Volume 16,Issue 7,2007 Table of Contents

1 Surgical treatment for type Ⅳ hilar cholangiocarcinoma

CHEN Yongbiao , JIANG Yi , ZHANG Shaogeng , CHEN Shaohua , LU Lizhi , LIN Hua

2007, 16(7):1. DOI: 10.7659/j.issn.1005-6947.2007.07.001

[Abstract](987) [HTML](0) [PDF 1.18 M](1059)

Abstract:
Abstract:Objective:To explore the surgical management in patients with Bismuth Ⅳ hilar cholangiocarcinoma.
Methods :Retrospective study was used to analyze the clinical data with operative and pathologic diagnosis of Bismuth Ⅳ hilar cholangiocarcinoma in the recent five years.
Results:Of the 22 patients, there were 13 males and 9 females, with M∶F=1.4∶1. In the group of non liver transplantation (NLTX), 5 cases(31.3%) underwent resection (radical resection in 2 cases; palliative resection in 3 cases), and 11 cases had nonresectional internal or external drainage.In the liver transplantation group(LTX), the resection rate was 100%（6/6）. Five LTX cases survived for 28, 19, 17, 12 and 9 months respectively, and one died from chronic rejection in 11 months after operation. In the NLTX group, the 1and 2yr survival rate was 32.1% and 0% respectively. The 1and 2yr survival rate of LTX was 80.0%（4/5）and 50.0%（1/2）respectively. There was significant difference between the two groups in average survival rate (P=0.041).
Conclusions:Aggressive surgical treatment should be adopted for Bismuth Ⅳ hilar cholangiocarcinoma, and radical resection is crucial to enhance survival rate. LTX is a good choice for the patients with unresectable Bismuth Ⅳ hilar cholangiocarcinoma and the prognosis is satisfactory.

2 Hepatectomy for treatment of hepatolithiasis accompanied with bile duct stricture

XU Liang

2007, 16(7):2. DOI: 10.7659/j.issn.1005-6947.2007.07.002

[Abstract](793) [HTML](0) [PDF 873.40 K](871)

Abstract:
Abstract:Objective:To evaluate the role of hepatectomy in the treatment of hepatolithiasis accompanied with hepatobiliary stricture.
Methods :The clinical data of 82 cases of hepatolithiasis who had surgical treatment during the past 16 years were reviewed.
Results:Preoperatively, all were examined with Bultrasound (accuracy: 75.6%), 46 cases with CT(accuracy: 87.0%), 22 cases with PTC(accuracy: 90.9%), 31 cases with ERCP(accuracy: 93.5%), and 18 cases with MRCP(accuracy: 94.4 %). All the cases were treated by resection of the hepatic lobe or segment with stones, cholangiotomy and removal of stones, hepatobiliary strictureplasty, and hepatocholangiojejunostomy at the hepatic hilum. Complications occurred in 17.1% of patients, the rate of residual stones was 15.9%. Seventythree cases were followed up for averag 10.6 years (1~16 years). In the followup period, the rate of recurrent stones was 6.8%. The excellent and good result rate was 90.4%.
Conclusions: (l) MRCP is the best technique for the diagnosis of hepatolithiasis accompanied with hepatobiliary stricture. (2) Hepatectomy is an effective means for treating patients with hepatolithiasis accompanied with hepatobiliary stricture. (3)The key to improve therapeatic results is to pay special attention in the treatment of bile duct stricture.

3 The combination of direct digital radiography and electrohydraulic shockwave lithotripsy in treatment of residual bile duct stones

TIAN Daguang , ZHU Quansheng , HUANG Jie , ZHANG Jie , LI Tiehan , WEI Xiaoping , HU Mingdao , LI Wen

2007, 16(7):3. DOI: 10.7659/j.issn.1005-6947.2007.07.003

[Abstract](760) [HTML](0) [PDF 971.51 K](900)

Abstract:
Abstract:Objective:To summaize the experience of application of direct digital radiography and electrohydraulic shockwave lithotripsy in treatment of residual bile duct stones.
Methods :A retrospective analysis of clinical records of 60 patients with residual bile duct stones treated in our hospital from 2003 to 2006 was made.
Results:In 59(95.9%) of 60 cases the stones were removed completely,including successful removal in one time of application of this method in 57 Patients（95.0%）, and 2 applications in 2 Patients ﹙3.3%). One case with bile duct stone complicated with dile duct cancer was unsuccessful. The biggest stone was 3.5cm×2.5cm×2.0cm.No serious complications occurred and changed to operation. The 59 cases were followed up for 6 mo to l yr, and all had a successful outcome.
Conclusions: The method of combination of direct digital radiography and electrohydraulic shockwave lithotripsy in treatment of postoperative residual bile duct stones after operation can facilitate removal of residual bile duct stones.The procedure is a safe way of treating residual stones.

