Case based teaching was applied in order to enhance the teaching efficacy and clinical safety for resident doctors in anesthesia training centers and to arouse their learning incentives and improve their clinical performance.Case based discussions on basic cardiopulmonary resuscitation and multiple traumas were conducted.Process consciousness was enhanced and theoretical knowledge analysis was combined with practical clinical skill training for residents in department of anesthesiology to improve the quality of training.

To explore the observation and nursing of complications in operative patients with massive and rapid transfusion,32 cases were studied,the author summarized that the observation and nursing experience in prevention and treatment of some complications,such as overloading circulation、bleeding tendency、hypokalemia and hypothermia.

Objective To investigate the effect of endoscopic treatment of delayed hemorrhage after endoscopic sphincterotomy.Methods Retrospectively analyzed the data of 2 638 patients who underwent endoscopic sphincterotomy.There were 26 patients who delayed hemorrhage after endoscopic sphincterotomy.All the 26 patients underwent duodenoscopy,and endoscopic treatment was underwent for the patients who had active bleeding.Results There were 21 patients had active bleeding,and the other 5 cases had no bleeding.There were 12 patients with capillary hemorrhage and 9 cases with petechial hemorrhage.In the 12 patients with capillary hemorrhage,9 patients had been sprayed tissue glue,and 3 patients had been local injected with 1 10 000 noradrenalin.In the 9 patients with petechial hemorrhage,5 patients were treated with titanium clip,and 4 patients were treated with argon ion.All the 21 patients were crued,and no patient was operated and no patient died.Conclusion There are few patients who delayed hemorrhage after endoscopic sphincterotomy.Tissue glue sprayed,local injection,argon ion and titanium clip can cure the bleeding.

Objective To investigate the expressions of acetylcholine and norepinephrine of the central nervous system in a rat model of irritable bowel syndrome (IBS), and to explore the possible roles of the classical neurotransmitters of the central nervous system in the pathogenesis of IBS. Methods The rat model of IBS was reproduced by intragastric instillation of 2.0ml water at 0-4℃ in male Wistar rats for two weeks. Both the model group and the control underwent rectal distention, then were sacrificed by deep anesthesia. Sections of the posterior horn of the spinal cord and hypothalamus were obtained and processed immunohistochemically using anti-tyrosine hydroxylase (TH) and acetylcholinesterase (AchE) antibodies respectively, and the staining results were analyzed semi-quantitatively using computerized color image analyzer. The statistical difference of the opacity density and immunoreactive areas between two groups was compared by t-test. Results Immunoreactive area, opacity density of AchE immunoreactive tissues in the posterior horn of the spinal cord and hypothalamus of the model group were all significantly higher than those in control group (P0.05). Conclusions The expressions of acetylcholine in the spinal cord and hypothalamus in the rat model of C-IBS were abnormal, which suggested that cholinergic nervous system in the central nervous system may play some roles in the pathogenesis of IBS.

Objective To investigate the quality of life(QOL),gastrointestinal symptoms and mental status of patients with irritable bowel syndrome(IBS),and to find out the possible factors affecting the patients' QOL.Methods The questionnaires which included three forms were sent to 55 IBS patients and 40 healthy controls recruited from the authors' clinical department.IBS was diagnosed according to the Rome II criteria,and patients with organic diseases were excluded from this study.The nine-item scores of QOL in all cases were calculated by using the disease-specific form included in the questionnaire of QOL.The mental-psychological status in all cases was evaluated by using the Hospital Anxiety and Depression Scale(HAD).The gastrointestinal symptoms in IBS patients were recorded and graded according to the Gastrointestinal Symptom Rating Scale(GSRS).The data mentioned above were analyzed with regression model.Results Patients with IBS had statistically significant lower scores(P

Purpose:Evaluate the operation methods and prognosis following Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy for carcinoma of the middle and lower third of the oesophagus. Methods:From March 1997 to March 2001, A total of 356 consecutive patients underwent Ivor Lewis esophagogastrectomy with two-field radical lymphadenectomy for carcinoma of the middle and lower third of the oesophagus ,The patients received cupula of pleura or cervical esophagogastroanastomosis with mechanical methods through two incisions (right posterolateral thoracotomy and upper abdominal).Results:The post-operative mortality was 0. anastomotic leakages occurred in 3 patients(0.8%). Gastric leaks for stress gastric ulcer occurred in 2 patients (0.6%). Chylothorax occurred in 2 patients(0.6%). Hoarseness occurred in 5 patients(1.4%),4 cases recuperated after 3 months. Barium swallowed postsurgery through anastomosis and pylorus went through smoothly.Full follow-up was 97.2%. Median survival for operative survivors was 2.6 years (range,61 days to 5 years). The overall 3-year survival rate was 74.5% .The overall 5-year survival rate was 55.49%,it was 94.2% for those in stage Ⅰ,81.5% for those in stage Ⅱa,78.3% for patients in stage Ⅱb,36% for those in stage Ⅲ and 0% for patients in stage Ⅳ. Conclusions:Ivor Lewis esophagogastrectomy with two-field radical lymphadenectomy for carcinoma of the middle and lower third of the oesophagus is a safe operation. There is the low post-operative morbidity. Long-term survival have been improved.

