Objective To compare the clinical efficacy between endoscopic thyroidectomy via breast approach conventional open thyroidectomy in patients with nodular goiter. Methods A series of 70 patients with unilateral nodular goiter divided into two groups, either receiving endoscopic thyroidectomy through breast approach(endoscopic group,35 cases),or conventional open thyroidectomy(open group,35 cases). The therapeutic efficacy was compared between the two groups. Results The operating time of endoscopic group was significantly longer in the endoscopic group (100.4±26.6)min than in the open group (73.5±14.5) min(t=5. 627, P=0. 000). The postoperative drainage volume in the endoscopic group (66.7±24.9) ml significantly more than that in the open group ( 13.3±6.4)ml( t = 14. 403, P = 0. 000 ). The postoperative hospital stasignificantly longer in the endoscopic group (4.3±1.1 )d than in the open group (3.6±0.9)d(t=2.886, P=0.005). And a satisfactory cosmetic result was achieved in significantly more patients in the endoscopic group(9/24 cases) than in the open group(34/51 )(x2 = 7.235, P=0.007). There was no significant difference in intraoperative loss between the endoscopic group (22.5±15.3)ml and the open group (18.3±7.5 )ml(t=1.273, P=0.207), a consumption of analgesics between the endoscopic group (9/24 eases) and the open group(21/51 cases) (X2=0.028, P=0.867), respectively. No severe complications was encountered ,such as massive hemorrhage,injuries of the recurrent or sularyngeal nerve, or parathyroidgland injury. Conclusion Both breast approach endoscopic thyroidectomy and conventional open thyroidectomy are safe and effective, former gives better cosmetic outcomes.

Objective To explore injury control in the abdominal injury with serious multiple injuries in the early diagnosis and treatment level.Methods Retrospectively analyzed 100 patients with abdominal injury with severe multiple trauma diagnosis and treatment for summing up experience.Results Phase Ⅰ results of 80 cases of abdominal surgery,the 20 patients with chest and abdominal surgery,the merger of trauma surgery 26 cases Ⅰ,Ⅱsurgery in 19 cases,cured 91 cases(91.0%),9 patients died(9.0%),the causes of death combine severe brain injury 4 csaes(44.4%),severe hemorrhagic shock in 3 cases(33.3%,deaths in the 2 cases),multiple organ failure after operation 2 cases(22.2%).Complications after abdominal surgery:stress ulcer 29 cases(29.0%),abdominal wound cracked 15 cases(15.0%),low-nutrition of 25 cases(25.0%),18 cases of intestinal obstruction adhesions(18.0%).Conclusion Surgery damage control applications can be effective in redueing the mortality rate in the abdominal injury with serious multiple injuries.

Objective To explore biological elements of early awaking in depression.Methods The plasma concentration of cortisol was measured by immunoradioassay in the morning in 59 depressive patients,and how many hours the depressive patients awake earlier than normal was evaluated.Results The plasma concentration of eortisol in the morning of early awaking group Was hisher than no early awaking group[(377.32±14.54)μm/L vs(324.15±16.44)μm/L,P＜0.05].There Was rectilinear correlation between the hours that the pafients awake earlier than normal and the plasma concentration of cortisol in the moming(r=0.353.P=0.006.n=59).There was linear regression between the hours that the patients awake earlier than normal and the plasma concentration of cortisol in the morning(β=0.006,P=0.006,n=59).Conclusion The high plasma concentration of eortisol in the morning probably leads to early awaking in depression.

25?cm H 2O). Three of 6 d ead cases died of right heart failure after transplantation, whose PVR were more than 5 woods preoperatively. Twenty-two patients survived for 18 months with g ood quality of life.ConclusionAccurate selection for donor and recipient, suitable surgical procedure, excelle nt myocardial preservation, effective protection of recipient's renal function, early prevention and management of right graft-heart dysfunction can significa ntly decline incidence of right heart failure at postoperative early stage.

Objective To explore the related causes and management of the death cases (following) orthotopic heart transplantation (OHT). Methods The data of the death cases (14 cases) were studied retrospectively.Results Fourteen cases died among the total 54 cases of OHT from Aug. 1995 to Dec. 2004 in our hospital. Eight cases died within 1 month and 1 case subject to combined heart-kidney transplantation died on the 38th day, and the other 5 cases died during the period from 17 weeks to 4 years. The death cases died of acute right ventricular failure (4 cases), lung infection (5 cases, including 3 cases associated with fungus infection), acute rejection (4 cases), acute renal failure (4 cases), arrhythmia (4 cases), adult respiratory distress syndrome (2 cases) and diabetes (2 (cases)). The death of 8 cases was related with several causes.Conclusion Various causes should be (responsible) for the results. In order to decrease the mortality rate, the recipients should be selected with low pulmonary vascular resistance and less preoperative complications. It is very important to discover and manage complications in time perioperatively.