4 Diagnosis and treatment of cystic duct stump concretion：a report of 22 cases

RU Bao-yuan

2007, 16(7):4. DOI: 10.7659/j.issn.1005-6947.2007.07.004

[Abstract](606) [HTML](0) [PDF 869.26 K](859)

Abstract:
Abstract:Objective:To explore the diagnosis and treatment of cystic duct stump concretion.
Methods :The clinical data of 22 cases of cystic duct stump concretion were retrospectively analysed.
Results:Of 22 cases, six cases were diagnosed by ERCP; 12 by MRCP; and the other four cases had long cystic duct stump with stones found at operation, and proved by intraoperative cholangiography. All cases were cured by re-operation, and at more than 3 years follow up, the results were satisfactory.
Conclusions:The cystic duct stump concretion is closely related to the first operation. MRCP and ERCP are the most valuable diagnotic methods. Re-operation is difficult and needs to be done with care.

5 Clincal analysis of choledochoscopic balloon dilatation of Oddi sphincter in treatment of cholelithiasis

BAI Yu-qiu， TAN Fu-yang， LIN Hui-chun , TIAN Zhuo

2007, 16(7):5. DOI: 10.7659/j.issn.1005-6947.2007.07.005

[Abstract](684) [HTML](0) [PDF 873.52 K](883)

Abstract:
Abstract:Objective:To evaluate the value of clinical application of the technique of choledochoscopic balloon dilatation of Oddi sphincter.
Methods :The clinical data of 67cases who underwent cholecloscopic ballon dilatation of Oddi sphinctor between Jul 2005 and Apr 2007 was analysed, and compared with those patients who had endoscopic sphincterotomy(EST) during the same period.
Results:There was no difference between balloon dilatation group and EST group in rate of short-term complications and therapentic results (P<0.05), but the rate of reflux biliary tract infection and retained stones was lower in the balloon dilatation group compared to that of EST group(P<0.05).
Conclusions:Choledoscopic dilatation of Oddi sphincter is a safe, feasible and more effective way to treat patients with gallbladder calculi complicated with bile duct calculi, and this method is worthy of widespread use.

6 Clinical analysis of congenital bile duct dilatation

ZHOU Gang , JIN Hong , XIAO Yun , ZHANG Tianrui， CHEN Yuping , CHEN Zhiyong

2007, 16(7):6. DOI: 10.7659/j.issn.1005-6947.2007.07.006

[Abstract](715) [HTML](0) [PDF 872.39 K](896)

Abstract:
Abstract:Objective:To summarize the etiology, classification and clinical characteristics of congenital bile duct dilatation and our experience in its diagnosis and troatment.
Methods :The clinical data of 37 cases of congenital bile duct dilatation were retrospectively analyzed.
Results:The 37 cases included TypeⅠin 31 cases, Type Ⅱ in 1 case, Type Ⅳ in 4 cases, and Type Ⅴ in 1case. All of the patients underwent operative treatment. External drainage of was done in 2 cases, Rouxeny cystojejunostomy in 3 cases, exeisison of cyst cyst and Rouxeny hepaticojejunostomy in 31 cases and left hepatectomy in 1case with malignant change of cyst. Five cases had postoperative complications that recovered with nonoperative treatment. Thirtytwo cases were cured. There were no operative deaths.
Conclusions:Congenital bile duct dilatation should be treated as soon as possible. Excision of the cyst and Rouxeny hepaticojejunostomy can reduce longterm postoperative complications and is the rational treatment for congenital bile duct dilatation.

