Objective To explore the method of laparoscopic splenectomy and pericardial devascularization . Methods Hand - assisted laparoscopic megalosplenic resection and portozygos disconnection (HLMRPD) was perfor medin 2 patients with portalhy pertension and hypersplenism from August 2 0 0 1to May 2 0 0 2 . Results Theoperation was completedsucces sfully in both patients.The intraoperative blood losswas 30 0ml and 35 0ml,respectively ,and the operation time ,2 35 min and 2 6 5 min ,respectively .Both patients recovered smoothly without posto perative complications . Conclusions HLMRPD is a safe ,minimally invasive and effective procedure.

Objective To study the sensitivity of radiotherapy on the cells in midsection and edge of glioma. Methods The glioma models were established in SD rats and exposed to X radiation. Proliferating cell nuclear antigen (PCNA), apoptosis rate and cell phase of the cells in the midsection and edge of glioma were detected by immunohistochemical assay, terminal transferase dUTP nick ending labeling (TUNEL) and flow cytometry. Results Immunohistochemical assay showed that PCNA-LI of the edge cells was significantly lower than that of midsection cells ((P

Naloxone is a synthetic pan-opioid receptor competitive antagonist of the opioid receptors inside and outside the cen-tral nervous system. After systemic administration, it reverses almost all opioid effects. Systemically administered naloxone is used to reverse the life-threatening opioid toxicity. A number of studies have analyzed the importance of oral naloxone as a peripheral opioid an-tagonist in cancer patients. Naloxone has shown satisfactory efficacy for opioid-induced constipation (OIC). Ultra-low dose of naloxone has been reported to enhance the anti-nociceptive effect of morphine and reduce morphine consumption. We summarize the results from current studies of naloxone administration in cancer pain management.

Objective: To analyze the clinical characteristics of opioid overdose in naloxone-antagonized advanced cancer pa-tients. Methods:Fifteen patients with moderate to severe cancer pain were diagnosed with opioid overdose. Five of the patients were treated with transdermal fentanyl, six with prolonged-release morphine sulfate tablets, and four with prolonged-release oxycodone hy-drochloride tablets. Naloxone was immediately administered upon discovery of opioid overdose. The reasons behind opioid overdose as well as the naloxone efficacy and patient prognosis were investigated. Results:In the patients of the group, the equivalent dosage of morphine, the treatment dosage is 10 mg/d to 640 mg/d, and the median dosage is 360 mg/d. The therapeutic dose of naloxone is 0.2 mg to 0.8 mg, and the median dosage is 0.4 mg. After naloxone use, the pupils of the patients were recovered in the first few min-utes, and respiratory depression improved within 10 min to 30 min. However, blood pressure recovery was slow for at least 1 hour. Two fever-afflicted patients were diagnosed with transdermal fentanyl overdose and impaired liver function, which exhibited rapid deteriora-tion immediately before the opioid overdose. Seven patients with poor pain control were diagnosed with opioid overdose during drug ti-tration. These patients were given poor prognosis, and their median overall survival time was 1.9 months. Conclusion: Opioid over-dose, which is shown to be common in advanced cancer patients, can be safely and effectively treated by naloxone. Early diagnosis and treatment of this condition would significantly improve the quality of pain control for the patient.

Objective:Evaluate the role of video-assisted thoracic surgery (VATS) in the treatment of bilateral synchronous multiple primary lung cancers.Methods and Results:Two paitents diagnosised as bilateral synchronous multiple primary lung cancers received one-stage treatment combined conventional thoracotomy with video-assisted thoracic surgery,performing open lobectomy to remove the larger tumor,performing wedge resection using thoracoscopy to excise the smaller one.The surgery time is short.Patients all recover smoothly without complications.To date,these two patients all alive without any sign of recurrence or metastasis of tumor,median follow-up time is 5 months (2 months+8 months).Conclusions:It is feasible to carry out one-stage treatment combined conventional thoracotomy with video-assisted thoracic surgery on patients with bilateral synchronous multiple prima-ry lung cancers,when one of the tumors of bilateral synchronous multiple primary lung cancers is classificated as T1N0M0.

