[Objective]To discuss the results of the GIEBEL system in high tibial osteotomy to treat varus knee.[Method]Nineteen patients with medium varus knee were selected to be treated with osteotomy.Preoperatively,the mean varus angle was 12.29?,without deformity in other department of the knee joint.The main symptom was the pain in medial department.Accurate high tibial osteotomy with GIEBEL system fixation was performed in 31 knees of these patients.Weight-bearing extremity X-ray testing,varus angle,mechanical axle and anatomical axle were marked preoperatively and postoperatively.Joint space discrepancy between lateral and medial joint,the range of motion,Lysholm assessment and objective satisfactory survey were also performed to determine the outcome of the treatment.[Result]The mean follow-up of nineteen patients was 22 months.During this period,one case of temporary common fibular nerve paralysis occurred and healed at several days.All of the osteomy interface achieved bony healing.The corrected abnormality was 12.32?.The mechanism axle of the extremity maintained as the level just after operation during the follow-up and no degeneration of the joint space aggravated.The excellent and good rate of the treatment was 89.5%,and 84.2% of the patients expressed satisfactory for the operation.No difference of the range of motion was found before and after operation,but the Lysholm score,joint space discrepancy between lateral and medial joint and varus angle were improved after the osteotomy.[Conclusion]The GIEBEL system can fixate the bony interface of the high tibial osteotomy effectively,and possess the advantages of minimal invasion,stronger intensity and higher healing rate.

Objective To study the clinical feasibility and effect of totally endoscopic resection of axillary accessory breast.Methods Totally endoscopic resection of axillary accessory breast was performed in 48 cases(59 sites).On the basis of liposuction,a camera port and two 5-mm working trocars were made.By using forceps,dissecting scissors,or harmonic knife,were inserted.The cobweb-like fibropartition around the accessory breast was dissected.Results Postoperatively,there were 1 case of subcutaneous liquid accumulation and 2 cases of subcutaneous petechia,and no hematoma or infection developed.All wounds healed by first intention.Follow-up observations for 2～58 months(mean,23.6 months) showed good appearance and satisfactory effects.Conclusions Totally endoscopic resection of axillary accessory breast is safe,offering good cosmetic effects and being worthy of recommendation.

Objective:To understand the pain experience of discharged patients after thoracoscopic lobectomy, identify the out-of-hospital pain management needs of patients, and help patients improve the level of out-of-hospital pain management.Methods:The phenomenological method in qualitative research was used in the study, and the Colaizzi 7-step data analysis method was used to analyze the interview data.Results:Six topics were summarized: pain cognition, different pain coping styles, misunderstanding of painkillers, negative emotions, postoperative paresthesia, and lack of professional guidance.Conclusion:Medical staff should strengthen the publicity and education of discharge, pay attention to the follow-up, provide professional guidance for patients outside the hospital, relieve pain and improve the quality of life of patients.

Objective To study the relationship between serum fibronectin(Fn) and hyaluronic acid(HA) in patients with hepatocellular carcinoma(HCC) and their clinical value.Methods The serum Fn and HA levels in 50 cases of HCC 14 cases of benign hepatic disease and 100 healthy persons were determined by enzyme-labelled turbidimetry and radioimmuoassay.Results The serum Fn content (125.85?29.47)mg/L of the patients with HCC was significantly lower than those of both the benign hepatic disease(210.14?18.36)mg/L and healthy controls (219.96?26.26)mg/L,P

Objective To investigate the feasibility of total hip arthroplasty through a small anterolateral incision. Methods Total hip arthroplasty through a small anterolateral incision was performed in 53 cases (58 hip joints) from February 2003 to December 2003, including 5 cases of simultaneous replacement of bilateral joints, 6 cases of total hip revision, and 4 cases of hip joint rigidity. The surgical modification features were as follows: the patient was placed in recumbent position, with the involved buttock region slightly hanging over the side of the surgical bed and normally drooping; the involved leg was placed in 10? of adduction, which was helpful to the exposure of the greater trochanter; after the exposure of the neck of the femur and the greater trochanter, osteotomy was performed firstly, then the femoral head was dislocated and removed. Results The length of incision was 7~12 cm (mean, 8.5 cm). The operation time was 70~140 min (mean, 88 min). The blood loss was 250~660 ml (mean, 470 ml). No severe complications occurred. Postoperatively, weight-bearing and mobilization exercise were begun in 6~14 days. All the cases were followed for 4~40 weeks (mean, 28 weeks). The Harris hip scores showed excellent outcomes in 37 cases, good in 12, fair in 4, with a rate of excellent or good results of 92.5% (49/53). Conclusions Total hip arthroplasty through a small anterolateral incision is a feasible procedure that is characterized with minimal invasion, less blood loss and quick recovery. It can be applied in total hip replacement for artificial hip joint revision, hip joint rigidity, or congenital dislocation of hip joint.

