Rule of Chinese Medicine Syndrome Differentiation in the Patients with Thoracic Diseases at Perioperation Stage

Objective： To study the rule of syndrome differentiation in the patients with thoracic diseases at perioperation stage. Methods： A standard was created referring to the related literature, and it was applied to differentiate the Chinese medicine syndrome in 150 patients before and three days after thoracic operation. Results： Before operation, Chinese medicine syndromes were as differentiated as phlegm type in 45.3%, blood stasis type in 17.3%, and qi-stagnancy type in 16.0%. The patients with asthenia syndrome markedly increased after operation, accounting for 34.0% （51 patients, including qi-, yin-, and blood-deficiency syndromes）. The most frequently seen intermixed syndromes were qi-deficiency with phlegm-stasis syndrome and Pi （脾）-deficiency with phlegm-dampness syndrome. The intermixed syndromes revealed in 37.5% and 42.0% of the patients before and after operation, respectively. Conclusion： The syndrome in the patients with thoracic disease before operation was mostly the excessive syndrome, mainly the phlegm syndrome type; at postoperation stage, Chinese medicine syndrome in patients become asthenia in essence with excessive superficiality, which is mostly revealed as Pi-deficiency with phlegm-dampness.

The Effect of Acupuncture on Intestinal Motility and Sero－Enzyme Activity in Perioperation

The authors studied 39 surgical patients suffering from abdominal illnesses. The patientswere divided into acupuncture and control groups. In the acupuncture group, needles were inserted atacupuncture points Zusanli (St 36) and Sanyinjiao (Sp.6) during the second 12 hours following the opera-tion. The patients were then observed to mark the time of the first passing of flatus. Sero-enzyme activityof glutamic pyruvic transaminase (GPT), glutamic-oxaloacetic transaminase (GOT) and glutamyltranspeptidase ( -GT) was determined before the operation, and measured at two day intervals from the1st to 7th days after the operation. The results show the time of passing flatus in the acupuncture group(58. 78±23. 94 h) was obviously faster than that in the control group (86. 14±20. 43 h) , P<O. 001. Thissuggests acupuncture can promote intestinal activity. After operation, sero-enzyme activity was raised200 % - 300 % over the average pre-operation activity. This is evidence of trauma to the cells caused bythe surgical procedure. This trauma caused the cells, directly or indirectly, to release enzymes into theblood. However, in those patients who received acupuncture therapy, sero-enzyme activity reduced to anormal level much faster. There is a possibility that acupuncture may be used to regulate reactivity of or-ganisms experiencing trauma, and to promote repair of the damaged cells.

The role of endoscopic retrograde cholangiopancreatography in perioperative period of laparoscopic cholecystectomy

Objective: To explore the indications and the value ofendoscopic retrograde cholangiopancreatography(ERCP)in perioperative phase of laparoscopic cholecystecto-my.Methods: From January 1998 to April 1999, a total of1500 consecutive laparoscopic cholecystectomies wereanalyzed. The indications for preoperative group (n=33) included elevated bilirubin level and alkalinephosphatase level, jaundice, pancreatitis, abnormalliver function, dilated bile duct and/or stones on ul-trasound or CT. The indications for postoperativegroup (n=20) included clinical signs or symptoms aswell as common bile duct stones demonstrated by in-traoperative cholangiography.Results: Preoperative ERCP for 32 patients (2.1%)showed abnormalities in 12 (37%). Postoperative ER-CP for 20 patients(1.3%) demonstrated abnormalitiesin 14 (70%). Super-selected criteria for preoperativeERCP would predict more than 66% ductal stones.Endoscopic sphincterectomy and duct stones clearancewere performed in all 16 patients with documentedcommon bile duct stones. The morbidity was confinedin 2 patients with self-limited pancreatitis (3%).Conclusions: Using super-selected creteria to selectpatients for preoperative ERCP can avoid unnecessaryERCP. As soon as postoperative patients have clinicalsigns or symptoms, endoscopic treatment should beperformed.

Application of a perioperative nursing strategy in the surgical treatment of elderly patients: a narrative review

With the steady increase of older people in society, a progressively greater number of patients belonging to the geriatric group need surgical treatment. Since elderly patients with reduced physiological reserve and organ failure often have chronic diseases, geriatric syndrome, and other clinical problems, the perioperative nursing of elderly patients is more complicated. Therefore, we need to comprehensively consider clinical issues, such as patients’ preoperative status, surgical risks, and postoperative quality of life and life expectancy, and conduct comprehensive evaluations and holistic, individualized, and continuous nursing and therapy through the participation of interdisciplinary teams to achieve better curative effects. Here, the perioperative nursing of elderly patients is reviewed, including preoperative evaluation and nursing, intraoperative management, and postoperative nursing.

