ObjectiveTo discuss the diagnosis and therapy of primary presacral tumor. Methods23 patients with primary presacral tumors underwent surgical treatment from 1983～1999 were studied retrospectively. ResultsIn respect to pathological type, congenital tumor was the most frequent one in 23 patients. Digital examination together with B ultrasound and CT examination were quite important in determining the extent and degree of tumor invasion. As for operative ways, transacral and transperineal approach were the most common choices to detect the tumor. Conclusion Complete and enbloc resection is the principal method in treating presacral tumor, whether the lesions are beign or malignant. Choices of operative way should be made accordial to tumor condition. Keep nerves and blood vessels from being injuried during operation.

Objective To investigate the correlation of tissue factor (TF) and p53 protein expression in colorectal carcinoma. Methods The expression of TF and p53 protein was studied by immunohistochemistry in 43 cases of primary colorectal carcinoma. Results TF expression was positive in 44.2% (19/43) of cases, and p53 protein expression was positive in 48.8% (21/43) of cases. The lymph node metastatic rate was 78.9% (15/19) in patients with positive expression of TF, and 85.7% (18/21) in patients with positive p53 protein expression. Both TF and p53 protein expressions showed significant correlation with lymph node metastasis (?~2=8.96 and 14.88, P

ObjectiveTo investigate the inhibition of telomerase activity of colorectal cancer by chemotherapeutic drugs.MethodsBy using telomerase repeat amplification protocol (TRAP) combined with PAGE silver staining, we detected the telomerase activity of human colorectal cancer cell line HT-29 under the effect of cisplatin, doxorubicin, pirarubicin, mitomycin C, and 5-FU.ResultsIn high doses,no inhibition of tolemerase activity was found when cells were collected after only 4 hours of drug treatment, but the telomerase activity was completely inhibited by cisplatin when the drug was removed and cells were reculured for 20 hours. However, doxorubicin, pirarubicin, mitomycin C, 5-FU had no such effect. ConclusionCisplatin inhibits telomerase activity of human colon cancer cell HT-29, while other drugs had no such effect.

ObjectiveTo explore the clinical characteristics and diagnosis of primary small intestinal tumor (PSIT). MethodsRetrospective analysis of the clinical and pathological data of the 112 PSIT cases was made. ResultsDuodenum was the most common site for PSIT (62 5%). Leiomyomas were most common benign tumors which were most likely found in ileum and jejunum. Adenocarcinoma was the most frequently seen malignant PSIT followed by lymphoma and leiomyosacroma. The chief method of diagnosis is barium meal X ray examination especially with the hypotonic contrast X ray examination. Endoscopy can increase the diagnostic rate. Superior mesenteric arteriography sometimes helps in determing the site of gastrointestinal haemorrhage. CT scan can be helpful in establishing diagnosis, preoperative classification and postoperative recurrences. Conclusion Duodenal adenocarcinoma is most common PSIT, followed by malignant lymphoma, liomyoma and leiomyosarcoma. Hypotonic contrast X ray examination is most effective in diagnosis, and locating of small bowel tumors. Superior mesenteric artery angiography and CT scanning are also helpful.

Objective To investigate factors affecting the metastasis of lymph nodes around the root of inferior mesenteric artery(IMA) in rectal cancer,and the significance of root lymph nodes dissection of IMA in radical surgery for rectal cancer.Methods Clinicopathological data of 105 rectal cancer patients undergoing root lymph node dissection of IMA during radical resection in Peking University First Hospital from January 2005 to December 2008 were analyzed retrospectively.Rectal cancer patients without root lymph node dissection of IMA during the same period served as control.Results were compared between these two groups for survival and local recurrence rates.Results The rate of lymph node metastasis around the origin of IMA was 9.5％ (10/105).The five-year survival rate in patients with IMA root nodal dissection was 71.3％,and that without was 70.6％ (P =0.995),while the local recurrence was respectively 1.9％ and 7.4％ (P ＜ 0.05).In multivariate analyses,IMA root nodal metastasis occurred more frequently in patients with pT3 and pT4 tumor(Wald =5.764,P ＜ 0.05) and poorly differentiated tumor(Wald =7.818,P ＜ 0.05).Conclusions Root lymph nodes dissection of IMA could not increase five-year survival rate,but it could reduce local recurrence rate in patients with rectal cancer.In radical surgery of rectal cancer,lymphadenectomy of IMA root should be performed in patients with T3 and T4 tumor with poorly differentiated tumor,so as to reduce local recurrence rate.

Objective To study the presentation,sensitivity of different diagnostic methods,snrgical modalities and pathological findings for patients of substemal goiter. Methods The clinical data of fifty nine cases of substernal goiter surgically treated were retrospectively analyzed. Results The main symptoms of substernal goiter patients were asymptomatic cervical mass(39/59),airway obstruction (13/59),hyperthyroidism(4/59),hoarseness(3/59)and choke(3/59).The sensitivity of chest X-ray,ultrasonography,CT and scintigraphy was 62.8%,15.8%,85.7%,and 50.0%respectively,and the specificity Was 99.4%,99.8%,99.5%and 99.0%,respectively.Standard cervical approach was successful for thyroidectomy operations in 57 cases.One patient underwent thyroidectomy by sternotomic approach,and another one by combined cervici-sternotomic approach.No major complications or perioperative deaths occurred.Pathology revealed nodular goiter in 48 cases.Grave's disease in one,thyroid adenoma in 2,and carcinoma in 8. Conclusions CT and chest X-ray are sensitive diagnostic techniques for substerual goiter.Cervical approach is appropriate for most substernal goiter.

