice for patients with perforation combined with severe intraabdominal infection.

Objective To explore the value of a set of combined vascular anastomosed flap.Methods The 36 cases were injured,the site of injury in knee and leg or ankle and foot,upper limb.Skin defect with bone and joint,tendon exposure.Selection of anastomosis of blood vessel with large flap,wherein the subscapular vascular anastomosis scapular-lateral thoracic flap in 7 cases,the maximum was 70 cm × 10 cm; anastomosis of subscapular artery lateral thoracic-latissimus dorsi muscle flap in 9 cases,the maximum was 42 cm× 24 cm.Anastomosis of subscapular artery of the scapular-back the latissimus dorsi muscle flap in 2 cases; anastomotic lateral circumflex femoral vessels with lateral femoral cutaneous nerve thigh anterior medial-tensor fascia latae flap in 8 cases; anastomosis of anterior tibial artery and the superficial peroneal nerve in the anterior ankle-dorsal foot flap in 5 cases; anastomosis of dorsal vessels and superficial peroneal nerve of the extensor digitorum brevis muscle-dorsal foot joint flap in 5 cases.Results Following up 8 months to 25 years,twenty-three cases were 19 years.All flaps survived and all the wounds were covered,infection were cured,the skin have aesthesia,fracture healing.Five cases were performed muscle tendon and arthrosis solution for creating conditions for the functional recovery of limb.Conclusion Anastomosis of blood vessel anastomosis combined flap can replace multiple vascular flaps combination,saving,convenient,high success rate,widen the indications.