During the process of teaching in clinical practice, there objectively exist the contradiction between the obligation of teaching and the invasion of the right to informed consent, and the contradiction between the growth of medical students and the invasion of patients' right to privacy. Health reforms, such as the regulation of "patient selecting doctor", bring some side effects to the teaching in clinical practice. In order to maintain the right to informed consent and privacy, to benefit the teaching in clinical practice, to develop the doctor-patient relationship, and to decrease medical disputes, the art to deal with the doctor-patient relationship must be explored. The laws and regulations of the teaching in clinical practice and of the right of doctors and patients must be developed too.

ObjectiveTo evaluate the efficacy of preemptive analgesia with parecoxib for acute postoperative pain after pulmenary lobectomy.MethodsSixty ASA Ⅱ or Ⅲ patients of both sexes aged 20-64 yr weighing 50-80 kg undergoing elective pulmonary lobectomy were randomly divided into 3 groups ( n =20 each): control group (group C); group A (parecoxib 40 mg was injected iv at 20 min before surgery) and group B (parecoxib 40 mg was injected iv when skin was sutured).Patient controlled intravenous analgesia (PCIA) with sufentanil and ramosetron (continuous background dose 2 ml/h,bolus dose 0.5 ml,lockout time 15 min) was used after surgery.When VAS score ＞ 3,iv bolus of tramadol 1-2 mg/kg was injected as rescue medicine.Agitation condition was observed after operation.The number of successfully delivered doses and the number of attempt were recorded.The consumption sufentanil and the number of rescue medicine were recorded during 24 h after surgery.ResultsThe incidence of postoperation agitation,number of successfully delivered doses and number of attempt,consumption sufentanil and number of rescue medicine were significantly lower in groups A and B than in group C.The consumption sufentanil and number of rescue medicine were significantly lower in group A than in group B ( P ＜0.05).ConclusionParecoxib can use for preemptive analgesia in patients after thoracic surgery,reduce the complication during anesthesia recovery and the opioid analgesics consupmtion.

[Objective]To evaluate outcome of the treatment of unstable distal radius fractures in the elderly patient using a volar T-shape plate.[Method]From January 2001 to April 2003,42 cases with unstable distal radius fractures older than 60 years(range 60～75 years;mean age 65.1 years) were treated with a T-shape plate fixation.The fractures were classified according to the AO classification of distal radius fracture: 4 A2,7 A3,5 B1,3 B3,9 C l,11 C2,3 C3.Artificial bone graft substitutes were used in 28 cases with severe cortex destruction and insufficient buttress.[Result]All patients were followed up(mean 18.2months,range 12～24months).Final volar tilt was averaged 3.66? and radial tilt 20.1?,and radial shortening averaged 1.59 mm in 6 cases.Step-off or gap of the articular surface was found in 6 cases(mean

Objective To investigate the effect of astragalus polysaccharide,a component of an aqueous extract of Astragalus Membranaceus roots,on differentiation and maturation of dendritic cells in vitro. Methods 30 BALB/c mice were randomly divided into three groups,normal control group,100,200 mg/kg APS intraperitoneal injection groups. After one week,weight the mouse spleen,account the splenetic index. Collect the mouse bone marrow cell,induced and cultured with rmGM-CSF and rmIL-4. With inverted microscope to investigate the morphous of DC cell. The phenotypes of DC were detected by flow cytometry and the expression of the GM-CSF protein in serum was tested by ELISA. Results Astragalus polysaccharide injection had obvious effects on the spleen weight of mice. The degree of CD11c and MHC-Ⅱ expression in 100 mg/kg and 200 mg/kg groups on flow cytometry were advanced significantly compared with that in normal control group,but the degree of CD80 and CD86 was not increased. And the expression of the GM-CSF protein in serum in 100 mg/kg group and 200 mg/kg group were both not increased significantly compared with nomal control group. Conclusion The intraperitoneal injection of astragalus polysaccharide could stimulate the proliferation of the pre DC in bone marrow. The angtigen presentation of DC might be enhanced,but this effects was not positive correlation with concentration of GM-CSF.

