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Objective:To investigate the brain characteristics of chronic schizophrenia by voxel-mirrored homotopic connectivity (VMHC).Methods:Forty seven patients with chronic schizophrenia from Tianjin Anding Hospital and 31 healthy controls from nearby communities were included in the study. The MRI data of the subjects were collected by Siemens Skyra 3.0 T MRI.Positive and negative symptoms scale (PANSS) was used to assess the illness severity of patients with chronic schizophrenia.SPM12 was used to process the collected MRI data. DPARSF was used to calculate the VMHC values of subjects in the two groups. The independent sample t test based on SPM12 was used to compare the VMHC values of the two groups. The significant brain regions in VMHC were regarded as regions of interest (ROI), and VBM8 was used to further analyze the gray matter volume of the ROI of the two groups. Results:Compared with healthy controls, the patients with chronic schizophrenia demonstrated decreased VMHC mainly located in lingual gyrus(voxel=208, T=4.98), occipital middle occipital gyrus(voxel=156, T=3.75) and postcentral gyrus(voxel=237, T=4.36) (FDR correction, q=0.05). Compared with healthy controls, the gray matter volumes in bilateral lingual gyrus(left(0.0034±0.0008), (0.0028±0.0013), t=-2.141, P=0.037; right(0.0025±0.0006), (0.0020±0.0011), t=2.268, P=0.028) and postcentral gyrus((0.0432±0.0051), (0.0372±0.0162), t=-2.070, P=0.045) increased, but non-significant change in postcentral gyrus of the patients with chronic schizophrenia. Conclusion:The abnormal VMHC mainly locate in lingual gyrus, middle occipital gyrus and postcentral gyrus in patients with chronic schizophrenia.
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Objective To summarize surgical experience for the treatment of substernal goiter.Methods 102 cases of substernal goiter underwent surgical resection,in 74 by low collar incision,12 cases by larger low collar incision and pillowing the shoulder pad about 20 degrees for neck hyperextension,8 cases by unilateral or bilateral infrahyoid muscles transection,8 cases by low collar and up-mid-sternal incision plus horizontal sawing in 2 and 3 ribs.Results Resection was performed successfully in all cases.Hoarseness occurred in 7 cases,4 cases recovered after one month,3 cases did not improve because of tumor invasion of laryngeal recurrent nerve.Postoperative transient hypocalcemia in 9 cases recovered after 2 to 3 months.102 patients were followed up for 1 to 3 years without recurrence.Conclusions Substernal goiter can be resected successfully through a transcervical approach or mid-sternal incision.CT scanning and chest X radiograph are decisive for the surgical approach.
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Objective To summarize the experiences in the diagnosis and treatment of delayed rupture of spleen.Methods The clinical data of 26 patients with traumatic delayed rupture of spleen who were admitted to the Dachang Hospital from January 2005 to December 2013 were analyzed retrospectively.The medical history,clinical presentation,results of laboratory examinations were analyzed,and the splenic trauma was graded.Surgical procedures were selected according to the condition,severity of the splenic trauma and time of injury.Patients were followed up via outpatient examination or telephone interview till June 2014.Results Twenty-six patients had the history of injury of the left hypochodriac region,and were accompanied by slight abdominal pain and a short period of pain alleviation,and then pain in all regions of the abdomen at postoperative hour 48.All thepatients had pale face,tenderness,rebound tenderness or tonus.The pulse above 100 per minute was observed in 20 patients,and 15 patients had blood pressure under 90/60 mmHg (1 mmHg =0.133 kPa).The level of hemoglobin under 5 g/L was observed in 3 patients,and 5-10 g/L in 21 patients.All the 26 patients received abdominal paracantesis,non-coagulating blood was extracted in 25 patients.Twenty-six patients received B ultrasonography,and 24 had splenic rupture.Nineteen patients received computed tomography (CT),and 19 had splenic rupture.Ten patients had type Ⅰ splenic rupture,12 had type Ⅱ splenic rupture,3 had type Ⅲ splenic rupture and 1 had type Ⅳ splenic rupture.All the 26 patients received