Objective To study the effect of Color Doppler in encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency (PDVI).Methods Eighty-seven limbs in 87 patients who were proved to be PDVI by ascending venography were divided into Group A (44 limbs) and Group B (43 limbs).All the patients were treated with the encircling constriction of venous wall at the first valve of superficial femoral veins and the high ligation and ablation of great saphenous vein,ablation of superficial veins and ligation of perforator veins.But during the operations of patients in Group A,we used Color Doppler to help us.We used lasting time of reflux flow of vein to evaluate the short time effect.CEAP classification and clinical scoring were proceeded from two months to six years after operation to evaluate the long time effect.Results In patients in Group A the lasting time of reflux flow was markedly shortened.The results of CEAP indicated that obviously effective rate of Group A was 95.00 %(38/ 40) while it was 76.74%(33/43) in Group B.The difference between two groups’ effective rate was significant (P0.01).The difference between preoperative and postoperative clinical scores of Group A and Group B were both remarkable.between Group A and Group B were also prominent (P0.01)Conclusion Appling of Color Doppler is useful to promote the effective rate in the operation encircling constriction of superficial femoral vein in the treatment of PDVI.

Objective: To analyze the result of 18F-2-deoxy-2-fluoro-D-glucose-positron emission tomography （FDG-PET） in suspicious primary breast cancer patients and to evaluate its value for the surgery therapy. Methods: Total 36 patients suspected of breast neoplasm were enrolled into the research. The result was compared with the pathology result. The rate of missed diagnosis, the rate of mi.sdiagnosis. the sensitivity and specificity were calculated and analyzed. Results:Compared with the pathology results, the misdiagnosis rate. the rate of missed diagnosis. the sensitivity and specificity of FDG-PET for breast cancer were 0% , 36. 36%. 63. 63% and 100%, respectively. To those who had a neoplasm no more than 2 cm in diameter, the rate of missed diagnosis was as high as 41. 67%. To 33 breast cancer patients, the misdiagnosis rate, the rate of missed diagnosis, the sensitivity and specificity for lymph node metastasis were 18. 75%, 41. 18%, 58. 82% and 81. 25%, respectively. Conclusion:FDG-PET has a perfect specificity and a considerable sensitivity to the primary breast neoplasm and similar to the lymph node metastasis diagnosis. It is an ideal choice for those patients with suspected breast cancer but reluctantly to receive a vulnerarious examination.

目的 探讨Fogarty导管取栓术治疗急性肢体动脉栓塞的方法和疗效.方法 回顾性分析87例急性肢体动脉栓塞患者(89条患肢)Fogarty导管取栓的疗效.结果 治愈78例,患肢血供保持良好,治愈率87.6%;4例(4.5%)好转;5例截肢(5.6%),其中2例死亡(2.3%).结论 Fogarty导管取栓术是治疗急性肢体动脉栓塞的有效方法;为防止误诊,对疑有肢体动脉栓塞者应施行超声多普勒检查;一经确诊,尽早手术取栓可减少肢体坏死的危险。

Objective:To study the feasibility of continuous insulin intravenous infusion and to evaluate its effect of blood sugar stability on the prognosis of diabetic tumor patients during the perioperative period.Methods:Fifty-seven patients performed operation were enrolled into the study and received continuous insulin intravenous infusion.Their blood sugar levels were expected to be ideally controlled by using insulin pump during the perioperative period.Results:Patients got the ideal blood sugar level after receiving the continuous insulin intravenous infusion by using insulin pump.71.93% patients returned to the normal level within 24h.No patient suffered hyperosmolar nonketotic diabetic coma or ketoacidosis during perioprative period,also obtained a better wound healing result compared with those patients without continuous insulin intravenous infusion(P0.05).Infections occurred only in 4 cases and all of thenm were cured within a week;the postoperative infection rate was 7.02%(4/57).Conclusion:Cont inuous insulin intravenous infusion by pump can be used to control blood sugar level in patients during perioperative period,the blood sugar in the perioperative period can be controlled to the satisfying level in a short time,and the operative complications could be reduced in diabetic cancer patients.

