AIM The incision in rectal cancer operation is adopted commonly in the left mid-lower abdomen. But thereare some defects for the incision, which is close to the artificial colotomy, readily be contaminated by feces,difficult to treat the lesions in hepatic and cholecystic area at the same time and in the weakened area ofabdominal wall. So, we employed the abdominal right lower paramedian incision to solve these problems.METHODS The abdominal right lower paramedian incision is from publc tubercle upward to 3 cm- 4 cmabove navel. The incision should be extended upward if individual need of performing hepatic and cholecysticoperation, or placing catheter or pump in hepatic artery or portal vein for chemotherapy at the same time.RESULTS One hundred and eighty three cases with rectal cancer were adopted this incision in differentoperation procedure, and out of them 41 patients were taken different operation on hepatic and cholecysticlesions and place a catheter or pump to hepatic artery or portal vein. Operators feel that the incision dose nothinder exploring and operating in all of the patients.CONCLUSION The right lower paramedian incision of abdomen is far away from the artificial colotomy,and it can reduce the feces contamination, lower down the rate of incision hernia and paramedian hernia orfistula. Furthermore, it is easy to treat the complicated hepatic and cholecystic lesion. So, authors suggestthat this incision is useful for the operation of rectal cancer, and it is worth to populize in clinical practice.

Acute severe pancreatitis (ASP) was habitually called acute hemorrhagic necrotizing pancreatitis. Butaccording to the pathological finditgs of our 139 surgical cases, 59.7% belonged to necrotizing type, whilehemorrhagic necrotizing type only accounted for 23.0%. Involvement of pancreas is not necessarily diffuse,3.7% only affected pancreatic tail. The incidence of the disease is highest in 41 - 60 year age group. Earlyrecognition of severe type of the disease is always an emphasis in clinical studies. CT scanning is the maindiagnostic tool used. Clinical diagnostic criteria offer some help in clinical practice. Banks' criteria is morecommonly used in western countries instead of Ranson criteria in the past. For clinical evaluation of theprogress of the disease, APACHEII scoring method is commonly used. Classification of CT findings ishelpful in judging the severity of the disease. Once the diagnosis was definitely established, should it betreated surgically or managed by medical way? The pendulum had swung for many years. Our currentconsensus is “combined treatment system”. That is: patients with uninfected pancreatic necrosis shouldreceive non-surgical treatment. The success rate is over 85%. Cases of infected necrosis went downhill,vigorous treatment should be given immediately. Otherwise, late stage operation should by all means be considered and wait for localization of theinfection with the hope of complete cure after single drainage operation. “Obstructive biliary pancreatitis”and “Ruptured pancreatic abscess causing peritoritis” are indicated for immediate operation. Cure rate bynon-surgical treatment is significantly increased, with a success rate of operative treatment of 80%. Medicaltreatment is administered by the combined traditional Chirtese and Western medicine. Besides all thenecessary supportive and symptomatic treatment, three major aspects of treatment should be speciallyemphasized: ① pancreatic infection. According to the bacterial spectrum, concentration of antibiotics in thepancreas and drug sensitivity test, we advocate the use of quinolone class antidacterial agents such asimipenem, Ofloxacin,ciprofloxacin, etc as drug of first choice. ② Inhibition of pancreatic secretion usingGabexate mesilate or synthetic analogue of somatostatin. The two analogues that are widely used in China areOctreotide (Sandostatin) introduced to China earlier; and the 14-pepitide somatostatin (Stilamin) introducedlater but also has been used for some years. There were reports about the benefits and drawbacks of the twoand sometimes quite controversial. According to our experience in using these two analogues, we have notmet with serious side effects of Octreotide as reported in the western literatures. The action of Stilamin onsphincter of Oddi is causation of relaxation, but the action of Octreotide on it was quite controversial. Somereported about its spasmodic action on the sphincter. We have studied in dog experimentation and provedthat Sandostatin can significantly lower the basal pressure of sphincter of Oddi. Our consensus of their use inASP is that either can be used as available, except in most severe cases, we prefer Stilamin. However,Saadostatiu has some merits in the following conditions: It can be given hypodermically orintramuscatarly. It is more suitable for outpatients with milder disease. (?) Chronic pancreatitis with acuteflare up. ③ Treatment with traditional Chinese medicine: according to the Chinese theory of thepathogenesis -“wetness and heat stagnated at middle focus”, the principle of treatment is “relieving liver,adjutsting gas, clearing heat, drying wetness, getting through and driving down”. We have made aprescription consisting of several important ingredients, in the form of decoction. Since the 1980s, we havestudied a few Chinese herbal medicines separately. They were all proved to have promising effect. Inconclusion, in ASP, we advocate combination of Western and traditional Chinese medical treatment.

