Objective To approach the effect of low damage endotracheal intubation on reducing the occurrence of cuff-related intubation complication and prolonging the intubation time. Methods On January 7th, 2015, 1 patient with respiratory failure after subarachnoid hemorrhage were admitted to Huludao Central Hospital. Immediate endotracheal intubation and ventilator assisted ventilation were performed. When the trachea was difficult to be removed in a short time, and tracheotomy was refused, a low damage endotracheal intubation was used for a long term. On the basis of the original high volume low pressure cuff, this tube was designed for inner cuff, the hole was allowed in the inner cuff to connect with the tube. During the period of ventilation, the cuff pressure changed with airway pressure automatically, therefore it would reduce the compression injury of tracheal mucosa, improve the tolerance of the patients, and prolong the intubation time. Results The patient was removed from the tube on October 12th, 2015 with an intubation day of 279, the intubation-related complications and severe aspiration pneumonia had not been observed during the application of low damage endotracheal intubation. Conclusions Design of this intubation ensured the cuff pressure changes with airway pressure, therefore, it could effectively avoid the cuff pressure become too high, and reduce the occurrence of intubation-related complication. This low damage endotracheal had an evident superiority in the aspects of cuff management. It has a better practical significance, especially for patients with long intubation time.

Objective To explore the change of serum leptin and significance in patients with chronic obstructive pulmonary disease(COPD). Methods The levels of leptin and tumor necrosis factor-? (TNF-?) of 34 COPD patients in stationary phase and 16 healthy people were measured by radioimmunoassay. The ideal body weight percentage(IBW%), triceps skin-fold thickness(TSF), arm muscle circumference(AMC), creatinine height index percentage(CHI%), total lymphocyte(TLC), albumin(ALB) were determined at the same time. The differences of parameters between patients and healthy people were compared. The correlation between parameters and leptin levels was analysed. Results Nutritional parameters were lower in COPD patients than in healthy controls(P

The arteries of the spinal cord on surface have been observed in 62 Chinese adults and 39 children.Anteriorly, the spinal cord was divided into 3 areas, according to the arterial supply.The superior cervical area(segments of C_(1～3) or C_(1～4))was mainly supplied by the anterior spinal arteries; the cervical enlargement area (segments of C_4 or C_5 to T_5 or T_6) was mainly supplied by the arteria intumescentia cervicalis and the lumbar enlargement area (below the segments of T_6 or T_7) was mainly supplied by the arteria intumescentia lumbalis. In the intermediate places between these areas (segments of C_(3～4) and T_(5～6)), the anterior median artery was often narrow or interrupted. Usually the anterior spinal artery united with its fellow of the opposite side to form a single trunk (46.53%). The anterior radicular arteries averaged 5.2 (2～10) in number. The arteria intumescentia cervicalis frequently existed at C_7 and C_8 (C_5～T_3). The arteria intumescentia lumbalis mostly located at T_9 (T_6～L_2), and 72.28% of them being on the left side.Posteriorly, the arteries developed well on the two enlargements. The posterior spinal arteries arised frequently from the vertebral artery (76.41%). The posterior radicular arteries averaged 9.3 (5～21) in number.The authors have raised an objection to the view that the segments of T_4 and L_1 of spinal cord are poor supplied with blood.