Objective To discuss the imaging diagnosis and surgical treatment of carotid body tumor (CBT).Methods A total of 24 cases with CBT admitted from 1998 to 2005 were analyzed retrospectively.The significance of magnetic resonance angiography (MRA) diagnosis and the surgical options as well as the outcomes of CBT were discussed.Results All of 24 cases were classified as Shamblin Ⅰ and Ⅱ type on the imaging of MRA, which revealed definitely a solid vascular mass and its relation with the surrounding arteries in the carotid bifurcation. Eighteen tumors were resected successfully, 3 tumors were resected combining with the lesioned external carotid artery, and 3 tumors were resected with internal carotid artery and following immediate reconstruction. No brain and severe cranial nerve impair after the operation and no reoccurrence of CBT were found during the period of eight-year's follow-up in all cases. Conclusion MRA plays an important role in the diagnosis of CBT and should be applied routinely for the suspected before surgery. Operation is the most effective way to cure CBT, and the protection or revascularization of internal carotid artery is critical in achieving the successful surgical outcomes.

AIM: To explore the curative effect of compression therapy on post-mastectomy upper extremity lymphedema of breast cancer patients, and evaluate its clinical efficacy by emission computer tomography (ECT). Methods: 1 A total of 48 patients with post-mastectomy upper extremity lymphedema were enrolled from the Department of Vascular and Endocrine, Xijing Hospital, the Fourth Military Medical University of Chinese PLA from November 2005 to July 2006. They were divided into 3 groups according to their, edema state (light, moderate and severe). 2 FLOWTRON ® extremity circulation activator, produced by Huntleigh Healthcare Limited in Luton, was used to perform the compression therapy in three groups, the inflation pressure was 5.3, 6.7, 8 kPa respectively for 30 seconds, then the deflation time was 30 seconds, 30 minutes for one time, twice daily for 3 weeks continuously. 3 Based on the measurement of arm circumference before and after treatment, the injured extremity and the uninjured side were compared, taking the post-treatment difference ≥ 25% as effective; 15 patients selected randomly were evaluated by ECT both just before and after the compression therapy to observe the change of lymph flow. Results: All of 48 patients were involved in the result analysis. 1 Circumference of injured extremity reduced significantly after the therapy in the patients with light or moderate lymph edema [light edema group: (27.2:±1.3), (28.8± 1.6) cm; moderate edema group: (28.3±1.6), (31.1 ±.4) cm; P < 0.01]. 2 The total response rate was 88% (42/48), and 96% (23/24), 90% (18/20) in the light and moderate lymph edema groups. Among 4 cases with severe edema, only one was effective.3 Before the treatment, the lymph flow of inured extremity was obviously lower than that of uninjured side, but the lymph circulation was similar to the uninjured side after the treatment evaluated by ECT. Conclusion: As for the breast cancer patients who experience mastectomy and suffer from light or moderate upper extremity lymph edema, the compression therapy is convenient and effective to relieve the edema of injured extremity significantly.

AIM: To evaluate the therapeutic effect and clinical value of indirect loop valvuloplasty plus endovenous laser treatment plus high ligation in the treatment of primary deep venous insufficiency (PDVI) in lower limb. METHODS: Twenty-four patients (29 limbs) with PDVI diagnosed by venography were treated by indirect loop valvuloplasty plus endovenous laser treatment plus high ligation. RESULTS: Successful occlusion of the varicose veins was noted in all patients after initial treatment. Colour Doppler showed successful occlusion in all greater saphenous vein trunks. Induration in 11 limbs (37.9%) along the course of the treated veins was present, ecchymosis in 2 limbs (6.9%) was noted, and slight burn in 1 limb (3.4%) appeared. During a median follow-up interval of 12 months (ranged from 12 to 36 months), the symptoms of 23 limbs (79.3%) disappeared or alleviated, ulcer in the lower portion of the 11 legs (73.3%) healed, and 2 limbs (6.9%) suffered from light edema and 1 limb (3.4%) from deep venous thrombosis. CONCLUSION: Indirect loop valvuloplasty plus endovenous laser treatment plus high ligation is effective and practical in the treatment of PDVI with such advantages as safety, minimal invasiveness, small scar and fast recovery.

Objective:To analyze the incidence characters of gastric cancer on the young patients,and to explore possibility to the screen and prevent hereditary gastric carcinoma.Methods:All 1839 gastric cancer inpatients' data during 1983~2003 in 1st Affiliated Hospitals of the Fourth Military Medical University were collected.The characters of incidence included sex,age,pathological type and hereditary effect were analyzed.Results:The youth with the hereditary background or in hereditary gastric cancer(HGC)kindred had a high possibility to develop the disease(39/189 vs.69/1454,P0.001;16/189 vs.21/1454,P0.001),and the male had a higher probability.Diffused gastric cancer was popular in the young patients(40.49%).The lists of pathological type were poorly differentiated adenocarcinoma,Krukenberg tumor,and signet-ring cell carcinoma,all had a bad prognosis.Conclusion:The gastric cancer in young presents an increase tendency and most of them are poorly differentiated.The incidence of young gastric cancer patients show a correlation to the hereditary factor,which suggests more attention should be paid to the youth exposed in the high gastric cancer HGC background.

