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??Value of abdominal three-dimensional medical image visible system in diagnosis and treatment of hepatolithiasis FANG Chi-hua,CHEN Zhi-xiang,FANG Ying-fang,et al. Department of Hepatobiliary Surgery,Zhujiang Hospital ,Southern Medical University,Guangzhou510282,China Corresponding author:FANG Chi-hua,E-mail: fangch_dr@126.com Objective To study the value of abdominal three-dimensional medical image visible system in diagnosis and treatment of hepatolithiasis. Methods 22 patients’ 64-slice spiral computer tomography (CT) scan data which admitted to Zhujiang Hospital from 2007 to 2009 were chosen. The data was imported into abdominal three-dimensional medical image visible system for sequence segmenting and three-dimensional (3D) reconstruction. According to the models, patients were diagnosed and the pre-operation plannings were made. The reconstructed models were used to perform simulation surgery with virtual surgical instruments simulation system. At last, clinical surgerys were guided by simulation surgery. Result within the 22 patients, 4 were type I, 2 were type ??, and 16 were type E. Including 6 patients with surgeries on biliary tract for several times; 16 cases with bile duct striture; 5 cases with cirrhosis; 16 cases with atrophy-mast syndrome. The 3D models showed the size, the amount and the location of the stone clearly, as well as the lacation, the degree and the lenth of the sticture. The clinical surgeries wre consistent with the simulation sugeries by 19/22(the other three wre emergency). T-tube angiography of the non-emergency patients showed that there were no stones residue. Conclusions The abdominal three-dimensional medical image visible system can make a rapid dignosis of hepatolithiasis, which was helpful for planning for the individual treatment.     

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??Preliminary study on a predict model for patients with cholecystolithiasis combined with common bile duct stones WU Zong-yang, ZHENG Xin ,ZAN Xian-feng,LIU Qing-guang. Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University ??Xi'an 710061??China
Corresponding author: LIU Qing-guang, E-mail??liuqingguang@vip.sina.com
Abstract Objective To develop a predictive equation with the factors previously identified by multivariate Logistic regression that were predictive for cholecystolithiasis combined with common bile duct stones ,Evaluate the diagnostic value of predictive equation,ultrasound and MRCP.Methods Make database with the index of 626 patients and select the variables that considered statistically significant for the Logistic equation.The sensitivity??specificity and accuracy of Logistic regression equation, ultrasound and MRCP are compared by χ2 test.Results P=1/1+EXP??-(-5.092 +3.101X1+1.754X2+1.647X3+1.306X4+1.175X5+ 0.963X6)??,The equation has a sensitivity of 69.5% , specificity of 97.1% , and accuracy of 92.5%.The sensitivity and accuracy of MRCP and Logistic regression equation are superior than ultrasound (P<0.05), The sensitivity of MRCP are superior than Logistic regression equation (P<0.05). The accuracy of MRCP and Logistic regression equation have no difference(P>0.05).The specificity of three methods have no difference(P>0.05).Conclusion The specificity and accuracy of Logistic regression equation is superior than ultrasound, it could provide reference for clinical diagnosis and treatment decision making for doctors.     

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??Hepatic ollicular dentritic cell sarcoma: a case report and review of the literature LIU Jun??ZHANG Zhong-tao??LI Jian-she, et al. Department of General Surgery, Beijng Friendship Hospital, Capital Medical University, Beijing 100050,China Corresponding author: ZHANG Zhong-tao , E-mail: zhangzht@medmail.com.cn Abstract Objective To explore the hepatic follicular dendritic cell sarcoma (FDCS) of the histopathological and immunohistochemical characteristics. Methods One case of hepatic FDCS was diagnosed and treated in June 2008 at Beijng Friendship Hospital of Capital Medical University. Histopathological and immunohistochemical characteristics of hepatic FDCS and related literature review were analyzed and summarized. Results The hepatic FDCS hadn’t special symptoms nor characterized imaging features, and was difficult to make correct diagnosis before operation. A large single mass in liver was showed in CT scan. Microscopically, the neoplastic cells were in ovoid or spindle and some of them had indistinct cell borders. Neoplastic cells were positive for CD35, but negative for CD21, CD23, S-100, ALK, EBER in immunohistochemical analysis. Conclusion The FDCS is a rare low-grade malignant tumor. Its diagnosis should mainly rely on histopathological and immunohistochemical findings. Complete excision is the main therapeutic method for it.     

