Objective To discuss the clinical application and features of coronary artery bypass grafting(CABG) through left intercostal thoracotomy approach. Methods A total of 36 cases of CABG were performed through left intercostal thoracotomy approach from September 1996 to August 2005 in this hospital.The patients fell into four categories: ①single vessel disease in the left anterior descending artery(LAD);②re-operation of CABG with a patent LIMA(left internal mammary artery)-LAD bypass;③severe calcified ascending aorta;and ④concurrent other procedures that required left thoracotomy.There were 26 cases of single vessel disease,3 cases of double vessel disease,and 7 cases of triple vessel disease.Five cases had a history of percutaneous coronary interventions(PCIs) and 6 cases had a history of CABGs.The left ventricular ejection fraction was 0.562?0.107. Results Off pump CABG with 1~4 distal anastomosis was successfully accomplished in all the 36 cases,with an operation time of 190.4?44.1 min.Concurrent procedures included 2 cases of transmyocardial laser revascularization(TMLR),1 case of lung cancer resection,and 1 case of esophageal cancer resection.There was no in-hospital mortality.Two fatal cases were seen in long-term follow-up observations.Recurrent angina developed in 2 cases 1 year after operation,and was cured with a PCI in 1 case and with a re-operation of CABG in 1 case. Conclusions The left intercostal thoracotomy is a safe and feasible approach for CABG surgery in patients with some special types of coronary heart disease.The procedure can be performed under beating heart.

Objective To report the experience of first 100 cases of off-pump coronary artery bypass(OPCAB) grafting by a training cardiac surgeon,and to discuss the feasibility of the training method.Methods The trainee,who had no previous experience of coronary surgery,received an OPCAB training program under the guidance by a director who had completed more than 2000 cases OPCAB.After 28 months of training,the trainee began to be an independent operator.The data of the first consecutive 100 cases of OPCAB by the trainee(Training Group) were collected for comparison with the director's 100 cases of OPCAB surgery(Control Group).Results There were 5 cases of conversion to on-pump surgery in the Training Group.The number of distal anastmosis in the Training Group(2.9?0.6) was smaller than that in the Control Group(3.5?0.7)(t=-6.508,P=0.001).Compared with the Control Group,there were less circumflex grafts(67/100 vs 88/100;?~2=12.645,P=0.000) and sequential grafts(3/100 vs 27/100;?~2=22.588,P=0.000) in the Training Group.There was no significant difference in mortality between the Training Group(3%,3 cases) and the Control Group(1%,1 case)(?~2=0.255,P=0.614).No significant difference was observed between the two groups in other postoperative severe complications.Conclusions The first 100 cases of OPCAB surgery performed by the trainee give favorable results,indicating a stable transition from training period to independent performance.It also testifies the feasibility of this training program.

Objective To explore clinical effect of nedaplatin combined gemcitabine on chemotherapy of advanced non-small cell lung cancer (NSCLC),and to observe the prognosis and complications of these patients. Methods 106 patients with advanced NSCLC were selected,they were randomly divided into the treatment group and the control group with 53 cases each group,according to the single and double of order registration number.The con-trol group were given cisplatin combined gemcitabine chemotherapy,the treatment group were administrated nedaplatin combined gemcitabine chemotherapy,three weeks repeat.The treatment effect was estimated after two cycles of chemo-therapy,and progression-free survival ( PFS) ,patients quality of life with KPS after treatment,and the adverse reac-tions were assessed.Results The disease control rates (DCR) of the treatment group was 77.36% (41/53),the control group was 71.70%(38/53),there was no statistically significant difference (χ2 =2.46,P>0.05).PFS of the treatment group were (4.26 ±0.38) months,the control group was (3.72 ±0.30) months,there was no statisti-cally significant difference (t=2.94,P>0.05).KPS of the treatment group was (74.48 ±4.04)points,which was higher than (69.76 ±3.28)points of the control group,the difference was statistically significant (t =7.33,P<0.05).The total adverse reaction of the treatment group was 81.13%(43/53),which was lower than the control group 90.57%(48/53),the difference was statistically significant (χ2 =7.61,P<0.05).Conclusion There is preferably clinical effect of nedaplatin combined gemcitabine treatment of NSCLC,the adverse reactions was lower sig-nificantly,the patients prognosis is good,and which is worth clinical promotion.

