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 To observe and study the variation ofinterleukin (IL),trace elements and adhesion molecule in allergic rhinitis patients.Methods Forty-seven allergic rhinitis patients who were diagnosed from March 2011 to March 2013 were selected as observation group.Among the total,intermittence was 27 patients,continuity was 20 patients,mild was 15 patients,moderate was 19 patients,severe was 13 patients.Forty-seven healthy person at the same time were selected as control group.The level of IL,trace elements and adhesion molecule in two groups were compared,and all the indexes of observation group with different types and severity were compared too.Results The level of IL-4,IL-5,IL-6,IL-10,soluble intercellular adhesion molecule (sICAM)-1,soluble vascular cell adhesion molecule (sVCAM)-1,soluble P-selectin (sP-selectin),soluble E-selectin (sE-selectin) in observation group were significantly higher than those in control group [(28.97 ± 3.27) ng/L vs.(4.35 ± 0.65) ng/L,(17.46 ± 2.15) ng/L vs.(2.71 ± 0.34)ng/L,(10.39 ± 1.28) ng/L vs.(5.96 ± 0.94) ng/L,(31.36 ± 3.44) ng/L vs.(5.53 ± 0.76) ng/L,(483.72 ± 39.25) μ g/L vs.(319.65 ± 29.86) μ g/L,(516.85 ± 50.27) μ g/L vs.(327.46 ± 31.53)μg/L,(12.58 ± 1.36) μg/Lvs.(3.43±0.76) μg/L,(31.34 ±2.84) μg/L vs.(10.22± 1.52)lμg/L] (P＜0.05).The level of serum Zn in observation group was significantly lower than that in control group[(7.14 ±1.35) μ mol/L vs.(16.83 ± 1.71) μ mol/L] (P ＜ 0.05).The level of serum Cu and Mn in observation group were significantly higher than those in control group [(23.24 ± 2.79) μ mol/L vs.(13.15 ± 2.08) μ mol/L,(4.13 ± 0.27) μ mol/L vs.(2.24 ± 0.19) μ mol/L] (P ＜ 0.05).In observation group,the change of above indexes in continuity and severe patients had significant difference compared with intermittence and mild,moderate patients (P ＜ 0.05).Conclusions The change of IL,trace elements and adhesion molecule in allergic rhinitis patients are obviously,and among different types and degrees,the change are obviously too.So,these indexes can be the important basis of clinical diagnosis and treatment.

Objective:To provide anatomic data for accurately localizing aperture of sphenoidal sinus without injurying sphenopalatine arteries in endoscopic transsphenoidal sella surgery.Methods: The anterior walls of spheroid sinus were observed and measured(layout,position,external diameter,distances to other structures of interest) with a vernier caliper and an angle gauge on 15 adult cadavers.Results: The distances from the root of columella nasi to the inforior pole of sphenoidal sinus aperture and the sphenopalatine foramen were(60.40?3.21,58.10-72.76) mm and(62.14?1.93,59.50-73.40) mm,respectively.The distance from the inforior pole sphenoidal sinus aperture to the sphenopalatine foramen was(12.20?1.10,8.10-16.35) mm.The diameter of the sphenopalatine artery was(1.99?0.13,1.50-2.80) mm.The distances from the inforior pole of sphenoidal sinus aperture to the superior and inferior posterior artery of nasal septum were(3.49?0.24,2.78-5.20) mm and(6.42?1.08,(4.30-8.50)) mm,respectively.Conclusion: Aperture of sphenoidal sinus is an important marker in endosopic transsphenoidal sella surgery.The anterior wall of sphenoid sinus should be opened from the inforior pole of sphenoidal sinus aperture to avoid injurying sphenopalatine artery.

Objective: : To investigate whether development of the sph e noid sinus affect the surgical approach via saddle area. Methods: The pneumatization of sphenoid sinus of 50 cadaver heads was studied through t hinner CT scanning of coronal, sagittal and axial position. The sphenoid sinus w as classified according to the degree of pneumatization of sphenoid sinus toward s sphenoid bone, small wing of sphenoid bone and epippium. Results: There were 4% conchal, 18% pre-sellar, 18% semi-sellar, 14% sellar, 46% sellar -occipital in 100 sphenoid sinus cases. The transversal diameter of left and ri ght was 18.48 mm and 17.58 mm; The sagittal diameter of left and right was 2 2.20 mm and 20.82 mm, The vertical diameter of left and right was 21.02 mm and 2 0.38 mm. The distance between centre track and the later wall of sphenoid sinus was 14.78 mm in left side and 15.18 mm in right side. Conclusion: Thinner CT scanning with coronal and sagittal position can clearly show pneum atization of sphenoid sinus on both sides. Different pneumatization of sphenoid sinus provide anatomical basis for choosing operation approach.

