BACKGROUND: The occurrence of sexual and urinary dysfunction is higher in patients who have received rectal cancer surgeries. This could most likely be correlated with the age of the patients and the approach applied in the operation. Therefore, how to preserve the sexual and urinary functions has become a hot point in this field.OBJECTIVE: This study was designed to investigate the influence of differences in age and therapeutical approach on the sexual and urinary function in patients with rectal cancer.DESIGN: Investigation study on patients.SETTING: General Surgery Department, the 309 Clinical Division, General Hospital of Chinese PLA.PARTICIPANTS: Some male patients with rectal cancer hospitalized in the General Surgery Department, the 309 Clinical Division, General Hospital of Chinese PLA were involved from January 1999 to October 2000. All of the 79eligible patients had received a radical surgery for rectal cancer by the time of study. Their sexual and urinary function before surgery were normal and an over-2-year follow-up after surgery was conducted on each of them. The two groups, which were classified into two groups according to surgical ap-proaches they received, contained comparable quantity of sampling and age distributions, which prompts the validity of the comparison.METHODS: By distributing follow-up letters, outpatient inquiries and phone call investigations; the follow-up was conducted to evaluate the sexual functions in these patients, including their penile erection and ejaculation. The erectile function was assessed according to the International Index of Erectile Function Questionnaire-5 (IIEF-5). The assessment on ejaculation was based on whether the patients had a sexual climax and whether they can ejaculate. The definition of urinary function consisted of both short-term and long-term urinary functions.MAIN OUTCOME MEASURES: The sexual desire, erectile function, ejaculation and the urinary function in patients within different age brackets.RESULTS: After Miles operation, 81% patients developed sexual dysfunction, 46% got short-term urinary dysfunction(19/41) and 5 % (2/41) had long-term urinary dysfunction. While after Dixon operation, 55% patients had sexual dysfunction, 29% (11/38) had short-term urinary dysfunction, and none of the patients had long-term urinary dysfunction. The difference between the outcomes of the two operations was significant( P ＜ 0. 05) .Sexual dysfunction occurred at a rate of 38% in the less-than-40 age bracket, 60% in the 40-to-59 age bracket, and 96% in the over-60 age bracket. The overall differences between different pairs of age brackets were significantly ( P ＜ 0. 05 ).CONCLUSION: There is a high rate of postoperative sexual and urinary dysfunction in male population. The age of patients and the approach adopted in the surgery are directly correlated with the rate of dysfunction. An autonomic nerve-preserving radical operation for rectal cancer can reduce the occurrence of sexual and urinary dysfunction effectively.

Objective To investigate the feasibility of breast conserving surgery after neoadjuvant chemotherapy for Ⅱ and Ⅲ stage breast cancer.Methods Forty-six patients,suffering from Ⅱ and Ⅲ stage breast cancer admitted to 309 Hospital of PLA from Jun.2003 to Dec.2008,and received breast conserving surgery after neoadjuvant chemotherapy,were followed-up.Chemotherapy protocol included intravenous injection of epirubicin 60mg/m2 on day 1 and continuous intravenous infusion of paclitaxel 150 mg/m2 for 3 hours on day 2.The neoadjuvant chemotherapy was repeated every 21 days for 2-4 cycles.Patients eligible for breast conserving therapy received quadrantectomy or wide excision of tumor plus axillary lymph node resection.Evidence of local recurrence and distant metastasis and breast contour were followed up after surgery.Results After neoadjuvant chemotherapy,9 patients showed complete clinical response(CR),37 patients showed partial response(PR).Post-operative pathological examination showed that there were varied degrees of apomorphosis and necrosis of tumor cells,interstitial edema,fibrous hyperplasia,and inflammatory cell infiltration,among them pathological remission was found in 4 cases.The patients were followed up for 8 to 70 months with a mean of 58 months,local recurrence was found in 4 cases distant metastasis was found in 3 patients,and 2 of them died.Assessment of breast contour was carried out in 31 cases 1 year after breast conserving therapy,and excellent results were obtained in 6 cases,good in 18 cases and poor in 7 cases.Conclusions It is safe for patients with Ⅱ-Ⅲ stage breast cancer to receive preoperatively treatment with neoadjuvant chemotherapy.Routine operation,postoperative irradiation and chemotherapy and systemic support are the keys to achieve satisfactory result of breast conserving therapy.