下肢静脉曲张是血管外科的一种常见病、多发病.静脉腔内激光治疗(endovenouslasertreatment,EVLT)的出现,给治疗下肢静脉曲张提供了一种全新的治疗方法.

AIM: To investigate the changes of calcitonin gene-related peptide (CGRP) in nerve fibers of skin in normal dogs and ones with diabetic foot before and after treatment. METHODS: Fifteen dogs were randomly divided into treatment(n=5), nontreatment(n=5)and normal control(n=5)groups. The diabetic foot model was made at left hindlimb in nontreatment and treatment groups. The treatment group was treated by negative pressure on affected limbs for 10 d (15 min/d) from the 14th day after the models were made. However, the nontreatment group was not treated. All the animals were detected for the change of CGRP immunoreactive nerve fibers in the skin of left hindlimb toes by immunohistochemistry. RESULTS: Compared with the normal control group (11.7±2.3) μm/mm2, the CGRP immunoreactive nerve fibers in the skin of nontreatment group (53.2±5.6) μm/mm2 were increased obviously (LSD-t=16.94, P<0.01). Meanwhile, the CGRP immunoreactive nerve fibers in the skin of treatment group (32.5±2.9) μm/mm2 were decreased obviously (LSD-t=8.47, P<0.01) compared with the nontreatment group, but were still more than those in the normal control group(LSD-t=8.47, P<0.01). CONCLUSION: The number of CGRP immunoreactive nerve fibers significantly increases in nerve fibers of skin of limb in diabetic foot. We consider that as a self-protect mechanism in body. Negative pressure can stimulate the releasing of CGRP in the sensory nerve fibers and expand the vessels, so it can be used for the treatment of diabetic foot.

Objective To investigate the expression of bag-1 gene and its correlation with axillary lymph node metastasis in breast cancer. Methods Expression of bag-1 in 100 cases of breast cancer (58 cases with axillary lymph node metastasis ) were detected by SABC immunohistochemistry. Results The positive rate of bag-1 expression in breast cancer was 85.0%. The bag-1 expression rate among pathologic grades I,II,III were 87.5%,82.4%,88.2% respectively, and no significant difference were observed (P0.05). The positive rates of bag-1 expression between breast cancer with axillary lymph node metastasis and that without axillary lymph node metastasis were 89.6%,78.6% respectively, and no significant difference was observed (P0.05). Conclusion There is an overexpression of bag-1 in breast cancer and the expression is not related to axillary lymph node metastasis.

AIM: To estimate the effect of human peripheral blood derived-endothelial progenitor cell(EPC) transplantation on the repairment of limb ischemia. METHODS: The mononuclear cells from human peripheral blood were cultured in M199 medium supplemented with 10% fetal bovine serum, 20 ng/mL VEGF and 4ng/mL bFGF in vitro. The specific markers of EPC were analyzed by FCS at day 6 and 14 during culture respectively. The bilateral femoral artery, great saphenous artery, iliac circumflex artery, and muscular branch of 15 Balb/c nude mice were ligated to cause limb ischemia. The 6-day adherence cells marked by CM-DiI were multipoint injected into the left local muscles of ischemic limbs(EPC group) and M199 was multipoint injected into the right local muscles of ischemic limbs (M199 group) in order to evaluate the therapeutic effect. Seven days after operation, 60 μg FITC-UEA was injected via tail vein.One hour later, the mice were killed.The heart,liver,lung,spleen,kidney and limb gastrocnemius were taken and examined with fluorescence microscopy. The number of capillaries of ischemic limbs was measured by factor Ⅷ related antigen immunohistochemical staining. RESULTS: The cultured cells at day 6 expressed KDR, CD133, CD34 and vWF,and the positive rates of KDR, CD133, CD34 and vWF were (46.4±9.3)%, (33.8±11.7)%,(73.5±6.3)%and (38.9±8.2)%, respectively. At the 14th day during culture, the cells expressed KDR, CD34 and vWF and the positive rates of KDR,CD34 and vWF were (81.5±7.6)%,(88.9±5.4)% and (78.3±13.6)%, respectively; the positive rate of CD133 dropped to (3.8±8.7)%. The necrosis and density of capillary of the ischemic limbs of nude mice were improved more obviously in the EPC group than that in the M199 group (P<0.05). Red and green fluorescence were observed in the paraffin section of ischemic limbs of nude mice in the EPC group. CONCLUSION: We can culture and obtain EPC from mononuclear cells of human peripheral blood in vitro under a certain condition. The transplanted EPC can incorporate into the local capillary networks and repair the ischemia of posterior limbs of nude mice.

