Objective To evaluate the efficacy and safety of self-management anticoagulation treatment for low pulmonary embolism severity index (PESI) outpatient with acute pulmonary embolism (APE).Methods Sixty-eight patients with APE of PESI grade Ⅰ-Ⅱ were divide into inpatient group and outpatient group with 34 cases each by random digits table.All the patients were treated with low molecular heparin followed by oral anticoagulation,and self-management was used in outpatient group.The efficacy was observed within 14 days and 3 months.The efficacy outcome included recurrent venous thromboembolism (VTE),standardization time of international normalized ratio (INR),VTE-related emergency department visit times,bleeding events and total mortality.Results There were 2 cases(5.9％,2/34) in inpatient group and 1 case (2.9％,1/34) in outpatient group with recurrent VTE,and there was no statistical significance between two groups (P ＞ 0.05).Standardization time of INR in inpatient group [(8.5 ± 2.9) d] was shorter than that in outpatient group [(16.1 ± 4.4) d],and there was significant difference (P＜ 0.01).There was no significant difference in the VTE-related emergency department visit times between two groups (P ＞ 0.05).There was 1 case with major bleeding and 1 death respectively in outpatient group.Conclusion It is effective and safe to give early self-management anticoagulation treatment to APE patients with PESI grade Ⅰ-Ⅱ,which could shorten time spending in hospital and release burden both physically and mentally.

Objective To compare the effects of butorphanol and tramadol on shiver in patients with cesarean section.Methods 200 cases with maternal shiver (both for waist hard combined anesthesia,ASA Ⅰ ～ Ⅱ) were chosen in this study.According to the digital meter method,they were randomly divided into two groups,100 cases in each group.The observation group(group Ⅰ) was intraoperatively given butorphanol (0.015mg/kg),the control group(group Ⅱ) was intraoperatively given tramadol(1mg/kg).Shivers rating before and after drug use 5min,10min,adverse reactions,blood pressure (MAP),heart rate (HR),respiratory (RR),pulse oxygen saturation (SpO2)and incidence rate of adverse reaction were recorded.Results Perioperative and postoperative BP,HR,RR,SpO2,etc between two groups had no statistically significant differences (P ＞ 0.05).At 5 min,10 min,the total effective rate of shiver vanishing of the observation group was 100％ and 98％,respectively,which of the control group was 100％ and 88％,respectively,the differences between the two groups were not statistically significant (P ＞ 0.05).In the observation group,intraoperative blood pressure decline occurred in 5 cases,sleepiness 8 cases,nausea and vomiting 1 case,recurrence of shivers in 2 cases,those in control group were 4 cases,6 cases,26 cases,12 cases.Blood pressure drop and incidence rate of sleepiness between two groups had no statistically significant differences(P ＞ 0.05).Nausea and vomiting,the incidence rate of recurrent shiver between two groups had statistically significant differences (x2 =26.7609,7.6805,all P ＜ 0.05).Conclusion The effect of butorphanol is better than tramadol in treatment of cesarean section intraoperatie shivers.

Objective To investigate the pathological characteristics of bile duct tumor thrombi (BDTT) and its inlfuence on the prognosis of patients with hepatocellular carcinoma (HCC) after surgical treatments. Methods Clinical data of 26 patients with HCC and BDTT (23 males, 3 females, age ranging from 23 to 78 years old and the median age of 52 years old) who underwent hepatectomy in Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from June 2007 to June 2012 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. The surgical procedures included regular hepatectomy (n=12), irregular hepatectomy (n=14). The treatments for BDTT included bile duct thrombectomy (n=13), extrahepatic bile duct resection (n=8), combined resection of BDTT and tumor (n=5). The pathological characteristics of BDTT were observed and its correlation with tumor recurrence was analyzed. The comparison of rates was conducted by Fisher's exact probability test. Results Two cases of pure small microscopic BDTT and 24 cases of big macroscopic BDTT (14 cases were combined with pure small microscopic BDTT) were observed. According to the Satoh's BDTT clinical classiifcation, there were 3 cases of typeⅠ, and 21 cases of type Ⅱin 24 cases of big macroscopic BDTT. In all 26 cases of BDTT, sub-epithelium spreading along the bile duct wall was observed in 23 cases, most of which were small microscopic BDTT or big macroscopic BDTT. Intraductal spreading was rare and was observed mostly at the end part of big macroscopic BDTT. During the follow-up, intrahepatic tumor recurrence was observed in 10 cases, in which 8 cases were combined with BDTT recurrence. The intrahepatic tumor recurrence rate was 3/9 in patients after regular hepatectomy, and was 58%(7/12) in patients after irregular hepatectomy. In the 13 cases receiving bile duct thrombectomy, 7 cases suffered from BDTT recurrence with the recurrence rate of 54%(7/13). In the 8 cases receiving extrahepatic bile duct resection, 1 case suffered from BDTT recurrence with the recurrence rate of 1/8, where signiifcant difference was observed (P<0.05). Conclusions BDTT of HCC includes macroscopic BDTT and microscopic BDTT. BDTT spreads mostly in sub-epithelium along the bile duct wall. Tumor recurrence rate may be reduced and the outcome may be improved by surgical treatments of regular hepatectomy combined with extrahepatic bile duct resection.