EFFECTS OF PERIOPERATIVE CIMETIDINE ADMINISTRATION ON TUMOR CELL NUCLEAR MORPHOMETRY AND DNA CONTENT IN PATIENTS WITH GASTROINTESTINAL CANCER

Objective: To explore the effects of perioperative cimetidine administration on tumor cell nuclear morphometric parameters and DNA content in patients with gastrointestinal adenocarcinoma. Methods: 49 patients with pathologically confirmed gastrointestinal adenocarcinoma were randomized into test group (n=25) and control group (n=24). The test group started oral cimetidine intake 400 mg, tid, 7–10d before operation, followed by standard curative operation. The control group did not receive cimetidine. Tumor specimens were paraffin embedded for microsection and stained with hematoxylin and eosin (HE) and Feulgen stain. Morphometric studies and DNA content of tumor nuclei were performed on IBAS Image Analyzer. Results: The tumor cell nuclear area (μm2), nuclear perimeter (μm), maximal nuclear diameter (μ) for test group/control group were 23.54 5.08/34.69110.08 (P<0.001), 22.064.43/24.884.05 (P<0.05), 7.8411.64/ 8.6211.24 (P<0.05), 4.4210.61/5.4110.89 (P<0.001), Respectively. The percentages (%) of diploidy, triple-tetraploidy, quintuple ploidy, and >quintuple ploidy tumor cells for test group/control group were 16.6412.58/5.3312.14 (P<0.002), 39.8412.28/35.7013.58 (P>0.50), 12.4215.00/14.4810.74 (P>0.20), 31.1116.86/ 45.9713.82 (P<0.005), respectively. Conclusion: Perioperative administration of cimetidine in gasgtrointestinal cancer patients could decrease the nuclear size and raise the percentage of diploid tumor cells, and convert high aneuploid tumor cells into low-aneuploid tumor cells, which might help reduce the invasiveness of tumor cells.

The Value of Perioperative Echocardiography in Percutaneous Balloon Mitral Valvuloplasty

in order to investigate the value of perioperative echocardiography in percutaneous balloon mitral valvuloplasty (PBMV),two-dimensional echocardiography (2-DE), Doppler echocardiography and color Doppler flow imaging (CDFI) were employed prior to PBMV in 52 patients and during or after PBMV in 15 patients. The results showed that TTE and TEE were helpful in the selection of candidates for 2-DE transseptal and balloon dilation procedures. Continuous monitoring of 2-DE, Doppler echocardiography and CDFI during PBMV could make this procedure safer and more effective, reduce X-ray exposure and avoid complications. Echocardiography was usefui in fluoroscopy and could be used for evaluation of the effects of operation.

Perioperative treatment for the central type carcinoma of lung by lung resection with bronchus-first cutting off through pericardium

Objective To investigate the perioperative treatment,the cause of death,and complications of the lung resection for therapy of central type carcinoma of lung.Methods we retrospectively analyzed the treatment and prognosis of 136 patients with central type carcinoma of lung using the bronchus-first lung resection through pericardium during May 1993 to December 2006.Results Total amount of complications in this group was 40 cases,among them,5 cases with pulmonary arterial bleeding,4 cases with respiratory dysfunction,3 cases with contralateral lung pneumonia,6 cases with heart dysfunction,15 cases with arrhythmia,2 cases with injury of recurrent laryngeal nerve,3 cases with chylopleura,and 2 cases with leaking of the bronchus nub.The total complication rate was 27.9%.3 cases died during perioperation,and the mortality was 2.2%.The older the patients were,the higher rate of complications occurred.Conclusion In this group of 136 cases of lung carcinoma,the frequent postoperative complications were the complications of respiratory system and cardiovascular system.The leading causes of death were respiratory dysfunction and heart dysfunction.According to our data,we concluded that the prevention and treatment should be performed during perioperation as follows:Airway should be intensively cared and prepared before operation.The ventilation should be kept unblocked after operation.Assistant ventilation should be performed if necessitated.For those with coronary heart disease or pulmonary heart disease active treatment should be given carefully.Efficient acesodyne and sedation and strictly monitoring of cardiograph should be given postoperatively,finding out the cause of arrhythmia for the correct therapy to protect the heart function.In addition,the indication of operation should be strictly predominated and the principle of operation should be kept on.

Towards personalized perioperative treatment for advanced gastric cancer

Gastric cancer is one of the most frequently diagnosed cancers worldwide. Although the rate of gastric cancer has declined dramatically over the past decades in most developed Western countries, it has not declined in East Asia. Currently, a radical gastrectomy is still the only curative treatment for gastric cancer. Over the last twenty years, however, surgery alone has been replaced by a multimodal perioperative approach. To achieve the maximum benefit from the perioperative treatment, a thorough evaluation of the tumor must first be performed. A complete assessment of gastric cancer is divided into two parts: staging and histology. According to the stage and histology of the cancer, perioperative chemotherapy or radiochemotherapy can be implemented, and perioperative targeted therapies such as trastuzumab may also play a role in this field. However, perioperative treatment approaches have notbeen widely accepted until a series of clinical trials were performed to evaluate the value of perioperative treatment. Although multimodal perioperative treatment has been widely applied in clinical practice, personalization of perioperative treatment represents the next stage in the treatment of gastric cancer. Genomic-guided treatment and efficacy prediction using molecular biomarkers in perioperative treatment are of great importance in the evolution of treatment and may become an ideal treatment method.

经皮椎间孔镜治疗腰椎间盘突出症围手术期护理

目的总结经皮椎间孔镜治疗腰椎间盘突出症围手术期的护理措施。方法选择2016年1月－2017年1月四川省德阳市人民医院骨科收治的147例采用经皮椎间孔镜治疗腰椎间盘突出症患者，予心理护理、体位训练、皮肤和用物准备等术前护理及病情观察、功能锻炼、饮食指导、并发症的观察和护理以及出院指导等术后护理。结果147例患者均顺利完成手术，术后发生1例切口感染，无椎间隙感染及脑脊液漏并发症。术前VAS疼痛评分为（8．27±2．04）分，术后为（2．51±1．46）分，差异有统计学意义（P〈0．05）。术后3个月随访，总优良率为91．1％。结论对腰椎间盘突出症经皮椎间孔镜治疗患者实施围术期综合护理，能较好促进患者康复。