Objective To assess the clinical application of microendoscopic discectomy (MED) system in the treatment of 36 cases of special lumbar disc herniation (LDH). Methods Laminectomy and decompression, and removal of fractured end plate or calcified herniated discs were performed by MED using self-made bone chisel, osteotome and L-shaped osteotome. Results Intraoperative dural laceration occurred in 2 cases, and no conversions to open surgery were required. Follow-up observation ranged (3～12) months (mean, 9.5 months). According to Macnab criteria, 28 patients had excellent, 5 had good, 2 had fair, and 1 had poor outcomes, with good or excellent results in 91.7% (33/36) of the patients. Conclusions MED may be carried out in patients in side position. Calcified herniated discs and fractured end plate can be excised by MED with self-made tools.

Objective To explore the angioarchitectrue characteristics and appropriate treatment strategies of dural arteriovenous fistula (DAVF) in foramen magnum region.Methods The clinical data of patients with DAVF diagnosed by digital subtraction angiography (DSA) were analyzed retrospectively.Results Thirteen patients intraoperative were found fistula and complete resection,patients discharged from hospital,DSA check showed that the DAVF fistula completely disappeared,all patients symptoms were improved to different extents.Conclusions The clinical features,prognosis and treatment methods of DAVF in forament magnum region depends on its angioarchitecture,especially the lesion site and venous drainage,surgical operation can usually find the fistula and can be completely removed.

The disc degeneration disease has been main research focus in spinal surgery,but the pathogenesis of disc degeneration is still not clear.Appropriate animal models are important for the study of pathogenesis of disc degeneration.Presently,models of disc degenetation are mainly classified into two categaries:vitro models and vivo models.The animal vitro models include disc cell models and disc tissue models.The vivo models include mechanics models and trauma models.This review tries to give a short introduction about the status and progress of animal model about disc degeneration.

Objective To investigate the feasibility of thoracoscopic minimal access anterior surgery for thoracic spine. Methods Minimal access anterior thoracic surgery was conducted under thoracoscope in 14 patients in this hospital from October 2001 to October 2002.Six patients with thoracic vertebral metastasis underwent vertebral body excision, reconstruction by cement and steel plate, and anterior internal fixation with screw-rod system;4 patients with thoracic vertebral tuberculosis received focus resection,bone graft and anterior internal fixation with screw-rod system; 2 patients with of thoracic disc herniation received discectomy and fusion;2 patients with thoracic vertebral facture and dislocation received reduction, decompression, bone graft and anterior screw-rod internal fixation. Results Postoperative imageological analysis revealed that the focus had been cleaned completely and the internal fixation was excellent. Follow-up for 4～12 months in 14 patients showed that the pain on chest and back disappeared in all the patients. Of the 13 patients with spinal compression, muscle strength recovered from grade A～D preoperatively to grade C～E postoperatively. Conclusions Thoracoscopic minimal access anterior thoracic surgery is feasible. It offers satisfactory short-term effects.

Objective To investigate the clinical value of fetal echocardiography in prenatal diagnosis of fetal truncus artery. Methods Retrospective analysis was made in 10 cases with fetal truncus artery for their fetal echocardiography and follow-up findings. Echocardiographic characteristics was summed up in various fetal heart views. Results Truncus artery was confirmed by autopsy in 7 fetuses,and 3 cases were correspondingly verified by postnatal echocardiography. Echocardiographic characteristic images of fetal truncus artery was larger ventricular septal defect, only 1 great artery arising from heart, and pulmonary artery arising from truncus artery. Conclusions Echocardiography has important value in accurate diagnosis of fetal truncus artery and caution should be paid in differential diagnosis with other fetal complicated congenital heart diseases.