7 Diagnosis and treatment of cholelithiasis in children

QIU Shu-sheng , WEI Yuan-ming , SUN Ke-jian , LIU Zhi-min , FENG Yan-chang

2007, 16(7):7. DOI: 10.7659/j.issn.1005-6947.2007.07.007

[Abstract](1104) [HTML](0) [PDF 875.28 K](915)

Abstract:
Abstract:Objective:To evaluate the etiology,diagnosis and treatment of cholelithiasis in children.
Methods :The clinical data of 22 children with cholelithiasis were retrospectively analysed. Twenty patients underwent operative treatments, 14 had cholecystectomy (including 8 patients with successful laparoscopic cholecystectomy); 3 with common bile duct exploration and Ttube drainage; 2 with cholecystectomy, bile duct exploration and Ttube drainage; and 1 with excision of choledochal cyst and RouxenY hepaticojejunostomy.
Results:Eighteen patients complelely recovered after operation. At followup of 5 months to 7 years in 18 cases(81.8%),all children grew up well,but 3 cases had occasional abdominal pain and distention,of which one recovered after choledochotomy and stone removal, and 1 was relieved with conservative therapy, but 1 still had recurrent symptoms.
Conclusions:Children with abdominal pain should first be examined by B-ultrasound. In cases with dilatation of common bile duct, additional CT exam can improve the accuracy of diagnosis. Children with evident symptoms of cholelithiasis should have early operative treatment. Laparoscopic cholecystectomy is the method of choice for gallbladder stones in children.

8 Study on induction of apoptosis of biliary duct cancer cells by γ-ray of the ¹⁰³pd biliary stent

HE Gui-jin , SUI Dong-ming , YU Fa-qiang , JI Da-wei , GAO Qin-yi， DAI Xian-wei , GAO Hong , JIANG Tao , DAI Chao-liu

2007, 16(7):8. DOI: 10.7659/j.issn.1005-6947.2007.07.008

[Abstract](733) [HTML](0) [PDF 1.40 M](1052)

Abstract:
Abstract:Objective：To investigate the mechanism and role of γ-ray of 103pd in the treatment of biliary duct cancer.
Methods ：A series of biliary duct cancer cells were treated with different γ-ray dose, and MTT ［3-(4,5-dimethy thiazol-2-yl)-2,5-diphenyl terazolium-bromide］ technique was used to determine the inhibition rate of γ-ray of 103pd on the biliary duct cancer cells; and electron micro-technique, DNA agarose gel electrophoresis and flow cytometry to evaluate the morphological characteristics and apoptosis rate of the biliary duct cancer cells were also used.
Results：The γ-ray radiation of 103pd resulted in significant inhibition of the biliary duct cancer cells. The features of biliary duct cancer cells apoptosis(e,g：apoptic bodies, DNA ladders band hypodiploid DNA peak) could be seen in the group with lower dosage (5.333mci), and cell necrosis was seen in higher dosage (more than 6.645 mci).
Conclusions：The γ-ray radiation could induce apoptosis of the biliary duct cancer cells, but with dose dependence, and apoptosis can be an important mechanism for radiation treatment of biliary duct cancer.

9 The inhibitory effect of survivin antisense oligonucleotide on human hepatocellular carcinoma cells

ZHANG Gewen，TANG Huihuan，WANG Zhiming , FENG Chao , WEI Wei

2007, 16(7):9. DOI: 10.7659/j.issn.1005-6947.2007.07.009

[Abstract](1118) [HTML](0) [PDF 1.26 M](1036)

Abstract:
Abstract:Objective:To explore the inhibitory effect of survivin antisense oligonucleotide(ASODN) on human hepatocellular carcinoma(HCC) cell line HepG2.
Methods :The expression of survivin protein in HCC tissue was detected immunohistochemically. Survivin ASODN was transfected into HepG2 cell by lipofectamine in vitro. The expression of survivin protein was detected by westernblot.Apoptotic index(AI) and colony formation were examined by flow cytometry and in soft agar respectively.Human HCC model in nude mice was established by subcutaneous injection of HepG2 cells.In vivo effect of survivin ASODN on tumor growth was observed.
Results:(1) The expression rate of survivin protein in HCC was 75.8％(25/33),which was significantly higher than that in corresponding noncancerous adjacent liver tissue and normal liver tissue(P<0.01).(2) The expression of survivin protein in HepG2 cells was obviously downregulated after transfected with survivin ASODN.AI of HepG2 cells in ASODN group were significantly higher than those in the control and SODN groups(P<0.01). Colonies of HepG2 cells in ASODN group were significantly fewer those that in the control and SODN groups(P<0.01).(3) The tumor growth of nude mice in ASODN group was significantly slower than that in the control and SODN groups(P< 0.01).The tumor weight of ASODN group was significantly lower than that of the control and SODN groups(P<0.05).
Conclusions:There is overexpression of survivin in HCC. Survivin ASODN can induce HepG2 cells apoptosis and inhibit the growth of HepG2 cells in vitro and in vivo.

