ObjectiveTo analyze the influencing factors of the blood pressure fluctuation during the perioperative period of pheochromocytoma,and discuss the ways to improve the hemodynamics.Methods The clinical data of patients with pheochromocytoma who had received operation from 2000 to 2010 werestudied retrospectively.The influencing factors of perioperative blood pressure fluctuation were analyzed by statistical methods including Pearson correlation analysis and Logistic regression.ResultsAccording to Pearson correlation analysis,the influencing factors of the highest fluctuation value of the systolic blood pressure ( △ SBP) during the operation included the preoperative highest systolic blood pressure (r =0.196,P =0.013 ),the content of preoperative 24-hour urine epinephrine ( r =0.207,P =0.008 ) and the lost blood volume during the operation (r =0.253,P=0.003).Logistic regression analysis showed that the postoperative persisting hypotension was influenced by the content of preoperative 24-hour urine norepinephrine(OR =1.273,P =0.002) and preoperative preparation duration(OR =0.921,P =0.034);the risk factors of postoperative hypertension were residual tumor (OR =16.920,P =0.001 ) and the preoperative hematocritchange(OR =1.467,P =0.018).ConclusionsIn spite of the adequate preoperative preparation,great changes of blood pressure would still occur during the perioperative period of pheochromocytoma,and it is influenced by many factors.Corresponding measures aiming to these factors should be taken to decrease the perioperative blood pressure fluctuation and surgical risks.

Objective To study the effect of acarbose on vascular endothelial function in patients with impaired glucose tolerance (IGT).Methods Fifty-six cases with IGT were chosen by OGTT,and they were divided into control group(27 cases) and therapy group(29 cases) by systematic sampling.The patients in control group were received placebo,the patients in therapy group were given acarbose 25-50 rug,3 times daily for 12 weeks.The body mass index (BMI),blood fat,fasting blood glucose (FPG),fasting insulin (FINS),glycosylated hemoglobin (HbA1c),high sensitivity C-reactive protein (hs-CRP),von Willebrand factor (vWF),2 h post-meal glucose (2hPG),2 h post-meal insulin (2hINS) and brachial artery endothelium-dependent dilation (EDD) was detected before and after treatment in two groups.Results Compared with that before treatment,BMI,2hPG,2hINS,HbA1c,hs-CRP and vWF were decreased and brachial artery EDD was improved after treatment in therapy group[ (24.69 ± 2.62) kg/m2 vs.(22.02 ± 2.59)kg/m2,(9.26 ± 1.02) mmol/L vs.(7.43 ± 0.95) mmol/L,(42.17 ± 9.98) U/L vs.(34.76 ± 9.86) U/L,(6.03 ±0.67)％ vs.(5.37 ±0.56)％,(5.45 ± 1.93) mg/L vs.(4.52 ± 1.55) mg/L,(187.22 ±26.57)％ vs.(165.13 ± 23.86)％,(6.08 ± 1.22)％ vs.(7.94 ± 1.25)％ ] (P ＜ 0.05 or ＜ 0.01).There was no significant difference before and after treatment in control group (P ＞ 0.05).Conclusion Acarbose can improve brachial artery EDD in patients with IGT by increasing insulin sensitivity and decreasing postprandial hyperglycemia and inflammatory factor,which delays the progression of diabetic mellitus and atherosclerosis.

ole on the development of septic AKI. It's useful to decrease the incidence of AKI by elevating the blood pressure and C1, but super-normal goal won't work better.

Objective To evaluate the clinical applications of noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema. Methods From Jan.2002 to Apr.2004 60 patients in Dalan Municipal Central Hospital were randomly assigned to receire conventional oxygen therapy or NMV supplied by a standard ventilator through a face mask,with adjustment of pressure support at 8-15 cm H_2O in addition to a positive end-expiratory pressure of 5-8 cmH_2O.Blood gas and vital signs were obtained at 1 h,2 h,3 h,4 h,and 12h.Results Endotracheal intubation was required in 5(16.7%)of 30 patients assigned to receire NMV and in 12(41.4%)of 29 assigned to receive conventional oxygen therapy(P=0037). Resolution time was significantly shorter in the NMV groupmedian 40(5~77)vs145(49~263)min,P

