Intravenous immunoglobulin (IVIG) is safe and effective concentration formulation which is obtained from the plasma of health adults.Domestic IVIG was used in clinical since 1979 by Liao Qingkui,who are pediatric doctor form West China Second Hospital.Researches on clinical applications of IVIG are quickly developed at home and abroad,which now become the indispcnsable treatment for primary and secondary immunodeficiency diseases,autoimmune diseases,infectious disease(especially for virus),stem cell or organ transplantation and ICU areas.Treatment dose and course are administered accordding to individuals and pharmacokinetic characteristics of IVIG,immunoglobulin rose to peak of drug concentration quickly,and recovery to the original level of plasma after 3-4 weeks.Common therapeutic dose of IVIG recommended by the literature were 400mg/(kg·per time),3-5 d,or 1000 mg/(kg·per time),2d,or 2000 mg/(kg·per time),1d,which were usually used for idiopathic thrombocytopenic purpura,Kawasaki disease patients.Treatment perscription of 200-600 mg/(kg·per time),1 d,and once every 2-6 weeks are used for immunodeficiency diseases and infections.Now,the clinical application of IVIG was reviewed.

Transsphenoidal microsurgery has become a major approach for removal of pituitary adenomas. Due to the anatomic differences of skull base between Chinese and foreigners and the different experience of surgeons, the pre- and post-operation managements of the operation are different. From 1982 to 2002, a total of 1 047 patients received transsphenoidal removal of pituitary adenomas in our hospital and gained satisfactory outcomes. This article summarizes our experience on 1 047 patients and discusses some relevant problems, including the diagnostic standards of adenoma size, surgery indications, the apoplexy operation, the re-operation for recurrent cases, management of complications, post-operation radiotherapy, and the anatomy of sphenoidal sinus and sellar area, hoping to improve the successful rate of the operation.

OBJECTIVE:Taking metoprolol succinate sustained-release tablets as an example,to explore the value of speckle tracking imaging in therapeutic efficacy evaluation of CHF drugs. METHODS:68 CHF patients who had never underwent regular treatment were given Metoprolol succinate sustained-release tablets and anti-heart failure agents for 3 months. NYHA classification, resting heart rate(RHR),6 min walk distance(6MWD)and conventional echocardiographic measurements were tested before and 1 and 3 months after treatment. Dynamic image were collected in the apical 2-chamber view,apical 4-chamber view and left ven-tricular long axis plane for speckle tracking imaging offline analysis. The left ventricular global longitudinal strain (LVGLS) were measured. After 3 months of treatment,CHF patients were divided into standard group(group A,RHR 55-60 times/min)and non-standard group (group B,RHR>60 times/min) according to resting heart rate. The improvement of above indicators were com-pared between 2 groups,and that of LVGLS was also compared. RESULTS:After 1 month of treatment,RHR,LVEDd,LVEF and LVGLS of group A were improved significantly,compared with group B,with statistical significance (P<0.05). After 3 months of treatment,there was statistical significance in above indicators between 2 groups(P<0.05). In group A,RHR,6MWD and LVGLS improved significantly after 1 month of treatment,there was statistical significance,compared with before treatment (P<0.05);there was statistical significance in above indicators after 3 months of treatment,compared with before treatment and after 1 month of treatment (P<0.05). In group B,RHR and 6MWD improved significantly after one month of treatment;there was statistical significance,compared with before treatment(P<0.05);there was statistical significance in significant improvement of each indicator between after 3 months of treatment and before treatment (P<0.05);only there were statistical significance in RHR and NYHA grading,compared with after one month of treatment(P<0.05). CONCLUSIONS:Speckle tracking imaging can early reflect the left ventricular function improvement of CHF patients after anti-heart failure treatment,especially in patients with RHR control standard earlier and more significant. Speckle tracking had good clinical application value in the follow-up treatment of heart failure as routine evaluation index.

