APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

Objective To assess the efficacy and safety of lornoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patient-controlled analgesia (PCA) in patients undergoing abdominal surgeries. Methods Thirty-nine patients scheduled for abdominal surgeries were randomly assigned to different PCA treatment groups using either lornoxicam or fentanyl postoperatively. Pain intensity difference (PID) and sum of pain intensity difference (SPID) were used to assess the analgesic efficacy of both drugs during a 24-hour period. Results The analgesic efficacy of lornoxicam is 1/66 of fentanyl, which was shown by SPID value of 3.250 and 3.058, respectively (P > 0.05). Lornoxicam caused fewer adverse events than fentanyl (33% vs. 68%, P < 0.05). Conclusion In clinic, we can use lornoxicam to treat postoperative pain effectively and with less adverse reactions com-pared with fentanyl.

Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters

AIM:To evaluate the effects of preoperative immunonutrition and other nutrition models on the cellular immunity parameters of patients with gastrointestinal tumors before surgical intervention.In addition,effects on postoperative complications were examined. METHODS:Patients with gastrointestinal tumors were randomized into 3 groups.The immunonutrition group received a combination of arginine,fatty acids and nucleotides.The second and third group received normal nutrition and standard enteral nutrition,respectively.Nutrition protocols were administered for 7 d prior to the operation.Nutritional parameters,in particular prealbumin levels and lymphocyte subpopulations(CD4+,CD8+,CD16+/56+,and CD69 cells)were evaluated before and after the nutrition protocols.Groups were compared in terms of postoperative complications and duration of hospital stay. RESULTS:Of the 42 patients who completed thestudy,16 received immunonutrition,13 received normal nutrition and 13 received standard enteral nutrition. prealbumin values were low in every group,but this parameter was improved after the nutritional protocol only in the immunonutrition group(13.64±8.83 vs 15.98±8.66,P=0.037).Groups were similar in terms of CD4+,CD16+/56,and CD69+prior to the nutritional protocol;whereas CD8+was higher in the standard nutrition group compared to the immunonutrition group.After nutritional protocols,none of the groups had an increase in their lymphocyte subpopulations.Also,groups did not differ in terms of postoperative complications and postoperative durations of hospital stay. CONCLUSION:Preoperative immunonutrition provided a significant increase in prealbumin levels,while it did not significantly alter T lymphocyte subpopulation counts,the rate of postoperative complications and the duration of hospital stay.

Minimally Invasive Perventricular Device Closure of Ventricular Septal Defect: a Comparative Study in 80 Patients

Objective To evaluate the efficacy of minimally invasive perventricular device closure of ventricular septal defect(VSD). Methods Between September 2011 and February 2013, we collected 40 patients who underwent perventricular closure via a small lower sternal incision(minimally invasive group), aged 15.5±3.5 years(12 months to 32 years) with a body weight of 24.2±7.5 kg(10.8-58.0 kg). The mean size of VSD was 5.6±0.5 mm(2-14 mm). Another 40 patients were included as the surgical group, receiving the conventional surgical repair of VSD. The device of the minimally invasive group was released under the guidance of transesophageal echocardiography. Success rate, cardiac indicators, and clinical outcomes of the 2 groups were compared. Results The patients in the surgical group and those in the minimally invasive group showed similar results in success rate(both 97.5%). The procedure time, intensive care unit stay, hospital stay, and postoperative recovery time in the minimally invasive group were significantly shorter than those in the surgical group(58±21 minutes versus 145±26 minutes, 2±1 days versus 8±3 days, 5±1 days versus 16±6 days, 3±1 days versus 90±20 days, all P<0.05). The minimally invasive group had a higher incidence of conduction anomalies(17.5% versus 2.5%, P<0.05). In the follow-up period of 3-12 months, there was no new residual shunt, noticeable aortic regurgitation, significant arrhythmias, or device failure except for new complications in the surgical group. Conclusions The success rate of minimally invasive perventricular device closure of VSD under transesophageal echocardiography guidance is similar to that of conventional surgical repair, but the short-term outcomes of the minimally invasive approach is much better. Long-term follow-up is necessary to confirm the effectiveness of this technique.