operation,including 2 received suture of the ruptured spleen,2 received resection of the lower part of the spleen,9 received total splenic resection,and 13 received total splenic resection + autogeneous transplantation of greater omentum.Two patients died of hemorrhagic shock intraoperatively,and the other 24 patients were cured.The operation time and volume of hemoperitoneum were (90 ± 15)minutes and (1 500 ± 700) mL,respectively.Twenty-four patients received blood transfusion,with the volume of transfused blood of 1 200 mL.The mean duration of hospital stay was 16.7 days.Two patients had complications after the operation,which were left pleural effusion and splenic fossa effusion,and they were cured by symptomatic treatment.No infection or other complications were observed.All the 24 patients were followed up for 6-108 months (median,46 months).One patient died of myocardial infarction at postoperative year 5,and the other 23 patients survived.Conclusions B sonography and computed tomography are important methods for the treatment of delayed rupture of spleen.Traumatic delayed rupture of spleen should be considered when the patient had symptoms including history of injury of the left hypochondriac region,the course of abdominal pain,abdominal pain alleviation,abdominal pain recurrence,time for abdominal pain alleviation longer than 48 hours,interperitoneal hemorrhage and the signs of splenic rupture indicated by B ultrasonography and computed tomography.The indication of spleen-preservation surgery or splenectomy for patients with delayed rupture of spleen should be strictly controlled and optimal surgical procedure should be designed according to the condition of the patient.
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Objective To explore the diagnosis and treatment of cystic dilatation of the cystic duct in adults.Method Clinical data of 25 cases of the cystic dilatation of cystic duct in adults in 3 hospitals in Songhuajiang river drainage area from 1991 to 2012 confirmed by surgery were analyzed retrospectively.Results The 25 cases were with manifestations of chronic cholecystitis,and 14 patients with right upper quadrant recurrent biliary colic and nausea,vomiting and other gastrointestinal symptoms,9 patients with yellowish discoloration of sclera and skin,and fever.Ultrasonography was done in 25 cases,ERCP in 16 cases and MRCP in 9 cases,displaying liquid dark area of diameter from 1.6 cm × 1.6 cm to 2.5 cm ×2.5 cm in the gallbladder tube suspective of calculi,and characteristic dumbbell shape image.Preoperative diagnosis was cystic duct cyst with stones or gallstones which was confirmed by surgery.Gallbladder and cyst resection was performed in all 25 cases,and bile duct jejunum Roux-en-Y anastomosis was done in 2 of these cases because of introgenic bile duct injury.Conclusions Cysts of the cystic duct is the special type (Ⅵ type) of choledochocele,and its prognosis is good after surgical treatment.
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Objective To study the etiology,diagnosis and treatment of xanthogranulomatous cholecystitis (XGC).Methods Clinical data of 78 cases with xanthogranulomatous cholecystitis (confirmed by postoperative pathology) from January 1985 to December 2012 were reviewed retrospectively.Results All 78 cases underwent ultrasonography,50 cases did CT scan.Preoperative diagnosis included chronic calculous cholecystitis in 60 cases,gallbladder carcinoma with cholelithiasis in 8 cases,gallbladder space-occupying lesions in 10 cases.Among those 68 cases of tentative gallstone disease,67 cases were with gallbladder neck incarcerated stones.Surgery were performed in all 78 cases including cholecystectomy in 48 cases,partial cholecystectomy or subtotal resection in 13 eases,cholecystectomy with partial hepatic wedge resection in 12 cases.Intraoperatively 5 cases were misdiagnosed as the carcinoma of the gallbladder and underwent partial liver resection along with cholecystectomy.17 cases underwent choledocholithotomy.2 cases suffered from hepatic duct injury and received Roux-en-Y hepatojejunal anastomosis.Conclusions XGC is a special type of chronic cholecystitis,and accompanied by yellow granuloma formation.Preoperative diagnosis of XGC is often difficult,the definite diagnosis depends on intraoperative fiozen and postoperative paraffin pathology.
