Cardiac surgery has a gradual change from traditional median sternotomy to minimally invasive surgery due to the appearance and application of peripheral extracorporeal circulation. There are great differences in the clinical practice of two different surgical methods in mitral valve operation. Minimally invasive thoracic surgery has the advantages of less trauma, less bleeding, faster recovery, beauty and so on. However, such surgery also has its weaknesses, such as longer learning curve, narrow operation space and high requirements of equipment. To compare the differences of early and long-term results in mitral valve operation between traditional median sternotomy and minimally invasive thoracic surgery is to better summarize and operate minimally invasive thoracic surgery for mitral valve surgery.
Objective To investigate the influence of different mechanical ventilation modes on inflammatory reaction among COPD patients with severe respiratory failure. Methods A total of 102 COPD patients with severe respiratory failure, admitted in Zhongshan Hospital between January 20007 and June 2012, were enrolled in this study. The subjects were divided into an ASV group receiving adaptive support ventilation, and a SIMV + PSV group received synchronized intermittent mandatory ventilation and pressure support ventilation, with 51 cases in each group. Breathing pattern, respiratory mechanics, hemodynamic parameters and seruminflammatory factors were examined among all patients. Results Tidal volume ( VT ) was significantly higher, and the control respiratory rate and ventilation time were significantly lower in the ASV group than those in the SIMV + PSV group ( P lt; 0.05) . Comparing with the SIMV + PSV group, obviously lower peak airway pressure ( Ppeak) ,mean airway pressure ( Pmean) and airway plateau pressure ( Pplat) were observed in the ASV group ( P lt; 0.05) . The patients in the ASV group had obviously lower levels of C-reactive protein, procalcitonin and α1 acid glycoprotein. Conclusion ASV ventilation mode may reduce the inflammatory reaction, facilitate spontaneously breathing and decrease mechanical ventilation time.
Objective To evaluate the results of thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. Methods Between March 2006 and August 2009, 35 patients with dysfunction of thumb opposition were treated and the thumb opposition function was reconstruced by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. There were 25 males and 10 females with an average age of 33.5 years (range, 20-53 years); 20 had median nerve injury in the wrist and 15 had median nerve injury with ulnar nerve injury. The causes were sharp instrument injury in 24 cases, blunt injury in 9 cases, and hot crush injury in 2 cases. Six cases complicated by shaft fractures of radius and ulna. All the patients underwent an operation of nerve repair at 1 to 3 hours after injury (mean, 2 hours). The time from injury to reconstructing operation was 6-14 months (mean, 7.5 months). Two cases was able to abduct thumb sl ightly, the others had no functions of thumb abduct and thumb opposition. Results All the wounds gained the primary healing. The patients were followed up 12-18 months (mean, 14 months). The wrist joint angle and thumb dorsal extension were satisfactory. Thumb abduct and thumb opposition function returned to normal in 20 patients with simple median nerve injury; in 15 patients with median nerve injury and ulnar nerve injury, thumb abduct and thumb opposition function returned to normal in 15 and 13, respectively. According to ZHAO Shuqiang’s standard, the results of thumb opposition function were normal in all patients at 12 months after operation. Conclusion It is a convenient and efficient procedure to reconstruct thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons.
【摘要】 目的 探讨住院患者肝功异常病因及影像学诊断意义。方法 对2008年1月—12月住院的223例18～83岁肝功异常患者进行相关实验室检查,以及B超、CT和MRI检查。结果 肝脏本身疾病引起135例,占6054%,肝外疾病引起83例,占37.22%,原因不明5例,占2.24%。B超作为无创性检查,价格低亷,准确率高,可作为常规检查。结论 住院患者肝功损害病因复杂,以药物性肝炎、胆道系统疾病及脂肪肝较多见。
目的:探讨青年人群中脂肪肝的相关危险因素。方法:收集2008年在我院体检中心同期体检,年龄≤45岁脂肪肝患者127人,非脂肪肝患者116人,询问病史,进行身高、体重、血生化及B超检查并分脂肪肝组和非脂肪肝组进行比较。结果:脂肪肝组肥胖、饮酒、高血脂、高血糖、肝功异常发病率明显高于对照组。结论:肥胖、饮酒是脂肪肝的重要危险因素,脂肪肝患者多伴有糖脂代谢紊乱及肝功受损。
目的:探讨纳米炭混悬注射液在乳腺癌淋巴结清扫及病理检查中的价值。方法:60例乳腺癌患者术前予纳米炭混悬注射液,统计术后淋巴结获检情况。结果:术中可见乳腺引流区淋巴结有广泛不同程度的染色,60例患者共检获淋巴结1 384枚,其中染色淋巴结862枚,171/862查见癌转移;未染色淋巴结522枚,43/522查见癌转移。染色淋巴结及未染色淋巴结转移比率差异有统计学意义(P=0.000)。结论:术前注射纳米炭混悬液对乳腺癌淋巴结清扫术有指导意义。
【Abstract】Objective To compare the sensitivity of HE,immunohistochemistry (IHC) and RT-PCR in detection of breast cancer metastases in axillary lymph nodes.MethodsTwenty female patients with newly diagnosed and clinically nodenegative breast cancers underwent modified radical mastectomy, including a complete axillary lymph node dissection. The ages of the patients ranged from 31 years to 65 years, and the diagnosis of breast cancer was approved by pathological finding. Two hundred and thirty-nine axillary lymph nodes were found in these 20 patients. Metastases in axillary lymph nodes were explored by HE， cytokeratin 19 IHC and RT-PCR for cytokeratin 19 respectively. ResultsSeven(2.9%) lymph nodes were found to have metastatic cancers by HE in 3 patients,all nodes were found in level Ⅰ. Metastatic cancers were found in 13(5.4%) nodes by IHC in 7 patients,11 nodes in level Ⅰ and 2 nodes in level Ⅱ; and 52(21.8%) nodes were found to contain tumor cells by RT-PCR in 14 patients,30 nodes in level Ⅰ and 22 nodes in level Ⅱ. All of 7 histologically(HE) positive nodes were found to contain tumor cells by IHC and RT-PCR. Among 232 histologically(HE) negative nodes,6(2.6%) nodes were found to contain tumor cells by IHC,and 45(19.4%) nodes were found to contain tumor cells by RT-PCR, all 6 IHC positive nodes showed the expected 460-base pair products on gel electrophoresis (P＜0.05).ConclusionThis study suggests that IHC and RT-PCR are more sensitive methods for the detection of micrometastases of breast cancer in lymph nodes than HE is,and RT-PCR is even better than IHC; the micrometastases of breast cancer in axillary lymph nodes could be detected accurately through these techniques.