Objective To compare the effects of Ephedrine and combined with small dose cisatracurium treatments on the onset time of cisatracurium and hemodynamics in elderly patients.Methods Sixty cases of elderly patients undergoing elective surgery under general anesthesia were randomly divided into 4 groups:E group (ephedrine pretreatment),P group (cisatracurium primin),PE group (cisatracurium priming and ephedrine pretreatment) and C group(control),and each group of 15 cases.Cisatracurium 0.15 mg/kg were given in P group and PE group,and then ephedrine 70 μg/kg were given in PE group and E group.Anesthesia was induced with target controlled infusion of propofol (target plasma concentration 3-5 pg/ml),fentanyl 3-4 pg/kg.Cisatracurium 0.015 mg/kg were given in E group and C group,and P group and PE group dose intravenous cannula remaining.Tracheal intubation was performed when the twitch height depressed to 0.Results The Onset time of PE,C,E and P group were (164±28) s,(306±61) s,(187±31) s and (193±40) s and there were significant differences(F=33.990,P＜0.01).The onset time of PE group was shorter than that in C,E,P group,and the difference was significant (P＜0.05).Systolic pressure (SBP) and mean arterial pressure (MAP) levels in four groups after induction were lower than those before induction (F =35.783,30.015,P =0.000).SBP,diastolic blood pressure (DBP),MAP in PE group and E group were significant higher than those in C group(P＜0.05).After inductions,heart rate(HR) in PE group was significant different form that in C group(P ＜0.05),and HR of C group was significantly decrease than before inductions(P＜0.05).After inductions,the cases with DBP were 11 patients(73.3％) in C group,10 patients(66.7％) in P group:,5 patients(33.3％) in E group,and 4 patients (26.7％) in PE group,the different were significant (x2 =9.867,P ＜ 0.05).After intubation,cases with increase blood press were 3 patients (20.0％) in C group,5 patients(33.3％) in E group,and 4 patients(26.7％) in E group and PE group(P＞0.05).Conclusion Ephedrine of 70 μg/kg can relief the circulatory depression and accelerate the onset time of cisatracurium in the elderly patients.Combined with cisatracurium priming can further shorten the onset time and be for elders.

Objective To observe the effects of dexmedetomidine hydrochloride on the cisatracurium-induced neuromuscular blockade in geriatric, young and middle-aged patients. Methods Forty elderly patients and forty young and middle-aged patients undergoing elective abdominal surgery under general anesthesia were randomly divided into 4 groups ( n=20 each):elderly dexmedetomidine hydrochloride group (group DE),elderly control group (group CE),young and middle-aged dexmedetomidine group (group DY) and young and middle-aged control group (group CY).In groups DE and DY,a loading dose of 0.5 μg?kg-1 dexmedetomidine was intravenously infused over 10 min before induction of anesthesia,respectively,followed by infusion at a rate of 0.4μg?kg-1?h-1 until the end of surgery.Equal volume of 0.9% sodium chloride was given in groups CE and CY.Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium 0.15 mg?kg-1.Four groups were maintained with infusion of propofol and remifentanil. Neuromuscular blockade was maintained with continuous cisatracurium infusion in the four groups and was monitored with TOF-Watch SX acceleromyography at the adductor pollicis.The onset time,TOF no reaction period,duration of action,the amount of cisatracurium consumption,and the spontaneous recovery index ( T1 25% to 75%) were recorded. Results The four groups were comparable in the demographic data.Intubation conditions,the onset time and recovery index were not significantly different among the four groups. The duration of blockade action in groups DE and DY was ( 61. 1 ± 8.9) min and (53.6±9.3) min,which was significantly longer than that in group CE [(49.9±5.8) min] and group CY [(44.8± 6.4) min] (P<0.01).The duration of blockade action was significantly longer in groups DE and CE than in groups DY and CY (P<0.05).The amount of cisatracurium consumption in groups CE and CY was significantly higher than that in groups DE and DY (P<0.05). Conclusion The neuromuscular blockade is longer and the requirement of cisatracurium is less in elderly patients than in young and middle-aged patients.Continuous infusion of dexmedetomidine hydrochloride can't accelerate the onset time of cisatracurium.But duration of action is prolonged and the amount of cisatracurium consumption is lower in patients with infusion of dexmedetomidine hydrochloride.

