Objective To study the feasibility of the cochlear implantation and effects in the treatment of large vestibular aqueduct syndrome.Methods A total of 37 patients(74 ears)diagnosed with large vestibular aque-duct syndrome received cochlear implants since 2002 at the Renmin Hospital of Wuhan University.We made a retro-spectively analysis of these 37 patients(37 ears).While 37 patients(37 ears)with normal cochlear structures were considered as the control group.After activation,their speech perception at pre-operation and at 3,6,9,12 months affer the operation were evaluated.Their CAP and SIR scores were collected through questionnaires at each assess-ment interva1 .Results In LVAS group,5 patients(5 ears)had serious gusher,while no gusher was abserved in the control group.The two groups of the electrodes were all inserted in the cochlea.No serious complications occurred after implantation in the two groups.The impedance of the electrodes,the T level,C level and the hearing thresholds were similar with the normal group with cochlear implantations.The results had no significant differences when compared with the normal cochlear group (P>0.05).The speech perception ability,CAP and SIR scores were im-proved along with the increase time of implant use.At the same recovery time,the results had no significant differ-ence in the two groups(P>0.05).At the same group,the results between pre-operation and 3,6,9,12 months post-operation after device activation had significant differences (P<0.05).Conclusion Cochlear implants could be performed safely in patients with large vestibular aqueduct syndrome.The primary outcomes for patients with large vestibular aqueduct syndrome were similar to those with normal cochlear structure following the cochlear im-plantation.

Objective To compare the results of treatment with biodegradable ligaments and metallic fixation for total acromioclavicular joint dislocation. Methods Twenty eight patients with total acromioclavicular joint dislocation were treated with two different materials, 1) by Kirschner pin and steel wire or screw and steel wire tension band (MF group,16 cases), and 2) reconstructed by artificial coracoclavicular ligament and coracoacromial ligament (BF group,12 cases). There were 17 males and 11 females. All patients had acute dislocation. The time from injury to hospital admission varied from 0-8 days (average, 1.5 days). Results All patients were availble for an average duration of follow up of 39.5 months (range,8-70 months). The results were evaluated by radiographic representations and joint function according to Lazcano's standards. In BF group, 10 patients were assesed as good and 2 as fair. In MF group, 13 patients were assesed as good, 2 as fair and 1 as poor. There were no statistic differences between these two methods. Conclusion Biodegradable ligament fixation is believed to be a good simple method for the treatment of acromioclavicular joint dislocation without the necessity of a second operation for removal of implants.

Objective To compare the effect of sevoflurane and propofol in elderly surgery patients towards cardiac damage.Methods 45 elderly patients with hypertension were divided into Sevoflurane group and Propofol group,which were observed changes of their ECG ST-segment,Mb,CK-MB,cTnI.Results 24 hours after induction of anesthesia,cardiac damage could be observed;Compared with Sevoflurane group,levels of CK-MB,Mb and cTnI increased significantly 24 hours after induction of anesthesia(t =2.771,0.681,0.557,all P ＜ 0.05),ST-segment significantly depressed at the same time[(-1.96±0.06)mV,(-1.45±0.04)mV](P ＜0.05).Conclusion Elderly patients with hypertension show cardiac damage during pevi-operative stage;Compared with propofol,sevoflurane shows lighter damage to cardiac muscle.

This paper reported one patient who was treated through transphenoidal-upslope approach by lateral rhinotomy and the tumor was successfully removed. The patient was male of 38 years old. He suffered intermittent headache with blurred vision and left eye outreach disorder for more than a year. The visual inspection showed there was dark area of the left eye lateral. CT showed slopes density placeholder and bone window showed the slope of bone quality had been severely damaged. MRI showed T1 image slopes parts and other low signal placeholder forward to invade the sphenoid sinus. In addition, there was undermine the slope bone and brain stem boundaries clearly and T2 images showed high-signal, inhomogeneous enhancement. We found during the operation that the slope was partially destroyed and part of the tumor was prominent to the pharynx tumor. The pathologic examination confirmed that it is chordoma.
Adult ; Chordoma ; surgery ; Cranial Fossa, Posterior ; surgery ; Humans ; Male ; Microsurgery ; methods ; Skull Base Neoplasms ; surgery ; Sphenoid Bone ; surgery

Objective:To study the effect of sevoflurane inhalation anesthesia on stress reaction and kynurenic acid ( KYNA) level in serum of the patients with laparoscopic cholecystectomy .Methods:Totally 48 patients undergoing laparoscopic cholecystectomy were randomly divided into two groups.Group S(n=24) received sevoflurane inhalation and group V (n=24) received intravenous general anesthesia.The levels of norepinephrine (NE), epinephrine (E), cortisol (Cor), KYNA and neutrophil and the neutrophil/lympho-cyte ratio were measured at five time points, namely T1(before the anesthesia), T2 (just after the surgery) , T3(in the morning of the first day after the surgery ) , T4 ( in the morning of the second day after the surgery ) and T5 ( in the morning of the third day after the surgery).The correlation of Cor, NE, E and NLR with KYNA was studied as well.Results:The levels of Cor, NE and E at the three time points after the surgery (T2, T3 and T4) in group V were significantly higher than those before the surgery (T1) with statistically significant difference (P<0.05), while those in group S had no significant changes (P>0.05).And the levels of Cor, NE and E at the three time points after the surgery (T2, T3 and T4) in group S were markedly lower than those in group V at the same time point (P<0.05).After the surgery (T2, T3, T4 and T5), KYNA levels in group V were significantly decreased and NLR values in group V were significantly increased when compared with those of T 1.In group S, KYNA levels and NLR values after the surgery (T2, T3, T4 and T5) were markedly increased , which were higher than those in group V at the same time point with statistically significant difference (P<0.05).The correlation analysis indicated the level of KYNA displayed positive correlation with the levels of NLR , Cr, Z and E (P<0.05).Conclusion:Sevoflurane inhalation anesthesia can inhibit the increase of stress reaction and KYNA level in the patients with laparoscopic cholecystectomy , which may be related with its anti-in ammatory properties .

