Objective To evaluate the therapeutic effect of laparoscopic hernioplasty for inguinal hernia in aged males.Method Forty cases of inguinal hernia in aged males were treated with laparoscopic hernioplasty(group L),while other 46 cases were treated with traditional inguinal hernioplasty(group S).Results To compare with group S,the time be in hospital and the time leave off the bed were significantly shorter in group L(P＜0.01 or＜0.05),but the mean operation time were longer and the operation expenses Was higher in group L(P＜0.05).Followed up for 2-47 months,there were no recurrence in two groups.Conclusions Laparoscopic hernioplasty for inguinal hernia in aged males can shorten the hospitalization time,quicken postoperative recovery.The comphcation is little and the wound ache is light.Along with the further improvement of laparoseopic technique and the amelioration of laparoscopic instrument.the opera-tion time will further shorten,the expenses also will descend.It will be a ideal way for the therapy of inguinal hernia in aged males.

ObjectiveTo investigate the clinical efficacy of pricking-medicinal cupping bloodletting therapy for knee osteoarthritis.MethodSixty patients with knee osteoarthritis were randomly allocated to pricking-cupping bloodletting (treatment) and conventional treatment (control) groups, 30 cases each. In the treatment group, specific points around the knee were pricked with bloodletting needles and blood was removed by cupping with decoction. In the control group, the same points were given acupuncture and the affected part was given microwave treatment. The WOMAC score was recorded in the two groups of patients before treatment and after the end of treatment course. The therapeutic effect was evaluated by comparing the pre-and post-treatment scores between the two groups.ResultThere was a statistically significant pre-/post-treatment difference in the WOMAC total score in the two groups (P<0.01). The range of decrease in the WOMAC total score was significantly larger in the treatment group than in the control group. There was a statistically significant post-treatment difference in the WOMAC total score between the two groups (P<0.01). The WOMAC item scores decreased in varying degrees in both groups after treatment (P<0.01). The total efficacy rate was statistically higher in the treatment group than in the control group; there was a statistically significantdifference (P<0.05). The clinical therapeutic effect was statistically better in the treatment group than in the control group.Conclusion Pricking-medicinal cupping bloodletting is statistically better than conventional treatment in treating knee osteoarthritis. It can effectively relieve the pain and stiffness and improve knee function and the quality of life in the patients.

Objective To evaluate the operative technique, perioperative management and outcomes of bilateral lung transplantation for idiopathic pulmonary artery hypertension. Methods There were 2 cases of idiopathic pulmonary hypertension subject to bilateral sequential lung transplantation with ECMO support (16, 17 years old, respectively). The pulmonary artery pressure was 10/70 and 148/72 mm Hg respectively. The heart function was NYHA Ⅳ, the operative procedure was right lung first, then left lung, and the cold ischemia time was 230 min/430 min and 185 min/300 min respectively. The ECMO support time was 550 min and 450 min respectively. The blood loss during the operation was 3000 and 1200 ml, respectively. Resuits The ECMO was withdrawn 16 and 13 h postoperation respectively. There was unstable hemadynamics and acute left heart failure on the 3rd and 4th day after the operation. The patients were treated with ventilate support and tracheotomy on 3rd and 6th day respectively. Additionally, the patients were given cardiotonic, dieresis and the ventilation was withdrawn on 33rd and 12th day after the operation respectively. They were discharged from the hospital on 93rd and 32nd day after the operation. The heart function both reached NYHA I, two cases were followed up for 25 and 10 months respectively.Both of them had an excellent quality life. Conclusion Bilateral lung transplantation is effective for end-stage idiopathic pulmonary artery hypertension even with slight right ventricular dysfunction with satisfactory short-term outcome. A limited operative time, an ECMO support for heart and lung during the peri-operative period and a perfect management for the left ventricular dysfunction after surgery are key roles for the success. Closed follow-up and surveillance are needed for long-term outcomes.