Objective To explore the significance of Community Mental Health Service funded by the government, organised by the Health Department and participated by the Community Psychiatric Service, which consists of community case managers, policemen, community health station, doctors, nurses and family of patients.Methods 150 patients, having the tendency to cause trouble or disturbance in their psychotic episodes, were placed in a case management system, monitored and treated throughout the year, gathered statistics for their number and extent of violence every month, and scored according to Social Disability Screening Schedule (SDSS).Results After one year's monitoring and treatment, the total number of occurrence of violence 5 grade among the 150 patients decreased from 20 person-times to 0 person-times; violence 4 grade decreased from 68 person-times to 2 person-times; violence 3 grade decreased from 66 person-times to 4 person-times; violence 2 grade decreased from 258 person-times to 12 person-times; violence 1 grade decreased from 432 person-times to 24 person-times. The number of patients who lost their violent tendency increased from 0 person-times to 72 person-times.Conclusion To establish community case management systems, monitor, treatment, conduct follow-up studies and providing appropriate recovery guidance for schizophreniac patients through the Community Psychiatric Service, are the effective ways to decrease the rate of causing trouble or disturbance, reduce the patients' social disability, and facilitate the patients' recovery of social functions.

Objective To observe the relationship of awake bispectral index (BISawake) and the postoperative cognitive dysfunction (POCD). Methods 100 patients aged 60~75 years with ASA status Ⅰ~Ⅱ, underwent elective lower abdominal surgery with intravenous anesthesia (propofol, remifentanyl and rocuronium). The BIS was adjusted in 40~60 during the surgery. Their cognitive function was assessed with the neuropsychological test battery commended by International study of postoperative cognitive dysfunction (ISPOCD). Results 8 patients withdrew for unwilling or serious complications. The BISawake was more than 65 in 68 patients (group A), and less than 65 in 24 patients (group B). The difference of the verbal learning immediate and delayed of Hopkins Verbal Learning Test-Revised was more in the group B than in the group A. Conclusion Lower BISawake may be associated with the decline of postoperative cognitive function.

Objective To study the independent risk factors of early rebleeding after endoscopic variceal ligation (EVL) and/or endoscopic injection of fibrin tissue adhesive.Methods Data of 370 patients who had cirrhosis and accepted 396 procedures of EVL and/or endoscopic injection of fibrin tissue adhesive were retrospectively studied.Independent risk factors for early rebleeding were determined by Logistic regression analysis.Results Results of all the factors that were significantly different between the re-bleeding and non-rebleeding patients,the portal vein diameter,ascites volume,Child-Pugh score and serum albumin were independent ones of early rebleeding after EVL and/or endoscopic injection of fibrin tissue adhesive ( P ＜ 0.05).Larger volume of ascites,wider portal vein diameter,reduced albumin,Child-Pugh score greater than 10 were indicative factors of rebleeding.Conclusion The early rebleeding rate after EVL and/or endoscopic injection of fibrin tissue adhesive is determined by portal vein diameter,ascites volume,ChildPugh score,and serum albumin.

Objective To assess the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary diseases in children. Methods Data of 9 patients younger than 14 years who underwent ERCP at between November 2004 and May 2010 were indentified through a computer database search. Therapeutic methods, success rate and procedure-related complications were evaluated.Results A total of 9 patients underwent 17 ERCP procedures under anesthesia, including 16 therapeutic and 1 diagnostic procedure. The success rate was 94. 1% (16/17) and the complication rate was 11.8%(2/17), including 1 mild pancreatitis and 1 peri-pancreatic infection. Conclusion ERCP is an important tool with high safety and efficacy for diagnosis and treatment of pancreaticobiliary diseases in children.

Objective To explore the safety and efficacy of endoscopic retrograde cholangiopancreatography(ERCP)by using carbon dioxide for malignant biliary obstruction.Methods A total of 60 patients with malignant biliary obstruction, hospitalized from September 2008 to February 2010, were randomly divided into 3 groups to receive ERCP by using carbon dioxide, contrast agent or magnetic resonance cholangiopancreatography(MRCP)without any agent.The safety and efficacy of 3 contrast methods were compared.Results Successful stent or drainage tube insertion was achieved in all patients.Carbon dioxide was superior to contrast agent in terms of lowering postoperative infection rate(P ＜ 0.05), and it was also superior to MRCP for more effective drainage(P ＜ 0.05).There was no significant difference in occurrence of postoperative pancreatitis and hyperamylasemia between 3 groups.Conclusion Using carbon dioxide during ERCP, safe and effective, is superior to use of contrast agent in less leukocyte increase, and to MRCP in more adequate drainage in patients with malignant biliary obstruction.Furthermore, there is no more risk of pancreatitis and hyperamylasemia.