Seawater,hyperosmotic and alkaline, is a complex wound factor. Specific pathophysiological changes appear when wounds are socked in seawater. and special treatments are needed for such injuries. This paper reviewed the pathophysiological changes and treatment of seawater-soaked soft tissue wound, cranioccrebral trauma, open chest trauma,open ahdom-inal trauma,sea water drowning and seawater immersion during shock.

Objective To compare the effects of autotransfusion and homologous transfusion on milieu interieurand secretion of erythropoietin (EPO) .Methods Thirty patients aged 8-21 yr undergoing surgical correction of kyphoscoliosis were randomly divided into two groups of fifteen: group A and group B. In group A patients received homologous transfusion during operation, while in group B shed blood was collected from operative field and after filtration RBCs were separated by a differential centrifugation and washed in normal saline and reinfused. Anesthesia was induced with fentanyl 2 ?g? kg-1 , propofol 1 mg ? kg-1 and vecuronium 0.1 mg ? kg-1 and maintained with inhalation of isofiurane and 50% N2O in oxygen and intermittent iv boluses of vecuronium and fentanyl. Blood routine, blood gases, electrolytes, plasma osmotic pressure and activated clotting time (ACT) were measured before operation, 2 h after skin incision and at the end of surgery. Blood EPO concentration was measured before operation, at the end of surgery and 24 h after operation. Results MAP and HCO3- were significantly lower during operation in group A than those in group B. Platelet count was significantly lower at the end of operation in group B than in group A but still within normal range. The EPO level increased at the end of operation and returned to preoperative level 24 h after operation in both groups, and there was no significant difference in EPO levels between the two groups. Conclusion Autotransfusion of the washes RBCs is helpful in maintaining the patients milieu interieur. There is no difference in EPO secretion and erythropoiesis between autotransfusion and homologous transfusion.

Objective To explore the recovery rate of exhale CO 2 and energy expenditure in the patients with cirrhosis.Methods The recovery rate of exhale CO 2 and energy expenditure in fourteen patients with cirrhosis and eleven healthy subjects were measured by using NaH 13 CO 3 as tracer.After overnight fast,all subjects were intravenously given NaH 13 CO 3 at a primed constant rate of infusion for two hours after a saturating dose infusion.Amount of 13 CO 2 in exhale air was measured using stable isotope mass spectrometry analysis,and the recovery rate of exhale CO 2 and energy expenditure were calculated.Results The recovery rate of exhale CO 2 in patients with Cirrhosis was (80 7?0 26)%,and in healthy control subjects was (78 3?0 84)%,which showed a significantly different between the two groups(P0 05)[(30 2?2 4)Kcal?kg -1 ?d -1 and (28 4?3 5)Kcal?kg -1 ?d -1 ,respectively].Conclusions The results provide theoretical basic to calculate meals for nutritional therapy in the patients with cirrhosis.

Objective To explore the correlation between the prealbumin synthetic rate and liver function damage in patients with liver cirrhosis resulted from hepatitis. Methods The prealbumin synthetic rate was measured using isotope tracer technique of 15 N-lysine injected by intravenous followed by intravenous drop at constant rate in 23 patients with liver cirrhosis and 12 healthy subjects. Results Prealbumin synthetic rate in the patients decreased significantly than that in normal control(P

Objective To investigate the clinical characteristics of sever acute pancreatitis (SAP) with high triglyceride(TG). Methods 82 patients with onset of SAP within 72 hours were involved in this study. These patients were divided into high TG group (n=26) and normal TG group (n=56) according to serum TG lev-els tested (high TG group≥1.7 mmoL/L;normal TG group<1.7 mmol/L on admission). Results 31.71% (26/82) SAP patients were discovered with high TG APACHE-Ⅱ grade of high TG group was higher than that of normal TG group on admission[(14.62±7.58) vs (10.68±5.21),P<0.01]. Within the onset of 72 hours,the incidence of cardiac,pulmonary and kidney dysfunction in high TG group was higher than those of normal TG group (34.62%,34.62% and 19.23% vs 5.36%,3.57% and 1.79%,P<0.01),and the incidence of pancreatic pseudocysts was higher in high TG group than that of normal group(42.31% vs 7.14%,P<0.01). No emergency and early-stage surgical cases in high TG group but 13 cases(23.21%) in normal group. There were 2 cases of high TG group and 4 of normal group averting to operation. Conclusion SAP patients with high TG have high incidence of early-stage organ dysfunction and local complication,in this case nonsurgical intervention is the first choice.