Objective To evaluate the safety and effectiveness of immunosuppression regimens,postoperative complications,dead causes and risk factors of lung transplantation (LTx).Methods The immunosuppression regimens and clinical data of 100 patients with end-stage lung diseases receiving LTx in our hospital were retrospectively analyzed between Sept.2002 to Dec.2010.There were 72 patients subject to single LTx and 28 patients to bilateral LTx,amongst them 61 patients received LTx under circulation support,including 5 cases of cardopulmonary bypass (CPB) support and 56 cases of extracorporeal membrane oxygenation (ECMO) support.The immunosuppression regimens including Cyclosporin,mycophemolate Mofeil and corticosteroids were utilized in 53 recipients before the year of 2007,and Cyclosporin was switched to Tacrolimus in 47 patients after 2007.All the patients received Daclizumab or Basiliximab as immunosuppression induction regimens.Results The 1-,2-,3-and 5-year survival rate after LTx was 73.3％,61.6％,53.5％ and 40.7％ respectively.The mean survival time post-transplant in the patients who received Cyclosporin-based regimens and Tacrolimus-based regimens were (36.57 ± 3.44) months and (35.00 ± 2.33) months,repectively,with no significant differences (P＞0.05).The main causes of mortality included primary graft dysfunction (PGD),acute rejection (AR),bronchiolitis obliterans (BOS) and sepsis.The incidence of AR and BOS in Tacrolimus group was significantly lower than that in Cyclosporin grou (P ＜0.05),but the incidence of diabetes mellitus was significantly higher in Tacrolimus group.Analysis of Spearman rank correlation revealed that there was a direct correlation between the incidence of AR and BOS (r =0.340,P＜0.01).The use of circulation support,diagnosis of IPF,postoperative complications such as AR,BOS and infection were associated with decreased survival time postoperatively,in both univariate and multivariate proportional hazards regression models (P＜0.05).Conclusion Cyclosporin-and Tacrolimus-based regimens were both effective immunosuppression strategies postoperatively,Consummate follow-up surveillance and prompt treatment of complications were the key points in prolongation of survival time and improving quality of life after LTx.

Objective To study the imaging features of sacroiliac joints(SIJ) in patients who were misdiagnosed as spondyloarthritis(SpA).Methods A total of 34 patients with chief complaint of back pain and misdiagnosed as SpA from January 2007 to April 2013 in Department of Rheumatology Chinese PLA General Hospital were enrolled.The imaging,clinical manifestations,laboratory examinations data were analyzed.Result The main reason for misdiagnosis as SpA was because of sacroiliitis presenting on imaging.The final diagnoses included 24 patients as SIJ infection,4 patients as neoplastic diseases,2 patients as metabolic bone diseases,2 patients as sacroiliac joint degeneration,1 patient as gout of sacroiliac joint,1 patient as diffuse idiopathic bone hypertrophy.For patients with infection,there were 10 patients receiving X-ray and 22 patients receiving CT of SIJ.However,5 and 7 patients had negative results respectively.These patients with infection had abnormalities in MRI including all with bone marrow edema,21 patients with erosion of bone and joint,22 patients with muscle involved.As to the patients with malignancies,SIJ CT scan appeared normal.Bone marrow edema and erosion in MRI were found in all neoplasm patients expect one as ependymoma.Adjacent muscles were involved in the patient with Ewing's sarcoma.Either X-ray or CT in other patients demonstrated obvious abnormalities,but only mild erosion of bone was found in MRI.Conclusion Bone marrow edema of SIJ in MRI represented not only in patients with SpA.Rheumatologists should analyze the clinical manifestations and laboratory examinations comprehensively in order to avoid the misdiagnoses.

ObjectiveTo evaluate the security and effectiveness of raffinose-low potassium dextran solution (RLPDs) for donor lung preservation.MethodsFrom Sep.2002 to Dec.2011,131patients underwent lung transplantation in our institution,including 81cases of single lung transplantation and 50 cases of bilateral lung transplantation.There were 95 males and 36 females.A total of 129 donors were used for organ harvest.Two donors denoted their lungs to four patients receiving single lung transplantation. All the donors were flushed, perfused antegradely and retrogradely,and preserved with hypothermal RLPDs.The repeated reperfusion was necessary when the cold ischemic time was fairly long and the function of donor was poor.During operation,the blood gas analysis,mean pulmonary artery pressure (mPAP) and breathing mechanics were monitored.Postoperatively,all the recipients received re-examination of cardiac ultrasonography,pulmonary function,blood gas analysis and chest imaging.ResultsAll lung transplantations were performed successfully,with a mean cold ischemic time of (193±21) min (range,65-630 min).There was a significant relationship between postoperative pneumonedema and donor lung cold ischernic time (P＜0.05),which was also observed between postoperative pneumonedema and primary graft dysfunction (P＜0.01). The blood gas analysis and oxygenation index were significantly improved postoperatively,with the mPAP and parameters of breathing mechanics being descended to a normal level.There were 24 early deaths in the first month post-transplant,with a mortality of 18.3％ (24/131),including 11cases of sepsis,7 cases of primary graft dysfunction,3 cases of heart failure,1case of bronchial stomal leak,1case of acute rejection,and 1case of pulmonary infarction.The pulmonary function was improved significantly 3 months postoperatively.Conclusion RLPDs is efficient in the preservation of donor lung,with the ability to alleviate ischemic reperfusion injury and improve pulmonary function.

