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Objective To observe the clinical effect of endoscopic retrograde cholangiopancreatography (ERCP)biliary stent implantation and percutaneous transhepatic cholangiography(PTCD)in the treatment of malignant obstructive jaundice(MOJ).Methods Eighty-eight patients with MOJ treated in the Second Affiliated Hospital of Hainan Medical University from January 2013 to March 2016 were selected and then randomly divided into ERCP group and PTCD group,44 cases in each group.ERCP group received biliary tract stent implantation via ERCP pathway, and PTCD group underwent percutaneous transhepatic biliary puncture.The success rate,clinical efficacy,liver function and complication rate of the two groups were compared.Results The success rate of ERCP group was 93.18%(41/44),and the success rate of PTCD group was 90.91%(40/44).There was no significant difference between the two groups(P>0.05).In terms of the clinical curative effect,the total effective rate of ERCP group was 92.68%(38/41),the total effective rate of PTCD group was 90.00%(36/40),there was no significant difference between the two groups(P>0.05);the low obstruction efficiency in ERCP group was significantly higher than that of PTCD group(100.00%vs.75%),the high obstruction efficiency in ERCP group was significantly higher than that of PTCD group (96.43% vs.83.33%),the differences between the groups were statistically significant(χ2=3.503,2.771,P<0.05);in terms of the liver function recovery after treatment,the liver function index of patients with low obstruction in ERCP group were better than that in patients with high obstruction,while in PTCD group,patients with high obstructive had better liver function,compared to the low obstruction patients,the differences were statistically significant(P<0.05); the complication rate in ERCP group and PTCD group were11.36% and 15.91%,the difference was not statistically significant(P>0.05).Conclusion The ERCP pathway and PTCD pathway implantation of biliary metal stent have great clinical efficacy,while in comparison,ERCP pathway performs better in low obstruction and PTCD pathway was more suitable in high obstruction.In the course of clinical treatment,the selection of surgical approach should be based on the different obstruction sites of the patients,so as to obtain the best therapeutic effect.
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Primary salivary duct carcinoma(SDC) featured with giant cell tumor(GCT) is a extremely rare, relatively new understanding lesion and its histogenesis has not been fully defined. This paper reported a case of SDC associated with GCT, its clinical, histopathologic features and histological origin were discussed in combination with literature review.
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Humans , Carcinoma, Ductal , Carcinoma, Squamous Cell , Giant Cell Tumors , Head and Neck Neoplasms , Salivary Ducts , Salivary Gland NeoplasmsABSTRACT
To investigate the influence of bear bile on rat hepatocarcinoma induced by diethylnitrosamine (DEN), a total of 40 rats were randomly divided into 4 groups: normal control group, model group, and two bear bile treatment groups. The rat liver cancer model was induced by breeding with water containing 100 mg x L(-1) DEN for 14 weeks. The rats of the bear bile groups received bear bile powder (200 or 400 mg x kg(-1)) orally 5 times per week for 18 weeks. The general condition and the body weight of rats were examined every day. After 18 weeks the activities of serum alanine transaminase (ALT), aspartate transaminase (AST) and total bilirubin (TBIL) were detected. Meanwhile, the pathological changes of liver tissues were observed after H&E staining. The expression of proliferative cell nuclear antigen (PCNA) and a-smooth muscle actin (alpha-SMA) in liver tissue were detected by immunohistochemical method. After 4 weeks the body weights of rats in normal group were significantly more than that in other groups (P < 0.05); and that in the two bile groups was significantly more than that in the model group. Compared with normal group, the level of serum glutamic-pyruvic transaminase and total bilirubin increased significantly in other groups; compared with model group, these two indexes decreased significantly in two bile groups. Hepatocellular carcinoma occurred in all rats except for normal group; there were classic cirrhosis and cancer in model group while there were mild cirrhosis and high differentiation in two bile groups. There were almost no expressions of PCNA and alpha-SMA in normal group while there were high expressions in model group; the two bile groups had some expressions but were inferior to the model group, and alpha-SMA reduced markedly. It indicated that bear bile restrained the development of liver cancer during DEN inducing rat hepatocarcinoma, which may be related to its depressing hepatic stellate cell activation and relieving hepatic lesion and cirrhosis.
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Objective To find out the best orientation and section for diagnosing rheumatic heart disease using multiplane transesophageal echocardiography (TEE). Methods The visible heart was compared with the images by multiplane TEE for the establishment of the best orientation and section for multiplane TEE for the diagnosis of rheumatic heart disease. Results The best orientation and section of mitral valve detected by multiplane TEE were the four chamber view at 0? orientation at the end part of esophagus. The best orientation and section of aorta valve were short axis section of the heart at 45? orientation and long axis section of the heart at 135? orientation at the middle part of the esophagus. The best orientation and section were the short axis section at 45? orientation and the oblique short axis section at 0? orientation of the aorta valve at the middle and the upper part of esophagus. Conclusion The best orientation and section of TEE based on the study of the visible heart are helpful to simplify the operation procedure of multiplane TEE and to shorten the examining time.