Objective: To determine the relationships between apoptosis induced by transforming growth factor beta 1 (TGF-β1) and Smad in human hepatoma cell lines. Methods: Three human hepatic carcinoma cell lines, involving different status of the p53 gene respectively, were used in this study.TGF-β1-induced apoptosis in hepatic carcinoma cell lines was quantitated using the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. For identification of the mechanism of apoptosis induced by TGF-β1, these cell lines were transfected with a TGF-β1-inducible luciferase reporter plasmid containing Smad binding elements (SBE) and luciferase gene using LF2000, then were treated with TGF-β1. Relative luciferase activity was assayed respectively. Results: Among three cell lines studied with TUNEL assay, addition of TGF-β1 induced apoptosis only in HepG2 cells (wild type p53). In contrast, Huh-7 ( mutant p53) and Hep3B ( deleted p53) cell lines lacked apoptosis. The detection of luciferase activity indicated that HepG2 cells dramatically increased the response to TGF-β1 induction, Huh-7 and Hep3B cell lines significantly lowered luciferase expression. Conclusion: HepG2cells were highly susceptible to TGF-β1-induced apoptosis compared with Hep3B and Huh-7 cell lines.Smad4 may be a central mediator of the TGF-β1 signaling transdution pathway.

Objective To evaluate the clinical features of and appropriate surgical modality for congenital choledochal cyst(CCC). Methods Retrospective study on the clinical data of 85 surgically treated CCC cases was made. Results Among the 85 cases 12 were found malignant in character(14%). Out of the 29 cases in which the junction of pancreaticobiliary ductal system was showed by image, junction anomaly was identified in 26 cases. Surgical correction was applied to 83 cases with cyst excision and Roux-en-Y hepaticojejunostomy as the main procedure. External drainage of the CCC was adopted first in 4 cases to tide the patients over serious infection, before second stage definite radical resection was carried out. Excellent and good result were achieved on follow-up in 47 out of 60 CCC cases undergoing CCC resection and Roux-en-Y reconstruction, while only one out of 6 undergoing CCC internal drainage enjoyed fair result. Conclusions External drainage is mandatory for CCC patients with severe infection. The total choledochal cyst excision, with Roux-en-Y hepaticojejunstomy is effective in the treatment of CCC.

Objective To investigate the apoptosis induced by TGF-?1 in human hepatic carcinoma cell lines and its relationship with p53 gene and Smad. Methods Three human hepatic carcinoma cell lines which involving in various status of the p53 gene were used in this study. TGF-?1-induced apoptosis in hepatic carcinoma cell lines was measured by the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. To study the mechanism of TGF-?1-induced apoptosis, these cell lines were transfected with a TGF-?1-inducible luciferase reporter plasmid containing Smad 4 binding elements (SBE) and luciferase gene using Lipofectamine 2000, then treated with TGF-?1, relative luciferase activity was assayed. Results Of three cell lines studied with TUNEL assay, TGF-?1 induced apoptosis was observed in HepG2 cells (wild type p53). Huh-7 (mutant p53) and Hep3B (deleted p53) cell lines showed less apoptosis. Luciferase activity assay indicated that the response to TGF-?1 induction in HepG2 cells was increased dramatically but was not significant in Huh-7 and Hep3B cell lines. Conclusion HepG2 cells seem to be highly susceptible to TGF-?1-induced apoptosis compared with Hep3B and Huh-7 cell lines. Smad 4 is a central mediator of the TGF-?1 signal transduction pathway.

Objective To explore the association between perioperative glycemic control and the post-operative complications of patients undergoing pancreatic surgery. Method The clinical data of 412 patients who underwent pancreatoduodenectomy between January 1995 and April 2010 were retrospectively analyzed. Results The average fasting glycemic level was significantly higher than normal postoperatively, and the post-operative application of insulin effectively controlled glycemic levels. The rates of postoperative mortality, pancreatic fistula,hemorrhage, and infections among patients with glucose level > 8. 3 mmol/L (7.0% , 23.7% , 9.7% , and 15. 1 % ) were significantly higher than those with glucose level ≤8. 3 mmol/L (2. 7% , 11. 9% , 4. 0% , and 6.6%) (P=0.037, P=0.002, P = 0.020, and P=0.005). On the contrary, the rates of postoperative mortality and hemorrhage among patients with glucose level≤6. 1 mmol/L (6. 2% and 8. 6% ) were significantly higher than those with glucose level between 6. 1 and 8. 3 mmol/L (0. 7% and 1.4% ) (P = 0. 023 and P = 0. 011).The rate of hypoglycemia was significantly higher in patients with glucose level ≤6. 1 mmol/L (7. 4% vs. 0. 7% ,P = 0. 009). Conclusions Postoperative glucose level can be stably controlled by continuous intravenous glucose infusion plus regular insulin therapy. A target perioperative glucose level between 6. 1 and 8. 3 mmol/L can effectively and safely reduce postoperative mortality and complications.