Objective To compare the influences of combined spinal-epidural anesthesia(CSEA)and general anesthesia(GA)on patients who underwent laparoscopic gynecological operation.Methods A total of 60 patients of ASA Ⅰ～Ⅱ,were divided into two groups:the CSEA group and the general anesthesia group.Each group consisted of 30 patients.Glucose and cortisol levels were determined before anesthesia,10 minutes after anesthesia,10 minutes after pneumoperironeum and 10 minutes after abdominal deflation.Results No significant differences existed between the two groups on age,weight,operation time,pneumoperitoneum time,time to regain consciousness after operation,HR,SpO2,ECG and MABP(P＞0.05)No significant difference was found in cortisol level between two groups at various time points(P＞0.05).In the general anesthesia group,glucose level at 10 minutes after pneumoperitoneum was significantly lower than that before anesthesia(P＜0.05),but no significant difference was found in glucose level between the two groups at other time points(P＞0 05).At the same time,significant difference was found in postoperative complication rate between two groups(P＜0.01).Conclusion Both CSEA and general anesthesia can effectively inhibit the patients'stress response in laparoscopic gynecological operation.

Objective To compare the therapeutic efficacy between laparoscopic peritoneal vaginoplasty and sigmoid loop vaginoplasty. Methods A total of 29 cases of congenital absence of vagina received either laparoscopic peritoneal vaginoplasty (Peritoneal Group, 14 cases) or sigmoid loop vaginoplasty (Sigmoid Group, 15 cases) from March 1998 to April 2003. Results The operation failed in 1 case in the Peritoneal Group, requiring a conversion to open sigmoid loop vaginoplasty. Both groups had no surgical complications or postoperative pyrexia. The operating time of the Peritoneal Group (118 9?19 0 min) was significantly shorter than that of the Sigmoid Group (202 0?18 6 min) ( t =-11 674, P =0 000). And the intraoperative blood loss of the former (36 2?12 6 ml) was significantly less than that of the latter (105 3?46 3 ml) ( t =-5 205, P =0 000). The conditions of reconstructed vagina of both groups were basically the same, but the vagina length of the Sigmoid Group (10 8?1 1 cm) was significantly greater than that of the Peritoneal Group (9 0?0 8 cm) ( t =-4 882, P =0 000). Among the Sigmoid Group, 3 cases had somewhat more amount of vaginal secretion and 4 cases had abnormal-smelling secretion. Patients in both groups reported the same satisfactory degree of sexual life. Conclusions Laparoscopic peritoneal vaginoplasty and sigmoid loop vaginoplasty present a similar therapeutic efficacy, but the former gives less surgical invasion than the latter.

Objective To evaluate the effect of ureteroscopic treatment for upper urinary tract obstruction. Methods A total of 56 cases of upper urinary tract obstruction were treated under ureteroscope by using direct-vision dilatation, electrocauterization or balloon dilatation. Results A successful dilatation was achieved in 49 cases (87.5%, 49/56) whereas a failure was encountered in 7 cases. There were no complications such as ureteral perforation, rapture or heavy bleeding. A follow-up for 0.5~3 years (mean, 2.5 years) in 43 cases was carried out. The obstruction disappeared in 33 cases, remained in 6 cases, and relapsed in 4. The hydronephrosis disappeared in 30 cases, subsided in 5 cases, and had no changes in 8. Conclusions The treatment of the upper urinary tract obstruction under ureteroscope offers advantages of minimal trauma and satisfactory outcomes.

Objective To investigate effect of coagulation, fibrinolysis, platelet and tumor markers in patients with advanced lung cancer by chemotherapy.Methods 21 cases of advanced lung cancer patients were selected to be the experiment group, and 20 healthy people were selected to be the control group.The experiment group were treated by chemotherapy,coagulation, fibrinolysis, platelet and tumor markers were compared before and after the treatment.ResuIts Compared with experiment group before chemotherapy, PT, APTT, TT levels of the patients after chemotherapy were lower, serum FIB concentrations were higher (P<0.05); PC and FPS were lower , D-D, PAI-1 concentration level were higher (P<0.05); PLT, MPV, PDW levels were lower (P<0.05); CEA, CYFRA21-1, NSE, CA125 levels were lower (P<0.05).ConcIusion Chemotherapy can enhance the effect of coagulation system in patients with advanced lung cancer, inhibit the fibrinolytic system and reduce the level of tumor markers.