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Objective To find out the best orientations and sections in diagnosing tetralogy of Fallot using multiplane transesophageal echocardiography(TEE).Methods The visible heart was compared with the images of multiplane TEE to determine the best orientations and sections in the multiplane TEE for tetralogy of Fallot.Results The best orientation and section of pulmonary artery and its branches in multiplane TEE was the pulmonary artery viewed at 0? from the upper part of esophagus;that of ventricular septal defect and aortic overriding were five chambers viewed at 0? from the middle part of esophagus or the left ventricle long-axis view at 135? from the middle and end parts of the esophagus;that of the right ventricular outflow tract stenosis and the right ventricular hypertrophy was the right ventricular outflow tract long-axis viewed at 45? from the middle part of esophagus.Conclusion The best orientations and sections in TEE based on the visible heart are helpful to simplify the operation procedure of multiplane TEE and to shorten the examination time.
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Objective To establish more detailed dataset of Chinese visible human male. Methods After undergoing macroscopical, CT and MRI examinations to exclude organic lesion, a young aged, middle sized male cadaver was selected as the subject. First, morphological measurement and vascular perfusion were performed. Second, after embedding with 5% gelatin, the cadaver was put in ice house and frozen to -30 ℃ for 1 week. Third, TK 6350 numerical control milling machine (milling accuracy of 0.001 mm) was used to shave off slices of the body layer by layer from head to foot at -25 ℃ in low temperature laboratory. Fourth, the successive cross sections were photographed with high resolution digital camera and scanned into an animation computer. Thus, data acquisition from cadaver model was completed to obtain structural dataset of the human body. Results The selected sample was a 21 year old, 1 820 mm in height, 66 kg in weight male died due to non organic disease. CT with 1.0 mm slice thickness for the head and neck and 2.0 mm for the rest of the body was performed. MRI with 1.5 mm slice thickness for the head and neck and 3.0 mm for the rest of the body was also performed. A total of 18 398 serial cross sections with the thickness of 0.1 mm of each section were obtained. The digital photographs were sampled at a resolution of 10 989 056 (4 064?2 704) pixels. The data file of each section occupies 62.9 MB. The complete data files occupy 1 157.23 GB. The research results are issued simultaneously on the Internet (http://www.chinese visiblehuman.Conclusion ① Review of the related literatures reveals that the thinnest thickness of the reported cross section of the visible human dataset is 0.2 mm(the thickness of the sections of the skull base of the first case of Chinese visible human reported by our research group is 0.1 mm.), and the slices consist of several thousands of serial cross sections with several millions of pixels. The data files occupy several tens of GB or more than 100 GB. However, the thickness of the cross sections of the whole body of the dataset achieved in our research is 0.1 mm. The total slices consist of 18 398 serial cross sections with the photographic resolution of 11 million pixels and the total data file reaches 1 157.23 GB. The three indexes mentioned above are elevated by 1 log unit. ② We have solved the key technical problems in data acquisition of visible human such as super thin serial cross sectioning, enormous quantity of data storing and display of tiny blood vessels.
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Objective To study the sectional anatomy of the heart with esophagus to provide the sectional anatomic data for transesophageal echocardiography(TEE). Methods Hearts with esophaguses were sectioned at the angles of 0?, 45?, 90? and 135? relative to the human cross section by frozen section technique. The sectional anatomic structures were observed and analyzed. Results A total of 140, 130, 44 and 130 slices were obtained at the angles of 0?, 45?, 90? and 135?, respectively. The anatomic structures of the key slices were described. Conclusion The thin sections of the heart can clearly display the anatomical details of the inner structures of the heart, which may play an important role in the clinical application of TEE.