Objective To explore the cause and the interventional treatment of restenosis after percutaneous transhepatic biliary stent.Methods 20 patients with biliary restenosis after percutaneous transhepatic biliary stent placement were collected.According to drainage volume from biliary tract and degree of amelioration of jaundice,post-operation hepatic function,blood,urine and stool routines,ultrasound,CT scan and cholangiography were performed to determine the nature and location of biliary restenosis,and then all cases underwent recanalization with intervention method by the exteriorized drainage tube approach.The China-made nickel-titanium alloy stents with diameter of 10 mm and length ranged from 40 mm to 80 mm were used.Results The biliary restenosis occurred in mid-inferior segment of common bile duct in 9 patients, common hepatic duct in 7 patients and hepatic porta in 4 patients. As regarding the causes of restenosis included tumor compression in 9 cases, angulation in upper segment of stent in 3 cases, obstruction in stent by bile, food or clot in 4 cases, cholangitic stenosis in 2 cases and granulation proliferation in 2 cases.The obstruction in all cases was relived by extraction through drainage tube, drug irrigation,dredging by wire, balloon dialtion or stent replacement, so that the total survival rate was beyond 6 months.Conclusion After percutaneous transhepatic biliary stent placement in treating the malignant biliary obstruction,the rate of biliary restenosis is still high,which should be attached importance to.

BACKGROUND:It has been demonstrated that shortening of femoral eccentricity would lead to decreased abductor muscle strength,and overlengthening eccentricity would increase the risk of femoral neck prosthesis fracture and the compressive stress of cemented femoral stem prosthesis after artificial hip replacement,which easily causes prosthetic loosening and subsidence.OBJECTIVE:To investigate the importance of eccentricity adjustment in the artificial hip replacement for treatment of femoral neck fracture in elderly patients.DESIGN,TIME AND SETTING:An observational study was performed at the Department of Orthopedics,First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine between January 2004 and December 2005.PARTICIPANTS:A total of 30 patients with femoral neck fracture,12 males and 18 females,averaging 73.8 years of age (range 62-90 years old),received treatment at the Department of Orthopedics,First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine and were recruited into this study.METHODS:All patients underwent artificial hip replacement operated by the same team of surgeons.Prior to surgery,some indices on the uninjured side were determined through the anteroposterior radiographs of pelvis using X-Caliper measurement tool,including rotation center of femoral head,rotation center of hip joint,collodiaphyseal angle,femoral transverse eccentricity,abduction moment arm,and moment arm of gravity.These indices were precisely calculated using trigonometric function.The angle of osteotomy plane was determined.Proper prosthesis was selected and eccentricity was adjusted.Following artificial hip placement,a comparison was made between uninjured and injured sides.MAIN OUTCOME MEASURES:Eccentricity and hip joint function.RESULTS:The eccentricity on uninjured side of 30 patients averaged 38.7 mm (range 22-57 mm) prior to surgery and that on the injured side averaged 39.2 mm (range 21-59 mm) after surgery.Limb discrepancy ranged 1.8-8.7 mm,with a mean of 3.4 mm,after surgery.There were 26 patients (86.7%) presenting long limbs and 4 patients (13.3%) showing short limbs after surgery.All patients were followed-up 0.5-2.5 years old.Harris hip score results were excellent in 10 patients,good in 19 patients,and fair in 1 patient,with an excellent and good rate of 97%.CONCLUSION:In treatment of femoral neck fracture,eccentricity adjustment during artificial hip replacement is closely associated with hip joint function after surgery.

