Objective To study the feasibility of the ultrasonic scalpel in the management of cystic blood vessels during laparoscopic cholecystectomy(LC). Methods Abdominal blood vessels of two dogs were managed by ultrasonic scalpel under the conditions of two step output power,low tension,low holding force and blunt scalpel head.The blood vessels were sealed and arteries and veins of (1～11)mm were cut.On this basis,the technique was applied to the management of cystic vessels during laparoscopic cystic and biliary operation. Results The sealing and cutting effect was good for the blood vessels of less than 9mm 140/150(93 3%).No blood oozing was found at the cutting ends of blood vessels during and after operation.In all 706 cases of laparoscopic gallbladder and biliary duct operations,no bleeding was found at the cutting ends of blood vessels during and after operation. Conclusions Ultrasonic scalpel can be directly used to seal and cut cystic artery during laparoscopic cholecystectomy.

Objective To explore the clinical value of the ten-point scale in the early diagnosis of fat embolism syndrome.Methods The data of 129 patients with fat embolism syndrome diagnosed by Gurd criteria admitted from January 1993 to February 2012 were analyzed retrospectively.At the same time,another 97 patients with single or multiple long bone fracture and/or pelvic fracture without fat embolism admitted from July 2005 to February 2012 were enrolled as control group.Patients were excluded if they had any of the following diseases:simple brain trauma,thoracic injury,spine fracture,hemorrhagic shock and the complications of cardiopulmonary cerebral resuscitation (CPCR).The patients of two groups were comparable in respect of clinical setting.The clinical data were analyzed and scored by the ten-point scale.The x2 test were applied to statistical works.Results Among all the clinical characteristics,the incidence of increased D-dimer was the highest (74.1％) in early fat embolism syndrome,followed by the progressive decrease in hemoglobin (63.6％) and hypoxemia (57.4％),and the occurrence of dyspnea was the lowest (17.8％).The percentage of total scores over ten points in patients with fat embolism syndrome group was higher than that in those without fat embolism syndrome (x2 =202.6,P ＜ 0.01).The sensitivity of tenpoint scale was 96.12％ and the specificity was 99.8％.Conclusions Ten-point scale could be used to make early diagnosis of fat embolism syndrome,thereby reducing the occurrence of misdiagnosis and misseddiagnosis.

Objective To investigate the effect of growth hormone replacement therapy on life quality of patients with growth hormone deficiency after sellar tumor surgery.Methods The data of 13 patients undergoing sellar tumor resection and suffering postoperative hypopituitarism from Jun.2009 to Dec.2010.were collected.Each of them was given daily 0.5 units growth hormone (about 0.17 mg) as replacement therapy.The life quality of patients at different time points was evaluated with QoL-GDHA scale.SPSS 17.0 software was used for statistical analysis.Results 1,3,and 6 months after treatment,QoL-GDHA score of the patients was 3.91± 2.29,3.38 + 2.43,and 3.23 + 2.28 repectively,significantly lower than before ( 8.69 ± 2.66).The difference had statistical significance (P ＜0.05 ).Conclusion Growth hormone replacement therapy can significantly improve the life quality of patients with hypopituitarism after sellar tumor surgery.

No abstract available.
Cerebral Infarction ; Infarction* ; Wrist*

Objective To investigate the prediction model of hypotension in patients with hepato-cellular carcinoma resection using controlled low central venous pressure technique(CLCVP).Methods A total of 144 patients with liver cancer admitted from January 2020 to June 2023 were retrospectively ana-lyzed,including 81 males and 63 females,aged 45-64 years,BMI 22-26 kg/m2,ASA physical status Ⅰ or Ⅱ.144 patients were randomly divided into trial set(n=96)and verification set(n=48)according to 2:1.The trial set and verification set were divided into hypotensive group and non-hypotensive group ac-cording to whether hypotension occurred after operation.Preoperative albumin,preoperative hemoglobin,op-eration method,operation time,tumor site,tumor size,hilar block time,number of hilar block times,hilar block interval time,blood loss,mean intraoperative CVP,intraoperative fluid volume,and intraoperative u-rine volume were collected.Univariate and multivariate Logistic analysis were used to analyze the risk factors of hypotension in the experimental group,and a risk prediction model was established.The risk prediction model was verified in the validation group.Results There were 29 patients(30.2％)of postoperative hy-potension in the test group and 15 patients(31.3％)of postoperative hypotension in the validation group.Compared with the non-hypotensive group,the preoperative albumin in the hypotensive group was signifi-cantly decreased(P<0.05),the operation time was significantly prolonged,the ratio of tumor diameter≥5 cm,and the amount of blood loss were significantly increased(P<0.05).Multivariate analysis showed that preoperative albumin elevation(OR=0.216,95％CI 0.164-0.665,P<0.05)was an independent protective factor for postoperative hypotension.Prolonged operative time(OR=2.649,95％CI 1.802-7.553,P<0.05),tumor diameter≥5 cm(OR=3.789,95％CI 2.011-12.458,P<0.05),in-creased blood loss(OR=8.873,95％CI 2.750-17.553,P<0.05)was an independent risk factor for postoperative hypotension.According to the results of multi-factor analysis,the risk factors of postoperative hypotension in patients with controlled low central venous pressure hepatocellular carcinoma resection were established:F=-408.64-(1.534×preoperative albumin)+(0.974×operation time)+(1.332×tumor diameter≥5 cm)+(2.183×blood loss).The risk model was validated in the validation set,and the area under the ROC curve(AUC)was0.821(0.695-0.943),the sensitivity was71.7％,and the speci-ficity was 86.5％.The Hosmer-Lemeshow goodness of fit test showed that χ2=10.654,P=0.222.Conclusion Prolonged operative time,tumor diameter≥5 cm and increased blood loss are risk factors for hypotension after hepatocellular carcinoma resection using CLCVP technique,and higher preoperative albumin is protective factor.The establishment of risk prediction model through multi-factor analysis has good forecasting value.