Objective To assess the association of serum resistin,TNF-? and insulin resistance in type 2 diabetes mellitus.Methods 42 cases of T2DM and 40 cases of control were involved in the study.Their waist circumference(WC),the levels of fasting serum resistin,TNF-?,fasting blood glucose(FBG) and fasting insulin(FINS)were measured.Results The levels of serum resistin,TNF-? and Homa-IR in T2DM group were significantly higher than those in control group,while serum FINS level was significantly lower than that in control group[(11.76?2.72)vs(8.65?3.00)?g/L,P

Objective To evaluate the application of helix hydro-jet in laparoscopic hepatectomy (LH).Methods Clinical data of 18 patients who underwent laparoscopic hepatectomy by helix hydro-jet were analyzed retrospectively.Results There were 18 cases including 9 cases of hepatic cavernous hemangioma,5 cases of primary hepatocellular carcinoma,2 cases of hepatic focal nodular hyperplasia,1 case of hepatic metastasis from colon carcinoma and 1 case of biliary cystadenoma in left liver.In 17 out of 18 patients laparoscopic hepatectomy was successfully completed by using helix hydro-jet.Only 1 patient was converted to open hepatectomy during operation due to uncontrollable hemorrhage from the branch of left hepatic vein.Partial hepatectomy was performed in 14 cases and hepatic left lateral hepatectomy was performed in 3 cases.Average intraoperative blood loss was 230 ml and average operation time was 170 minutes.No postoperative hemorrhage and hepatic function failure was observed.Postoperative bile leakage was observed in 1 patient,which was cured by drainage.Asymptomatic pleural effusions was found in 2 patients,necessitating no special intervention.The average hospital stay after the surgery was 5.6 days.5 patients with hepatocellular carcinoma were followed up for an average of 17 months and the patient converted to open hepatectomy suffered from tumor recurrence 13 month postoperatively.No implantation metastasis was observed on the trocar sites.Conclusions Laparoscopic hepatectomy by helix hydro-jet device can provide excellent visualization of vessels and bile ducts,which can assure the safe margin of hepatic neoplasm.No severe complications were observed.Laparoscopic hepatectomy by helix hydro-jet is a safe and feasible technique.

Objective To evaluate the treatment experience on primary retroperitoneal neoplasms involving large blood vessels.Methods In this study 82 patients with primary retropetropeal neoplasms were treated surgically from 1990 to 2010 and the clinical data of these patients including preoperative radiological examinations and surgery were retrospectively analyzed.Result The sensitivity and specificity of preoperative imaging examination for identifing large blood vessel involvement was 70％ and 73％respectively.Compared with those of no large blood vessel involvement,patients with large blood vessels involvement had a lower rate of tumor complete removal,more intraoperative blood loss and longer operation time( P ＜ 0.05).In group of large vascular involvement,patients undergoing complete tumor resection were all alive after 12 months,and none of those undergoing palliative resection survived more than 9 months.Conclusions Preoperative imaging allows precise evaluation on the status of large blood vessel involvement in patients of retroperitoneal tumors.Involving large vessels often predicts inability in total resection of retroperitoneal tumors.

Objective To evaluate the preoperative diagnosis and treatment of primary duodenal adenocarcinoma ( PDA). Methods Clinical data of 89 PDA cases undergoing laparotomy from 1985 to 2009 in three hospital in Beijing and Zhengzhou were analyzed retrospectively. Results The prevalence rate of PDA is comparatively low and its clinical manifestations are not specific. The correct diagnostic rate of auxiliary examination were 93% by endoscopy,90% by gastrointestinal X-ray air barium double radiography,82% by MRCP,42% by BUS,70% by CT/MRI. The most common location of the adenocarcinoma(65% ) was at the second portion of the duodenum. Among 67 PDA cases 48 cases underwent pancreatoduodenectomy, 19 cases received segmental deodenectomy. The 5 year's survival rate was 47% and 50% respectively. Conclusions Endoscope and X-ray radiography are mainstays for the diagnosis of PDA. Early diagnosis and radical operation are the key to improve the resection rate and the long term survival.

Objective To discuss the clinical presentation and management of pancreatic arteriovenous malformation.Methods The data pool for the analysis was collected from pancreatic arteriovenous malformation cases encountered by our hospital and sporadic case reports in the literature.Results A total of 95 cases were collected,including 83 males (87.37％) and 12 females (12.63％).The most common presenting symptom was epigastric pain (45.26％),followed by melena (17.89％),epigastric pain accompanied melena (14.74％) and haematemesis (8.42％).The most commonly associated complications were gastrointestinal bleeding (48.42％),pancreatitis (23.16％),duodenal ulcer (16.84％),portal hypertension (11.58％),pseudocyst (4.21％) and hemobilia (3.16％).Most cases were of singular lesion,located in the pancreatic head (61.05 ％) in 58 cases and in the pancreatic body-tail (20％) in 19 cases.Surgery (51.58％) was the most common treatment for pancreatic arteriovenous malformation cases,followed by transarterial embolization (17.89％),a combination of surgery and transarterial embolization (7.37％) and radiotherapy (4.21％).Watchful conservation was adopted in 20％ cases.Conclusions Pancreatic arteriovenous malformation occurs most commonly in males.Epigastric pain and gastrointestinal bleeding are the main clinical presentations.Surgical resection is indicated in symptomatic patients.