OBJECTIVE To master the pathogenic conditions,clinical characteristic,and diagnostic clues about AIDS combinated with penicilliosis marneffei and malignant lymphoma.METHODS The clinical data about AIDS combinated with penicilliosis marneffei and malignant lymphoma were summarized in order to learn by experience.RESULTS The clinical symptoms of AIDS combinated with penicilliosis marneffei and malignant lymphoma could be unique,but most were various,the primary symptoms were always fever and enlargement of liver and spleen.CONCLUSIONS AIDS combinated with penicilliosis marneffei is common to be seen,but with penicilliosis marneffei and malignant lymphoma are rarely seen in the clinics,which should be taken high attention.

Objective To explore the anatomy for transethmoidal-sphenoid optic nerve decompression under endoscopy and its significance in operation. Methods Fifteen cases (30 sides) of formalin-fixed adult optic canal specimens were dissected under the microscope. The anatomic characteristics of the optic canal and its adjacent were observed, and the relative parameters were evaluated according to nasal endoscopic approach. Results ①The relationship between the optic carotid triangle(OCT)with the optic canal, the ophthalmic artery, the cavernous sinus and the internal carotid artery were invariable, its present ratio were in 66.7%. ②The mean distance from the front margin of nasal columella floor to medial wall of the orbital opening, middle portion and the cranial opening in the optic canal were (72.79 ± 5.40)mm, (75.85 ± 5.10)mm and (79.34 ± 4.95)mm, respectively, and the elevation angles were (39.45 ± 3.68)°, (37.30±4.24)°and (35.45 ± 4.16)°, respectively. ③The mean thickness of sheath in the medial wall of the orbital opening,middle portion and the cranial opening were (0.70 ± 0. 18)mm, (0.51 ± 0.15)mm and (0.49-0.22)mm,respectively. The difference in thickness between the orbital opening and middle portion, the cranial opening were very remarkable(P ＜ 0.01 ). ④The lateral deviate distance from medial wall of the orbital opening, middle portion and cranial opening to sagittal median plane of cadaveric were 1/2 (12.69 ± 2.73)mm、1/2( 19.61± 3.47)mm and 1/2 (25.79 ± 3.23)mm, respectively. Conclusion OCT is the most reliable anatomic landmark to locate the optic canal, and the key point is at the orbital opening of the optic nerve in the optic nerve decompression. It is secure and feasible to cut the sheath from the place where the medial wall crosses the superior wall of the optic nerve.

Feedback for teaching refers to the mutual transmission and interaction of various information between teaching and learning in teaching process,and is an inevitable result and objective existence of teaching in which teachers and students participate.Effective feedback for teaching is characterized by timely,comprehensive and authentic.Teachers can continuously modify teaching per formance through the feedback of students;the feedback of teaching by students is reflected in examination performance,which really reflects the idea that teaching benefits teachers as well as students.Clinical comprehensive course of eight-year program students is an important bridge between basic medicine and clinical medicine,and the foundation of teaching clinical medicine.Feedback for teaching was applied in students of academic year 2011 from the Department of Surgery of Clinical College in Pekjing Union Medical College,and teaching approach was adjusted in time,contributing to good teaching effectiveness.

Objective: To screen for the differentially expressed genes in laryngeal squamous cell carcinoma and normal laryngeal tissue using cDNA microarray. Methods: The PCR products of 4 096 genes were spotted on a chemical material coated glass plates in array. The DNAs were then fixed on the glass plate by a serial of treatments. The total RNAs were isolated from the tissues, and then were purified to mRNAs by Oligotex. Both the mRNAs from the laryngeal squamous cell carcinoma and normal tissue were reversely transcribed to cDNAs with the incorporations of fluorescent dUTP, for preparing the hybridization probes. The mixed probes were then hybridized to the cDNA microarray. After high stringent washing, the cDNA microarray was scanned for the fluorescent signals and showed the differences between 2 tissues. Results: Among the 4 096 target genes, there were 36(0.88%) genes whose expression levels differed between the carcinoma and normal tissues in all 4 cases. Bioinformatical analysis of those genes had been performed. Conclusion: DNA microarray technology is an effective technique in screening for differentially expressed genes between 2 different kinds of tissue. Further analysis of the obtained genes will help to understand the molecular mechanism of malignant carcinoma. [