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Objective To explore the etiology,diagnosis and treatment of omohyoid muscle syndrome(OMS).Method Clinical data of 34 OMS cases was analyzed retrospectively from 1980 to 2008.In the autopsy of 19 bodies we studied omohyoid muscle,especially the intermediate tendons,sheaths of tendon and projection of omohyoid muscles.Result The symptom of omohyoid muscle syndrome lies in a mass that can be seen on the neek while swallowing,and the patient feels discomfort and dysphagia.The mass disappears immediately after swallowing and cann't be found by palpation.Congenital fascia weakness,intermediate tendon sheath relaxation,atrophy,degeneration and contracture of omohuoid muscle causes OMS.OMS was diagnosed on clinical manifestation.All 34 patients were treated surgically including cutting off the cross part of omohyoid muscle and sternocleidomastoid muscle,separating adhesion of muscle and fascia.Postoperatively symptoms disappeared in all these 34 patients.Conclusions Omohyoid muscle syndrome is a disease that can be easily diagnosed basing on characteristic clinical symptom and sign,the prognosis is good if treated properly by an operation.
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Objective To summarize the etiology,pathological mechanism, and the experience of diagnosis and treatment of bronchobiliary fistula (BBF). Methods Clinical data of 29 BBF patients admitted and operated on from 1976 to 2009 were analyzed retrospectively. Results Clinical menifestation included abdominal pain, chill and high fever,jaundice, hepatomegaly, chest distress, cough, hemoptysis,bilious cough, moist rale in the lower right lung or decreased or disapeared breath sound. Abdominal radiograph, chest X-ray, BUS, CT, PTC, MRCP and ERCP are helpful for localizing diagnosis. All the 29patients were surgically treated. 19 patients were treated by choledochotomy to extract common bile duct stones, T-tube drainage, liver abscess drainage, fistula excision and diaphragmatic repair. Three patients were treated by cholecystectomy, choledocholithotomy, and T-tube drainage. One patient underwent cholecystectomy, choledocholithotomy, and Roux-en-Y hepatojejunostomy. Three patients received liver abscess drainage, choledochotomy, T-tube drainage. 2 patients did subphrenic abscess drainage,choledochotomy, T-tube drainage. One patient complicating Oddi sphincter stenosis received liver abscess drainage, diaphragmatic repair, and Roux-en-Y hepatojejunostomy. 26 patients were cured. 3 patients died.Conclusions The etiology of BBF is obstruction related bilious tract infection leading to liver abcess and lung abscess. In the process of surgical treatment, relief of bilious tract obstruction, clearance of focal lesion and effective drainage of biliary tract are the mainstay of management.
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ObjectiveTo summarize our experience on the diagnosis and surgical treatment of hepatocellular adenoma (HCA).MethodsClinical data of 47 HCA cases managed from 1989 to 2009 were analyzed retrospectively. ResultsAll were single lesions.Preoperative correct diagnosis was established in only 7 cases ( 14.9％ ).Tentative malignant space-occupying lesions was diagnosed in other 40 cases (85.1％),including hepatocellular carcinoma in 11 cases,liver hemangioma in 10 cases,liver focal nodular hyperplasia in 14 cases and miscellaneous in the remaining 5 cases.Local resection,segmental hepatectomy,hepatic lobectomy and hemiheptectomy were performed according to the size and location of the lesions.To prevent recurrence or malignant transformation,not less than 1.0 cm safe margin was allowed in all cases.Final diagnosis was made by fast frozen pathology or postoperative pathology.Postoperatively 45 cases were followed up to 6 years without recurrence.ConclusionsPreoperative misdiagnosis of HCA is common.Surgical resection is the only effective treatment,and the prognosis of HCA is favorable.
