BACKGROUND:The preemptive analgesia is stil a controversial issue. Existing studies have not paid much attention to effects of preoperative factors on the hypersensitivity of peripheral and central mechanisms. Visual analog scale scores cannot subjectively and repeatedly reveal patient’s pain.
OBJECTIVE:To investigate the validity of the preventive analgesia effect of Celebrex in patients with total knee arthroplasty.
METHODS:Patients with osteoarthritis of the knee who received total knee arthroplasty were accessed by Pittsburgh sleep quality index, self-rating depression scale and self-rating anxiety scale. In al , thirty patients were enrol ed in the study. They were randomized into Celebrex group and vitamin C group, and each group had 15 patients. The patients in the Celebrex group and vitamin C group took 200 mg Celebrex and vitamin C, respectively, twice a day from day 2 to day 4. Both of their knees were evaluated by resting visual analogue scale and moving visual analogue scale in the evening of day 1 before treatment and day 3 after treatment. Meanwhile, the pain threshold and pain tolerance were accessed by a pain-threshold machine.
RESULTS AND CONCLUSION:No statistical significance of the changes of resting and moving visual analogue scale scores was found in both knees in the Celebrex group (P>0.05). The pain threshold of both knees were significantly increased (P<0.05), and the severe knee, which had less visual analogue scale scores than the minor one, turned out to increase more obviously than the minor knee (P>0.05). There were no significant changes in the pain tolerance in both knees (P>0.05). The changing values of resting or moving visual analogue scale were not significantly correlated with the pain threshold and pain tolerance (P>0.05). There were no significant changes in visual analogue scale scores, pain threshold and pain tolerance in both knees of the vitamin C group (P>0.05). Celebrex could increase the pain threshold of patients receiving total knee arthroplasty, especial y the severe knee, which indicates that the Celebrex is good for the preventive analgesia. Comparatively speaking, the pain threshold might be more sensitive than visual analogue scale in revealing the change of pain after analgesia. There is no significant correlation between visual analogue scale score and the hypersensitivity of pain.

BACKGROUND:Ischiogluteal bursitis has been recognized for a long time, but its treatment stil limits to local blocking injection and surgery methods that were developed 40 years ago. OBJECTIVE:To observe the efficacy of platelet-rich plasma on ischiogluteal bursitis. METHODS:Data of 15 patients with ischiogluteal bursitis were colected. Al the patients with ischiogluteal bursitis were treated with bilateral platelet-rich plasma (n=10) or local blocking injection (n=5). Patients’ outcomes were assessed by visual analogue scale, the Treatment Satisfaction Questionnaire for Medication (TSQM) Version II and recurrence rate. The folow-up time was from 6 to 14 months. RESULTS AND CONCLUSION: There was no statistical difference in visual analogue scale score between the platelet-rich plasma group and local blocking group (F=0.219,P=0.643), but the score of visual analogue scale in the platelet-rich plasma group was higher during short-term folow-up (within 1 week after treatment), but lower in the long-term folow-up. In the aspects of overal satisfaction score, clinical effectiveness and side effects, the platelet-rich plasma group was inferior to the local blocking group at short-term folow-up, especialy at 1 week after treatment; however, these scores became better in the platelet-rich plasma group than the local blocking group during the long-term folow-up period. In addition, no statistical difference in the convenience score was found between the two groups. At the last folow-up, the recurrence rate in the platelet-rich plasma group was lower than that in the local blocking group. Both the platelet-rich plasma and local blocking injection can significantly reduce the pain of patients with ischiogluteal bursitis. Local blocking injection has better short-term effectiveness. Platelet-rich plasma injection works moderately, but its effectiveness can last for longer time, and the recurrence rate is lower.

OBJECTIVETo explore the pattern of lymph node metastasis and evaluate the modes and extent of mediastinal lymph node dissection in patients with ≤ 3 cm, clinical stage I primary non-small cell lung cancer (NSCLC).