Background In many European and American hospitals, represented by the House Ear Clinic (HEC), the overlay tympanoplasty is used with rare exception, with simultaneous canal wall up or down mastoidectomy being taken if needed. In China, underlay tympanoplasty is used across the country, but the overlay tech-nique is used rarely. The aim of the current study was to report the authors’experience with overlay tympa-noplasty in 83 Chinese patients and study its value. Methods Eight-three patients (86 ears) underwent over-lay tympanoplasty in accordance to the standard of the HEC. The patients were followed up and conditions of the external auditory canal, tympanic membrane and hearing were reviewed and analyzed. Results All patients gained stage I incision healing. The size of external auditory canal and tympanic membrane mor-phology were satisfactory. Hearing either remained unchanged or improved. There were no hearing deterio-ration or serious complications. Conclusions Overlay tympanoplasty carries positive value in treating chron-ic otitis media and cholesteatoma with the merits of procedure standardization, adequate operative exposure, thorough disease elimination and extensive adaptation.

Object To explore the procedures in per-operative harvesting and management of fresh human cochlear specimens for research. Methods During trans-cochlear surgery to remove large petro-clival meningiomas causing life-threatening compression on the brainstem, cochleae are normally destroyed and drilled away in order to reach the apical petrous and clivus region. Instead the cochlea can be dissected out after ethical per-mission was obtained from the local ethical committee (EPN) and allowance gained from the patients. Sur-gery is performed by a team consisting of oto-and neurosurgeons as a two-day procedure with total petro-sectomy in combination with an inferior re-routing of the facial nerve. Fixation of the cochleae was done in the operating room as soon as the specimens had been separated from the temporal bones. Decalcification began after hours’to overnight’s fixation for 4 weeks. Sectioning parallel to the modiolus (mid-modiolus) was performed with a cryostat microtome. The sections were subjected to immunofluorescence (IF). Results Using freshly prepared 4%paraformaldehyde (PFD) solution, adequate fixation of fine inner ear structures was achieved with hours’immersion of the cochlear specimens. Decalcification in 6.2% ethylene di-amine-tetracetic acid (EDTA) solution for 4 weeks yielded a thoroughly decalcified cochlea. Experiences in processing 14 human cochleae and analysing main landmarks in five human inner ear plastic/silicone casts showed that the oval window/stapes footplate are backward tilted, at an angle about 15 degrees, from the plane perpendicular to the modiolar axis. The distance from the modiolar apex to the anterior border of the oval window/footplate in these inner ear casts measured between 4 and 5 mm. High quality IF staining was obtained. Conclusion Surgically obtained human cochlear specimen, when properly processed, contains ide-ally preserved antigenicity for immunohistochemical study. Adequate orientation during sectioning helps ob-tain optimal mid-modiolar sections showing fine structures of the cochlea.