Objective To explore the clinical application of reconstruct ion interlocking nail in treating ipsilateral fractures of femoral neck and shaf t. Methods Twelve cases of ipsilateral fractures of femoral neck and shaft trea ted with reconstruction interlocking nail by static locking were reviewed. The d iaplasis of the fracture was done in a close manner or in an open manner but wit h a little incision, and the two sides of the fracture were locked with nails by a three-dimensional aim implement. Two lag screws were inserted into the femor al neck at a 15 degree dip angle. Results Eleven cases were followed up (average 12.3 months). Their long term effects were evaluated according to MaYuanzhang e valuation criteria: 5 cases gained excellent clinical results, 4 good, 2 fair; t he excellent and good rates were 81.8% (9/11). The average period of femoral n eck fracture healing was 5.2 months and that of shaft fracture healing 6.7 month s .72.7 % of the patients(8/11) showed fracture healing at one stage. There were no necrosis of femoral head, no femoral neck nonunion or malunion, or no n ail rupture. Conclusions Reconstruction interlocking nail is a principal way in treating ipsilateral fractures of femoral neck and shaft because of its effecti ve fixation and excellent clinical effect. Anatomy reduction of femoral neck and non-open reduction should be emphasized in treatment of femoral neck fractures , while close nail insertion, limited reaming and static locking should be a rou tine way in treatment of femoral shaft fractures.

Objective To study the clinical characteristics and treatment of neurofibromatosis type Ⅱ (neuro-fibromatosis type 2 ,NF2 ,bilateral acoustic neuroma) ,and the effects of auditory brainstem implant for treating to-tal deafness after bilateral acoustic neuroma resection .Methods One case of bilateral acoustic neuroma and all clini-cal data in terms of diagnosis ,treatment and hearing -speech rehabilitation after surgery were retrospectively stud-ied .Results The patient was a thirteen years old boy .His clinical symptoms were hearing loss on the right ear ,tin-nitus ,hoarseness and gait instability three years .MRI showed space occupying lesion in the cerebellopontine angle . The postoperative pathological diagnosis was bilateral acoustic neuroma .The initial switch -on was peformed six weeks after the surgery ,and confirmed that all electrodes generated listening responses .As the extension of recov-ery time ,the correct recognition rate of patients on the natural environment sound ,vowel ,monosyllabic were on the rise and the pure tone hearing threshold gradually decreased .The vowel correct recognition rate of postoperative 6 , 9 ,12 ,24 ,and 36 months were 14% ,18% ,20% ,24% ,and 20% ,respectively .The recognition rate of monosyl-labic and open words at each postoperative rehabilitation stage were 0 .Conclusion The clinical characteristics and treatment of bilateral acoustic neuroma were different from the unilateral acoustic neuroma .The individualized treat-ment should be followed .Auditory brainstem implant could be performed in patients with post - bilateral acoustic neuroma resection .The accurate location of the cochlear complex during the surgery was the crucial point for the success of ABI .

Seven cases scheduled for cesarean section following combined spinal-epidural anesthesia,complicating the premature detachment of placenta,which occurred in the 2nd Affdiated Hospital of Wenzhou Medical College from January 1997 to December 2006,were analyzed to determine the risk factors.The results showed that the supine hypotensive syndrome after combined spinal-epidural anesthesia and anxiety before cesarean section were closely related to the premature detachment of placenta.The incidence rate of the premature detachment of placenta after combined spinal-epidural anesthesia is low,but the prermature of detachment of placenta is severe if it occurs,and the effectively prophylactic measures should be taken,including premedication with midazolam to eliminate anxiety before cesarean section and prevention of supine hypotensive syndrome after combined spinal-epidural anesthesia.

Objective We aimed to compare the critical thinking ability between clinical nurses and college nursing students at different grades so as to provide scientific references for reform in nursing education and nursing practice. Methods A total of 287 clinical nurses and 656 nurses in grade one and grade three underwent the investigation by adopting Chinese version of critical thinking disposition inventory (CTDI-CV). Results The total scores of CTDI-CV of nursing students in grade one, nursing students in grade three and clinical nurses were (292.82±26.41), (284.71±26.20) and (290.58±24.87). Statistical difference existed between these groups. The scores of open-mindedness, inquisitiveness and maturity of judgement of nursing students in grade one and grade three were higher than that of the clinical nurses, while the scores of systematicity and self-confidence of critical thinking were less than that of the clinical nurses. Conclusions The current nursing education system needs further reform. At the same time we should also promote the transform of modern clinical nursing model.

With the development of techniques and methods of medical researches, the ethic review of clinical research has become essential for healthy development of medical research. This article analyseds the practice of ethic reviews of research projects involving human subjects in our hospital and the difficulties in the process are discussed.