Objective:To study the clinical efficacy of acupuncture at Zusanli (ST 36)combined with Traditional Chinese Medicine (TCM) enema in the treatment of gastroparesis syndrome after gastrointestinal tumor operation.Methods:A total of 96 patients with gastroparesis syndrome after gastrointestinal tumor surgery in our hospital from June 2016 to May 2021, who met the inclusion criteria, were randomly divided into three groups by random drawing, with 32 in each group. The control group took mosapride citrate tablets orally, the TCM enema group added TCM enema on the basis of the control group, and the combined group added acupuncture Zusanli (ST 36)on the basis of the TCM enema group. All three groups were treated continuously for 4 weeks. The main syndromes were scored before and after treatment. The levels of serum gastrin (GAS), motilin (MTL) and somatostatin (SS) were detected by radioimmunoassay. The gastric electrophysiological parameters (waveform response area, waveform frequency and average amplitude) were detected by intelligent dual channel gastrointestinal electrograph, the adverse reactions during treatment were recorded, and the clinical efficacy was evaluated.Results:The total effective rate was 96.9% (31/32) in the combined group, 81.3% (26/32) in the TCM enema group and 68.8% (22/32) in the control group. There was significant difference among the three groups ( χ2=8.72, P=0.013). The scores of abdominal fullness and distention, fatigue, belching acid reflux, dry mouth and bitter mouth in the combined group were significantly lower than those in the TCM enema group and the control group ( F values were 16.39, 13.21, 11.28 and 10.23, respectively, P<0.001). After treatment, the levels of GAS [(140.62±15.19) ng/L vs. (128.79±14.34) ng/L, (115.98±12.40) ng/L, F=21.09], MTL [(268.66±28.21) ng/L vs. (245.89±25.24) ng/L, (230.78±22.43) ng/L, F=30.29] and SS [(70.58±8.17) ng/L vs. (65.50±7.76) ng/L, (59.73±7.05) ng/L, F=33.19] in the combined group were significantly higher than those in the TCM enema group and the control group ( P<0.01). The waveform response area [(172.62±17.14) μV/s vs. (158.56± 15.32) μV/s, (145.48±14.13) μV/s, F=20.24], waveform frequency [(3.86±0.61) cpm vs. (3.29±0.50) cpm, (3.01±0.63) cpm, F=13.17] and average amplitude [(86.51±8.98) μV vs. (75.70±7.93) μV, (68.65±7.46) μV, F=28.11] were significantly higher than those in TCM enema group and control group ( P<0.01). During the treatment period, the incidence of adverse reactions was 18.8% (6/32) in the combined group, 15.6% (5/32) in the TCM enema group and 12.5% (4/32) in the control group. There was no significant difference between the three groups ( χ2=0.47, P=0.789). Conclusion:Acupuncture at Zusanli (ST 36) combined with TCM enema can improve the TCM syndrome scores, gastrointestinal hormone level and gastric electrophysiological parameters of patients with gastroparesis syndrome after gastrointestinal tumor operation, improve the curative effect with safety.

OBJECTIVE: To explore a simple and accurate method for localization of upper airway obstruction in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and provide instructions for surgical treatment. METHOD: Fifty OSAHS patients confirmed by PSG underwent acoustic rhinometric and pharyngometric assessment by Eccovision. The parameters were recorded, including nasal minimal cross-sectional area (NMCA), distance of MCA from the nostril (DCAN), minimum cross-sectional area at the nasal valve(MCA), nasal resistance (NR) and nasal volume from 0 to 6 cm from the nostril (NCV), as well as pharyngeal cross-sectional area (CSA) and volume from 4.8 to 15.0 cm. The sensitivity and specificity of acoustic rhinometry and pharyngometry on localization of airway obstruction was determined by a comprehensive imaging and endoscopic study. RESULT: In 50 cases with severe OSAHS, NMCA, DCAN, MCA, NCV, NR were (0.61 +/- 0.35) cm2, (2.06 +/- 0.12) cm, (0.87 +/- 0.12) cm2, (9.24 +/- 2.31)cm3 and (0.51 +/- 0.32)kPa/(L x min), respectively. Pharyngeal CSA and volume were statistically significantly lower than that in control group (P < 0.01). The value of DCAN was (2.06 +/- 0.12) cm, (9.50 +/- 4.08) cm, (13.10 +/- 2.52) cm in type I II, III patient, respectively. Compared with the control group, the difference was statistically significant. CONCLUSION Acoustic rhinometry and pharyngometry is a simple and safe method in localization of airway obstruction in patients with OSAHS.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Nasal Cavity ; physiopathology ; Nasopharynx ; physiopathology ; Rhinometry, Acoustic ; Sleep Apnea, Obstructive ; physiopathology ; Young Adult