Objective Finding characteristic of senile colon diverticula in 70 cases senile colon diverticula diagnosed by colonoscope through comparing and summarizing. Methods From Jan 1997 to Dec 2001, 70 cases older than 60 years old senile colon diverticula diagnosed by colonoscope in endoscopy department of PLA general hospital. Male 54 cases ,female 16 cases .Age from 60 to 84 years old, average age 68.70?5.39. Results ①With age increased, detectable rate of colon diverticula and multiple colon diverticula rised; ②Detectable rate in male higher than female; ③Whether the single or multiple diverticula ,all predilection site is in the right colon, rate of the right to the left is 2.8∶1(42∶15), and the single diverticula is more obvious. Conclusions ①Occurrence of diverticula have relation to age; ②Incidence in the right colon of senile is lower than of young people; ③The left colon diverticula and bilateral colon diverticula in senile is higher than in young people.

Objective To study the effects of intragastric ice water stimulation on bowel sensitivity, mast cells (MCs), the serum contents of serotonin (5-HT), leukotriene B 4 (LTB 4 ), histamine(HA)and bradykinin (BK) in rats, and explore the possible pathogenesis of cold drinks-induced irritable bowel syndrome (IBS). Methods 40 Wistar rats aged 4 weeks were randomly divided into two groups. Twenty rats of group A as experimental group were gavaged 0-4℃ ice water for 14 days, and the rats of group C as control group were not treated. On day 28, the group A and group C were again divided into two subgroups, respectively, i.e. A1, A2, C1, and C2. In the rats of subgroups A1 and C1, a balloon was introduced into the rectum of each animal, and number of abdominal withdrawal reflexes (AWR) was recorded after the balloon was distended for 3 minutes to assess bowel sensitivity. One hour after rectal distention, blood sample of each rat was collected from the heart for the measurement of the contents of 5-HT, LTB 4 , HA and BK in serum by enzyme linked immunoadsorbent assay (ELISA). Tissues harvested from the ileocecal junction and colon were sectioned and stained with haematoxylin-eosin (HE) for routine pathological examination, and with the improved toluidine blue method for the identification of MCs. Results The number of AWR to 1.0ml balloon distention in subgroup A 1 was significantly lower than that in subgroup C 1 (P0.05). Routine pathological examination did not show abnormality in both subgroups. In group A 1 , the numbers of MCs in the ileocecal junction and colon were significantly higher than those of group C 1 (P0.05). Conclusion The stimulation of the stomach with ice water results in lowering of bowel sensitivity, increase of MCs and elevation of serum contents of 5-HT, LTB 4 and HA, and the results might imply that cold stimulation of the stomach might play a role in the pathogenesis of IBS.

Objective To investigate the features of non-senile colonic diverticula as diagnosed by coloscopic examination in 47 cases. Methods 47 cases of non-senile colonic diverticula were diagnosed by colonoscopy in the Department of Endoscopy, General Hospital of PLA, from Jan. 1996 to Dec. 2001. Results There were 38 males and 9 females, whose age was under 60, with a mean age of 43.2 years. The incidence and detectable rate for simple and multiple diverticula showed no relationship to patients' age. The detectable rate of colon diverticula was higher in males than in females. Right colon was the predilection site for both simple and multiple colonic diverticula, especially for simple diverticula. The ratio of incidence for right to left colon was 20.5∶1. The ratio was 2.8∶1 in senile patients (aged above 60, detectable rate of colon diverticula was16.9‰). Conclusion The incidence of colonic diverticula in non-senile patients showed no relationship to age. The incidence of diverticulum in right colon was higher in non-senile patients than in seniors. The incidence of diverticulum in the left colon or both sides of colon was lower in non-senile patients was in seniors.

Objective Drug resistance is a major problem for the successful chemotherapeutic treatment and prognosis of cervi -cal cancer .The article investigated the role of Twist on cisplatin resistance of Hela cervical cancer cells in hypoxia microenvironment and its possible mechanism to provide an experimental basis to improve the therapeutic efficacy for cervical cancer . Methods Hela Cells were divided into two groups, normal oxygen group A (no CoCl2) and hypoxia group A (addition of 150μmol/L CoCl2 medium).6 hours later, different degrees(10-3, 10-4, 10-5, 10-6, 10-7 mol/L) of cisplatin (10 -3 , 10 -4 , 10 -5 , 10 -6 , 10 -7 mol/L) were added into two groups .24 hours later , MTT were added to measure IC 50 and growth inhibition ratio .CoCl2 were used to mimic hypoxia environ-ment.The working concentration and the treatment duration of Cispla-tin was optimized by MTT method.The expressions of Twist and MDR1 in normal oxygen group , cisplatin group , hypoxic group B and hypoxic cisplatin group B were determined by immunofluores-cence and western blot . Results The IC50 values were 10 -5.3 mol/L and 10 -4.5 mol/L of cisplatin respectively in normal oxygen group and hypoxia group, and there was significantly difference between them (P<0.05).The optimized working concentration and work time of cisplatin was 10 -5 mol/L and 24 h.Compare to the normal oxygen group (13.08 ±2.39, 29.57 ±12.80), the expres-sions of Twist (20.81 ±2.07, 24.25 ±4.51, 33.14 ±4.24) and MDR1 (35.26 ±8.41, 60.13 ±22.32, 76.00 ±9.96) was signifi-cantly higher than those in other three groups and which were the highest in hypoxic cisplatin group (P<0.05).There were significant positive correlations among them in hypoxic group and hypoxic cisplatin group (r =0.686,P <0.05;r =0.546,P <0.05). Conclusion The hypoxia microenvironment may be related to the cisplatin resistance of Hela cervical cancer cells .The possible mechanism is hypoxia activates Twist and upregulates MDR 1 expression , resulting in cisplatin resistance of Hela cells .