Objective To study the preoperative nursing care in excision of adrenal tumor by using laparoscope. Methods 72 patients with adrenal tumor have undergone the excision of adrenal tumor by using laparoscope in our hospital. Preoperative nursing included mental care, cardiac and pulmonary function assessement, pharmacotherapy, gastrointestinal and skin preparation. Postoperative monitoring the condition of all the patients, and given oxygen uptake to prevent hypercarbonemia. All the patients were encouraged to do functional recovery early and were guided to diet properly. Results All patients were successful obtained the excision of adrenal tumor by using laparoscope except two were reversed to open surgery. The patients could take food and leave bed in the first post-operative day. The mean post-operative stay was 6 days. Hydrothorax occurred in 2 cases and fat liquidation and wound infection occurred in 2 cases. There were no major complications such as hemorrhage and hypercarbonemia occurred. Conclusion The excision of adrenal tumor by using laparoscope is safe and reliable. Sufficient preoperative preparation, careful post-operative monitoring and timely using counter-measure are the key points in nursing care.

Objective To evaluate the clinical usefulness of manometry of esophgeal varices with endoscopic balloon technique. Methods The variceal pressure was measured by endoscopic balloon technique in 26 patients with portal hypertension, at the same time , laboratory parameters of liver function were determined. ResultsDetermination of variceal pressure was successful in 23/26 patients, while no side effects was observed. The intraobserver coefficient of variation was 7.18% ?2.64%,and there was a significant(P

Pharmacogenomics refers to all the genes encoding drug-metabolizing enzymes,drug transporters,and other drug targets. Studying the relations betweeen gene polymorphisms and drug effects as well as the prediction of adverse reactions at the gene level will be a new method for the clinical therapy of digestive system diseases. Therefore,pharmacogenomics will be a complement of traditional methods for forming and administering drugs regimens.

Drug Resistance, Neoplasm ; Humans ; Stomach Neoplasms ; drug therapy

Objective To evaluate the diagnostic accuracy of drug-induced liver injury over a 10-year period . Methods The 112 cases of drug-induced liver injury were retrospectively studied. Inter-national consensus criteria were applied to assess the causality of suspected drug hepatotoxicity,in which the chronological criteria and elimination of other causes were analysed. Results Among 1127 adult inpatients with acute hepatitis over 10-year period, 112 patients(10%) were recorded as drug-induced liver injury. Based on the causality assessment of 112 cases, either incompatible time to apparent onset of the reaction or incompatible course of the reaction was found in 60 cases(53.6%) and 20 cases(17.9%), respectively. The presence of other possible causes for the reaction was found in 34 patients (37.5%). Therefore, 26 cases(23.2%) of liver injury were related to the incriminated drug, 25 cases(22.3%) unrelated,61(54.5%) were considered to indeterminate cause. Conclusions The international consensus criteria were helpful to identify drug-related or unrelated liver injury, but more than half of reported hepatic adverse drug reactions are still in suspected condition. The current diagnostic methods for drug-induced liver injury are needed to be revised in clinical practice.

OBJECTIVE To investigate in vitro antibacterial activity of meropenem in Gram-negative bacilli isolated from clinical specimens.METHODS Gram-negative bacilli were isolated from various clinical specimens in our hosptial from Jan 2008 to Dec 2008.The identification test was determined by VITEK-32 Full Automated Microbiology Analyzer,the antimicrobiol susceptibility was detected by K-B method.RESULTS The resistance rate of Enterobacteriaceae to meropenem was extremly low.The resistance rates of Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae to meropenem were 0,27.6% and 4.2%.The resistance rates of Stenotrophomonas maltophilia,Burkholderia cepacia,Chryseobacterium meningosepticum,Pseudomonas aeruginosa and Acinetobacter baumannii to meropenem were 100.00%,48.81%,94.12%,21.85% and 31.72% respectively.CONCLUSIONS Meropenem has high in vitro antimicrobial activity to Enterobacteriaceae.but generally low to non-fermentative Gram-negative bacilli.