Evaluation of orthotopic liver transplantation with no veno-venous bypass

Objective: To assess the feasibility and outcome of orthotopic liver transplantation(OLT) with no veno-venous bypass(v-v bypass) in adult patients. Methods: Between 1999 and 2001, 43 adult patients underwent OLT with v-v bypass, 33 with no v-v bypass. The operation time, anhepatic time, amount of blood loss, amount of blood transfusion, ICU stay days of the two groups were compared; renal function and gastrointestinal function in the two groups were examined. Results: There was no significant difference in mean serum creatinine on day 3 and gas discharge time in patients with v-v bypass or not. With no v-v bypass , the average operation time was 5.7±1.3 hours, anhepatic time was 64±13 minutes, median amount of blood loss in operation was 4000±820 mL, median amount of blood transfused intraoperatively was 4650±910 mL, median ICU stay was 5.7 days; all those were lower or shorter than those with v-v bypass; and these differences between the two groups had statistical significances. Conclusion: OLT with no v-v bypass is safe and can be performed in the majority of adult patients. The practice of liver transplantation with no v-v bypass is associated with shorter total operation time, shorter anhepatic time, lower blood product usage, and shorter ICU stay compared with standard technique of OLT with routine use of v-v bypass.

COMPARISON THE EFFICIENCY OF DIFFERENT SURGICAL PROCEDURES FOR URINARY STRESS INCONTINENCE

Objective.To analyse the efficiency of two operations for treatment of unirary stress incontinence (USI). Methods. The clinical data of 95 USI cases or accompany USI treated by surgical procedures (Kelly operation 63 cases, Colposuspension 32 cases) was analysed retrospectively in our department. Results.The cure rates during three months after operation were 92.9% in Colposuspension group and 68.9% in Kelly operation group (P<0.05), and decreased to 73.7% and 57.5% one year after operation in Colposuspension group and Kelly operation group respectively (P>0.05). Abnormal senses rates of sexual intercouse was 3.7% in Cloposuspension and 7.3% in Kelly operation group. The length of retaining Folly catheter after Colposuspension was more than Kelly operation. [WT5”BX]Conclusion.[WT5”BZ]The cure rate during three months after Colposuspension is better than Kelly operation. But the cure rates during one year after surgery are the same in two groups.

FAILURE AND COMPLICATION FOLLOWING SURGICAL TREATMENT OF SCOLIOSIS——AN ANALYSIS OF 101 CASES

Complications occur frequently after surgical treatment of scoliosis.In order to prevent from them effectively,101 cases with failure and postoperative complications were analysed.They included rod fracture in 22 cases(15 Harrington rods,4 Zielke rods,and 3 Luque rods);recurrence of curve severity in 12 cases;broken or loossened luque wires in 15 cases;loss of thoracic kyphosis(flat back) in 6 cases;progressive kyphosis with or without paraplegia following incorrect posterior decompression in 5 cases;and increased unbalance of shoulders after instrumentation in 2 cases due to neglect of the tilting of the first thoracic vertebra.Infection occurred in 8 cases(incision infection 7 cases,deep wound infection in 1 case);and pneumothorax in 1 case.They were induced by biomechanical factors in 23 cases(22 8%),incorrect selections of indications in 29 cases(28 7%),operational mistakes in 37 cases(36 6%),internal fixation factors in 15 cases(14 9%).The authors hold that there are quite a lot of factors leading to occurrence of complications and the effective way for prevention from them is to understand the factors and main technical points related to internal fixation.

Postmyotomy dysphagia after laparoscopic surgery for achalasia

AIM: To determine predictive factors for postoperative dysphagia after laparoscopic myotomy for achalasia.METHODS: Logistic regression was used to investigate the possible association between the response (postoperative dysphagia, with two levels: none/mild and moderate/severe)and several plausible predictive factors.RESULTS: Eight patients experienced severe or moderate postoperative dysphagia. The logistic regression revealed that only the severity of preoperative dysphagia (with four levels; mild, moderate, severe, and liquid) was a marginally significant (P=0.0575) predictive factor for postoperative dysphagia.CONCLUSION: The severity of postoperative dysphagia is strongly associated with preoperative dysphagia. Preoperative symptomatology can significantly impact patient outcome.

POSTOPERATIVE EVALUATION OF TENSION-FREE VAGINAL TAPE PROCEDURE

Objective To study the outcome of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with cystocele. Methods Forty-two patients with SUI confirmed by urodynamics underwent the TVT procedure under local anesthesia. A prolapse repair was done simultaneously. Results Mean TVT operation time was 26.29 minutes. Mean blood loss was 29.86 mL. Eighty-eight percent of the patients were able to micturate spontaneously within 12 hours and residual urine was less than 100 mL. And 12% of the patients had to use indwelling catheter for 3-11 days. Average hospital stay was 2.91 days. Eighty-eight percent of patients were discharged within 2 days. All patients were followed up (an average of 10.26 months). According to subjective and objective assessment of the outcome, 39 patients (93%) were cured, another 3 patients (7%) were significantly improved and none was failed. There were no major complications such as bladder injury occurred. Conclusion TVT procedure is a minimal invasive, effective, and safe surgery for treatment of SUI.