Objective To analyze the serum level of procalcitonin (PCT) in children with bacte-rial or viral pneumonia, explore its diagnostic value in diagnosis of bacterial pneuminia in children, and so as to provide evidence for clinical use of antibiotics. Methods A total of 42 children with pneumonia(mean age was 5.6 yrs, including 24 boys and 18 girls) were divided into viral neumonia group (n=25) and bacterial neumonia group (n=17). Semi-quantitative solid-phase immunoassay was applied to measuring serum procalcitonin. There were four PCT grades:<0.5 ng/mL,≥0.5 ng/mL,≥2 ng/mL and≥10 ng/mL. X2 test was performed. Results The serum level of PCT was more elevat-ed in bacterial neumonia group than that of viral neumonia group, and the difference was statistically significant (P<0. 01). Conclusion As a sensitive marker of bacterial pneumonia in children, serum procalcitonin contributes to diagnosis and differential diagnosis of pneumonia in children, which may provide basis for clinical use of antibiotics.

Objective To evaluate the effect of internal iliac artery and portal vein chemotherapy in preventing local recurrence and hepatic metastasis after radical operation of rectal carcinoma. Methods 96 patients in PLA 309 Hospital with rectal carcinoma undergoing radical resection were divided into 2 groups: Portal vein and iliac artery perfusion chemotherapy group (pump chemotherapy group, 48 cases) and peripheral venous chemotherapy control group (48 cases). Results In the pump chemotherapy group, the 1 , 3 , and 5 year survival rates, local recurrence rate and hepatic metastasis rate were respectively 100%?83%?52%?13%? and 13%, compared with 88%?68%?32%?26% and 28% in control group (all P

Objective To investigate the effect of hypertonic saline on TNF-а, IL-1β, S-100β level following focal cerebral ischemia-reperfusion injury in rats and explore the mechanisms involved. Methods Ninety rats were randomized equally into 4 groups,namely the pseudo-operated group (A group),untreated IR injury group (B group),C group (4.2% hypertonic saline) and D group (7.5% hypertonic saline). Cerebral ischemia was induced by middle cerebral artery occlusion for 2 h followed by administration of the corresponding treatments in group C and D. After 22 h of reperfusion , TNF-а, IL-1β, S-100βexpression in the ischemic brain tissue were measured by enzyme-linked immunosorbent assay (ELISA). Results After hypcrtonic saline treatment, the two saline-treated groups showed significant reduction in TNF-а、IL-1β、S-100β levels , but were still higher than pseudo-operated group(A group). Compared with B group, significant difference can be seen among C and D group. Conclusion Hypcrtonic saline can reduce cerebral TNF-а、IL-1β、S-100βlevel of isehemia-reperfusion injury.

Objective To evaluate the technique of treating severe tuberculous peritonitis complicated with intestinal obstruction. Method Clinical data covering 44 cases from Jan. 1994 to Dec. 2004 were analyzed retrospectively. All the 44 cases were suffering from severe tuberculous peritonitis complicated with intestinal obstruction for a long time. Among them 36 cases were diagnosed pre-operatively and 8 cases were confirmed post-operatively. All the patients underwent laparotomy, and all intestinal adhesions were divided, then the intestine loops were regularly aligned. Result 43 cases were cured, 2 patients developed postoperative intestinal fistula, and one patient died. Conclusion No curative effect could be obtained if medical treatment only was given for tuberculous peritonitis complicated with complete intestinal obstruction. The present surgical technique offers a better chance to relieve intestinal obstruction as a reult of tuberculous peritonitis.

Objective To investigate the effect of preoperative regional intra-arterial chemotherapy on apoptosis and apoptosis-regulating genes in advanced breast cancer.Methods 56 patients were divided into 2 groups:Preoperative regional intra-arterial chemotherapy group(treatment group,28 cases)and non-preoperative chemotherapy group(control group,28 cases).Apoptotic cells were examined by TUNEL and bcl-2 expression,and bax was detected by immunohistochemical techniques.Results Apoptotic index(AI)of breast cancer in the treatment group was 8.74%,while that of the control group was 4.65%.The bcl-2 expression in treatment group was 0.68?0.06,while in control group was 2.24?0.36.Expression of bax in treatment group was 0.72?0.06,while in control group was 0.38?0.04(P