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Objective To summarize the diagnosis and surgical treatment of hepatic focal nodular hyperplasia (FNH). Methods The clinical data of 63 patients with FNH proved by pathology were analyzed retrospectively. Results The disease mainly affected young to middle aged, 50 cases (79. 4% )were of 31-50 years old. Male and female ratio was 2.94: 1. Fifty-six patients (89%) were asymptomatic, 3 cases were HBsAg positive (4.8%). Liver function was basically normal (92. 1%),5 cases (7.9%) were with elevated level of total bilirubin and rGT. AFP, CEA and CA19-9 was all negative. FNH occured as a single node in 95.2% cases, ranging from 1.5 cm to 17 cm in diameter ( average 4. 5 cm). Of these patients, 25 lesions were present in the left lobe, 29 in the right lobe, 6 in the mid lobe, and 3 in the caudate lobe. A big central artery was found in 2 cases (3. 2% ) as found by color Doppler ultrasound. CT scan showed transient immediate enhancement in 96. 8% (61/63) of patients, with central scar in 6 cases. MRI demonstrated early vigorous enhancement in 93. 7% (59/63) of patients, with central scar in 5 cases. All patients underwent surgical resection; including local resection in 34 cases;segmentectomy or hepatectomy in 13 cases; hemihepatectomy in 13 cases. There was no postoperative mortality and major complications. Conclusions FNH is a kind of hepatic benign disease and characteristic of high preoperative misdiagnosis rate (25. 4% ).
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OBJECTIVE: To evaluate the features and application of tissue engineered biomaterials in repairing femur defects, and to search an optimal femur substitution.METHODS: Papers published between January 1993 and October 2009 were searched using computer with key words of "tissue engineering, femur defect, mesenchymal stem cells, cytokines and materials" both in English and Chinese. Documents addressing biomaterials and tissue engineered bone in repairing femur defects were included. Repetitive research or Meta analysis was excluded. After that, 21 literatures were selected to discuss the features and application of tissue engineered biomaterials in repairing femur defects.RESULTS: Stem cells technology is obtaining seed cells from myeloid tissues, amplifying in vitro, combining with scaffold material, and in vitro constructing tissue engineered bones. The cultured cells could maintain osteoblast biological characteristics and fully fused with bone tissues at recipient sites, simultaneously, avoid immunological rejection. The combination of materials or modify the material surface could promote cells adhere to materials and increase the cellular biological activity. When transfecting seed cells to bone defect areas using certain carriers, the transplanted calls could form new bones and secret bone growth factor, induce determined osteogenic precursor cells differentiated into inducible ostegenic precursor cells, thereby, fasten the bone healing. The composite materials prepared by three-dimensional virtual surgical simulation and computer numerical control exhibited advantages of composite materials and histological anatomy conjunction, which had perfect appearance.CONCLUSION: Currently, there is no material can fully meet the requirement of bone tissue engineering. Thus, promoting adhesion between cells and materials, increasing cellular biological activity, and maintaining biological functions by combing materials or modifying material surface are the research focuses.
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BACKGROUND: In vivo and in vitro experiments have demonstrated that polyetheretherketone (PEEK) polymer is the best cervical fusion cage material due to its good biocompatibility, elastic modulus similar to human bone, and satisfactory plasticity and hardness.OBJECTIVE: To assess the outcomes of polyetheretherketone (PEEK) cage filled with nano-artificial bone following anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy.METHODS: In total 17 patients with cervical spondylotic myelopathy were collected from the Department of Orthopedics, First Affiliated Hospital of Harbin Medical University between May 2007 and September 2009. There were 12 males and 5 females,averaging 55 (range 42-67) years of age. All patients underwent ACDF using PEEK cage filled with nano-artificial bone. Patients'neurological functions were assessed on the basis of Japanese Orthopaedic Association (JOA) scoring system. The distance between the midpoint of the upper end plate and lower end plate was measured as interboby height. Radiographs with the neck in lateral flexion and extension were obtained to evaluate fusion results.RESULTS AND CONCLUSIONS: Seventeen patients with cervical spondylotic myelopathy participated in the final analysis.Almost all patients had symptomatic improvement. Within postoperative several days, muscle strength of lower limb was increased, and limb was more flexible after surgery than prior to surgery. At 3 months after surgery, JOA scores were significantly increased compared to prior to surgery, the operated segments were stable and disc space height was satisfactory. In addition, no complications were found, and all cases achieved solid fusion, as confirmed by radiographs. These findings suggest that the immediate stability of the operated segments can be obtained by anchoring PEEK cage, and the nano-artificial bone-filled PEEK cage is safe, simple, and with relatively few complications. It is therefore a good choice for patients with cervical spondylotic myelopathy.
