BACKGROUND: Inadequate hyperventilation may trigger cerebrovascular contraction and lead to lowered cerebral perfusion and oxygen supply-demand imbalance.OBJECTIVE: To investigate the influence of hyperventilation on oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the cerebral arteries and veins in patients with serious traumatic brain injury.DESIGN: Case analysis.SETTING: Department of Anesthesiology, First Hospital Affiliated to Shantou University.PARTICIPANTS: Sixteen patients who received emergency operations in the First Hospital Affiliated to Shantou University between January and July 2002.METHODS: Patients with traumatic brain injury underwent operation under general anesthesia, and the PaCO2 was maintained at 30 mm Hg for 15 minutes by regulating the respiration rate, followed by decrease to 25 mm Hg, maintained for 15 minutes before restoration to 30 mm Hg for 15 minutes. The fractional concentration of inspired oxygen was adjusted to maintain blood PaO2 at around 100-150 mm Hg, and the blood sample was collected from the artery and internal jugular vein 15 minutes after adjustment of PaCO2 for blood gas analysis. The PaO2 was then increased to 200-250 mm Hg by increasing the fractional concentration of inspired oxygen, and the PaCO2 was adjusted from 30 to 25 and then back to 30 mm Hg in the described manner, and the oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the arteries and the veins were measured.MAIN OUTCOME MEASURES: Influence of blood PaO2 and PaCO2 on oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the arteries and the veins.RESULTS: Sixteen patients met the diagnostic criteria and completed data collection. The arterial PaCO2 decreased from 30 to 25 mm Hg when arterial blood oxygen pressure increased from 100-150 to 200-250 mm Hg, which leads to obvious decrease of oxygen saturation in the internal jugular vein and obvious increased difference in oxygen content between the cerebral artery and vein. However the absolute value of oxygen saturation in the internal jugular vein was obviously higher at PaO2 of 200-250 mm Hg than that at PaO2 of 100-150 mm Hg, while the absolute value of cerebral arteriovenous difference of brain oxygen content was obviously lower. Compared to the basal level, the arteriovenous lactic acid difference was obviously increased at PaO2 of 100-150 mm Hg,PaCO2 of 30 and 25 mm Hg, and at PaO2 of 200-250 mm Hg and PaCO2 of 25 mm Hg.CONCLUSION: Relatively higher PaO2 (200-250 mm Hg) and mild hyperventilation (PaCO2 of 30 mm Hg) has no obvious effect on brain oxygen supply-demand balance.

Oncogene Pim-1 has a close relationship with the occurrence and development of several tumours.It is involved in a number of signal transduction pathways and regulates the expression of the downstream biological factors or acts synergistically with other oncogenes.Pim-1 plays an important role in the clinical diagnosis,treatment and prognosis of some tumors,and provides a new potential target in the chemotherapy of tumors.Recently,Pim-1-targeting treatment strategy has be a research hotspot and it would be used for cancer clinical treatment hopefully.

Objective To investigate the preemptive analgesic effects of somato-visceral blockade in laparoscopic cholecystectomy (LC). Methods One hundred patients were randomly divided into four groups: Group A received peri-portal infiltration of 25 ml 0.25% bupivacaine (contained 1:200 000 epinephrine) before incision; Group B received intraperitoneal spray of 35ml 0.25% bupivacaine immediately after the establishment of pneumoperitoneum; Group C received the management of both Group A and Group B; Group D was control group without management. The extent and location of pain and nausea were recorded and assessed at 1, 2, 3, 6, 12, 24 and 48 postoperative hours, respectively. Results In the control group the incisional pain dominated over other pain locations within 24 hours postoperatively (P

A giant basilar artery aneurysm of young woman with endocrine disturbance was misdiagnosed as a large pituitary adenoma and treated surgically via a trans-sphenoidal approach was planned.But the neurosurgery was finally aborted because of massive bleeding during the procedure. One year later, a cerebral angiography confirmed this basilar artery aneurysm was obviously regressed and then endovascular coiling was successfully performed. No neurological complication occurred post-procedure and the endocrine dysfunction symptom was obviously improved.

The patient was a 38-year woman.Six years prior to presentation,she developed erythema and papules with occasional pruritus in both labium majora,which gradually confluenced into plaques with the formation of superficial erosion and ulcer;extension into the vulva and crissum occurred later.Half a year prior to presentation,a subcutaneous firm nodule measuring about 1.5cm in diameter with intact epidermis,developed on the right submaxilla,associated with mild swelling in the area;the nodule enlarged gradually.A subcutaneous induration measuring 0.5 cm in diameter was observed in the left chin 2 months later.She also reported a 20-year history of dry eye and dry mouth.The patient tested postive for antinuclear antibody cally,there was a focal infiltration of lymphocytes in tissue of minor salivary glands.The pathology of lesions on the right labium majus showed a dense dermal infiltration with S100-and CD1a-positive,irregulady-shaped histiocyte-like cells with abundant eosinophilic cytoplasm and few mitotic figures.Needle biopsy of the right submaxilla area showed tumor cells.A diagnosis of Langerhans cell histiocytosis and Sj(o)gren syndrome was made based on clinical manifestation,laboratory findings and histopathological features.Combination chemotherapy with cyclophosphamide,vincristine,corticosteroids and etoposide resulted in clinical improvement.