Opioid-induced constipation (OIC) is the most common side effect of opioid. OIC influences the quality of life of pa-tients suffering from cancer pain. However, given that the drug is often overlooked and underappreciated, most of the time, the patients would avoid or abandon using opioid and, as a result, they continuously suffer from cancer pain. Therefore, OIC prevention and man-agement must be made before opioid use. The consensus on the diagnosis of OIC has only been reached recently. Thus, a unified defini-tion of OIC must be developed to exchange therapeutic option among departments in hospitals and compare treatment outcome. The di-agnosis of OIC is discussed, and the management of OIC, including medicinal and non-medicinal treatment, is summarized. Mean-while, the initial program for prevention and treatment of OIC is established to make OIC management more convenient for clinical physicians. Much work is still needed to establish a consensus on OIC diagnosis and a suitable program for prevention and treatment of OIC.

[Objective] To study the application and clinical result of extended trochanteric osteotomy in hip joint revision.[Methods]Thirteen hips in 13 patients who were treated with extended trochanteric osteotomy in hip joint revision from 2003 to 2007 were followed-up for an average time of 32.3 months.The revision reasons,Harris score,osteotomed length,and the oeteotomed union time were analyzed.[Results]The average preoperative Harris score of all patients was 38(24~68),the average postoperative Harris score was 77(57-100),with the improvement of 39 points.The average osteotomed length from the tip of great trochanter to distal osteotomy site was 12.4 cm(9~15.1 cm).The osteotomy sites were healed in 11 patients at 3 months and 2 patients at 6 months after operation.[Conclusion]Extended trochanteric osteotomy is useful in hip joint revision.After osteotomy femoral prosthesis and cement could be taken out easily,and the osteotomy site could be healed easily.

Objective To explore the clinical characteristics of primary central nervous system malignant lymphoma (PCNSML). Methods The clinical data of 22 cases of PCNSML were analyzed retrospectively.Results The patients in our study mainly presented with headache (16 cases), vomiting (11 cases), weakness of extremities (5 cases) and numbness (1 case). The tumors were supratentorial in 19cases, infratentorial in 3 cases and multiple in 5 cases. CT scan showed same density or high-density lesions with surrounding mild edema. Brain MRI demonstrated slight-hypointense lesion of 9 cases and isointense lesion of 5 cases on T1-weighted imaging. On the T2-weighted imaging, the lesions were slight-hyperintense in 11 cases and isointense in 3 cases. Enhanced scanning showed that the lesions were contrasted evenly and obviously on CT and MRI. Misdiagnosis was given preoperatively in 17 patients. The pathological examination revealed B cell malignant lymphoma in all cases. In 18 cases of follow-up, 5 patients with multiple lesions who only received stereotactic biopsy all died within 6 months, the mean survival time of 6 patients who were treated with total resection of the tumors and radiotherapy was 27 months, 4 patients treated with partial resection and ?-radiotherapy was 21 months, 4 patients treated with partial resection and radiotherapy was 10 months. The patient who was treated with only total resection of the tumor died in 11 months because of recurrent. Two patients with only partial resection died in 5 and 8 months, respectively.Conclusions There are no specific clinical manifestations of PCNSML and the disease is often misdiagnosed preoperatively. Although certain characteristic performance may be found on CT and MRI scans, the final diagnosis of this disease depends on pathological examination. Comprehensive treatments may prolong the survival time of the patients.

Objective To evaluate the value of neuronavigation-assisted microsurgery for volumetric resection of gliomas near the central sulcus of the brain.Methods The neuronavigation system was used to demarcate the boundary of the gliomas before the resection and guide the resection at the real time of the surgery.16 cases of gliomas near the central sulcus were removed by volumetric microsurgery resection.Results Volumetric resection was achieved in 14 cases,and subtotal resection was in 2 cases.Nerve disfunction of 13 patients were improved or no changed after the operation,but nerve disorders of 3 cases became more serious after the operation,and got better than that of the level before the operation after 3 months.Conclusions It is very helpful of neuronavigation systerm to elevate the rate of total resection of gliomas near the central sulcus and reduce the injury of the brain and nerve disfunction.

Objective To discuss the effect of microsurgery of intracranial arachnoid cyst. Methods 42 cases of intracranial arachnoid cyst treated with microsurgery were studied retrospectively.Results Total resection was performed in 23 cases and partial resection in 14 cases. 5 cases received partial resection and communication between cystic cavity and brain cistern. CT scans of 29 cases after operation showed completely obliteration or marked diminution in cystic size. The symptoms and signs of all the patients were improved significantly after a 1-year follow-up.Conclusion The effect of microsurgery of intracranial arachnoid cysts is satisfactory. It is important to communicate cystic cavity with subarachnoid space or brain cistern.