OBJECTIVE To discuss the clinical utility of the self-made curved laryngoscope.METHODS Clinical data of 198 patients with vocal cord polyps from September 2012 to October 2014 was analyzed retrospectively in which 99 cases were treated under the self-made curved larngoscopic surgeries (curved laryngoscope group) and 99 cases were treated by microlaryngoscopic surgeries (microlaryngoscope group).The duration of follow-up was 3 months in all patients.The clinical efficacy, times of inserting laryngoscope, glottic exposure and operation complications of two kinds of operations were observed and compared.RESULTS The total clinical efficacy in curved laryngoscope group showed no significant difference as compared with that in microlaryngoscope group. But for patients with difficult laryngeal exposure,the efficacy of curved laryngoscopic surgery was significantly better compared with that in the microlaryngoscopic surgery group. The results of times of inserting laryngoscope, glottic exposure and operation complications in the self-made curved larngoscope group were all better than those in microlaryngoscope group (P <0.05). CONCLUSION The operation under the self-made curved laryngoscope is a minimal invasive procedure to the laryngeal mucosa, with such more advantages like clear view of operation field and accurate management to the lesion tissue.Furthermore, the self-made curved laryngoscopic surgery is the first choice for the treatment of patients with difficult laryngeal exposure.

Surgical base teaching is an important part of medical education.It is the important tache whether the medicos can become excellent doctors.The thesis analyses the young surgeon's problems in their working abilities in hospital,and discusses the strategies of how to improve the quality of surgical teaching,aiming to establish a solid foundation for the cultivation of the medicos.

ObjectiveTo evaluate validity,reliability and sensitivity of Chinese version quality of life in epilepsy inventory for adolescents (QOLIE-AD-48).Methods 143 cases of young epilepsy patients were tested with QOLIE-AD-48 and analyze validity,reliability and sensitivity of the scale.ResultsPolymerization/discriminant validity showed that there was correlation above 0.4 about each question within the subscale and its component table.Structural validity showed that all of the component list was significantly associated with total score (P ＜ 0.01 ).The cronbach's α coefficient of the scale was 0.92,and 0.62 ～ 0.90 of the subscale,and ICC was 0.81.Good sensitivity was the total score decline with the increase of seriousness.ConclusionChinese version QOLIEAD-48 has good validity and reliability and sensitivity.

Objective To evaluate the effect of levofloxacin-chitosan microsphere administrated in early stage seawater immersed wound of soft tissue. Methods A rabbit model of seawater immersed wound of soft tissue was reproduced. Among the control group (n=8) and the group locally treated with levofloxacin powder (n=8) or levofloxacin-chitosan microsphere (n=8), the bacteria number in the wound, the serum endotoxin level, the content of tumor necrosis factor-alpha(TNF-?) in the wound and the serum were assayed before and 6, 12, 24, 48, 72h after seawater immersion. In the latter 2 groups, levofloxaxin concentration in plasma and wound was compared 6, 12, 24, 48, 72h after seawater immersion. Results The bacteria number of the wound in the microsphere group and levofloxacin powder group was lower than that in the control group since 6h after seawater immersion(P

The theory of Constructivism was applied in different aspects of clinical teaching of surgery.The lessons were designed according to the character of students.Problem solving was emphasized during the course of teaching.An interactive and cooperative atmosphere was constructed.And a variety of additional related materials were provided.All these measures made the teaching activity more accord with the objective rule of clinical knowledge learning.Hence a better teaching effect was achieved.