失手

单位一直用着一个包工头．这包工头跟单位领导是朋友。两年前，领导刚上任，就带着包工头在单位转了一圈，觉得单位的大门太旧了，便让包工头把单位的大门拆了重做。

Urodynamic analysis of non-improvement after prostatectomy

OBJECTIVE: To study the factors that affect the prognosis of the patients with benign prostatic hypertrophy (BPH) after prostatectomy. METHODS: Using urodynamic methods, we studied 50 BPH patients with embarrassing outcomes after prostatectomy. RESULTS: Detrusor instability (Dl) appeared in 20 (40%) patients. Twelve (24%) patients suffered from weak contractility of the detrusor and 18 (36%) patients had bladder outlet obstruction. CONCLUSIONS: Dl, weak contractility of the detrusor and bladder outlet obstruction are the most frequent causes affecting the prognosis of BPH patients after prostatectomy. Urodynamics may play a significant role in the identification of the causes of unsatisfied prognosis of BPH patients.

Traumatic cardiac injury： Experience from a level-1 trauma centre

Purpose： Traumatic cardiac injury （TCI） is a challenge for trauma surgeons as it provides a short thera- peutic window and the management is often dictated by the underlying mechanism and hemodynamic status, The current study is to evaluate the factors influencing the outcome of TCI. Methods： Prospectively maintained database of TCI cases admitted at a Level-I trauma center from July 2008 to June 2013 was retrospectively analyzed. Hospital records were reviewed and statistical analysis was performed using the SPSS version 15. Results： Out of 21 cases of TCI, 6 （28.6%） had isolated and 15 （71.4%） had associated injuries. Ratio be- tween blunt and penetrating injuries was 2：1 with male preponderance. Mean ISS was 31.95. Thirteen patients （62%） presented with features suggestive of shock. Cardiac tamponade was present in 12 （57%） cases and pericardiocentesis was done in only 6 cases of them. Overall 19 patients underwent surgery, Perioperatively 8 （38,1%） patients developed cardiac arrest and 7 developed cardiac arrhythmia. Overall survival rate was 71.4%. Mortality was related to cardiac arrest （p = 0.014）, arrhythmia （p = 0.014）, and hemorrhagic shock （p = 0.04）. The diagnostic accuracy of focused assessment by sonography in trauma （FAST） was 95.24%. Conclusion： High index of clinical suspicion based on the mechanism of injury, meticulous examination by FAST and early intervention could improve the overall outcome.

Memory response to manual acupuncture in chronic insomniacs: evidence from event-related potentials

Objective:To investigate the effectiveness and safety of manual acupuncture for memory loss and sleep quality in chronic insomniacs.Methods:A total of 60 eligible participants were enrolled and randomized into either a treatment group or a control group,with 30 cases in each group.The treatment group was intervened by manual acupuncture whereas the control group was given sham acupuncture.In the two groups,the interventions were offered once every other day and three times a week,for 8 weeks in total.Before and after the treatment,Pittsburgh sleep quality index (PSQI) and eventrelated potentials (ERPs) were used to assess the patients' sleep quality and memory,respectively.Meanwhile,adverse events were monitored and recorded.Results:After 8-week treatment,both the treatment group and the control group showed a significant decrease in the PSQI global score (P<0.001,P<0.01),and the decrease in the treatment group was more significant than that in the control group (P<0.001).The intra-group comparisons of ERPs indicated that,the latencies of N1 and P3 were shortened and the amplitudes of N1 and P3 were increased in the treatment group after the intervention,and the differences were statistically significant (P<0.05,P<0.001);in the control group,there were no significant changes in the latency and amplitude after the treatment (P>0.05).The between-group comparisons of ERPs showed that the treatment group was more effective than the control group in shortening the latency of P3 (P<0.01).Conclusion:Acupuncture can be a safe and effective treatment option for chronic insomnia coupled with memory impairment.

Surgical treatment strategy for multiple injury patients in ICU

Objective： To investigate the surgical treatment for patients with multiple injuries in ICU.Methods： Clinical data of 163 multiple injury patients admitted to ICU of our hospital from January 2006 to January 2009 were retrospectively studied, including 118 males and 45 females, with the mean age of 36.2 years （range, 5-67 years）. The injury regions included head and neck （29 cases）,face （32 cases）, chest （89 cases）, abdomen （77 cases）, pelvis and limbs （91 cases） and body surface （83 cases）. There were 57 cases combined with shock. ISS values varied from 10 to 54, 18.42 on average. Patients received surgical treatments in ICU within respectively 24 hours （10 cases）, 24-48 hours （8 cases）, 3-7 days （7 cases） and 8-14 days （23 cases）.Results： Forthe 163 patients, the duration of ICU stay ranged from 2 to 29 days, with the average value of 7.56 days. Among them, 143 were cured （87.73%）, 11 died in the hospital （6.75%） due to severe hemorrhagic shock （6 cases）,craniocerebral injury （3 cases） and multiple organ failure （2 cases）, and 9 died after voluntarily discharging from hospital （5.52%）. The total mortality rate was 12.27%.Conclusions： The damage control principle should be followed when multiple injury patients are resuscitated in ICU. Surgical treatment strategies include actively controlling hemorrhage, treating the previously missed injuries and related wounds or surgical complications and performing planned staging operations.