Objectives To evaluate the application of flow-through hybrization and gene chip (HybriMax) on human papillomavious (HPV) subtype detection in clinical.Method 3 086 sexually active females from out-patient department were selected for HPV subtype analysis using HybriMax. Cervical tissue samples were taken under the colposcope from 463 females who had cervical lesion for pathological analysis. The predictive value of HybriMax in cervical abnormality was compared with pathological results, which were used as a golden standard. DNA sequence in HPV E6/E7 region was performed among 80 females with HPV 16 positive by HybriMax to determine the accuracy of HybriMax.Results All 21 different subtypes were found and total HPV positive rate was 63.1%(1 947/3 086). Among the 21 HPV subtypes, 5 of them had a infection rate over 5% and they were HPH16(15.9%, 490/3 086), 58(11.2%, 346/3 086), 52(8.5%、261/3 086)、33(6.3%、195/3 086)、53(6.2%、192/3 086)、6(5.6%、172/3 086), and CP8304(5.0%、155/3 086). The sensitivity for high degree squamous intraepithelial dysplasia(HSIL, CINⅡ+CINⅢ) by HybriMax was 95.49%(95%CI=95.44%～98.27%), while specificity was 34.85%(95% CI= 32.59%～37.57%)、Positive predictive value for HSIL was 37.13%(95%CI=30.79%～40.96%),while negative predictive vale was 95.04%(95%CI=89.24%～98.44%). Eighty sequence results in E6/E7 region completely matched to HybriMax results.Conclusion HybriMax has a high accurate rate in HPV subtype diction with good sensitivity and specificity for HSIL and above. It is an effective method to detect HPV subtype in clinical.

AIM:To compare the short-term and long-term curative effect between two implantation methods for treating refractory glaucoma.METHODS:A total of 150 patients with refractory glaucoma (150 eyes) were divided into Group A (treated by implantation with Ex-press glaucoma drainage device) and Group B (treated by implantation with Ahmed glaucoma valve) according to different implantation methods.Changes of intraocular pressure and anti-glaucoma drugs at different time points, the success rate of surgery, improvement of visual acuity and complications were compared between the two groups.RESULTS:The intraocular pressure of two groups at 1d, 1wk, 3, 6 and 12mo after surgery was significantly lower than that before surgery (P<0.05).The intraocular pressure of Group A at 3, 6 and 12mo after surgery was significantly lower than that of Group B, while anti-glaucoma drugs at 6 and 12mo after surgery were significantly fewer than those in Group B at the same time point (P<0.05).There were no significant differences between the two groups in 12-month success rate of operation, improvement rate of visual acuity and incidence of postoperative complications (P>0.05).CONCLUSION:The effects of implantation with Ex-press glaucoma drainage device are similar to those of implantation with Ahmed glaucoma valve in the treatment of refractory glaucoma.However, the intraocular pressure control effect of the former is better than the latter, and used anti-glaucoma drugs are fewer.

● AIM: To explore the role that hepatocyte growth factor plays in proliferative vitreoretinopathy (PVR) after retinal detachment.● METHODS: The contents of hepatocyte growth factor in subretinal fluid (SRF) in 49 cases with retinal detachment were measured with enzyme-linked immunosorbent assay.● RESULTS: With the worsening of PVR and vitreous opacity and prolonging of disease course, the content of hepatocyte growth factor increased (P＜0.05), the difference being statistically significant.● CONCLUSION: The change of hepatocyte growth factor in SRF had a close relation ship with the occurrence and development of PVR after retinal detachment.