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Objective To achieve computer visualization of the first Chinese visible male and female Methods After acquisition of the dataset of the first Chinese visible male and female (2 518 cross sections were obtained from the visible male, the complete data files take up 90 468 GBs; while 3 640 cross sections from the female, the complete data files take up 131 04 GBs ), we processed 2 D images in an SGI Workstation and on P4 computer respectively Then, image registration was performed through reserved scaling point Reconstruction was achieved by two approaches: volume rendering reconstruction and surface rendering reconstruction Results We visualized the whole body and special parts of Chinese visible male and female on an SGI Workstation and a personal computer respectively Furthermore, by optimizing 3 D reconstruction and data processing technique, interactive 3 D visualization of the dataset was achieved Conclusions ①The dataset of the first Chinese visible male and female proves to be eligible for 3 D visualization research ②The platform setup of interactive 3 D visualization of Chinese visible male and female dataset provides foundation for digital human anatomy and virtual surgery ③The models of human organs and parts built through data segmentation, classification, registration and drawing lay basis for rendering complex structures of the whole human body delicately
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Objective To build the dataset of Chinese visible human female. Methods After undergoing macroscopical, CT and MRI examinations to exclude organic lesions, a young female cadaver of medium height was selected as the subject. After morphological measurement and vascular perfusion, the cadaver was embedded with 5% gelatin and cryopreserved in a -30 ℃ icehouse for 1 week. A digital milling machine TK 6350 (milling accuracy of 0.001 mm) was used to shave off slices of the body layer by layer from head to foot in a laboratory at -25 ℃. The successive cross sections were photographed with a high definition digital camera, and the pictures were put into a computer to establish a dataset of human body. By utilizing the image dataset derived from the successive cross sections, 3D reconstruction and stereodisplay of human structure were finished with a SGI Workstation which was equipped with an independently self developed software package for 3D reconstruction. Results The selected specimen, a 22 year old female native of Chongqing, was 1 620 mm in height, 54 kg in weight and died of non organic disease. CT scans were made in every 1.0 mm for head and neck and every 2.0 mm for rest parts, and the thickness for MRI scans was 1.5 mm for head and 3.0 mm for rest parts. For serial cross sections, the thickness was 0.25 mm for head and 0.5 mm for rest parts. Thus, a total of 3640 slices were obtained, and the photo for every slice was saved as a 36 MB file in a resolution of 6 291 456 pixels (3 072?2 048). Finally, the complete data files reached to 131.04 GB. Conclusion ① This is the first formally reported case of Chinese visible human female, suggesting that China becomes the second country owning visible human female dataset of her population. We set up a website for the purpose of exchanging ideas and information on this subject. So, the results are issued simultaneously on the Internet (http://www.chinesevisiblehuman.com).② According to US Visible Human Project(VHP), the data of the 3 junctional parts of their female cadaver were absent because the body was cut into 4 segments. Taking the age of 59 year old into account, the visible human female's body was not exactly perfect. The sections of 0.33 mm in thickness were saved to pictures at a resolution of 2 490 368 pixels (2 048?1 216). While, the first Chinese visible human female reported here is a young female without organic disease or lesion. No sectional datum is lost for being acquired from successive sections of the whole body. The resolution of cross sectional image reaches to 6 291 456 pixels (3 072?2 048).
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Objective To provide anatomic proof for the localization in neck operation and clinical diagnosis of infection and tumor infiltration. Methods A total of 15 cadaver heads and necks were sectioned on transverse plan with cryosection. The layers and characteristics of the deep cervical fascia were observed. Results The deep cervical fascia was divided into four layers with the fasciae of the infrahyoid muscles being a single layer. The deep layer of the deep cervical fascia was subdivided into alar fascia and prevertebral fascia. The carotid sheath was composed of all the layers of the deep cervical fascia. Conclusion The model figure of the deep cervical fascia is obtained.
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Thirty adult hands were dissected under dissecting microscope, and it was found that the nutrient arteries of the superficial thenar muscles arise from the nearby branches directly or indirectly from the radial artery. They take a centripetal course supplying the muscles from the periphery towards the center. Both the muscles and arteries are superficially located with abundant anastomoses between the vessels. From the morphological point of view, it is less likely that there will be ischemic contracture of the muscles if the arteries are compressed.
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In many textbooks and literatures the superficial circumflex iliac artery (SCIA) is generally described, but only its superficial main branch (SMB) is referred, Its deep main branch (DMB) is always neglected, though it is present constantly. In 56％ of fifty cases we studied the SCIA trunk possesses both these main branches.The SMB is present in 86％ of the cases studied. After it originates from the trunk, it usually emerges promptly from the back of deep fascia into the subcutaneous layer. The points of emergence were found in an area around a center located 15 mm lateral and 10 mm below the origin of femoral artery. The course of the SMB can be marked as a line which located between a point 15 mm below the origin of femoral artery and anterior superior iliac spine. The SMB supplies an area along the lateral half of inguinal ligament, and its terminal branch usually turns upwards to the lateral portion of the abdominal wall.The DMB is a constant branch in our cases. It runs parallel to and 15mm beow the inguinal ligament, It supplies the upper lateral portion of the thigh, and its terminal branch usually turns downwards and laterally into the superficial layer of the gluteal region. The site where the DMB penetrates the deep fascia was found in an area around a center located 20 mm below the anterior superior iliac spine.The caliber of each of the two main branches is intimately correlated with the size of the skin which supplies. The course of the(SCIV)is similar to one of the main branches of the SCIA or runs between them (70％) The axes, thickness, size of the groin skin flaps were discussed.