OBJECTIVE: To assess the inhibitory effect on the proliferation of lymph node metastases with local injection of liposomal adriamycin (LADR) into rabbits bearing VX2 tumors in the mammary gland. METHODS: Thirty breast-tumor-bearing rabbits were divided into three groups, with 10 rabbits in each. Group 1 received a sham treatment. Group 2 received subcutaneous injection of LADR adjacent to tumor. Group 3 received intravenous injection of free adriamycin (FADR). The breast tumor and axillary lymph node were resected after the treatment was repeated three times. Node sizes before and after treatment were measured. Proliferating cell nuclear antigen (PCNA) mRNA expressions in breast tumors and lymph nodes were determined by RT-PCR. RESULTS: The mean growth ratios of axillary lymph nodes in groups 1, 2 and 3 were 3.70%, 1.55%, and 2.89%, respectively, with significant difference between groups 3 and 1 (P=0.004), and further difference between groups 2 and 3 (P=0.002). The relative values of PCNA mRNA expressions in breast tumors in groups 1, 2, and 3 were 0.486, 0.513, and 0.396, respectively. Group 3 expressed a sufficiently lower level of PCNA mRNA compared to groups 1 (P=0.023) and 2 (P=0.005). The PCNA mRNA expressions in axillary lymph nodes in groups 1, 2, and 3 were 0.541, 0.329, and 0.450, respectively. Compared with group 1, group 3 showed a markedly decreased level of PCNA expression (P=0.021). The lowest expression level was found in group 2, with a further significant difference from group 3 (P=0.004). CONCLUSION: Local injection of LADR appears to be an effective method in the treatment of lymphatic metastases from breast cancer, regardless of its little influence on the primary tumor.

Objective To explore the treatment protocol and evaluate the outcome of Weekly paclitaxel administration with or without epirubicin in breast cancer. Methods Total of 42 female patients with breast cancer in different stage were enrolled into the research, and were treated with Weekly paclitaxel administration with or without epirubicin immediately after pathological diagnosis. After 3 weeks operation was preformed in all patients, the administration lasted 1 to 4 circles with 3 weeks pause and would be changed if the patients have no response to it. Results No CR was acquired in 3 weeks treatment before the operation, but 6 and 29 of 42 patients were PR, and MR respectively ,the total response rate was 83.3%. The breast conservative surgery was performed in 10 patients and the modified radical resection was performed in 32 patients. No serious side-effect was observed in all patients. Conclusion Weekly paclitaxel administration is a safe and effective administration for breast cancer, which also can supply reliable foundation for operation and chemical treatments after operation. Therefore , it is warranted for wide use.

The objective of this study was to evaluate the role of fine needle aspiration cytology combined with mammography in the diagnosis of T_1 primary breast cancer.A total of 385 cases undertaking fine needle aspiration cytology combined with mammography in diagnosis who were identified to be T_1 primary breast cancer after operation were analysed retrospectively.Seventy-one point six percent of 213 cases undertaking fine needle aspiration cytology were identified to be breast cancer,while 21.6 percent of 213 cases were false negative;70.9 percent of 165 cases undertaking mammography were identified to be breast cancer,while 29.1 percent of 165 cases were false negative;93.5 percent of 93 cases undertaking fine needle aspiration cytology combined with mammography were identified to be breast cancer,while 6.5 percent of 93 cases were false negative.There were no statistically significant differences between fine needle aspiration cytology group and mammography group,P0.05,but fine needle aspiration cytology group and fine needle aspiration cytology combined with mammography group,P=0.000 0;mammography group and fine needle aspiration cytology combined with mammography group,P=0.000 0. In conclusion,Fine needle aspiration cytology combined with mammography is a useful,safe and convenient diagnosis method for breast cancer,which also can supply reliable foudation for operation and other treaments.