Objective To strengthen the understanding of the imaging features in congenital aberrant left pulmonary artery (CALPA). Methods All 4 patients underwent chest film and Doppler echocardiography. Thres cases were examined by enhanced spiral CT examination. In addition, MRI and DSA were performed in 2 cases respectively. Thres cases were proven by surgery or autopsy. Results (1) appearances on chest films included cardiomegaly, pulmonary overvascularity, left hilum a little lower than the right one, emphysema, atelectasis, and pneumonia. (2) bronchography showed stenosis of trachea and/or bronchia. (3) Barium esophagram showed an imprint on the left anterior wall of esophagus. (4) Contrast-enhanced spiral CT and MRI showed marked dilatation of main pulmonary artery (MPA) and the root of MPA extended backward to become right pulmonary artery (RPA), the left pulmonary artery (LPA) arose from the RPA directly. (5) echocardiography indicated LPA arose from RPA. (6) DSA showed MPA was marked dilated, and LPA arose from RPA. (7) other abnormalities included 3 PDA, 2 PLSVC, and ~1 ASD. Conclusion CT and MRI are the best methods to diagnose CALPA.

Objective To discus the diagnosis,favorabl management and diagnosis of pilocytastrocytoma.Methods Provided by the information from CT,MRI and operation,we try to discus and confirm the characteristics of this tumor.Results Pilocytastrocytoma commonly occurs in 20 years old or younger.The most frequent location involve by tumor were cerebellum.The most common presenting sympton was increased intracranial pressure,and then cerebellum symptoms such as incoordination.Final diagnosis made depending on mainly pathology.We found the relationship between prognosis and the extent of surgical removal.Conclusions Pilocytastrocytoma usually occur in children and adolescent.The most common site of these tumors are the cerebellum.And the more complete extent of surgical removal,the better prognosis.So it was called as "benign" tumors.If pilocyticastrocytoma were subtotally excised,the addition of postoperative irradiati could significantly prolong survival.

ObjectiveTo assess the values of 320-detector row dynamic volume CT angiography (CTA) and transthoracic echocardiography (TTE) in follow up of coronary artery aneurysm (CAA) caused by Kawasaki disease (KD).Methods320-de-tector row CTA and TTE were applied in long-term follow-up of 8 patients with CAA caused by KD.ResultsIn 8 patients, the mean age at onset was 41.63±22.70 months and the mean follow up time was 43.50±10.99 months. In acute phase, 3 cases of giant coronary artery aneurysms (GCAA) and 5 cases of mid-small CAA were diagnosed by TTE. A total of 16/32 arteries (50%) were involved. At the end of follow-up, 3 cases of GCAA and 2 cases of mid-small CAA were still diagnosed by TTE, and small CAAs were regressed in another 3 cases. A total of 6/32 arteries (18.75%) were involved. Simultaneously at the end of follow-up, a total of 7/32 arteries (21.9%) were involved by 320-detector row CTA. The distribution was consistent with that of TTE. Mean-while, there were one case of left circumlfex artery, one case of GCAA at distal of the right coronary artery, 2 cases of thrombus, 1 case of coronary stenosis and 2 cases of calciifcation.ConclusionsCAA caused by KD may be persistent for a long time. The thrombus, stenosis, and calciifcation of coronary can occurr at late phase in GCAA. TTE is sensitive and reliable to detect proxi-mal and middle segment of coronary lesions, but has limitations in detection of distal segment of coronary arteries. 320-detector row CTA has more comprehensively view of each coronary artery lesions and is especially sensitive and reliable to detect coro-nary thrombosis, calciifcation and narrowing in proximal and distal coronary arteries after acute phase.

BACKGROUND:As an important cytokine, interleukin-6 regulates immune responses in inflammation sites and has an autocrine/paracrine activity that stimulates osteoclast formation and bone resorption, which is related to bone remodeling during orthodontic tooth movement.
OBJECTIVE:To investigate the effects of orthodontic force on the expression of interleukin-6 mRNA in the periodontal tissue of rats.
METHODS:In situ hybridization was performed to measure the expression of interleukin-6 mRNA at 1, 3, 5, 7, 10 and 14 days after the application of orthodontic force on the maxil ary first molars of rats.
RESULTS AND CONCLUSION:The expression of interleukin-6 mRNA was observed at a low level in the normal periodontal tissue of rats. After the application of force, the induction of interleukin-6 mRNA was observed to reach a maximum on day 3 and to decline thereafter. The expression of interleukin-6 mRNA can be evoked by orthodontic force but with a certain self-limiting. As a multifunctional cytokine, interleukin-6 plays a very important role in periodontal remodeling during orthodontic tooth movement.

Objective To discuss the clinical value of intravascular ultrasound (IVUS) in treatinginternal carotid arteries occlusion.Methods The patient was diagnosed with internal carotid artery occlusionthat was confirmed by CTA.Cerebral perfusion imaging showed that low perfusion area was consistent withischemic symptoms.Guided by IVUS,percutaneous transluminal angioplasty (PTA) was performed.By usingmicro-catheter coaxial technology,the micro guide wire was inserted in the carotid artery until it passedthrough the obstructed segment;After IVUS examination proved that the micro guide wire was in the truelumen of carotid artery,angiography through micro-catheter was carried out to confirm that the distal arterywas unobstructed;after adjusting the device position the embolism protector was placed.The plaque andlumen condition were assessed with IVUS,which was reevaluated after pre-expansion of balloon.After normaldirection blood flow was regained,the plaque stability was assessed with IVUS virtual organization sequence.Simple balloon dilatation therapy was adopted as the fibrous cap of plaque was in stable condition and thelumen stenosis rate was ＜40％.Results After balloon dilatation,the obstructed artery was reopened and theblood flow regained normal direction.IVUS examination showed that during the whole operation process thefibrous cap of plaque at the narrowed segment remained in stable condition,the lumen stenosis rate was ＜40％.Cerebral perfusion imaging revealed that after the treatment the low perfusion state was markedlyimproved.Conclusion IVUS plays an important guiding role in performing PTA for internal carotid arteryocclusion.This technique can increase the success rate of vascular recanalization and reduce the incidence ofcomplications.