Objectives: To evaluate outcomes in treating carcinoma of external auditory canal (EAC) and to analysis factors which effect the prognosis of this disease.
Methods: A retrospectively review of 16 patients treated for carcinoma of EAC at our department between April 2000 and April 2014 was conducted. All patients underwent surgical treatment and the diagnosis confirmed by pathological examination.
Results: There were adenoid cystic carcinoma (ACC) in 8 patients, squamous cell carcinoma (SCC) in 5 patients, adenocarcinoma (AC) in 2 patients, and verrucous carcinoma (VC) in 1 patient. The tumors were classified as Stage I in 4 cases, Stage II in 2 cases, Stage III in 3 cases, and Stage IV in 7 cases. Five patients underwent extensive tumor resection (ETR), 2 patients underwent lateral temporal bone resection (LTBR), 5 patients underwent modified LTBR, 2 patients underwent subtotal temporal bone resection (STBR), and 2 patients underwent only open biopsy. Besides, adjunctive procedures, including neck dissection, parotidectomy and pinna resection were performed when indicated. Ten patients received postoperative radiotherapy. By the end of follow up, two patients had died of their disease, 2 lost to follow up, 2 survived with the disease, and the rest survived disease-free. The median follow-up period was 24 months.
Conclusion: Complete tumor resection appears to be an effective treatment for carcinoma of the EAC. Patients with SCC seem to have worse prognosis than those with ACC. Radiation therapy seems less effective for the disease than surgical treatment.

无细胞异体真皮基质在烧伤后整形患者功能部位的应用

AIM:To investigate the effect of allogeneic acellular dermal matrix(ADM) on cograft in joint functional positions of patients with post burn plastic operation. METHODS:9 patients with hypertrophic scar and joint dysfunction after severe burns were used. After pre treating with trypsin and TritonX 100, 13 reticulated ADM were overlapped with autogenous ultrathin split thickness skin grafts(USTS), and were transplanted to the scar excision wounds in the joints of four limbs at the same time. The neighbouring autogenous thin split thickness skin grafts(TSTS) were used as control.RESULTS:The composite skin grafts as well as the controls were all survived. The rejection and hypertrophic scars were not found during (1- 5) years follow up studies. The appearance, fiber and function of composite skin grafts were near to normal skins. CONCLUSION:The ADM could be used to joint functional positions of patients with post burn hypertrophic scars and could produce satisfactory plastic results as dermal substitute.

正颌治疗对颞下颌关节功能的影响

A1M: To investigate the effect of temporomandibular joint position and re-molding process and the signs and symptoms of temporomandibular joint inpatients undergoing orthognathic surgery.METHODS: The standardSchuller' s position radiographs were used to examine the position temporo-mandibular joint form and condylar position change of 32 case after orthognathic surgery Helkimo index was used to analyze the anamnestic and clin-ical data. RESULTS: Changes of condylar position had happened after theoperation, but within one year the conlylar had resumed the same position asthe preoperative. The change of temporomandibular joint symptoms and signsafter orthognathic surgery was not significant. CONCLUSION: The effect oforthognathic surgery on the condylar position and TMJ form is not signifi-cant, and most of the changes are within the normal adaptability of tem-poromandibular joint.

Venous malformations (VMs) are problematic common vascular malformations that are challenging even for experienced physicians. Several treatments are available including sclerotherapy, surgery, laser or combinations of these procedures. As none of these is specific, we still need therapies that would allow to cure these patients without complications. Hopefully, the unraveling of the causative defects of VMs will give us new tools for the management of this difficult condition.

Juvenile cemento-ossifying fibroma of the maxilla:Report of one case and renew of the literature

Juvenile cemento-ossifying fibroma (JCOF) is a rare lesion that exhibits a slow growing but may reach massive proportion and cause considerable cosmetic and functional problems.This lesion has the tendency for recurrence following incomplete excision.A case report of giant JCOF in a 46-year-old female with 23-year history is presented.Local excision and thorough curettage was performed and the normal skeletal structure was maximally preserved. 15month follow up demonstrated no sign of recurrence.

New developments in colorectal surgery: German experience

Modern therapy in colon and rectal cancer is a multdisciplinary approach, where high quality surgery is still of primary importance. Several new aspects have evolved during the past years, of which screening colonoscopy, standardization of surgical procedures, quality control, the further development of stage dependend multimodal therapies and fast track rehabilitation have significanly contributed to improving patient outcome. Adjuvant chemotherapy in UICC stage Ⅲ colon cancer patients and neoadjuvant radiochemotherapy in T3/4 and/or lymph node positive rectal cancer patients are well established. The preoperative assessment of the circumferential resection margin in rectal cancer is emerging as an important parameter for the indication to neoadjuvant therapy. In a selected group of patients with early T1 colorectal cancer endoscopic polypectomy might be appropriate while laparoscopic surgery for colon cancer is at the edge of becoming an equivalent option to open surgery. Molecular and genetic factors, such as thymidylate synthase, microsatellite instability or mutations of the K-ras protein, might help to better select patients for adjuvant chemotherapy or antibody based antitumor therapy in the future.