10 Changes in glucose metabolism after operation in liver cirrhosis with portal hypertension

LIU Ya-guang， SONG Bo， WANG Tao-tao

2007, 16(7):10. DOI: 10.7659/j.issn.1005-6947.2007.07.010

[Abstract](910) [HTML](0) [PDF 874.26 K](925)

Abstract:
Abstract:Objective:To explore the method of treatment for cirrhosis associated portal hypertension and hepatogenic diabetes.
Methods :The clinical data of 46 cases of cirrhosis with portal hypertension and hepatogenic diabetes treated in recent 10-year period were retrospectively analyzed.
Results:All the patients received operative treatment after basic nutritional support and adjunctive insulin therapy. Surgical intervention included portoazygos veins devascularization procedure in 39 cases,and devascularization combined with splenorenal shunt in 7 cases. Results showed that the hepatogenic diabetes improved in 39 cases(84.8%).
Conclusions:Patients with cirrhosis and hepatogenic diabetes should have treatment directed to the primary disease and mainly to aggressively improve live function, and additionally treat the abnormal glucose metabolism.

11 The influence of glucagon-like peptide-1 on cytosolic free calcium ion concentration in isolated rat hepatocytes after hepatectomy

JIA Qian-bin , PENG bing , LIU Zi-ming , WU Hong-bin , LI Shuang-qing , WU Yan-tao

2007, 16(7):11. DOI: 10.7659/j.issn.1005-6947.2007.07.011

[Abstract](636) [HTML](0) [PDF 1.17 M](897)

Abstract:
Abstract:Objective:To investigate the effect of glucagonlike peptide1(GLP1) on cytosolic free calcium ion concentration(［Ca2+］ i) in isolated rat hepatocytes after hepatectomy.
Methods :The rats were allocated randomly to two groups: The rats of group one did not undergo hepatectomy. The rats of group two had 65% liver resection. The blood specimen taken from vena cava was mensurated for glucose, insulin, glucagon, and glucagonlike peptide1（GLP1） on the first, third and fifth day after hepatectomy. The ［Ca2+］i in isolated rat hepatocytes was investigated by using fura2 fluoresence, and then, in vitro, the effect of GLP1 on the ［Ca2+］ i in hepatocytes was investigated in 2 groups.
Results:The blood glucose value in group two was significantly higher than that in group one after operation (P<0.05), especially on the first day. The plasma GLP1 value was also significantly higher than that of group one (P<0.001). The level of serum insulin was decreased obviously (P<0.001), while the value of glucagon was increased,but not significantly, which led to reduction of the ratio of insulin to glucagon. The ［Ca2+］ i in hepatocytes on the first, third and fifth day after hepatectomy was decreased slightly (P>0.05) compared with that of group one. In vitro, GLP1 produced a slightly increase in the ［Ca2+］i in hepatocytes (P>0.05).
Conclusions:After hepatectomy, in rats is associated with an obvious insulin resistance, mainly due to the level of serum insulin was obviously decreased (P<0.001), and the value of glucagon was increased, which led to reduced ratio of insulin to glucagon. GLP1 is insulinomimetic upon glucose metabolism in hepatic tissue, which acting through specific receptors is not associated to ［Ca2+］ i increase.

12 Establishment of C57BL/6J mouse liver cancer model

KUANG Zhi-peng , XIE Yu-an , YANG Fan , LIANG An-min , LUO Xiao-ling , WU Ji-ning

2007, 16(7):12. DOI: 10.7659/j.issn.1005-6947.2007.07.012

[Abstract](1971) [HTML](0) [PDF 1.29 M](4492)