Objective To evaluate the clinical efficacy of percutaneous nephrolithotomy (PNL) in combination with pneumatic and ultrasonic lithotripsy in the treatment of complex renal calculi. Methods Under general anesthesia,an ureteral stent was placed into the patient by cystoscopy. With the prone position,percutaneous access was established by inserting an access needle into the intended calix under the guidance of ultrasonography or fluoroscopy. Afterwards,combined pneumatic and ultrasonic probes were used by nephroscopy for lithotripsy. Results A single tract was used in 137 patients,while two or three tracts were created in the other patients (11 and 2 respectively). One-step procedure to remove the stones was achieved in 119 patients,while a second intervention was performed in 27,and three procedures was carried out in 4. The mean time of the operations were (88?34) min. After the operation,one patient developed infectious shock,and then was cured by anti-shock therapy;two patients showed secondary hemorrhage in two weeks postoperation,and was cured by conservative therapy. In this series,the rate of stone clearance was 84.7% (127/150);23 cases had residual stones,10 of them received ESWL (the stone was removed completely in 7 of the 10 cases),and the other 13 were treated by oral medicines. Six months after the operation,follow-up examination showed a stone-free rate of 89.3% (134/150). Conclusion Combination of ultrasonic and pneumatic intracorporeal lithotripsy is effective and safe for complex renal calculi,which is intractable by open surgery.

Objective To evaluate argon-helium cryoablation combined with transcatheter arterial chemoembolization (TACE) in treating primary hepatocellular carcinoma by comparing the changes of AFP level and T cell immunity after the therapy with that obtained after the treatment of argon-helium cryoablation alone and with that obtained after the treatment of TACE alone. Methods (1) Ninety-nine patients with primary hepatocellular carcinoma were randomly divided into three groups: group A (n=30), treated with argon-helium cryoablation; group B (n=34), treated with TACE; and group C (n=35), treated with argon-helium cryoablation together with TACE. The patients' gender, age and pathology of three groups were comparable with each other. (2) The peripheral blood T cell immunity and AFP level both before and after the treatment were determined and the results were statistically compared. Results After the treatment the AFP level in all 3 groups was significantly reduced when compared to that determined before the treatment (P < 0.05). And the difference in the decrease of AFP level between group C and A, also between group C and B, was statistically significant (P < 0.05). After the treatment the T cell immunity, including Th, TS and Th / TS, in all 3 groups was significantly different from that determined before the treatment (P < 0.01), and significant difference also existed between group C and A and between group C and B (P < 0.01). Conclusion The statistic analysis of AFP and T cell immunity, which are regarded as the index of therapeutic efficacy, indicates that argon-helium cryoablation combined with TACE is superior to simple argon-helium cryoablation and also to simple TACE in the treatment of primary hepatocellular carcinoma.

In early stage of the severe acute pancreatitis, mediators of inflammation make the permeability of the microcirculation blood vessel increasing and more fluidify aggregates in tissue space. Pancreatic tissue is dropsical and necrotic ; a great quantity of body fluid accumulates in abdominal cavity, which induce utility circulation volume and returned blood volume decreasing rapidly. As more and more utility circulation volume decreases, the blood current of the coronary arterY is insufficient and the cardiac muscle cell is ischemic, the cardiac muscle is suffering injury to different extent. The cardiac load is overweight relatively. The cardiac muscle fiber is prolonged and interchanged idand cardiac muscle cellular membrane is damaged. The chain reaction and magnification of the mediators of inflammation let body delivery generous cell factors such as TNF-α,interleukin, oxygen free radical and so on, which make cardiac muscle cell's integrality damage,apoptosis,cardiac functional disturbance even exhaustion. In addition, abdominal compartment syndrome,pancreatitis associated ascetic fluid and electrolyte disturbances etc are also the important factors that affect the development of the disease.

Objective To explore the influence of parenterai nutrition(PN) on nutritional status and immune function in breast cancer patients undergoing postoperative chemotherapy.Methods 94 patients with breast cancer postoperative patients were randomly divided into the treatment group(47 cases) and the control group(47 cases).All the patients were given chemotherapy with VBP.The treatment group was given glutamine fortified PN,and the control group was given normal nutrition support,respectively.The nutritional status and immune function before and after chemotherapy,and main toxicities were observed.Results Compared with those before chemotherapy,there were no significant decrease on the level of ALB,PA and HB in treatment group(all P ＞ 0.05),while those indicators in control group was significantly decreased (all P ＜ 0.05).After chemotherapy,CD4,CD8,CD4/CD8 and IgA,IgG,IgM levels of the two groups were lower than those before chemotherapy (all P ＜ 0.05),and the levels of immune indicators of the treatment group were significantly higher than those of the control group(all P ＜ 0.05).The main toxicities in two groups were nausea and vomiting,diarrhea and mild bone marrow suppression,and the body weight in control group decreased (0.91 ± 0.53)kg,while it increased (0.45 ± 0.21)kg in treatment group (t =5.53,P ＜0.05).Conclusion PN treatment for breast cancer patients during chemotherapy can improve nutrition status and immune function,enhance the tolerance of chemotherapy,so as to improve curative effect and prognosis.