Objective To analyze the diagnosis and treatment of airway stenosis in a consecutive series of bronchial anastomosis after lung transplantation in our center.Methods We performed a retrospective study on 100 cases of lung transplants in our center from September 2002 to December 2010.Seventy-two cases were subjected to single lung transplants (SLT), and twenty-eight to bilateral sequential single lung transplantation (BSSLT). There were totally 128 bronchial anastomoses.All recipients received long-term follow-up to monitor the lung function.Lung CT and fibrobronchoscopic examinations were done when necessary. Results Twenty-five cases with 37 bronchial anatomoses were died.A total of 12 airway stenosis occurred in 10 cases (12/128,9.4 ％).Four cases underwent telescopic anastomosis and 6 cases underwent end-to-end anastamosis.Mean diagnosis time was 60.1 35.6 days post-operation (ranging from 15-120 days,median 59 days).There were 8 cases of unilateral airway stenosis (3 on the left,and 5 on the right) and 2 cases of bilateral airway stenosis.The number of simple airway stenosis was 3,that of exophytie granulation tissue was 8,and that of bronchus intermedius stenosis was 1.Culture of bacteria by fibrobronchoscopy with protected specimen brush revealed:3 strains of Pseudomonas aeruginosa,2 strains of Klebsiella pneumoniae,2 strains of Aspergillus,1 strain of Escherichia Coli. 10 cases were treated with fiberoptic bronchoscopic balloon dilation:5 cases with high-frequency electrotome,4 cases with stent placement,and 1 case with argon plasma coagulation (APC).Seven cases were cured or improved and 3 cases died.Conclusion Airway stenosis after lung transplantation remains a major problem.The fiberoptic bronchoscopic procedure is the gold standard to diagnose. The preferred treatment is fiberoptic bronchoscopic balloon under expansion,and other approaches include high-frequency electrotome,APC and stem placement,etc.

Objective To evaluate the clinical effect of lung transplantation for pediatric pulmonary artery hypertension (PAH).Methods The recepter 1 and 2 with idiopathic pulmonary artery hypertension (IPAH) were diagnosed by right catheterization.The heart fuction was NYHA IV.The pulmonary artery pressure and mean pulmonary artery pressure were 110/70mmHg and 148/72 mmHg respectively.They underwent bilateral sequential lung transplantation with extracorporeal membrane oxygenation (ECMO) support.During operation,the ECMO support time was 550 min and 450 min and the blood loss was 3000 ml and 1200 ml respectively.The recepter 3 with end-stage congenital ventricular septal defect with Eisenmenger syndrome (ES) who had received open heart exploration underwent right single lung transplantation and ventricular septal defect repair under cardiopulmoanry bypass(CPB).There were ventricular septal defect and bidirectional shunt through UCG assessment The pulmonary artery pressure and mean pulmonary artery pressure were 110/60 mmHg.CPB time was 244 min.The three recepters had the same ABO blood group and the similar body type with the three donors.Results The recepter 1 and 2 was sustained by ECMO after operation for 16 h and 13h respectively.But unstable hemadynamics and acute left heart failure occured on 3rd and 4th day after the operation respectively.We treated them with ventilate support and tracheotomy on 3rd and 6th day respectively.They were also treated with cardiotonic; dieresis and the patients were weaned away from the ventilation on 33rd and 12ed day after the operation respectively.The transplanted lung of the receptor 3 had pneumochysis in the first 3 days.The patient was treated with ventilate support and tracheotomy on 7th day and was weaned from the ventilation on 12ed day after the operation.An acute rejection episode occurred on 14th day.The cordioform and heart function of the three cases improved and especially the receptor 3 had intact repaired of ventricular septal defect.They were discharged from the hospital on 93rd,32ed and 62ed day afer the operation.The heart function all reached NYHA I and the pulmonary artery pressure and mean pulmonary artery pressure was reduced to 54/32 mmHg,60/36 mmHg and 53/39 mmHg respectively.The three cases have been followed up for 41 months,21 months,and 82 months.They are having an excellent quality life.Conclusion Lung transplantation is effective to improve the quality of life for end-stage pediatric pulmonary artery hypertension even with slight right ventricular dysfunction with satisfying short-term results.