Objective To analyze the therapy and prognosis of palindromic ovarian carcinoma. Methods The clinical data of 40 cases of palindromic ovarian carcinoma were reviewed retrospectively. Results After the first surgery, the mean recurrent time of the patients with remained tumors smaller than 2 0 cm was (37 26?11 79) months, and that of the patients with remained tumors larger than 2 0 cm was (7 88?1 49) months. There was a significnat difference in the mean recurrent time between the two groups of the patients with different size of remained tumors(P0 05). Conclusion The recurrence of ovarian cancer was related to the size of remained tumor. Secondary operation plus chemotherapy could improve the short-term survival rate of the patients with palindromic ovarian carcinoma.

Objective To study the clinical characteristics of elderly sleep apnea syndrome (ASA). Methods 329 SAS patients diagnosed by 7-hour polysomnography(PSG) were classified into the aged and the middle aged groups. Results Both the body mass index(BMI) and neck circumference were significantly lower in the aged group than those in the middle aged group(P

Objective To report the diagnostic and therapeutic effects of arthroscopic surgery on elbow sports injuries. Methods Nineteen patients with elbow diseases were treated by arthroscopic methods from January 1996 to February 2000. The modified HSS elbow rating scale was used as criteria of the efficacy. All patients were followed up for 4.5 months to 4.5 years (an average 8.6 months). Results Among nineteen patients, eleven had an excellent results, seven good, one poor, and satisfactory rate was 94.7 percent. Ten patients were satisfied greatly with the results,eight patients satisfied, one unsatisfied, the satisfactory rate was up to 94.7 percent according to the responses of questionnaire from the patients. The time resuming daily was in a medium of 7 days, and that for sports was in an average of 2.5 months. All the 11 cases of athletes and actors(actresses) resumed their previous seats. Complications occurred in 3 earlier cases, one had radial nerve temporary paralysis, the other two had residue loose bodies. Conclusion Elbow arthroscopic treatment is a reliable method with the advantages of minor trauma, quicker recovery and less traumatic manipulation. Careful pre-operative examination, selection of a safer portal of entry, and standard manipulation are very important points for the attainment of better results and less complications.

Objective To investigate the anatomical character and clinical application value of external malleolus periosteum bone flap pedicled with facia and external malleolus anterior artery. Methods Applied anatomy was studied with 10 adult corpse specimen after artery perfusion,observed the origin.trackway,and measured the external diameter and major vessel's length of external malleolus anterior artery,observed the composition of external malleolus artery net,and completed the performance in clinic in 10 patients and followed up for 6 months～6 years. Resultes The bone flap had abundant blood-supply,its pedicle was long enough for transfer,little injury to donor,the surgical procedure was easy to manipulate,and was used in clinic to treat talus fracture in 9 cases (fresh 5 and old 4) and old tibia fracture in 1 case,10 cases were involved with satisfactory outcome. Conclusion External malleolus periosteum bone flap pedicled with fascia and external malleolus anterior artery is a good new donor for the patients with fracture of talus or lower tibia,especially ununited case or osteonecrosis.

0.05), but BIS was markedly lower in group Ⅲ than that in group Ⅰ (P

Objective To introduce a better and quicker technique of transperitoneal laparoscopic ureterolithotomy. Methods 42 cases of ureterolithiasis (23 males and 19 females;mean age of 42.4 years,range from 16 to 63 years) were included.Of them 26 cases had calculi on the left side and 16 cases,on the right side.All the cases underwent laparoscopy through 3-port technique. Results The operations were successful in all of 42 cases.The mean operative time was 43 min (range,33 to 56 min).Blood loss was 20 to 50 ml.The postoperative hospital stay was 3 to 5 days.None experienced urinary leakage.During the follow-up of 12～18 months no ureteral stricture was found.The renal functions were improved. Conclusions Our experience indicates that appropriate trocar location,exactly checking of calculi,good D-J tube drainage and skillful intra-abdomenal suturing are the keys to perform laparoscopic ureterolithotomy quickly.