Objective To discuss the imaging manifestations of chordoma.Methods The imaging manifestations of chordoma in 42 cases proved by surgery and pathology were retrospectively analysed.Results The lesions located at the region of skull base in 23 cases(54.8%),at the sacrococcygeal region in 18 cases(42.9%) and one case(2.3%) outside the axial skeleton as an extra-axial chordoma or parachordoma.Bone destruction in the areas near skull base and sacrococcygeal region could be found on radiography.On CT,chordoma typically appeared as a expansile soft-tissue mass that arises from the clivus and sacrococcygeal region with associated extensive lytic bone destruction.MR imaging was considerably superior to CT in the delineation of lesion extent.Conclusion Chordoma has typically distribution and characteristic imaging manifestations,especially MRI.

Purpose: To study the clinical efficacy, toxicity of preoperative chemotherapy and survival time with Gemicitabine-Cisplatin combination in the treatment of stage Ma( N2) NSCLC. Methods: Thirty patients with stage IIIa( N2) NSCLC were included. Gemicitabine was administered on dl, 8 and 15 at a dose of 1000 mg/m" and Cisplatin at a dose of 100 mg/m on d2. The chemotherapy was repeated every 28days. Results: Thirty patients were evaluable for response. The overall response rate was 70%. Surgical'excision rate after preoperative chemotherapy was 93%. Total surgical excision rate was 70%. Median survival time was 15 months, one year survival rate was 67%. The main toxicity was hematological, thrombocytopenia of grade III-IV appeared in 46% course of treatment, but it did not lead to hemorrhage. Conclusions: Preoperative chemotherapy with Gemicitabine-Cisplatin combination is effective and well-tolerated in the treatment of stage IIIIa( N2) NSCLC. So it is worthy to be further studied and popularized.

Objective To discuss the way and effect of washing intestine and pelvic cavity to prevent the fistula of lo place close entrance's in carcinoma of rectum. Methods Cut the rectum and lymph node,used the tip large intestine to connect with washing machine tube. cut vermiform appendix and put urine tube enter ileocecal them use 500ml N.S to wash large intestine for sustained.After se the recturn and large intestine.Use two tube(0.8～1cm) pelvic cavity about 1～6 days. Results The improvement group(38 cases) had not occur leak of lo place cclose entrance, classical group (18 cases) had occur 2 cases (11.1%)leak of lo place close entrance, usestatistics to deal with, P

More than 20 studies published during the past 10 years concerning preoperative radiotherapy in rectal cancer were reviewed carefully. And we evaluated the role of IMRT being routinely used in preoperative treatment of rectal cancer.

The delineation of clinical target volume (CTV) is a critical step in planning conformal radiotherapy for rectal cancer.Several guidelines suggest different subvolumes and anatomical boundaries in radiotherapy for rectal cancer, potentially leading to a misunderstanding of CTV definition.This article reviews recent advances in the delineation of CTV in radiotherapy for rectal cancer.

Objective To evaluate the selective angiography and interventional management in nonvariceal gastrointestinal hemorrhage.Methods 94 cases with nonvariceal gastrointestinal hemorrhage were accepted for selective angiography.According the location and cause of hemorrhage finding by angiography,these patients were checked by arterial embolization and/or perfusion of vasoconstrictor substance.Results DSA revealed positive result in 58 cases(61.7%) of 94 cases.Meanwhile,13 cases accepted 99m Tc-labeled erythrocytes nuclear scan,11 cases(84.6%) showed hemorrage.Arterial embolization was carried out in 34 cases,the hemostasis and relapse rate was 91.2% and 8.8% respectively.Besides arterial embolization,8 cases were selected vasopressin infusion,the hemostasis and relapse rate of vasopressin infusion was 75.0% and 25.0% respectively.No severe complication such as intestinal necrosis occurred among the 42 cases with interventional therapy.Conclusion Selective angiography is a valuable method for the diagnosis of the nonvariceal gastrointestinal hemorrhage of unknown reasons.The()~(99m)Tc-labeled erythrocytes nuclear scan is more sensitive than selective angiography in detecting bleeding,however,as to find bleeding location accurately,it was inferior to selective angiography.

OBJECTIVE:To observe clinical efficacy and safety of Bifidobacterium triple viable capsules in the adjunctive treatment of Helicobacter pylori(Hp)positive chronic atrophic gastritis(CAG)complicated with anxiety-depression. METHODS:A total of 100 Hp positive CAG patients with anxiety-depression were divided into control group and observation group according to random number table,with 50 cases in each group. Control group was given standard triple therapy (rabeprazole+amoxicillin and clavulanate+levofloxacin). Observation group was additionally given Bifidobacterium triple viable capsules 0.42 g,tid. The treatment lasted for 14 d in both groups. Clinical efficacies,Hp eradication rates as well as HAMA and HAMD scores before and after treatment were all observed in 2 group. The occurrence of ADR was compared. RESULTS:Total response rate of observation group was 94.0%,and Hp eradication rate was 92.0%,which were significantly higher than 76.0% and 78.0% of control group, with statistical significance (P<0.05). Before treatment,there was no statistical significance in HAMA and HAMD scores in 2 groups(P>0.05). After treatment,HAMA and HAMD scores of 2 groups were decreased significantly,the observation group was significantly lower than the control group,with statistical significance (P<0.05). The incidence of ADR in observation group (4.0%)was significantly lower than control group(20.0%),with statistical significance(P<0.05). CONCLUSIONS:Adjunctive use of Bifidobacterium triple viable capsules can significantly improve Hp eradication rate,clinical symptom,anxiety and depres-sion,while reduce the incidence of ADR.