Objective To discuss the manifestations,diagnosis and management of acute superior mesenteric artery embolism.Methods The clinical data of 22 cases of acute superior mesenteric artery embolism(admitted) in our hospital in recent 10 years were analyzed retrospectively.Results The preoperative diagnostic rate was 77.3%.Among them,2 cases who refused operation died(100%);20 cases were subjected to operation,in whom 5 cases underwent simple resection of necrotic bowel and 3 of them died(60%),while 15 cases were subjected to resection of necrotic bowel after removal of the embolus and 5 of them died((33.3)%).The overall mortality was rate 45.5%.Conclusions Acute superior mesenteric artery embolism should be suspected in every patient with sudden abdominal pain,especially in those who have organic cardiac disease.CTA is an effective method for diagnosis of acute superior mesenteric embolism.Early diagnosis and prompt embolectomy are the key points to improve the therapeutic effects.

BACKGROUND: Graphene oxide (GO) has good conductivity, adsorption, biocompatibility and stability of aqueous solution, and its functional groups are beneficial to its chemical functionalization.OBJECTIVE: To study the effect of acellular nerve allograft modified by GO in the repair of sciatic nerve injury in rats.METHODS: Firstly, the biocompatibility of GO was detected in 10 Sprague-Dawley rats, and then the GO/acellular sciatic nerve graft complex (GO20) was prepared in another 15 Sprague-Dawley rats. Forty Sprague-Dawley rats were divided into sham operation group, GO20 group, acellular nerve allograft group (empty frame group) and autologous transplantation group (rotation group), with 10 rats in each group, and were subjected to corresponding transplantation or rotation experiment. The biological and functional experimental system was used to detect sciatic nerve action potentials.The wet mass ratio of the gastrocnemius (the operated side/the contralateral side) was measured by analytical balance.The morphology of the sciatic nerve scaffold was observed by transmission electron microscopy.RESULTS AND CONCLUSION: During the 10 weeks of observation, the rats in each group had no abnormal food/water intake and no abnormal performance in the presence of normal motor activity, and there was also no significant difference in the body mass. Liver function results indicated that GO had good biocompatibility. The nerve action potential peak value, ratio of maximum tension on the operated side/the contralateral side, gastrocnemius wet mass ratio,myelin sheath thickness, and axon diameter in the GO20 group were significantly higher than those in the empty frame group and rotation group (P < 0.05). To conclude, GO can modify the acellular nerve allograft to repair sciatic nerve injury by promoting regeneration of the injured nerves.

Objective To investigate the clinical and immunohistochemical features,diagnosis and treatment of gastrointestinal stromal tumor(GIST). Methods Clinic and pathological datas of 38 cases with GIST were retrospectively analyzed. Results The most common clinal maifestions were abdominal pain,distention or discomfort in 24 cases(50%), abdominal mass in 10,melena and liematemesis in 8 cases. The tumor was located in the stomach in 20 cases, the small infestine in 14,the colorectum in 4.All the cases underwent operation. Conclusion Endoscopy and imaging examination are main methods to detect GIST. Surgical resection is the main mothod of pathologic diagnosis and treatment.

Objective To explore the experience of long-term outcomes of orthotopic heart transplantation. Methods From Aug. 1995 to Dec. 2004, 40 patients with end-stage dilatation cardiomyopathy, 36 males and 4 females, aged 13～60 years underwent orthotopic heart transplantation (OHT) , 39 standard styles and 1 total style. Results 40 cases were all successful treated. The survival time is from 8 to 112 months with heart function of 0-I degree. All cases are in good quality of live and enjoy normal entertainments and work. Pulmonary infection and cardiac arrhythmia are the most common complications but they did not degrade the result after proper treatments. Conclusion Heart transplantation is an effective treatment for patients with end-stage heart diseases. Appropriate selections of recipients with low pulmonary vascular resistance, satisfactory myocardial preservation are the key points to success. The precautions and prompt treatments to the postoperative complications are guarantee for the ultimate results of heart transplantations.

Objective Assess the value of pleura sliding sign with chest ultrasonography in the prediction of pleura adhesion prior to video-assisted thoracoscopic surgery(VATS).Method 63 patients were evaluated for pleura sliding signs with chest ultrasonography at 9 points along the chest wall prior to thoracotomies and were compared with the findings of the same points during the operation.Methods Pleura sliding signs on 567 points were examined in 63 cases,and 106 points pleura adhesion were found by chest ultrasonography and 72 points were proved by operations.461 points were no pleura adhesion under chest unltrasonography and 495 points had no pleura adhesion confirmed by operations.Results The sensitivity,specificity,negative predictive value,positive predictive value and overall accuracy were 80.56%,90.03%,96.96%,54.72% and 9.07%,respectively.The Receiver Operating Characteristic(ROC)curve showed that there should be no pleura adhesion if there were more than 8 points positive pleura sliding signs.Conclusion Examination of pleura sliding sign by chest ultrasonography is helpful to predict the presence and location of pleura adhesion prior to VATS.