Laparoscopic skills has been widely applied in colorectal surgery. The definition, indications and contraindications, the oncologic principles, port side recurrence, and the newer advances are reported in this article .

Uterine papillary serous carcinoma (UPSC) was established as a distinct type of endometrial carcinoma by Lauchlan in 1981 and Hendrickson et al in 1982, and accounted for 1% ～ 10% of endometrial cancers. Theoccurencer of papillary patterns of endometrial adenocarcincma had been reportedly recognized since 1900, while until the late 1970s several authors have had described a variant of papillary endometrial cancer. UPSC is a morphologically unique variant of endometrial carcinoma that is pathologically defined by the presence of high nuclear grade, distinct papillary architechtural changes, psammoma bodies, and extensive lymph- vascular space invasion. CA125 is often mentioned a usefultumor marker either for diagnosis before starting treatment or in monitoring recurrence. The ptimal treatment of UPSC is controversial and appears to be dependent upon the stage of the disease. Primary surgery comprised of TAH/BSO and complete staging is the mainstay of treatment. The patients with recurrent UPSC in many studies were treated with various combinations of surgery, radiation therapy, and chemotherapy. The molecular basis for the general poor response of UPSC to adjuvant chemotherapy and radiotherapy is not well understood. UPSC tumors are more often aneuploid and contain overexpressed mutant p53 protein as compared to encdometrioid adenocarcinoma. Unlike patients with adenocarcinoma of the endomeutrium, women with UPSC were less likely to be obese, hypertensive, or diabetic.

关于成立国家卫生部内镜专业技术考评委员会“经自然腔道内镜外科专家委员会（Natural Orifice Translumenal Endoscopic Surgery，NOTES）”，严格实施NOTES临床监督应用的通知

经自然腔道灯镜手术（Natural Orifice Translumenal Endoscopic Surgery，NOTES）是刚兴起的一项探索性治疗技术，其主要特点是通过自然存在的腔道来进行检查或治疗，诊治范围除自然腔道内部外，还拓展到腔道周围，操作形式也有很多的革新。如：胃镜下胆囊切除、肠道镜下胃部分切除、尿道镜下阴道膀胱瘘修补、宫腔镜下子宫壁内手术、经耳／鼻腔颅底肿瘤切除，等等。

220例完全切除Ⅱ期非小细胞肺癌术后患者的生存分析

Background and Objective: Surgery is the main therapy for patients with stage-ll non-small cell lung cancer (NSCLC), but patients still have an unsatisfactory prognosis even though complete resection is usually possible. Adjuvant chemotherapy provides low rates of clinical benefit as well. We retrospectively analyzed prognostic factors of patients with completely resected stage-ll NSCLC to find patients with unfavorable factors for proper management. Methods: Clinical data of 220 patients with complete resections of stage-ll NSCLC at the Sun Yat-sen University Cancer Center between January 1998 and December 2004 were retrospectively analyzed. Cumulative survival was analyzed by the Kaplan-Meier method and compared by log rank test. Prognosis was analyzed by the Cox proportional hazards model. Results: The overall 3- and 5-year survival rates were 58.8% and 47.9%, respectively. The 3- and 5-year disease-free survival rates were 45.8% and 37.0%, respectively. Of the 220 patients, 86 (39.1%) had recurrence or metastasis. A univariate analysis demonstrated that age (> 55 years), blood type, the presence of symptoms, chest pain, tumor volume (> 20 cm3), total number of removed lymph nodes (≥10), number of involved N1 lymph nodes (≥3 ), total number of removed N2 lymph nodes (> 6), and the ratio of involved N1 lymph nodes (≥35%) were significant prognostic factors for 5-year survival. In the multivariate analysis, age (> 55 years), chest pain, tumor volume (> 20 cm3), total number of removed lymph nodes (≥10), and number of involved N1 lymph nodes (≥ 3) were independent prognostic factors for 5-year survival. Conclusions: For patients with completely resectable stage-ll NSCLC, having > 55 years, presenting chest pain, tumor volumes > 20 cm3, and ≥ 3 involved N1 lymph nodes were adverse prognostic factors, and ≥ 10 removed lymph nodes was a favorable one. Patients with poor prognoses might be treated by individual adjuvant therapy for better survival.