The factors influencing the long-term survival of patients with proximal gastric cancer (PGC) after curative resection were investigated. Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed. The patients were grouped according to the clinicopathological factors and operative procedures. The tumor depth (T stage) and lymph node metastasis (pN stage) were graded according to the fifth edition of TNM Staging System published by UICC in 1997. The metastatic lymph node ratio (MLR) was divided into four levels: 0%, <10%, 10%-30% and >30%. The data of survival rate were analyzed by Kaplan-Meier method (log-rank test) and Cox regression model. The 5-year overall survival rate of 171 patients was 37.32%. The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size (chi (2)=4.57, P=0.0325), gross type (chi (2)=21.38, P<0.001), T stage (chi (2)=27.91, P<0.001), pN stage (chi (2)=44.72, P<0.001), MLR (chi (2)=61.12, P<0.001), TNM stage (chi (2)=44.91, P<0.001), and range of gastrectomy (chi (2)=4.36, P=0.0368). Multivariate analysis showed that MLR (chi (2)=10.972, P=0.001), pN stage (chi (2)=6.640, P=0.010), TNM stage (chi (2)=7.081, P=0.007), T stage (chi (2)=7.687, P=0.006) and gross type (chi (2)=6.252, P=0.012) were the independent prognostic factors. In addition, the prognosis of patients who underwent total gastrectomy (TG) was superior to that of patients who underwent proximal gastrectomy (PG) for the cases of tumor >/=5 cm (chi (2)=6.31, P=0.0120), Borrmann III/IV (chi (2)=7.96, P=0.0050), T4 (chi (2)=4.57, P=0.0325), pN2 (chi (2)=5.52, P=0.0188), MLR 10%-30% (chi (2)=4.46, P=0.0347), MLR >30% (chi (2)=13.34, P=0.0003), TNM III (chi (2)=14.05, P=0.0002) or TNM IV stage (chi (2)=4.37, P=0.0366); and combining splenectomy was beneficial to the cases of T3 (chi (2)=5.68, P=0.0171) or MLR >30% (chi (2)=6.11, P=0.0134). It was concluded that MLR, pN stage, TNM stage, T stage, and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC, in which MLR was the most valuable index. TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM III/IV stage, serosa invasion, or extensive regional lymph node metastasis.

Objective To study the influence and mechanism of hepatocyte growth factor (HGF) on myotube phenotype by myotube transdifferentiation induced by transforming growth factor-β1 (TGF-β1). Methods C2C12 cells were cultured in differentiation medium to induce myotubes formation. The cells were randomly devided into 3 groups. The control group without growth factor interruption. The induction group was supplemented with TGF-β1 (5 ng/mL) while the inhibition group was supplenmented with both TGF-β1 (5 ng/mL) and HGF (30 ng/mL). After 12 hours, the expressions of connective tissue growth factor (CTGF) protein in myotubes were detected by Western blot, the levels of CTGF mRNA were measured by RT-PCR. Results Compared to the control group, the protein and mRNA levels of CTGF significantly increased in TGF-β1 treated group , whereas the protein and mRNA levels of CTGF were significantly lower in inhibition group than those in induction group (P < 0.05). Conclusion HGF can inhibit the effect of TGF-β1 on the expression of CTGF in myotubes , which provides the evidences on the study of skeletal muscle cell transdifferentiation.

Objective To observe the alteration of bone metabolism and to study the pathogenesis of osteoporosis and factors in elderly patients with chronic obstructive pulmonary diseases (COPD). Methods The biochemical markers of bone metabolism, bone mineral density (BMD) of the lumbar spine and the right femur, parameters of calcaneal quantitative ultrasound(QUS), blood partial pressure and pulmonary functions in 39 male patients with COPD and 30 controls were measured. Results The broadband ultrasonic attenuation (BUA) and the speed of sound (SOS), BMD of the lumbar spines and the femur were significantly lower than that in control group. The biochemical markers of bone metabolism such as HOP/Cr, Ca/Cr, and PTH in the COPD group was significantly raised than that in control group〔(60 2?7 0)dB/MHz vs (66 5?4 9)dB/Mhz,(1 328 4?41 5)m/s vs (1 505 8?26 9)m/s,23% vs 34%,21% vs25%〕. The serum levels of Testosterone(T) reduced significantly ( P