Objective To explore the feasibility of endoscopic thyroidectomy through the approach of areola of breasts.Methods Endoscopic thyroidectomy via areola of breasts approach was carried out in 26 cases from March 2003 to September 2005.Thyroid nodules were right-sided in 13 cases,left-sided in 10 cases,bilateral in 1 case,and not palpable in 2 cases of hyperthyroidism(grade 1).There were 9 cases of solitary nodule and 15 cases of multiple nodules.The nodules were cystic in 5 cases,solid in 13 cases,and mixed in 6 cases,with 1~4 cm in diameter.Preoperative diagnoses included 9 cases of thyroid adenoma,15 cases of nodular goiter,and 2 cases of primary hyperthyroidism.Results The thyroidectomy was performed successfully under endoscope in 25 cases,with an operation time of 50~210 min(mean,112 min),including 4 cases of tumor enucleation,10 cases of unilateral partial thyroidectomy,8 cases of bilateral partial thyroidectomy,and 3 cases of bilateral subtotal thyroidectomy with isthmus resection.A conversion to open surgery was required in 1 case owing to thyroid carcinoma with trachea involvement.Pathological findings showed 4 cases of thyroid adenoma,18 cases of nodular goiter,2 cases of primary hyperthyroidism,and 2 cases of thyroid carcinoma.The drainage tubes were removed at 24~48 hours after operation.No nerve or parathyroid injuries occurred.The length of postoperative hospital stay was 3~6 d(mean,4.2 d).Follow-up observations in 25 cases for 3~33 months(mean,13 months) revealed no local recurrence.The patients were satisfied with cosmetic effects.The 2 cases of thyroid carcinoma were followed for 9 and 11 months,respectively,presenting no recurrence or metastasis.Conclusions Endoscopic thyroidectomy via areola of breasts approach is feasible and effective,offering satisfactory cosmetic outcomes.

Objective To evaluate effects of neoadjuvant chemotherapy on axillary lymph node status in patients with breast cancer.Methods A total of 45 patients with stage Ⅱ or Ⅲ breast cancer treated with neoadjuvant chemotherapy followed by surgery(Combination Group) were compared with 79 patients with breast cancer treated with initial surgery only(Surgery Group) in respect of axillary lymph node status,including the total number of the lymph nodes and the number of positive and negative lymph nodes,according to findings of physical examination,B-ultrasonography,and molybdenum target radiography.Results The total number of the lymph nodes and the number of positive lymph nodes were significantly less in the Combination Group(16.9?5.9 and 2.5?2.2) than in the Surgery Group(20.8?8.0 and 3.9?3.0)(t=-2.856,P=0.005;t=2.790,P=0.006),whereas the number of negative lymph nodes were 14.4?5.4 and 16.7?7.0 in the Combination Group and the Surgery Group,respectively,without statistical significance(t=-1.904,P=0.055).Four patients were found loco-regional relapse in each group during follow-up checkups for 6~19 months(mean,10 months) in 40 patients in the Combination Group and 7~21 months(mean,12 months) in 67 patients in the Surgery Group.Conclusions Total and positive axillary lymph nodes retrieved after axillary lymph node dissection decrease in number after neoadjuvant chemotherapy.

Objective To investigate the teaching effects for students of seven-year program.Method Symposiums were hold among 3 batches for seven-years program and questionnaire collected.Results We need to further modify the curriculum and improve clinical teaching skills,and students also need to have more research ideas.Conclusion We should modify current teaching content,curriculum,and skills.Clinical skills and humanization management should be highlighted.This is the key to ensure that teaching effects and teaching quality can be improved effectively.

The present study on 24 cases disclosed that the erythrocyte deformability(ED) of patients with acute myocardial infarction (AMI) was significantly lower than normal control. After incubate the patients' erythrocyte with Prop-lene Glycol Mannituse Sulfate(PGMS) and Pro-plene Glycol Alginate Sudium Sulfate (PSS ) , The ED was significantly higher than that of in-cubated without drug. PGMS was more effi-cious. The result indicated that PGMS and PSS may have high value in improving the microcir-culation of patient with AMI, increasing the blood flow of capilliaries in ischemic myocardium and reducing the area of infarction.