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??Open abdomen technique in the management of gastrointestinal fistula complicated with severe intra-abdominal infection REN Jian-an Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing 210002, China Abstract Objective To investigate the result of open abdomen technique in the treatment of gastrointestinal fistula complicated with severe intra-abdominal infection. Methods The clinical data of 73 gastrointestinal fistula patients complicated with severe intra-abdominal infection received open abdomen therapy from January 1999 to December 2008 at Nanjing General Hospital of Nanjing Military Command of PLA were analyzed retrospectively. Results Fifty-six of 73 patients (76.7%) survived to discharge. Ten patients (13.7%) died and 7 patients ( 9.6%) gave up the treatment. The main causes of death were hemorrhage of abdominal cavity (5 cases), infection and organ nonfunction (5 cases). The average APACHEII score for survivors was 13.5±4.3 before open abdomen and dropped to 9.2±4.5 and 8.1±6.2 after 5 and 15 days of open abdomen. The average APACHEII score for dead patients was 16.0±5.8 before open abdomen and dropped to 12.9±5.5 and increased to 16.3±11.8 after 5 and 15 days of open abdomen. The score of organ function changed similarly .Conclusion The open abdomen therapy is an effective treatment for gastrointestinal fistula complicated with severe intra-abdominal infection. Open abdomen could improve the severity score of severe intra-abdominal infection patients. The therapy can be divided into three stages including temporary closure of the open abdomen, skin graft of open wound and permanent closure of abdomen and resection of enteric fistula. The reconstruction operation of digestive tract and abdominal wall can be performed simultaneously.     

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??The postoperative recurrence of liver cancer??diagnosis and standardized treatment FAN Jia??WANG Zheng. Liver Cancer Institute and Zhongshan Hospital??Fudan University??Shanghai 200032??China
Corresponding author??FAN Jia??E-mail??jiafan99@yahoo.com
Abstract The recurrence and metastasis (as high as 70%) after surgical treatments of liver cancer are of the main obstacle to achieve better results. Early detection, diagnosis and standardized treatment should be performed for the improvement of surgical effects. Combination therapies to utilize the advantages of individual method according to the stage and liver functional reserve of different patients are of paramount importance. The randomized controlled clinical trials are the basis to evaluate the therapeutic strategies.     

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??Objective    To explore the application of digital technology to the treatment of dento-maxillofacial deformities. Methods    Twelve patients with dento-maxillofacial deformities were enrolled and DICOM data were reconstructed with 3D-CT of maxillary and mandible. The DICOM data were input into the software of Proplan CMF. We built digital skull model and 3D-printed skull model to perform surgical planning?? postoperative prediction and simulate operation. Clinical examinations of facial symmetry were performed 3 months later. Results    All the surgical plannings?? postoperative predictions and simulate operations of the twelve patients with dento-maxillofacial deformities were performed. And the orthognathic surgery was successfully. The patients were satisfied with the facial symmetry 3 months after operations?? with a satisfaction rate of 91.67%?? Conclusion    When using digital technology to perform surgical planning and simulate operation??the accuracy of surgeries is improved with satisfactory effect. So the digital technology has practical value in the treatment of dento-maxillofacial deformities.     

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??With the rapid development of pediatric critical care medicine in recent years??the mortality of children in intensive care unit??ICU?? has decreased significantly. A large proportion of surviving patients still have physical dysfunctions several years after discharge. The functional status and quality of life of these patients begin to become focus problems??and pediatric critical care rehabilitation??a new interdisciplinary field??has attracted people’s attention. Rehabilitation evaluation runs throughout the medical activities of pediatric critical care rehabilitation. Because the related work began late with weak foundation in our country??ithasn’t been done in many hospitals yet. Therefore??it is urgent to realize the importance of rehabilitation evaluation and to improve the pediatric critical care rehabilitation and rehabilitation evaluation.