ObjectiveTo study the amplification and expression of HER-2 gene and protein in breast cancer and to investigate the relationship between HER-2 gene and Ki-67 、P53 、ER、PR、lymph node metastasisandTNMstaging.MethodsFluorescenceinsituhybridization(FISH) and immunohistochemistry(IHC) method were used to detect the amplification and expression of HER-2 and the expression of Ki-67、P53、ER、PR in 150 cases of breast cancer. Results49 out of 150 cases were amplificated,positive rate of HER-2 gene was 32.68％.In the 32 patients whose expression of HER-2 protein was ( + + + ),HER-2 gene was expressed in 28 cases.In The 46 patients whose expression of HER-2 protein was ( + + ),HER-2 was expressed in 16 cases.In the 26 patients whose expression of HER-2 protein was ( + ),HER-2 was expressed in 3 cases.In the 47 cases that the expression of HER-2 protein was negative,there were 45 cases that the expression HER-2 gene was negative.The expression of HER-2 was correlated with ER,PR expression and TNM staging,but not significantly related with age,Ki-67,P53 and lymph node metastasis.ConclusionsFISH and IHC correlate well with each other in the determination of HER-2 gene amplication and protein expression in cases of invasive breast cancer.

Objective To evaluate the clinical application of CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules (SPNs) before video-assisted thoracoscopic resection.Methods CTguided localization the SPNs before resection in 56 patients and 60 nodules,then underwent video-assisted thoracic surgery (VATS) resection.Among 56 patients,19 males and 37 females,aged from 35 to 81 years,mean age was (61.1 ±8.9)years.Results SPNs diameter (6.80 ±4.12) mm,distance from the parietal pleura (15.38 ±4.63) mm.CT-guided localization success rate was 100％,positioning time (10.76 ± 8.17) min,8.9％ (5/56) had micro pneumothorax aftet positioning,7.1％ (4/56) occurrence of needle tract bleeding,no conservative treatment.VATS resection rate was 100％.The pathology of 60 lesions were shown:Bronchiolo-alveolar carcinoma(BAC) were 33 lesions(55.0％),BAC and adenocarcinoma were 11 lesions(18.3％),Atypicaladenomatous hyperplasia (AAH) were 7 lesions (11.8％),Inflammation were 4 lesions (6.7％),Harmatoma were 3 lesions(5.0％),Tuberculoses were 2 lesions(3.3％).Conclusion CT-guided localization with combination of methylene blue and a Hookwire system before video-assisted thoracoscopic resection is a promising technique for small solitary pulmonary nodules.It could play an important role in accurate localization of small pulmonary nodules,and it is a safe technique with clinical application.

Objective To evaluate the effect of paraesophagogastric devascularization and splenectomy with transabdominal esophageal transection and reanastomosis in the treatment of portal hypertension Methods Clinical data of 48 portal hypertensive patients undergoing this procedure from June 1997 to June 2002 were analyzed retrospectively to evaluate the effect and complications of the operation Results Forty three patients were followed up for an average of 39 months The varicose veins eliminating rate was 93% The rebleeding rate was 2% The survival rate was 93% Two patients died of severe intra abdominal infection due to leakage of esophageal anastomosis and hepatic failure respectively during the early postoperative period Postoperative thrombosis rate in portal system was 8%, hydrops rate in splenic recess was 6%, the leakage and stenosis rate of anastomosis were 8% and 6% respectively Conclusion Paraesophagogastric devascularization and splenectomy with transabdominal esophageal transection is an effective method for the treatment of portal hypertension Because there is a risk of postoperative anastomosis leakage and stenosis, attention should be paid to the choice of patients for operation and manipulations during the operation

Objective To retrospectively review the results of intraperitoneal placement of composite mesh for the repair of ventral incisional hernia. Methods Ten patients, in which the peritoneum was difficult to close direcdy, underwent repair of ventral incisional hernia with composite mesh between November 2003 and June 2005. The mesh was placed intraperitoneally. The mean duration of follow-up was 18 months (range 6 to 24). Results All the patients (10/10) were cured without postoperative complications such as wound infection, subcutaneous seroma and hematoma. During the follow-up study, no recurrences was observed. There were no long-term complications, such as bowel obstruction, fistula formation and fistulization to the small bowel. All the 10 patients felt comfortable. Conclusions Intraperitoneal placement of composite mesh is a safe and effective repair method for ventral incisional hernia.

Objective To study prognostic factors after surgical resection for distal bile duct cancer. Methods A retrospective muhicenter clinical analysis,including Beijing Shijitan Hospital,Peking University People's Hospital and Peking University First Hospital,was made for 103 patients of distal bile duct cancer receiving surgical resection from 1995 to 2009.Potential clinicopathological prognostic factors were examined bv univariate and multivariate survival analysis. Results The 1.3 and 5 years overall survival rate was 72%,41%and 25% respectively (median survival time,24.13 months).Univariate analysis revealed operative modality,lymph node status,surgical margin and TNM stage as significant factors influencing postoperative survival.Positive surgical margin,lymph node metastasis and TNM stage were significant independent predictors of poor prognosis by a Cox proportional hazards regression model. Condusions Surgical margin margin,lymph node metastasis and TNM stage were the most important prognostic factors for bile duct carcinoma after resection.Radical pancreaticoduodenectomy was the choice of therapy for distal bile duct carcinoma.