AIM To study the comprehensive prevention and treatment of gastric cancer among high-risk population inthe high risk areas.METHODS A gastrocarcinoma mass screening was performed in 16 villages of Zhuanghe region. About50 000 population were involved and 3033 cases aged above 35 suffering from gastric diseases, and/or hadfamily history of gastric cancer were screened. Clinical epidemiological investigation, double-contrast X-ray,serum pepsinogen monitor, gastroscopic biopsies and histopathologic examinations were adopted in thescreening.RESULTS The ratio of the examined patients with gastric disorder reached up to 82% and 32 patients withgastric cancer were detected (1.06%) and 18 cases were early gastric cancer (56.25%). Patients with gastriccancer were treated successively. Aside from gastric cancer, several gastric lesions were also detected, whichlaid a good foundation for further interventional treatment. It was also found in the examination that93.97% of the local residents were addicted to salted pork and more than 60% of the residents had Hpinfection.CONCLUSION Gastric diseases, Hp infection of gastric mucosa and eating salted pork are very common inZhuanghe region. These are very dangerous factors causing gastric cancer. It is feasible to quit eating saltedpork and eradicate Hp infection and cure precancerous diseases.

AIM To provide evidence that UBT is the most cost-effective tool for evaluation of H. pylori eradication.METHODS Data on twenty-six consecutive patients at Atlanta VA Hospital who underwent UBT wereretrospectively reviewed. All patients had endoscopic diagnosis of peptic ulcers and biopsy proven H. pyloriinfection. Eight to ten weeks after completion of triple therapy (amoxicillin, biaxin and prilosec), allpatients had C14 UBT (PY test kit, Charlottesville, Virginia). Ten patients had repeated endoscopicexaminations and gastric biopsies. Twelve patients had serology tests for H. pylori.RESULTS UBT was negative in all patients (two patients had indeterminate result on the first time, butshown to be negative on the second UBT). Biopsies from all ten patients who were re-endoscoped werenegative for H. pylori. Serology tests on all the twelve patients were positive. Cure of H. Pylori could notbe determined on the titer change. All patients spent about 30 minutes in nuclear medicine laboratory, theendoscopic patients spent 2 hours to 4 hours in endoscopic laboratory; the cost for a UBT was about 50, thecost for an endoscopy with biopsy was above 200.CONCLUSION The 04 UBT is a rapid, economic and accurate test to monitor H. pylori eradication. Thetest should be considered a gold standard test for evaluating the effectiveness of treatment of H. pyloriinfection, unless patients need repeated endoscopy to rule out gastric cancer.

AIM To investigate the short-term and long-term therapeutic effect of traditional medicine preparation andIFN-α1 b on hepatic fibrosis due to chronic hepatitis B.METHODS Fifty-two patients with hepatic fibrosis of hepatitis B were treated by IFN-alb and traditionalmedicine preparation, then observed the change of serum indexes of hepatic fibrosis, liver biopsy,ultrasonography and fibergastroscopy.RESULTS The serum indexes of hepatic fibrosis decreased significantly after 3-month treatment(P<0.05). The improvement of liver fibrosis was confirmed by liver biopsy, ultrasonography andfibergastroscopy. After 3-year continuous follow-up, the conditions of patients were got better. Symptomsand signs were disappeared. The pathohistologic change of liver, serum index of hepatic fibrosis and liverfunction were continuously improved.CONCLUSION The good short-term and long-term effects were obtained by using IFN-α1b to suppressduplication of hepatitis B virus and traditional medicine preparation to reverse hepatic fibrosis.