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Objective To summarize the diagnosis and surgical treatment of the cavernous transformation of portal vein (CTPV). Methods Clinical data of 63 patients with adult CTPV trea-ted in our hospital from 1976 to 2006 were retrospectively analyzed. Results The diagnosis of CT-PV was comfirmed according to (1) The main symptoms were repeated haematemesis, hemafecia, hy-persplenotrophy, hypersplenia and normal hepatic function. (2) B uhrasonography or ultrasonic Doppler manifested that portal vein thinning or obstruction or embolism, honeycomb appearance con-duit can be seen around. Portal vein frequency spectrum can be seen in the honeycomb appearance con-duit. (3) CT and MR scan materials were exhibited that the main portal vein and its branches lost the normal shape and had the shaggy edge. (4) percutaneous splenoportography or selective arteriography of superior mesenteric artery showed that occlusion of the main branch of portal vein at the porta hepa-tis was revealed, and a masslike network of tortuose veins around the porta hepatis and many small ir-regular veins radiating from the network to the liver were demonst rated. Splenectomy and devaseu-larization was performed in 23, spleneetomy and splenorenal shunt in 32, portal systemic shunt plus porta-azygous devascularization in 8. Portal hypertension was treated first in CTPV with disease of biliary tract. No death happened. The rascult of haemogram recovered in a short period of time.Conclusion Once the patients are diagnosed to suffer from adult CTPV, they should receive explora-tory laparotomy. It is important to choose the most effective treating method for the disease.
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Objective To compare extramedullary fixation (EF), intramedullary fixation (IF) and dipolar femoral replacement(DFR) in the treatment of intertrochanteric fractures in the elderly patients. Methods From July 1999 to December 2008, 172 old patients with intertrochanteric fractures were treated by either EF, or IF or DFR. The operative procedures, complications and therapeutic effects were compared between the 3 methods. Results The patients included in the present study were followed up for 8 to 36 months (average, 19. 6 months). There were significant differences ( P<0. 05) in incision length, operation time, intraoperative blood loss, functional recovery and complications between the 3 methods. IF had the shortest incision length and the least intraoperative blood loss. DFR had less blood loss than EF. IF had the least operation time, followed by DFR. DFR had the best functional recovery one year postoperatively. IF had shorter rehabilitation and healing time than EF. Conclusions EF is the first choice for intertrochanteric fractures of A 1.1, A 1.2, A 1.3 and A2. 1. IF is more appropriate for the aged and unhealthy patients with intertrochanteric fractures of A1. 1, A1. 2, A1. 3, A2. 1, A2. 2, A3. 1 and A3.2. DFR is fit for the elderly patients with severe comminuted fractures and osteoporosis.
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Objective To improve the diagnosis and treatment of sliding hernia of adult urinary bladder. Methods Clinical data of 32 cases of adult sliding hernia of the bladder from 1984 to 2009 were analyzed retrospectively. Discomfort was complained in all the 32 patients along with palpable mass. Twentynine cases suffered from urgency of micturition, ascheturesis and dysuria, 15 cases had interruption of urination. The mass was saddle-shaped in 29 cases, when the bladder was filling. In all the 32 cases of hernia block were in a sense of fluctuations and flat on percussion. In 26 cases the bladder appeared a dumbbell-shaped image on cystography. By B-ultrasonic examination an opaque dark area of fluid was detected in 29 cases when there was retention of urine. Results Preoperatively 29 cases were diagnosed of bladder sliding hernia, 3 cases with misdiagnosis ( misdiagnosis rate of 9.4% ). 32 cases were cured by surgical treatment. The prolapsed portion of the bladder including stones in 2 cases were resected. 32 cases were followed up from 1 to 5 years without recurrence. Conclusions Once the sliding hernia of the bladder is diagnosed, patient should receive surgery. Intraoperatively the key of preventing inadvertent cut or missed diagnosis is familiar with pathological anatomy and careful exploration.