Paraganglioma is a rare neuroendocrine neoplasm observed in patients of al ages, with an estimated incidence of 3/1,000,000 population. It has long been recognized that some cases are familial. The majority of these tumors are benign, and the only absolute criterion for malignancy is the presence of metastases at sites where chromaffin tissue is not usual y found. Some tumors show gross local invasion and recurrence, which may indeed kil the patient, but this does not necessarily associate with metastatic potential. Here, we report a case of vertebral metastatic paraganglioma that occurred 19 months after the patient had undergone partial cystectomy for urinary bladder paraganglioma. We believe this to be a rarely reported bone metastasis of paraganglioma arising original y within the urinary bladder. In this report, we also provide a summary of the general characteristics of this disease, together with progress in diagnosis, treatment, and prognosis.

In this issue of the Chinese Journal of Cancer, European experts review current standards, trends, and future prospects in the difficult domain of high-grade glioma. In al fields covered by the different authors, the progress has been impressive. For example, discoveries at the molecular level have already impacted imaging, surgery, radiotherapy, and systemic therapies, and they are expected to play an increasing role in the management of these cancers. The European Organization for Research and Treatment of Cancer (EORTC) has pioneered new treatment strategies and contributed to new standards. The articles in this issue will cover basic molecular biological principles applicable today, novel surgical approaches, innovations in radiotherapy planning and delivery, evidence-based standards for radiotherapy alone or combined with chemotherapy, current standards and novel approaches for systemic treatments, and the important but often neglected field of health-related quality of life. Despite the advances described in these articles, the overall prognosis of high-grade glioma, especially glioblastoma, remains poor, and more research is needed to address this problem.

Pulmonary Hemorrhagic Infarction due to Fat Embolism and Thromboembolism after Maxillofacial Plastic Surgery: a Rare Case Report

The long-term effect of minimal invasive TLIF technique in reducing postoperative low-back pain

Treatment strategies for the surgical complications of thoracic spinal stenosis:a retrospective analysis of two hundred and eighty three cases

Surgical Management of Intramedullary Spinal Cord Tumors: Surgical Resection and Prognosis

BACKGROUND & OBJECTIVE: The majority of intramedullary spinal cord tumors (IMSCT) are low-grade gliomas.Radical resection for IMSCTs remains challenging.Recently, improved neuroimaging and advanced microsurgical technique have made great success in surgical management of the intramedullary spinal cord tumors.METHODS ＆ RESULTS: Twenty-nine patients with intramedullary spinal cord tumors were treated by radical resection during the past 4 years in our institute.The histological results were as follows: 12 ependymomas, 4 astrocytomas, 4 hemangioblastomas, 4 epidermoids, 1 cavernoma, 2 lipomas, 2 metastatics.A gross-total resection (> 95%) was achieved in 25 surgical procedures.Subtotal resections (80-95%) were performed in 4 cases.There was no surgical death.When comparing the preoperative and 3-month postoperative functional grades, 12 patients were stable 14 improved, and 3 deteriorated.Patients with either no deficit or only mild deficit before surgery were rarely impaired by the procedure, reinforcing the importance of early diagnosis and treatment.The major determinant of long-term survival was histological composition of the tumor.Patients in whom an IMSCT was only partially resected (< 80%) fared significantly worse.CONCLUSIONS: The long-term survival and quality of life for patients with low-grade gliomas treated by radical resection alone is comparable or superior to minimal resection plus radiotherapy.The optimal therapy for patients with high-grade glioma is yet to be determined.For benign lesion, such as hemangioblastoma and cavernoma could be cured by total resection of the tumor.For lipoma and epidermoid, fibrous adhesions to the cord make total removal difficult, and thus, removal is not the goal of surgery.The carbon dioxide laser is particularly useful during surgery for this lesion.