Objective To explore the etiology,diagnosis and treatment of postsurgical gastroparesis syndrome(PGS)after radical gastrectomy for gastric carcinoma.Methods The data of 585 patients who had undergone radical gastrectomy for gastric carcinoma were retrospectively studied.The diagnosis was established with fiberoptic gastroscopy and biopsy before operation in all the patients,and radical subtotal gastrectomy was performed,with antero-colonic Billroth's Ⅱ anastomosis of the remnant stomach and jejunum.Results PGS occurred in 24 patients(age 46-81,mean 58.6 years)among 585 patients,the prevalence was 4.1%.In all the 24 patients,PGS occurred at the period when liquid diet was changed to semifluid diet,with the symptoms of epigastric fullness,nausea,vomiting and intractable hiccup.The vomitus contained large amount of gastric contents and a small amount of bile.The quantity of gastrointestinal decompression was 800-2000 ml/d.Upper gastrointestinal radiography using 38% meglucamine diatrizoate was performed in all the 24 patients,the contrast agent was taken orally or through gastric tube.It showed that the remnant stomach was atonic,gastric peristalsis was weak or absent,and evacuation of contrast agent was delayed.The anastomosis stoma was patent.Gastroscopy was performed in 18 patients,and a large amount of residual gastric content and anatomotic edema of anastomosis stoma were found.Howener,the gastroscope could be introenced into the duodenum or jejunal efferent loop through anastomotic stoma without difficulty,and no signs of mechanical obstruction were found.All the 18 patients were cured within10-38 days by conservative treatment.Conclusion The main causes of PGS may be the loss of gastrointestinal motility and anastomotic edema,while the risk factors may include old age,malnutrition,water-electrolyte imbalance,and peritoneal infection.Gastrointestinal radiography and gastroscopy are important diagnostic methods,and the patients can be cured by conservative treatment.

Objective To evaluate the effects of indigenous staplers on anus-preservation,and postoperative target chemotherapy to prevent local recurrence and distant metastasis of low-situated rectal cancer.Methods 284 patients with low-situated rectal cancer hospitalized during Jan.1990 to Dec.2004 in the Second Affiliated Hospital of PLA General Hospital were treated surgically with indigenous staplers for anus-preservation,interoperative implantation of iliac artery pump and postoperative target infusion chemotherapy.They were followed up for 2~8 years.The clinical data including the result of anus-preservation,local recurrence rate,distant metastasis rate and long-term survival rate were retrospectively analyzed.Results All the 284 patients received anus-preservation operation with successful result.Among them 282 cases(99.3%) undervent the operation once,and the remaining two(0.7%) were operated on twice with success.Control of defecation was good in 247 cases(87.0%),anastomotic fistula occurred in 2 cases(0.7%),stanosis of anastomosis occurred in 1 case(0.4%),and bleeding from anastomotic site occurred in 1 case(0.4%).The follow-up data were completely collected from 236 cases(83.1%).The 1-,3-,5-year local recurrence was found in 2 cases(0.8%),6 cases(2.5%) and 8 cases(3.2%),respectively.The 1-,3-,5-year distant metastasis was found in 11 cases(4.7%),22 cases(9.3%) and 10 cases(4.3%),respectively.The 1-,3-,5-year overall survival rate were 97.0%(229/236),86.0%(203/236) and 65.3%(154/236),respectively.Conclusion The use of indigenous staplers is safe and dependable in operation for anus-preservation in low-situated rectal cancer.Postoperative target chemotherapy may decrease the local recurrence rate and distant metastasis rate,and raise the long-term survival rate as well.

To evaluate the effect of local resection plus axillary dissection in the treatment of early breast cancer, 112 cases of early breast cancer were divided into 2 groups: quadrant resection plus axillary dissection group(66 cases) and Halsted′s method group(46 cases).Their survival rate, local recurrence rate, metastasis rate,cosmetic effect of breast were observed for a prolonged period. The results showed that the 3,5,8 year survival rates in the first group were respectively 97 0%,87 9% and 71 2%. The 3,5,8 year survival rates in the second group were respectively 97 8%,80 5%,76 1%. The rate of local recurrence was 6 1% in the first group and 4 3% in the second group.The metastasis rate of the first group was 16 7%,and that of the second group was 21 6%.In 83 8% of patients in the first group,the breasts retained a satisfactory cosmetic form.It suggested that similar to the Halsted's method,the quadrant resection plus axillary dissection method is an ideal method to treat early breast cancer.