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OBJECTIVE: To investigate feasibility and effectiveness of pedicle screw bi-cortical fixation in lumbar spondylolisthesis or destabilization of aged people. METHODS: The statistical significance of the distance between the anterior edge of vertebral body and the anterior major blood vessels at the level of pediculus arcus vertebrae by CT scan at random were measured and analyzed. 82 cases of lumbar spondylolisthesis or destabilization, aged 65 years (range 51 to 75 years), including 35 males and 47 females, were treated pedicle screw bi-cortical fixation, with the anterior edge of the vertebral body penetrated by one screw thread. The function was evaluated by Macnab backleg pain scale standards. RESULTS: There was significant difference in the distance of the anterior edge and the major vessels between the old and the young (P< 0.05). All the 82 cases were operated successfully, and the mean time was 145 minutes and the mean amount of bleeding was 530 mL. The 43 cases including 15 males and 28 females were followed up for 18 months (range 3 to 53 months). There was one case of rupture of the spinal dura mater with no sequela after the suture. There were 3 cases of transient paralysis and pain of lower limbs, which were alleviated after 2 months' treatment. No complications of nerve root or vessel injuries were found. All incisions healed well at the primary stage. The lumbocrural pain of all 43 cases was alleviated to a certain content. There were 31 cases of excellent, 10 of good, and 2 of fair; the excellent and good rate was 97%. CONCLUSION: It is feasible and safe to treat the lumbar spondylolisthesis or destabilization in the old with the pedicle screw bi-cortical fixation.
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Objective To evaluate the diagnosis and surgical treatment of adult congenital choledochal cyst(ACCC). Methods Clinical data of 345 ACCC cases from 1974 to 2007 were analyzed retrospectively. Results There were only 110 patients (31.9%) with typical triad (abdominal pain, palpable mass and jaundice). B-ultrasound, CT, ERCP, PTC and MRCP were methods for diagnosis. Cancer arising from choledochal cysts was found in 19 cases who had undergone internal drainage and its incidence of cholangiocarcinoma is much higher than in the general population. All cases underwent surgical treatment, in which total excision of choledochal cyst and Roux-en-Y hepaticojejunostomy was main operation, 337 cases recovered well and 8 (2. 3%) died. C..ondusions Accurate diagnosis of ACCC was difficult depending on clinical symptoms only. B-ultrasound was the choice of atraumatic diagnosis. All patients with an established diagnosis of ACCC should undergo exploratory laparotomy. Total excision of eholedochal cyst and Roux-en-Y hepaticojejunostomy is most effective treatment for ACCC.
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Objective:To summarize diagnosis and surgical treatment of syndrome of splenic flexure of colon(SSFC) .Methods:The clinical data of SSFC in 81 patients between Jan,1987 and Dec,2008 were analysed retrospectively.Results:The main clinical manifestations were repeated abdominal pain,abdominal distension,constipation and chronic incomplete colon obstruction.X-ray barium enema showed that splenic flexure of colon was 7 cm higher than hepatic flexure of colon.The angle of splenic flexure of colon was less than 45 ?.Two patients underwent release of splenic flexure of colon and 3 patients accepted side-to-side anastomosis of splenic flexure of colon which were suitable to old,weak and emergent patients.The effects of these methods were well shorthy after operation,but not in long term(6 months to 2 years) .As to the rest 76 patients,thorough operation were done:subtotal resection of proximal segment colon(14 patients) ,subtotal resection of colon(20 patients) and total resection of colon(42 patients) .Conclusion:The diagnosis of SSFC is depended on clinical manifestations and barium enema.Thorough surgical treatment is the best method including proximal part resection,subtotal resection and total resection of colon.