Objective: To summarize and analyze the early outcomes and clinical experience in 1198 patients undergone off-pump coronary artery bypass (OPCAB). Methods: This multi-center report covers 15 different institutes in China from October 1996 to May 2002. The ratio of OPCAB to conventional coronary artery bypass grafting (cCABG) was 85.2%. The mean age was (61.6?9.0) years. 77.3% patients were male and 22.7% were female. There were 34.6% patients with myocardial infarction, 58.2% with unstable angina pectoris, 18.7% with left main lesion, 76.9% with triple-vessel disease, 1.5% was redo surgery, and 9.9% emergent or urgent surgery. The mean left ventricular ejection fraction was 0.56?0.17. Results: The number of distal anastomosis was 3.1?0.9. IMA was used in 65.6% patients and radial artery was used in 18.0%. 13.5% OPCAB was combined with TMLR. IABP was used in 5.2% patients. The hospital mortality was 1.2%. The morbidity included 0.4% peri-operative myocardial infarction, 0.3% heart failure, 1.2% fatal arrhythmia, 2.0% pulmonary complications, 1.2% neurotic disorder, 0.7% renal dysfunction, 1.0% reopen for bleeding, and 0.6% delayed wound healing. Conclusion: OPCAB surgery is a safe and feasible procedure with good early results. Its late outcomes need further follow-up. OPCAB requires certain special skills and methods in practice so a specific training course should be designed.

Objective To investigate the clinical characteristics of diabetes complicated with peripheral neu- ropathy and increase the cognition of diabetic peripheral neuropathy in clinical work.Methods The clinical data of 160 diabetic patients were analyzed with retrospective analysis.Results 118 diabetic patients had different levels neuroelectrophysiologic abnormality,and the incidence rate was 73.8 %.The cure rate of diabetic peripheral neuropa- thy was 11.0%.Conclusion The incidence of peripheral neuropathy is high in diabetic patients,neuroelec- trophysiologic examination is a sensitive index in diagnosis of diabetic peripheral neuropathy,and the therapeutic ef- fect of diabetic peripheral neuropathy is poor.

ObjectiveDiabetes is an independent risk factor for coronary artery bypasss grafting(CABG). Off pump coronary artery bypasss (OPCAB) experience in 251 cases was reviewed to determine whether diabetes wou ld be applicable in OPCAB procedures.MethodsConsecutive 251 patients underwent OPCAB over 12 month period. This study included 71 diebetic patients (DM group) and 180 nondiabetic patients (NDM group). Preoperative v ariables were compared between the two groups by univariate analysis.R esultsNo differences were found regarding the length of stay in cardio intensive care unit [DM group(2.4?0.3)d; NDM group (2.4?0.3) d;P=0. 386], and sternal complication (DM group: 5.7%;NDM group: 3.9%;P=0.511) . In hospital complications were as follows: death rate(DM group: 2.8%; NDM gr oup: 1.1%; P=0.680); stroke (DM group: 2 8%; NDM group: 1 7%; P=0 623 ); hemofiltratioin renal failure (DM group: 2.8%; NDM group: 0.5%; P=0.194); myocardial infarction(DM group: 0%; NDM group: 0.5%;P=1.000); blood using were more frequent in DM group comparied with NDM group (P=0.111). ConclusionOPCAB in diabetic patients is as safe as in non diabetic patients.

Objective To evaluate the value of whole body 18F-FDG PET/CT in the detection of recurrence/metastasis of cervical cancer.Methods A retrospective study was performed on 95 patients with cervical cancer who underwent 18F-FDG PET/CT after treatment.The lesion characteristics on 18F-FDG PET/CT were assessed visually and semi-quantitatively.A final diagnosis was confirmed by histopathology,diagnostic treatment and clinical follow-up imaging.The data were analyzed by Kappa test.Results 18 F-FDG PET/CT was positive in 54 patients,including 24 with local recurrence and 30 with distant metastases.The sensitivity,specificity and accuracy of 18F-FDG PET/CT for the detection of recurrence/metastasis of cervical cancer were 98.1％ (52/53),95.2％ (40/42) and 96.8％ (92/95),respectively.The positive predictive and negative predictive value were 96.3％ (52/54) and 97.6％ (40/41),respectively.18F-FDG PET/CT showed concordant results with pathological/clinical follow-up findings (Kappa =0.936,P＜0.05).Conclusion 18F-FDG PET/CT is a sensitive and specific modality for the detection of recurrence/metastasis of cervical cancer and might be useful for further treatment plan.