Clinical study of catgut embedding combined with Chinese herbal medicine for treatment of anemia due to blood loss after major operation of orthopaedics

Objective To observe the therapeutic effect of catgut embedding treatment on bilateral Zúsānlǐ（足三里ST 36） combined with Huangqi Ejiao decoction （黄芪阿胶汤） orally taken. Methods Patients with anemia due to blood loss after major operation were randomly divided into a control group and an observation group. There were 30 cases in the control group which were treated by blood transfusion and 32 cases in the observation group which were treated by catgut embedding on bilateral Zúsānlǐ （足三里ST 36） after local anesthesia combined with oral administration of self-made Huangqi Ejiao decoction （黄芪阿胶汤）. The herbs included Huangqi （黄芪Radix Scutellariae Milk Veteh）10 g, Ejiao （阿胶Colla Corii Asini Donkey-hide Gelatin）10 g, Danggui （当归 Radix Angelicae Sinensin Chinese Angelica）10 g, Baizhu （白术 Radix A tractyloes Macrocephalae Large-headed Atractylodes） 10 g, Dangshen （ 党参 Radix Codonopsis Dangshen）20 g, Danshen （丹参 Salvia Miltiorrhiza Root of Red Rooted Salvia） 10 g, Honghua （ 红花 Carthamus Tinctorious Safflower） 10 g, Shudi （熟地 Rehmannia Glutinosa Prepared Rhizome of Rehmannia） 20 g, etc. After 1 d, 3 d, 7 d, 15 d, 21 d, RBC, Hb, IgM, IgG were tested. Results In the control group, Hb and RBC count immediately went up in the beginning, that peaked on the 7^th day and kept gently after. While in the observation group, there was a minimal increase in Hb and RBC in the beginning, followed by a sharp increase during 15-21 d, and peaked on the 21^th day. There was a significant difference between the observation group and the control group（P〈0.05）. While, the level of IgM, IgG rose markedly in the observation group, with a significant difference between the two groups （P〈O. 01）. Conclusion Catgut embedding treatment on bilateral Zúsānlǐ （足三里 ST 36） combined with oral administration of Huangqi Ejiao decoction （黄芪阿胶汤） can improve anemia due to blood loss after operation, and likewise increase the level of IgM and IgG.

Quantity-effect Relationship of Electroacupuncture for Urge Incontinence:A Multicenter Randomized Controlled Trial

Objective：To investigate the quantity-effect relationship of electroacupuncture in treating urge incontinence （UI）.Methods：A clinical multicenter randomized controlled trial was carried out.One hundred and ninety-nine UI patients meeting the inclusion criteria were randomly allocated,at a ratio of 2：1,to acupuncture and medication groups.The acupuncture group of 199 patients was treated with electroacupuncture plus manual acupuncture,and the medication group of 68 patients was treated with oral administration of Tolterodine Tartrate tablets.Results：The total scores of international consultation on incontinence questionnaire-short form （ICIQ-SF） score plus the international prostatic symptom score （I-PSS） were significantly lower in both groups at each follow-up visit （after 3,6 and 9 treatments） than before treatment.The effect was accumulated with an increase in the number of treatments.The improving effect was significantly better at each follow-up visit in the acupuncture group than that in the medication group （P0.05）.Conclusion：The improvement degree of urinary symptoms and the number of treatments are positively correlated in the treatment of UI by electroacupuncture plus manual acupuncture and by oral administration of Tolterodine Tartrate tablets.Acupuncture has a more marked effect.

Clinical analysis of thoracoscopic surgery combined with intraoperative autologous blood transfusion in the treatment of traumatic hemothorax

From January 2013 to January 2015, 19 patients of traumatic hemothorax with hemorrhagic shock were treated in our department by thoracoscopic surgery combined with autologous blood transfusion. This study retrospectively analyzed the therapeutic effect and shared our experience. The average amount of blood transfused back was 662.41 ml ± 269.15 ml. None of the patients developed transfusion reaction and were all discharged uneventfully. Thoracoscopic surgery combined with autologous blood transfusion is effective in the rescue of patients with progressive hemothorax and hemorrhagic shock. When corresponding indications are well managed, treatment for these patients is quicker, safer, and more effective.