支气管内超声引导针吸活检术的麻醉方法

目的 观察支气管内超声引导针吸活检术(EBUS-TBNA)的不同麻醉方法的效果,寻求较佳的EBUS-TBNA手术麻醉方法.方法 60例择期EBUS-TBNA手术患者,ASA Ⅰ～Ⅱ级,随机分为3组:舒芬太尼组(S组)、瑞芬太尼组(R组)和舒芬太尼+瑞芬太尼组(SR组),每组20例.麻醉方式采用静脉输注丙泊酚全麻复合TCI舒芬太尼和或瑞芬太尼辅助2％利多卡因局部表面麻醉,术中维持双频谱指数( BIS)50 ～60.记录患者进入手术室后5min(T0)、手术开始后30min( T1)和术毕定向力恢复时(T2)心率、平均动脉压、脉搏氧饱和度及呼吸频率、手术开始后30min动脉血气、术中呛咳次数、丙泊酚和利多卡因用量、术毕至定向力恢复时间、患者满意度和不良反应发生情况.结果 (1)R组T1时呼吸频率下降明显(P＜0.05),S组和R组动脉二氧化碳分压高于SR组(P＜0.05).(2)R组和SR组术中呛咳次数、术毕至定向力恢复时间明显减少(与S组比,P＜0.05).(3)三组患者丙泊酚、利多卡因用量、麻醉满意度及不良反应差异无统计学意义(P＞0.05).结论 静脉输注小剂量舒芬太尼与瑞芬太尼,同时复合丙泊酚静脉全麻并辅助局部麻醉可以满足EBUS-TBNA的手术要求,安全、有效,可作为EBUS-TBNA的常规麻醉方法之一.

Factors determining cosmetic results after periareolar excisional biopsy of benign breast lesions

内镜超声引导下Trucut针活检

EUS is a sensitive method for staging gastrointestinal malignancies and pancreatic lesions. EUS FNA offers a diagnostic accuracy of about 60% - 90% for pancreatic tumors and more than 90% for lymph nodes.There are several limitations of EUS FNA including the need for on - site cytopathology review. In addition, accuracy of cytologic review is hampered by the presence of blood, benign epithelial cells, desmoplasia and well - differentiated tumors. Furthermore, the small biopsy sample and destruction of tissue architecture limits the diagnostic sensitivity for GISTs and lymphomas. Many of these problems can be overcomed with use of EUS trucut biopsy (TCB) needles. These large calibers , cutting needles, acquire larger tissue samples allowing preservation of tissue architecture and histologic examination. Our recently described experience with EUS TCB initially in swine and later humans demonstrated the safety for acquiring histologic tissue representative of the target organs sampled enabling accurate diagnosis. These studies suggested greater diagnostic accuracy of EUS TCB for submucosal mass lesions and lymphoma and potentially the need for fewer needles passes for solid pancreatic neoplasms. In this paper we reviewed the current TCB literature, device design and technique, help trouble shoot potential problems, and offerred opinion as to the utility and role of this new device.

Accuracy of CT-guided biopsies in158patients with thoracic spinal lesions

Objective: To analyze the clinical features of lung cancer diagnosed by bronchoscopy. Methods:The clinical features of2168 patients with lung cancer diagnosed by bronchoscopy were retrospectively analyzed, including gender, age, pathological type, diseased region, manifestations under bronchoscopy and methods of drawing materials. Results:The ratio of male/female was 4.8:1 and the peak onset age was 60~69 years old. The major pathological type was squamous cell carcinoma (44.5%), then adenocarcinoma (25.9%) and small cell lung cancer (18.3%). The incidence of squamous cell carcinoma was the highest in males (50.6%), while that of adenocarcinoma in females (56.2%). The positive diagnostic rates of forceps biopsy, brush biopsy, bronchial alveolar lavage and transbronchial needle aspiration were 81.6%, 49.4%, 18.2% and 62.6%, respectively, whereas that of biopsy combined with brush biopsy came up to 89.0%. Conclusion: Bronchoscopy is an important method in diagnosis of lung cancer. Different ages and genders of patients with lung cancer have different onset, and the distribution of pathological types is diverse. Attaching more importance to bronchoscopy and improving biopsy technique can signiifcantly improve the diagnostic rate and provide reliable evidences for clinical treatment.