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Objective To evaluate the diagnosis and surgical treatment of primary retroperitoneal extraadrenal pheochromocytoma(PREAP). Methods Clinical data of 17 cases with PREAP from 1976 to 2006 were analyzed retrospectively. Results It was not difficult for the diagnosis of PREAP based on the primary symptoms, including paroxysmal hypertension or persistent hypertension. PREAP is usually deep, large and invading on adjacent organs. B-uhrasound was used for preliminary screening. CT and MRI with high soft tissue resolution and multi directional imaging are of great value for correct diagnosis and determination of exact extent of the tumor in diagnosis of PREAP. 24 h urinary VMA output imcreased in 12 cases (92. 3%) and urinary catecholamine level was up to 526. 1 μg- Precise location of PREAP by 123I-MIBG is superior to that by 131I-MIBG. The diagnosis was tentative in 4 cases and definite in 13 cases. Complete tumor resection was achieved in 15 cases, among them 2 cases died on table due to inadequate preparation before surgery in 1970's. In the remaining 2 cases with huge tumors partial resection, silver clips were put in during operation to locate the extent of the tumors for further management after operation. Conclusions Locating and qualitative diagnosis before operation are valuable and once the patients are diagnosed as PREAP, they should receive exploratory laparotomy after an adequate preparation.
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Objective To summarize diagnosis and surgical treatment of insulinoma. Methods Clinical data of 64 patients with insulinoma from 1980 to 2006 were analyzed retrospectively. Results All patients had Whipple's triad. Accurate preoperative localization rate of B ultrasonography, CT and enhanced CT, MRI, DSA was 46.9% (30/64), 58.2 %(23/39) and 91.7%(11/12), respectively. Localization rate of intraoperative ultrasonography (IOUS) was 92% (23/25). The tumors were single in 58 cases, and multiple in 6 cases. In the location of single tumor, 19 of them were in the head, 17 in the body, and 22 in the tail;while for multiple tumors, 2 tumors were both located in the body in 4 patient, and 2 tumors were separately located in the body and tail respectively in 2 patients. Treatment Local enucleation was performed in 39 cases, resection of pancreatic body and tail in 13 cases, resection of pancreatic body and tail plus splenectomy in 6 cases, resection of pancreatic tail in 8 cases, resection of pancreatic tail plus splenectomy in 4 cases, laparoscopic resection of insulinoma in 1 case, piecewise resection of pancreas from left to right (blind resection) in 2 cases, pancreaticoduodenectomy in 1 case. The tumor was benign in 62 cases, and malignant in 2 cases. Pancreatic fistula developed after operation in 3 cases, acute pancreatitis in 4 cases, and in these cases, they healed after non-operative treatment. All patients had no symptoms of hypoglycemia after operation. At follow-up visit in 62 cases, 2 case of benign tumor recurred 4 years after operation, and was cured by resection of the pancreas body with tumor, 2 malignant tumors cases, recurred and died of hepatic metastasis in 3 years and 4 years after operation. Conclusions Whipple's triad and IRI/G>0.3 are the bases for qualitative diagnosis of insulinoma. Meticulously palpating the gland combined with IOUS during operation is the most effective method for accurate tumor localization. Resection of insulinoma is the best mode of surgical treatment of insulinoma.
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[Objective]To study the stability function of Luschka Joint(LJ) of lower cervical spine.[Method]C_(3、4) and C_(5、6) as a funtional spinal unit(FSU) were taken from 16 fresh adult cadavers and randomly divided into experimental group,its LJ was cut out and in control group,LJ was maintained.The FSU of C_(3、4) and C_(5、6)was loaded and tested on the AG-10 AT automatic electronic versatile machine in normal,flexion ≤10? and extension ≤7.5? positions.Data of sigattal horizontal displacement(SHD),rotational angulation(RA) and coronary laterral displacement(CLD) were collected,counted and 3-dimesionally analyzed by computer.[Result]The SHD,RA and CLD of FSU experimental group were significantly different with that of control group(P