1 病例报告男,52岁.2004-04-30因上腹部和胸背部剧烈疼痛2 d, CT诊断为腹主动脉瘤,急诊转入我科.因腹部CT不能明确诊断,急诊行核磁共振动脉造影检查,结果为胸主动脉夹层动脉瘤,病变范围从左锁骨下动脉至肾动脉,DeBakey分型为Ⅲ型.入院后经降压等治疗,症状得到控制.因该患者有家族病史,强烈要求手术治疗,遂行动脉造影,明确破口位于胸主动脉降段靠近左锁骨下动脉开口处,大部分夹层分离腔内血液已机化,破口处只残留一大小约1.0 cm×1.5 cm的小腔.

AIM: To evaluate bag 1 expression in breast cancer and to evaluate its clinical significance. METHODS: One hundred samples of breast cancer specimens were analyzed by SABC immunohistochemical stain for anti apoptotic gene bag 1 expression. RESULTS: The positivity rate of bag 1 expression in breast cancer, benign tumor and normal tissues was 85.0%, 10.0%, 10.0% respectively,and significant difference was observed ( P 0.05). The bag 1 expression rate in pathologic grade I, II, III was 87.5% , 82.4%, 88.2% respectively, and no significant difference was observed ( P 0.05). The positivity rate of bag 1 expression in duct carcinoma, lobular carcinoma and special carcinoma was 85.5%, 84.8%, 80.0% respectively, and no significant difference was observed ( P 0.05). Following up 100 breast cancer patients showed that 5 year survival rate of bag 1 positive patients was 78.7%, and that of the bag 1 negative ones was 8.5%, significant difference was observed ( P 0.05). CONCLUSION: There is an overexpression of bag 1 in breast cancer. The positivity rate of bag 1 expression is not related to the pathologic grade and the clinical type. bag 1 might serve as a biomarker to diagnose and prognose breast cancer in the earlier period.

目的:探讨乳腺叶状肿瘤的临床病理特点、治疗原则和影响预后的因素.方法:1987-08/2002-06我院收治的24例乳腺叶状肿瘤患者的临床资料.结果:24例患者平均年龄37岁,按WHO分类标准,其中良性13例,交界性7例,恶性4例.10例行局部切除术,9例行乳腺单纯切除术,5例行乳腺癌改良根治术.随访20例,平均随访时间17mo(9～60mo),1例行乳腺癌改良根治术后2 mo复发,伴有广泛的肺转移,行左下肺叶切除术后1 a死亡,2例行局部切除术后复发.2例恶性患者术后行新辅助化疗(泰索帝+表阿霉素)2个疗程,肿瘤无明显变化,其余病例术后均未行放疗和化疗.结论:对直径＜5 cm的乳腺叶状肿瘤的应首选扩大局部切除术,切除肿瘤边缘不少于2 cm;对直径＞5 cm的乳腺叶状肿瘤尽早进行单纯乳房切除术.

目的:观察压力循环驱动对乳腺癌术后上肢淋巴水肿的治疗效果,并以双侧上肢放射性核素扫描检查评估治疗效果.方法:48例患者根据患侧上肢水肿程度分为轻度、中度和重度3组,分别以不同方案进行压力循环驱动治疗,随机抽选15人在治疗前、后分别行双侧上肢放射性核素扫描检查,观察淋巴流量的变化.结果:轻度和中度水肿组治疗后患侧肢体周径较治疗前明显减少(P＜0.01),肢体水肿程度明显减轻,经双侧上肢放射性核素扫描检查,患侧肢体淋巴流量较治疗前增加,总有效率为87.5%.但对于4例重度水肿患者仅1例有效.结论:对于乳腺癌术后的轻度-中度上肢淋巴水肿,肢体压力循环驱动治疗是一种经济、简便而又十分有效的方法,适合临床推广.

Objective To estabilish the method for evaluating post mastectomy upper extremity lymph edema by ECT,and to evaluate the curative effect by compression therapy.Methods Every patient was given continuous compression therapy immediately after post mastectomy upper extremity lymph edema.The ECT was performed in 14 patients selected randomly from 50 patients that enrolled in the research.And the parameters were collected by the ECT computer and analyzed.Results The circumference of the injured upper extremity reduced significantly(P0.05) after compression therapy.The lymphatic return increased significantly(P0.05) after compression therapy according to evaluation parameters by ECT.Conclusion Compression therapy is effective to post mastectomy upper extremity lymph edema in breast cancer patients.