Objective To investigate the morphology change of posterior cricoarytenoid muscle myofiber in patients with idiopathic vocal fold paralysis and to provide experimental evidence for the clinical treatment of idio‐pathic vocal cord paralysis .Methods Thirty -nine cases of vocal fold paralysis patients were recruited into and di‐vided into 2 groups :idiopathic vocal cord paralysis group(n=16) ,and traumatic vocal cord paralysis group(n=23) . Both groups were further divided into 3 subgroups:0 .5~1 year(5 cases and 7 cases) ,>1~2 years(5 cases and 10 cases) ,>2 years(6 cases and 6 cases) .Part of posterior cricoarytenoid muscle(PCAM ) were acquired from all of vo‐cal cord paralysis patients .Normal human posterior cricoarytenoid muscles were treated as the control group (n=5) . They were all stained with Masson three-color staining ,the fiber crosssectional area of muscle tissue and collagen connective tissue were quantitatively analyzed with the image pro plus analysis system .Differences of two observa‐tion indexes were compared with each other among groups and subgroups .Results The number of myofibers was decreased ,but the numbers of the collagen fibers was increased with the onset time course extension ,the ratio of cross sectional area of myofibers to those of collagen fibers was progressively decreasd with increased time course of denervation and more decrease within 1 year .There was obvious difference between the control group and 0 .5~1 year ,>1~2 years ,>2 years subgroup of idiopathic vocal cord paralysis (P<0 .05) .Although without no signifi‐cant difference between >1~2 years subgroup and >2 years subgroup ,the trend of shrinking still existed .Com‐pared two observation indexes of traumatic vocal cord paralysis with the same period subgroup indexes of idiopathic vocal fold paralysis ,there was no significant difference about these two observation indexes (P>0 .05) .In some special cases with 10 years duration in idiopathic vocal cord paralysis group ,the posterior cricoarytenoid muscle at‐rophy fibrosis was not serious .However ,in some case which the course lasted for only 1 .5 years ,the muscle atrophy was very obvious .There were great individual differences among idiopathic vocal cord paralysis patients .Conclusion If there is no recovery after half year treatment ,for PCA muscle function recovery ,the recurrent laryngeal nerve injury repair surgery could be considered to carry out within 1 year .In some cases with long disease duration (>2 years) ,they may still have the muscle morphological basis for nerve repair .

Objective To study the multi-slice spiral CT anatomy of pulmonary veins.Methods After accomplishing the scanning of coronary CT angiography in 120 cases with multi-slice spiral CT,the volume rendering and multi-planner reconstruction based on the original transverse images were performed.The pulmonary veins style according to the number of pulmonary-atrium ostium,pulmonary vein,common ostium and additional pulmonary vein were classified.The difference of sex in presence of the common ostium and additional pulmonary vein was analyzed statistically.Results The incidence of the common ostium and additional pulmonary vein was 22.5% and 15.8%,respectively,there was no difference in sex.The pulmonary veins included 4 types:standard type(62.5%),common ostium type(21.7%),additional pulmonary vein type(15.0%),mixed variation type(0.8%).Conclusion Multi-slice spiral CT can accomplish the observation of pulmonary vein,which can provide anatomic informations for clinic.

OBJECTIVE: To investigate the surgical effect and complications of arytenoid resection in bilateral vocal cord fold paralysis(BVFP) patients via endoscopic laser approach and external cervical approach. METHOD: A total seventy-eight BVFP patients who underwent arytenoid resection surgery via endoscopic laser approach (laser group, n=30) or external cervical approach (external cervical group, n=48) were enrolled in this study. Videostroboscopy, vocal perception evaluation, maximum phonation time (MPT) text were preformed in all patients both preoperatively and postoperatively. The decannulation rate was also calculated. RESULT: Videostroboscopy showed that vocal fold on the operated side in both groups could abduct to various extent postoperatively, which showed significant difference when compared with preoperative abductive movements (P<0. 05). Postoperative glottal closure showed various increment in both groups. However, when with preoperative glottal closure, external cervical group showed significant difference (P < 0. 05), while laser group showed no significant difference (P> 0. 05). Postoperative videostroboscopy showed no significant difference in vocal fold position and glottal closure between these two groups(P>0. 05). Vocal perceptual evaluation(RBH score) showed a significant deterioration in voice quality postoperatively in both groups respectively (P<. 05). Postoperative MPT values showed no significant difference between the two groups (P>. 05). However, they were significantly shorten/shorter than preoperative ones in these two groups respectively (P<0. 05). The overall decannulation rate were 90. 0% and 95. 8% for laser group and external cervical group respectively. In Both groups, patients presented aspiration symptoms postoperatively, except one patient of external cervical group who developed pneumonia due to recurrent aspiration. CONCLUSION Arytenoid resection surgery via both endoscopic laser approach and external cervical approach can both enlarge glottic area so as to solve respiration problems, in BVFP patients. Two kinds of surgery have obvious voice damage.
Arytenoid Cartilage ; surgery ; Endoscopy ; methods ; Humans ; Lasers ; Neck ; surgery ; Postoperative Complications ; Postoperative Period ; Vocal Cord Paralysis ; surgery ; Vocal Cords ; physiopathology ; Voice Quality