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The arteries of the palmar part of the hand were examined in 50 hands of adult under the operating microscope.The arteries of the hand are arranged at three main levels: the superficial palmar arteries, the deep palmar arteries and the dorsal network. The arterial anastomoses between the levels may be divided into 2 groups: the marginal and the central anastomoses, the former which is situated at the radial and ulnar borders of the palm can be subdivided into superficial and deep groups, the latter is located in the central part of the palm including the direct and indirect anastomostic branches, the proximal and distal perforating branches, and the intermetacarpal perforating branches. The deep arch and its branches, as the center in the total arterial architecture of the palmar part of the hand, closely links with the arteries of the superficial and dorsal ones, playing an important role in regulating the collateral circulation of the hand.The flow formula of the Poiseuille's law indicates that the significant correlation exists between the arterial diameter and the blood flow. For the variety of diameter of each portion of the anastomostic branches, we inferred that the main source of blood flow in the superficial arteries is the ulnar artery and in the deep is the radial artery. The blood within the marginal anastomoses flows from palmar to dorsal, the central mainly from the deep arch and its branches.The dominant parts of the collateral circulation of the hand were found, that is, the deep arch dominantes over the superficial arch and the dorsal network, the central anastomosis over the marginal, the deep branches of the marginal over the superficial branches.The arrangement of the digital arteries has been discussed.
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The pattern and distribution of vimentin intermediate filament in synovial cell in vitro were observed by means of immunohistochemistry,confocal scanning laser microscopy (CSLM) and three-di-mentional photograph reconstruction on adherent cell analysis and sorting (ACAS 570). The result showed that vimentin presented spongy stero-structure in whole cytoplasmic space. The reconstructed three-dimentional photograph was similar to the appearance of the cultured synovial cell. The relationship between the distribution of vimentin and the morphological change of cultured synovial cell in different growth period was discussed in this paper.
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In 82% of fifty groin regions of the cadavers studied, the superficial external pudendal artery (SEPA) possesses an upper and a lower main branches (UMB, LowMB). In 66% of them, the two main branches come from one common trunk and in the rest, they arise independently. Most of the SEPA trunks or main branches arise from the femoral artery. The penetrating points of the SEPA trunk or main branches through the cribriform fascia are located at the medial or lateral margin of the terminal end of the great saphenous vein around a center 10 mm medial and 50 mm distal to the origin of femoral artery. If the SEPA trunk or main branches are crossing the great saphenous vein, it is frequently found that the SEPA trunk and LowMB are crossing behind but the UMB in front of it.The UMB supplies the suprapubic, prepubic and medial part of the inguinal regions. A line which connects a point 50 mm distal to the origin of femoral artery with the pubic tubercle is suggested as the axis of UMB free skin flap. The LowMB supplies the upper part of anterior medial femoral and prepubic regions. A line which is parallel to the pubic crest and 50 mm distal to the origin of femoral artery is suggested as the axis of LowMB free skin flap. The caliber of each of the two main branches is intimately correladed with the area of the skin which they supplied.In 82% of cases, two sets of superficial veins are not present. These superficial external pudendal veins are also the accompanying veins of the corresponding arteries.The advantages of using these vessels as skin flap pedical vessels were discussed.
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1000 fibulae of Chinese adults were observed and measured. It was found that the angle between the capital articular surface and the long axis of fibula is positively correlated with the circumference of the fibula. In 84.3% among the 1000 specimens, the body of the fibula posesses four borders and four surfaces. It would be more rational, if the nomination of these surfaces were based on their muscle attachments.The average maximum length of the fibula is 340.42?22.76 mm, the smallest circumference is 33.68?4.40 mm, the middle circumference is 39.52?4.99 mm. The caliber index, middle caliber index and the diaphyseal index were calculated respectively. The results obtained show that the side difference as a whole was statistically insignificant, but the diameter at the middle part is an exception. In the paired bones, there are more cases with larger circumference and diameter at the middle on the right side than on the left.According to our observations, some of the relationships between the morphology and function of the fibula were discussed.
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The arteries of thirty human adult upper extremities, injected with red lead oxide, were treated with angiography, sectional dissection and photography. A microcomputer was used to determine the positions of the vessels and reconstruct the arterial system of the hand.The arteries of the palm are arranged in 2 or 3 layers. The area of three layers were only observed in the middle portion of the palm. The divisions of the territories of the radial and ulnar arteries are not the same in different layers. The anastomotic branches in the palmo-dorsal direction are usually observed in the third, fifth and seventh sections. There are three chief anastomotic channels between the radial and ulnar arteries in the palm, i.e. the deep palmar arch, the superficial palmar arch and a third pathway. The patterns of the blood supply in the palm and its clinical significance have also been discussed.