Abstract:
Abstract:Objective:To establish a stable primary hepatocellular carcinoma(HCC) model of C57BL/6J mice, and establish a basis for indepth laboratory research in hepatocellular cancer.
Methods :Ninety C57BL/6J mice were induced to establish HCC models by combination of diethylnitrosamines (DEN), carbon tetrachloride (CCl4) and ethanol for twenty weeks, then the occurrence and development of HCC were observed, and other 10 C57BL/6J mice were used as normal control(no drug was given). RTPCR method was used to observe AFP mRNA expression in liver tissues and tumor tissues.
Results:seventyone of 90 mice developed HCC(78.9%), cirrhosis was observed in 11 of 90 mice(12.2%)， and 8 of them died of toxic hepatitis and acute hepatocellular necrosis. AFP mRNA was expressed only in liver cancer tissues. No obvious liver pathologic changes were observed in the control group. The histopathologic changes of HCC were high or middle differentiation.
Conclusions:An AFPsecreting C57BL/6J mouse liver cancer model was established by induction with combination of DEN, CC14 and ethanol in a relatively short time. The rate of cancerous change was high, and some of the hepatic changes included hepatitis and cirrhosis. This is a rather ideal animal model for the study of liver cancer.

13 The CT features and the value of MSCT in the diagnosis of cholangiocarcinoma

LI Hui， CAO Jue， LONG Xueying， LIU Hui，ZHU Zhiming

2007, 16(7):13. DOI: 10.7659/j.issn.1005-6947.2007.07.013

[Abstract](839) [HTML](0) [PDF 1.31 M](1072)

Abstract:
Abstract:Objective:To evaluate the value of MSCT in the diagnosis of cholangiocarcinoma.
Methods : A retrospective study was undertaken in 82 patients with cholangiocarcinoma, in which 38 had singleslice CT(SSCT), and 44 had multislice CT（MSCT) including 11 with delayed scanning.
Results:On CT scanning, the lesions′ characteristics were varied,depending on their growth pattern, while the indirect CT features were specific,like dilated bile duct, hepatic lobe atrophy,etc. The accuracy in location and assessment of extent of infiltration of the lesion by singleslice CT and multislice CT was 82.4％，97.4％and 52.9％，81.0％ respectively.
Conclusions:MSCT scan is superior to SSCT in diagnosis of cholangiocarcinoma.

14 Comparison between primary closure and Ttube drainage of common bile duct after laparoscopic exploration

CHEN Xiaoxun， HUANG Shunrong， LUO Hanchuan， LIN Yuan， LI Shixin， WU Duanzheng

2007, 16(7):14. DOI: 10.7659/j.issn.1005-6947.2007.07.014

[Abstract](1068) [HTML](0) [PDF 872.99 K](1172)

Abstract:
Abstract:Objective:To investigate the safety of primary closure of common bile duct after laparoscopic exploration.
Methods :We retrospectively analyzed the clinical results of laparoscopic common bile duct exploration (LCBDE) for common bile duct stone performed on 113 cases between June 2002 and January 2007. Of which, 61 cases had primary closure of common bile duct (closure group), while 52 cases had Ttube drainage of common bile duct(drainage group).
Results:There was no significant difference in terms of operation time and abdominal drainage time between the two groups (P>0.05). Postoperative hospital stay was shorter and fluid replacement was less in closure group than that in drainage group. Postoperative bile leakage was seen in 4 cases（4/61）in closure group, and 2 cases (2/52) in drainage group (P>0.05). Retained bile duct stones were seen in 2 cases（2/61）in closure group, and 3 cases (3/52) in drainage group (P>0.05). Bile duct recurrent stones was seen in 5 cases（5/61）in closure group, while 4 cases (4/52) in drainage group (P>0.05). Bile peritonitis was seen in 2 cases after T tube removal. There were no cases of postoperative extrahepatic duct stenosis in the two groups.
Conclusions:Primary closure of common bile duct after LCBDE for common bile duct stones is safe.

15 Clinical study on the length of jejunal segment for choledochojejunostomy

LI Zhengping , LUO Daoyun , ZHANG Yu

2007, 16(7):15. DOI: 10.7659/j.issn.1005-6947.2007.07.015

[Abstract](866) [HTML](0) [PDF 781.62 K](953)

Abstract:
Abstract:Objective:To explore the relationship between clinical result and the length of jejunal segment for cholangiojejunostomy.
Methods :One hundred and tow patients who had choledochojejunostomy from May 2002 to August 2004 were divided randomly into 2 groups: In group 1 the length of jejunal segment was 60cm,and other group 2 was 40cm.Clinical results were observed by xray barium meal examination and followup survey.
Results:No difference in degree of reflux and clinical symptoms was found between the 2 groups.
Conclusions:The group with 40cm jejunal segment had similar antireflux function as the group with 60cm jejunal segment.However,the short jejunal segment can enhance nutrition uptake from the intestine and decrease excessive amount of intestine that can cause recurrence of hepatolitihiasis.