OBJECTIVE:To investigate the effects of lidocaine epidural block combined with general anesthesia on postopera-tive related indexes of lung cancer patients. METHODS:In retrospective analysis,108 patients with lung cancer were divided into observation group (56 cases) and control group (52 cases) according to anesthesia method. Both groups were given intravenous dripping of Propofol injection combined with Fentanyl injection,inhaled 1%sevoflurane for inhalation to assist anesthesia and inter-mittent intravenous drip of Vecuronium for injection to maintain muscle relaxation. On this basis,observation group was treated with epidural infusion of 2.0% Lidocaine hydrochloride injection 5 mL/h to maintain anesthesia;control group was given epidural infusion of 0.9% Sodium chloride injection 5 mL/h to maintain anesthesia. The anesthesia time,operation time,intraoperative bleeding volume,postoperative recovery time,the amount of fentanyl,propofol,vecuronium bromide and sevoflurane,the occur-rence of postoperative anesthesia complications (nausea,vomiting,dizziness,drowsiness,skin itching) and other complications (cardiac function insufficiency,cardiovascular events,atrial fibrillation,infection,transient cerebral ischemia,acute coronary com-prehensive syndrome,cerebral apoplexy)were observed in 2 groups as well as active and calm VAS score 4 h and 1,2,3,4,5 after surgery. RESULTS:The anesthesia time,operation time,intraoperative bleeding volume,postoperative recovery time,the amount of fentanyl,propofol,vecuronium bromide and sevoflurane,calm VAS score 4 h,1 d,2 d after surgery and active VAS score 4 h,1 d,2 d,3 d after surgery,the incidence of drowsiness in observation group were significantly shorter or lower than control group,while the incidence of dizziness was significantly higher than control group,with statistical significance(P<0.05). There was no statistical significance in the amount of vecuronium,calm and active VAS score in other time,the incidence of nau-sea,vomiting,skin itching,cardiac function insufficiency,cardiovascular events,atrial fibrillation,infection,transient cerebral ischemia,acute coronary syndrome and stroke between 2 groups(P>0.05). CONCLUSIONS:Lidocaine epidural block combined with general anesthesia can reduce the perioperation bleeding amount,postoperative pain,shorten postoperative recovery time and do not increase postoperative complications.

Objective To evaluate the role of the sodium removal and explore the relationship of sodium balance and blood pressure in patients with traditional hemodialysis.Methods Fourteen patients with maintenance hemodialysis were randomly enrolled in this study.Serum sodium concentration was measured at the pre-dialysis and post-dialysis.At the beginning of dialysis and every half hour,20 ml waste dialysates were collected,10 ml were drown from total 180 ml waste dialysates that had being mingled for measuring total NaCl removal and the removal caused by ultrafiltration.The Fisher's Exact Test was used to analyze the difference in incidence of hypertension(≥ 150/90 mmHg group or ＜ 150/90 mmHg) between the different NaCl removal groups.Results The total NaCl removal in single hemodialysis session was (29 ±14.9)g,A average of (18 ± 6.9)g sodium was removed by ultrafiltation (83 ± 58.6)％.The patients whose sodium removal in a hemodialysis session were less than 29 g,which were vulnerable to hypertension (≥ 150/90 mmHg group) (P =0.023).Conclusions The factors that effected sodium removal in hemodialysis session were complicated; most of sodium was removed by ultrafiltration of plasma water.These results demonstrated that adequate ultrafiltration volume in triple times a week rather than restriction of fluid intake was the principal factor that controls blood pressure in patients with traditional hemodialysis.

ObjectiveTo review the etiology and classification of cholangiectasia. MethodThe clinical data of 1098 patients with cholangiectasia treated from January 2000 to December 2009 were retrospectively analyzed. Results For the 1098 patients, 69 patients (6.3％) had congenital choledochal cyst, and 1029 patients (93.7％) had secondary cholangiectasia which were secondary to 22 diseases, The top 5 of the etiological diseases were bile duct stones (366 patients, 33.3 ％), pancreatic head carcinoma (137 patients, 12.5％), peri-ampullary carcinoma (122 patients, 11.1％), cholangiocarcinoma (68 patients,6.2％),and chronic pancreatitis or pancreatic head cyst (62 patients,5.6 ％). ConclusionsCholangiectasia can be divided into two major categories (congenital and secondary). Congenital choledochal cyst accounted for 6.0％, secondary cholangiectasia accounted for 94 ％.The most common etiologies were bile duct stones, pancreatic head carcinoma and peri-ampullar carcinoma.