ObjectiveTo study the anatomy of the soleus muscle perforator flap and its clinical application.MethodsIn 6 cadavers specimen with 12 lower limbs,the cutaneous branches and soleus muscle perforator artery were dissected and their measurements were recorded.Fourteen patients with skin and soft tissue defects from July 2002 to October 2010 were repaired by the soleus muscle perforator flap.Of the 14 patients,eight for dorsal and anterior defects of foot,two for anterior defects of malleolus,two for hand defects,two for elbow defects.The size of the flaps was 5 cm × 6 cm - 12 cm × 20 cm.Flap success rates and postoperative course were evaluated. ResultsThe soleus musclocutaneous perforators mostly appeared within 5 - 24 cm length below the head of fibula.The diameter of the artery cutaneous perforator was( 1.08 ±0.22)mm,vena concomitants was (1.20 ± 0.32)mm.All flaps were survived completely and the wounds got primary closure in 14 cases.The flaps were not overstaffed,and their shape,texture and color were similar to normal.All of the 14 cases were evaluated as satisfactory after 6 months to 12 months follow-up. ConclusionThe free soleus muscle perforator flap is an ideal flap for repairing skin and soft tissue defects with the merit of simple procedure,minimal trauma and more physiological circulation established.

BACKGROUND: The operation on cervical spondylosis is usually done through anterolateral cervical vertebrae to mainly expose cervical vertebrae,intervertebral disc, hook joint and so on. The recent reports are mostly local studies. The observation data of the distance between cervical vertebrae and the corresponding nervus vascularis is limited.OBJECTIVE: The relation of the blood vessels and nerves to cervical vertebrae was observed in neck so as to prevent iatrogenic blood vessels and nerve injuries in the operation on cervical spondyloisis.DESIGN: A single sample trial based on the anatomic samples SETTING: The department of anatomy of a medical college PARTICIPANTS: The experiment was conducted in the Department of Anatomy of Changzhi Medical College from July 2003 to May 2004. Twenty adult antiseptic samples with 40 sides including 36 from males and 4 from the females supported by the Department of Human Anatomy, Changzhi Medical College.METHODS: The accompanying relation of the blood vessels to the nerves,the length of the blood vessels, and the distances from their starting point and end to the neighboring cervical vertebrae were observed and measured in 40 adult antiseptic samples of the neck.the distances from their starting point and end point to the neighboring cervical vertebrae.RESULTS: Totally, 40 sides of 20 samples entered the stage of the result analysis. The facial artery followed the lingual nerve, and the length from its starting point to the neighboring cervical vertebrae C3 was ( 18.5 ± 7.2) mm. The lingual artery followed the hypogolossal nerve, and the distance from its starting point of the lingual artery to C2 -3 was( 19.7 ± 8.4)mm. The superior thyroid artery followed the lateral branch of the superior laryngeal nerve, and the distance rom its starting to the point of the superior thyroid artery to C3 was (17.0 ± 5.7) mm, and the length from the end of the superior thyroid artery to C5 was (18.2 ± 2.5 ) mm. The superior laryngeal artery followed the medial branch of the superior laryngeal nerve, and the distances from its starting point and end point to C3 were( 15.7 ± 6.7) mm and(19. 7± 5.8) mm respectively. As for the inferior thyroid artery, the distances from its starting point and the end point to C7 were ( 17.3 ± 5.5 ) mm and ( 11.3 ± 3.4 ) mm respectively.CONCLUSION: In the operation on cervical spondylosis, attention should be paid to the anatomic stricture of the special position at different positions so as to reduce the iatrogenic blood vessels and nerve injuries.

Objective　To study the clinical manifestation of small bowel tumors and the prognostic factors. Methods　Retrospective analysis of the clinical data were made on 42 cases of primary small bowel tumors (except periampullary tumors) admitted to our hospital from 1974 to 1999. Results　In this series, there were 6 cases of benign small bowel tumors, 5 of them were leiomyoma and 1 adenoma. Of the 36 cases of malignant 　tumors, there were malignant lyphoma in 17 cases (47.2%), adenocarcinoma in 11 (30.6%),　 leiomyosarcoma in 6(16.7%), carcinoid tumor in 1 (2.8%) and neurofibrosarcoma in 1 (2.8%). There was no characteristic clinical sign in small bowel tumors; endoscopy and barium series were the main diagnostic methods. About 50 per cent of patients with malignancy had metastasis, and only 18 cases (50%) received radical resection. Follow-up were available on 36 cases. The overall 5-year survival rate in the patients with malignant small bowel tumors was 47.3%. Multivariate analysis showed that metastasis and diameter of tumors were the main prognostic factors of the 5-year survival. Conclusions　Early diagnosis and early treatment play the key roles in improving the prognosis of malignant small bowel tumors. Radical resection should be taken if no metastasis is found.