Objective To determine the efficacy of hysteroscopy and laparoscopy in differential diagnosis of pregnancy-related diseases,including gestational trophoblastic neoplasia(GTN),incomplete abortion and ectopic pregnancy.Methods Twenty-seven patients with a suspected diagnosis of GTN were transferred to Peking Union Medical College Hospital from September 2003 to March 2006,and underwent hysteroscopy and laparoseopy.Clinical data of patients were reviewed retrospectively.Most patients had abnormal vaginal bleeding and persistently elevated plasma beta human chorionic gonadotropin(?-hCG) level for a median(53?37)days(range,15-125 days)after evacuation.Ultrasound revealed a lesion with affluent blood flow in intrauterine,unilateral horn of uterus,or myometrium.No positive findings were revealed by computerized tomography or X-ray of the chest in all patients.Eleven patients underwent evacuation under hysteroscope,10 patients were diagnosed and treated by laparoscopy,and 6 by hysteruscopy and laparoseopy.Results Choriocarcinoma was diagnosed in 4 patients,who achieved complete remission by chemotherapy later.The diagnosis of GTN was ruled out in the other 23 patients, including cornual pregnancy in 12,pregnancy in rudimentary horn in 1,and incomplete abortion in 10,who were cured by hysteroscopic and laparoscopic surgery and postoperative adjuvant single dose methotrexate.Conclusions The major causes of pregnancy-related abnormal bleeding include incomplete abortion,eetopic pregnancy,and GTN.Hysteroscopy and laparoseopy are effective alternative of diagnosis for differentiation of GTN from non-GTN and can also offer therapeutic treatment.

0.05).Compared with control group,significant decrease in positive group was found in the interval from first evacuation of HM to resolution of serum ?-hCG level,(83?18) days versus(126?31)days(P0.05).Conclusions Once HM is diagnosed,evacuation should be performed as soon as possible,the later the evacuation begins,the higher the risks of lung metastasis and chemotherapy are.It is not necessary to worry about lung metastasis before evacuation of HM,the outcome of post- chemotherapy is very good.

Background Retinopathy of prematurity is mainly due to retinal neovascularization.Objective This laboratory work was to evaluate the efficacy of different dosage of avastin for inhibiting retinal neovascularization.Methods Ninety 7-day-old clean C57BL/J6 mice were randomized into six groups as follows:air control group,hyperxia control group,hyperxia BSS group and avastin groups.C57BL/J6 mice in air control group were raised in regular air environments.The fifty mice were fed under the environment with 75％ ±2％ oxygen for 5 days to establish the retinal neovascularization models.The 1.25,2.50 and 5.00 g/L avastin (0.5 μl) were injected inteavtreally in forty-five mice models as low,moderate and high dosage avastin groups respectively,and 0.5 μl BSS was used at the same way in fifteen models as hyperxia BSS group.The mice were sacrificed in the 17-day-old age using excessive anesthesia method and the retina sections were prepared for the calculation of the numbers of vascular endothelial cell nuclei broken retinal inner membrane after hemotoxylin and eosin staining.The expression of CD34 in the retina was detected by immunochemistry.The morphology and distribution of retinal neovascular vessel in various groups were observed using retinal flat.The use of the animals followed the Regulations for the Administration of Affairs Concerning Experimental Animals by State Science and Technology Commission.Results The numbers of cell nuclei broken the inner limiting membrane was significant increased in the hyperxia group compared with the air control group( P＜0.01 ),and those in difference doses of avastin were considerably reduced in comparison with hyperxia BSS group (P＜0.01) and hyperxia group (P＜0.01 ).The decrease of numbers of cell nuclei broken the inner limiting membrane was obvious in low dose of high dose of avastin compared with low dose of avastin (P＜0.05 ).CD34 was positively expressed in retina internal membrane of hyperxia group.Retinal flat revealed the regular distribution and normal structure of retinal vessels in air control group and avastin groups.However,retinal and vitreous cavity neovascularization,leakage and enlarged non-perfusion regions in the perimeter of the retina were seen in hyperxia group and hyperxia BSS group. Conclusions Intravitreal injection of avastin can arrest retinal angiogenesis in oxygen-induced retinal neovascularization models in a dose-dependent manner.