Objective To summarize the clinical efficacy of Millikan's modified modality using tension-free mesh-plug inguinal herniorrhaphy. Methods A retrospective study was performed in 185 cases with in-guinal hernias. They received surgical treatment using Millikan's modality in our hospital from Jan. 2005 to Dec. 2006. Results There were 184 males and 1 female in these patients with a average age of 47 years ( range 32 - 75 years). Among them, 7 cases had bilateral hernia. The mean operative time of each hernia was 49 min (range 30 -70 min), and the average postoperative hospital stay was 5. 1 days (range 3 - 18 d). The complication rate was 10. 8% (20/185). All patients had no recurrence after following-up over 24 months. Conclusion Millikan's modified mesh-plug hemioplasty is a safe and effective modality in the pri-mary inguinal hernia repair, and has fewer complications and lower recurrence rate.

The facial, retromandibular and external jugular veins of the neck were studied in a total of 230 Chinese cadavers.1. The external jugular vein can be divided into six types and fourteen subtypes. Type Ⅰ(40.22％) and type Ⅲ (29.13％) occurred more frequently in this series.2. The facial vein drains into the external jugular vein in 41.09％. It drains directly or indirectly into the internal jugular vein in 43.91％.3. The anterior branch of the retromandibular vein usually drains into the internal jugular vein and it runs through the space deep to the posterior, belly of the digastric and the stylohyoid muscles in 83.70％.4. The presence of the so called common facial vein occurred only in 29.13％.5. The external jugular vein often drains into the subclavian vein. It appears in 46.57％ in our observation.6. The external jugular vein crosses the inferior belly of the omohyoid muscle, when it runs downwards in the lower part of the external cervical triangle. It usually lies superficial to the omohyoid in 66.16％, deep to it in 26.35％.

Objective To investigate the therapeutic effects of latarjet nerve and pylous preserved pancreaticoduo-denectomy (LPPPD). Methods Clinical data and postoperative follow-up of Latarjet nerve and Pylous Preserved Pancreaticoduodenectomy since1996 of 32 cases were analyzed retrospectively, and 36 cases being carried out con-temporaneous Pylous Preserved Pancreaticeduodenectomy(PPPD) were compared with. Results The recovery time of postoperative gastrointestinal function recory time is five days of LPPPD group on average; but the time is eight days of PPPD group on average, and significantly slower than LPPPD group ( t = 3.01, P < 0.05 ) ; the occurrence of abdominal distenal, retention of gastric juice and enterogastric recurrent flow are significantly slower in LPPPD group than that in PPPD group( P < 0.05 ). Conclusion The postoperative gastrointestinal function recovered fas-ter, and the postoperative complications were less in LPPPD group than that in PPPD group.

Objective To investigate the peripheral blood cytopenias in patients with portal hypertension complicated with splenomegaly. Methods The clinical data of 309 patients with portal hypertension who had been admitted to our department from January 1991 to December 2006 were retrospeetively analyzed. Results Of all patients, 278 showed peripheral blood cytopenia, ineluding 71 with paneytopenia, 48 with leukocyte and platelet decrease, 25 with erythroeyte and platelet decrease, 33 with leukocyte and erythroeyte decrease, 28 with platelet decrease, 26 with leukocyte decrease, and 47 with erythrocyte deerease. The number of blood cells increased significantly after splenectomy ( t=6.53, P<0.01). The whole blood cells of the remaining 31 patients without hematocytopenia were normal. Conclusions Patients with portal hypertension eomplieated with splenomegaly do not always accompany peripheral blood eytopenia. Peripheral blood cytopenia is one of the complications of splenomegaly, hut it dose not always appear. Splenectomy is effective in the treatment of hematocytopenia. The reason for some patients do not have peripheral blood cytopenia may be related to the slight pathological changes of spleen and severe hyperplasia of bone marrow.