METHODSData of 270 eligible patients who underwent pulmonary resection with systematic lymph node dissection in our hospital between March 2012 and August 2013 were retrospectively analyzed in order to investigate the relationship between the clinicopathological features and lymph node metastatic patterns. Patients with multiple primary carcinomas or non-primary pulmonary malignancies and those who received any chemotherapy or radiotherapy or did not undergo systematic nodal dissection were excluded. The criteria of systematic nodal dissection included the removal of at least six lymph nodes from at least three mediastinal stations, one of which must be subcarinal. The data were analyzed and compared using Chi-square test.

RESULTSThe postoperative morbidity rate was 14.8% and no death occurred in this series. The imaging findings showed 34 cases of pure ground glass opacity lesions, 47 partial solid nodules, and 189 solid nodules. Apart from 34 p-GGO lesions, among the other 236 cases, ≤ 1 cm lesions were in 22 cases, 1 cm- ≤ 2 cm lesions in 138 cases, and >2 cm- ≤ 3 cm lesions in 76 cases based on radiologic findings. The pathological types included adenocarcinoma (n = 245), squamous cell carcinoma (n = 18) and other rare types (n = 7). The overall lymph node metastasis rate was 18.9% (51/270), and the incidence of lymph node involvement was 0(0/34) in cancers with p-GGO, 2.1% (1/47) in mixed solid nodules, 26.5% (50/189) in solid nodules, 18.2% (4/22) in nodules ≤ 1 cm, 14.5% (20/138) in 1 cm < nodules ≤ 2 cm, and 35.5% (27/76) in 2 cm < nodules ≤ 3 cm. The metastasis rates of non-specific tumor-draining region lymph nodes detected in the patients with positive and negative lobe-specific lymph node involvement were 20.0%-50.0% vs. 0-2.9% (P < 0.001).

CONCLUSIONSUsually NSCLC with p-GGO nodules has no lymph node metastasis, therefore, systematic nodal dissection may be not necessary. The larger the tumor size is, the higher the lymph node metastatic rate is for mixed or solid nodules. Intraoperative frozen-section examination of the lobe-specific lymph nodes should be performed routinely in patients with ≤ 2 cm stage I NSCLC, and systematic nodal dissection should be done if positive, but it may be not necessary if negative. However, the effectiveness of the systematic selective lymph node dissection still needs to be further confirmed.

Carcinoma, Non-Small-Cell Lung ; diagnosis ; surgery ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; surgery ; Lymphatic Metastasis ; diagnosis ; Neoplasm Staging ; Retrospective Studies

BACKGROUNDIn order to minimize the injury reaction during the surgery and reduce the morbidity rate, hence reducing the mortality rate of esophagectomy, minimally invasive esophagectomy (MIE) was introduced. The aim of this study was to compare the postoperative outcomes in patients with esophageal squamous cell carcinoma undergoing minimally invasive or open esophagectomy (OE).

METHODSThe medical records of 176 consecutive patients, who underwent minimally invasive esophagectomy (MIE) between January 2009 and August 2013 in Cancer Institute & Hospital, Chinese Academy of Medical Sciences, were retrospectively reviewed. In the same period, 142 patients who underwent OE, either Ivor Lewis or McKeown approach, were selected randomly as controls. The clinical variables of paired groups were compared, including age, sex, Charlson score, tumor location, duration of surgery, number of harvested lymph nodes, morbidity rate, the rate of leak, pulmonary morbidity rate, mortality rate, and hospital length of stay (LOS).

RESULTSThe number of harvested lymph nodes was not significantly different between MIE group and OE group (median 20 vs. 16, P = 0.740). However, patients who underwent MIE had longer operation time than the OE group (375 vs. 300 minutes, P < 0.001). Overall morbidity, pulmonary morbidity, the rate of leak, in-hospital death, and hospital LOS were not significantly different between MIE and OE groups. Morbidities including anastomotic leak and pulmonary morbidity, inhospital death, hospital LOS, and hospital expenses were not significantly different between MIE and OE groups as well.

CONCLUSIONSMIE and OE appear equivalent with regard to early oncological outcomes. There is a trend that hospital LOS and hospital expenses are reduced in the MIE group than the OE group.

Aged ; Carcinoma, Squamous Cell ; surgery ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Thoracoscopy ; Treatment Outcome