Objective To analysis the changes of heart function in early stage after lung transplantation,and to explore its relationship with decreased pulmonary artery pressure.MethodsFrom 2002 to 2010,echocardiography results of 90 patients before and after lung transplantation in Wuxi People's Hospital were collected, 20caseshadcompletedateofpreoperativeandpostoperative echocardiography.Echocardiographic changes had been analyzed.Pearson linear correlation analysis was applied to determine the relationship between the early postoperative changes in cardiac structure and function and decreased pulmonary artery systolic pressure.ResultsPostoperative pulmonary artery systolic pressure ([38.30 ± 8.92]mm Hg) compared with preoperative([60.05 ± 29.10]mm Hg) was significantly lower(t =3.120, P = 0.006) , Postoperative right ventricular diameter was significantly reduced compared with the preoperative(t = 36.000, P = 0.008) , tricuspid and pulmonary valve regurgitation significantly reduced (t =57.000 and 66, Ps ＜ 0.05) .Postoperative left atrial diameter and left ventricular end diastolic diameter ([35.15± 5.73]mm and [43.25 ± 5.56]mm) compared with preoperative([32.40 ± 7.29]mm and [40.15 ± 6.20]mm)were significantly expanded (t =-2.384 and t =-2.153, Ps ＜ 0.05) .Although postoperative stroke volume ([59.54 ± 14.97]ml)compared with preoperative ([44.18 ± 15.85]ml)significantly increased (t =-3.918, P = 0.004) , but the postoperative left ventricular ejection fraction ([63.10 ± 8.48]％)compared with preoperative ([71.75 ± 8.10]％)was significantly decreased (t =3.742, P = 0.001) .Pearson linear correlation analysis showed the greater degree of decreased systolic pulmonary artery pressure after lung transplantation, the larger rate of increased postoperative left atrial diameter and left ventricular end diastolic diameter, and the bigger range of decreased postoperative LVEF (r = 0.642,0.737 and 0.448, P ＜ 0.05) .ConclusionIn early stage after lung transplant, right heart structure was normalization, right heart function improved,left heart enlarged, stroke volume increased, but left ventricular function reduced.There were a linear correlation between those changes and reduced systolic pulmonary artery pressure.

Objective To summarize the experiences of extracorporeal membrane oxygenation (ECMO) technique in human lung transplantation. MethodsECMO was used in 45 patients undergoing lung transplantation.There were 32 cases of dilated pulmonary fibrosis and pulmonary hypertension,4 cases of chronic obstructive pulmonary disease,2 cases of pneumosilicosis,2 cases of phthisis,one case of diffuse panbronchiolitis,2 cases of bronchiectasis and 2 cases of primary pulmonary hypertension. In 3 patients, ECMO conduit was used as a bridge to the lung transplantation for 13,19 and 6 days respectively before operation,and ECMO support was done after the operation.In 40 patients ECMO support was done during operation.In 2 patients without using cardiopulmonary bypass, ECMO support was done after operation because of primary graft dysfunction.Results In 40 patients undergoing ECMO support during operation,the ECMO conduit was removed in 37 patients immediately after the operation.ECMO mean blood flow was (2.8 ± 0.6)L/min,running time was (7.7 ± 0.9) h,and 31 patients survived. In 3 patients undergoing postoperative ECMO support,ECMO was removed in 2 cases at 36th h and 6th day after the operation respectively,and the remaining one died from acute renal failure 2 weeks after the operation though the continuing hemofiltration was applied through ECMO conduit. In 2 patients without using cardiopulmonary bypass and 3 patients using ECMO during operation,ECMO support was used initially or again after operation because of PGD or acute heart failure.Three patients were cured,and 2 patients were died from multiple system organ failure.Conclusion ECMO is an important auxiliary tool in lung transplantation for preoperative,intraoperative and postoperative supports. As the transition bridge to recipients,ECMO can be used for preoperative supports; during operation,it can stabilize the haemodynamics,and postoperation,it can improve severe pulmonary function dysfunction and PGD.