16 Surgical treatment for hepatocellular carcinoma with tumor thrombi in the vascular system

HE Rui-ling

2007, 16(7):16. DOI: 10.7659/j.issn.1005-6947.2007.07.016

[Abstract](1135) [HTML](0) [PDF 886.85 K](960)

Abstract:
Abstract:Objective:To study the value of surgical treatment for hepatocellular carcinoma (HCC) with tumor thrombi in vascular system.
Methods :The clinical data of 68 patients of HCC with tumor thromb in the vascular system who underwent hepatic resection with tumor thrombectomy, from Jan 1993 to Jan 2001, were retrospectively analyzed. Among them, 63 patients had tumor thrombus of portal vein, 1 patient had tumor thrombus of left hepatic vein, 1 patient had tumor thrombus of middle hepatic vein and left branch of portal vein, 1 patient had tumor thrombus of right hepatic vein, inferior vena cava and right branch of portal vein, and 2 patients had tumor thrombus of inferior vena cava. Six patients with tumor thrombus of portal vein caused by HCC underwent portal vein chemotherapy (PVC) after operation.
Results:Six patients died from liver and kidney function failure 3 months after operation; 62 patients made a good recovery. The 1-, 3- and 5-year survival rate was 41.7%, 20.8% and 4.1%, respectively.
Conclusions:Hepatic resection with tumor thrombectomy is effective in treatment of HCC with tumor thrombi in vascular system. After operation, adjuvant treatment can have a favourable effect on the prognosis.

17 Percutaneous radiofrequency ablation combined with interstitial hemotherapy for primary hepatic cancer

ZHU Tong， CHEN Tao， HU Zhi-qian

2007, 16(7):17. DOI: 10.7659/j.issn.1005-6947.2007.07.017

[Abstract](687) [HTML](0) [PDF 875.31 K](958)

Abstract:
Abstract:Objective:To study the efficacy and indications of percutaneous radiofrequency ablation combined with interstitial chemotherapy for primary liver cancer.
Methods :The clinical data of 52 cases with primary liver cancer treated by percutaneous radiofrequency combined with interstitial chemotherapy were analysed retrospectively.
Results:Symptoms were significantly ameliorated in 85% of the patients. After the treatment, AFP level declined in 58% of the patients. The postoperative 1-,2-,3-,4-year surrival rate were 92%,78%,56%,43%, respectively.
Conclusions:Percutaneous radiofrequency ablation combined with interstitial chemotherapy is a new safe, reliable and effective method for management of liver cancer.

18 Comparative study on laparoscopic total extraperitoneal hernia repair and tension-free hernioplasty under local anesthesia

DUAN Xin , WANG Yong , HE Tao , LI Ming-jie , ZHENG Ying-jian.

2007, 16(7):18. DOI: 10.7659/j.issn.1005-6947.2007.07.018

[Abstract](832) [HTML](0) [PDF 877.56 K](989)

Abstract:
Abstract:Objective:To compare the clinical efficiency of laparoscopic total extraperitoneal hernia repair(TEP) with Lichtenstein tension-free hernioplasty under local anesthesia (TFH).
Methods :The clinical data of 252 adult patients with inguinal hernia were retrospectively studied. Fifty-six cases were repaired by TEP, and 196 cases had TFH. Clinical evaluation was made at one week and at half a year after operation.
Results:In TEP group, the frequency of analgesic use in 72 hours after operation, the time of return to regular activity, and chronic local pain were significant better than those in TFH group (P<0.05). There was no significant difference between the two groups in complication and recurrence rate (P>0.05). But in Lichtenstein procedure group, the operation time, length of postoperative hospital stay, time to ambulation, and cost, were more better than those in TEP group (P<0.05).
Conclusions:TEP has small incision, less pain and quick recovery, but with high cost. The TFH is simple, lower cost, and wide indications, espicially suitable for elderly patients.

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Volume 16,Issue 7,2007 Table of Contents

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