[Objective] A retrospective study of patients with osteosarcoma in the proximal humerus was carried out to evaluate the effect of limb salvage surgery.[Methods]Thirty-eight patients received neoadjuvant chemotherapy and limb salvage were included in the study.Extraarticular or intraarticular resections of the proximal humerus were performed in 5 patients and 33 patients,respectively.The reconstructions included 31 custom-made prosthetic replacements,4 allograft prosthetic composites,1 bone cement spacer,and 2 autografts.The image files of patients receiving intraarticular resection were studied to identify tumor invasion of glenoid and deltoid muscule.[Results]Local recurrence encountered in 5 patients(13.2%)including 1 with extraarticular resection and 4 with intraarticular resection.In patients with intraarticular resection,image study revealed gleoid and deltoid muscule invasion occurred in 7 patients,of whom only 4 had local recurrence.The overall 5-year survival rate was 56.4%,and the disease-free survival rate was 40.5%.Complication rate of limb salvage surgery was 18.4%,which included two autograft bone fractures,one embolism of upper limb artery combined with radial nerve injury,and 4 shoulder joint instabilities.The functional outcomes of mean MSTS 93 score was 22.7 points(75.6%).The active external extension of shoulder joint was restricted in patients with extraarticular resection of no more than 30 degrees,and in patients with intraarticular resection of mean 45 degrees.[Conclusion]Acceptable oncological result and better function could be obtained after intraarticular resection of osteosarcoma in proximal humerus if glenoid or deltoid muscle invasion was not found on image study.Prosthetic replacement in these patients had lower complication rate,and better upper limb or hand function.

[Objective]To summary wound related complications and risk factors of sacral tumor surgery,and discuss the prevention and treatment strategy in order to decrease surgical risk and prevent the related complications.[Methods]From August 1997 to June 2008,302 patients with sacral tumors who underwent operations were retrospective studied to review complication types,risk factors and treatment strategies of complications.[Results]Wound nonunion,deep infection,cerebrospinal fluid leakage,viscera injuries and severe bleeding were the most common complications of peri-operation stage.Tumor diameters larger than 10cm,surgery and radiation history were the major risk factors of wound nonunion,deep infection and viscera injuries.Severe bleeding happened in 11 patients,and the major risk factors were tumor larger than 10cm,tumor locating at S2 or higher and en bloc surgery.Surgery and radiation history were the main reasons of cerebrospinal fluid leakage.[Conclusion]Understanding the risk factors of complications of sacral tumor surgery are helpful to judge and prevent complications after surgery.Some measures of prevention and treatment are effective to decrease the surgical risks.

[Objective] To discuss the surgical treatment strategy of spinal hemangioma.[Methods]Data on 33 patients with spinal hemangioma treated from October 1997 to October 2008 were reviewed.There were 19 females and 14 males.The average age was 54 years old.Chief complaints were pain(n=13),myelopathy(n=12),radiculopathy plus local pain(n=8).Nine patients without spinal cord and radial nerve compression underwent percutaneous vertebroplasty(PVP),and 24 patients with spinal cord and radial nerve compression,paravertebral soft tissue mass or spinal unstability were treated by operation.Anterior,anteroposterior and posterior approaches were used in 9,12,and 3 patients respectively.Transarterial embolization was done in 3 patients.[Results]No perioperative complication was observed in 9 patients after PVP,with a mean follow-up of 41 months.Pain was relieved.There was no perioperative death among the 24 patients who received operation.The blood loss during operation was 2739 ml and 1619 ml for anterior and posterior approaches,respectively(P=0.12).One case of paravertebral hematoma,one case of spinal canal hematoma,and one case of wound infection were observed in this group.Pain was relieved in 89%(17/19)of the patients.According to the Frankel Scale,the neurologic situation was improved in all the 12 patients with myelopathy.By a mean follow-up of 48 months,no internal fixation failure was seen.Tumor recurrence or growth was found in 4 patients,two had no symptoms and one underwent radiotherapy for pain.Repeated operation was performed in one patient with myelopathy.[Conclusion]Most patients with symptomatic spinal hemangioma could be treated successfully by surgery.Individual surgical plan should be made according to the reason causing symptoms and the general condition of the patient.

[Objective]To evaluate the diagnostic strategy for bone metastasis from unknown primary. [Method]One hundred and twenty five patients with unknown primary bone metastasis were treated from June 2003 and December 2006.The distribution of bone metastasis while initial diagnosis mainly focused on spine,sacrum,pelvis,femur and humerus.The diagnostic strategy contained a series of physical examination,laboratory test,imaging study and pathological examination.[Result]The primary tumor was found in 70.4% cases,while 40% was in the lung,8% in kidney,5.6% in prostate,4.8% in liver,4% in breast,both 2.4% in thyroid and gastric,and 3.2% in other visceras.The physical examination revealed the occult primary site of the malignant tumor in only 9.6% cases.Although,43.2% patients had higher level of tumor antigen,but most of them were non-specific.Sixty percent of primary tumor was found by various imaging studies including plain radiograph,computed tomography and ultrasound.The pathological result after biopsy or operation identified or suggested the primary tumor in 66.4% cases.The one year survival rates after diagnosis were 58.57% and 22.93% in patients of bone metastasis with known and unknown origin,respectively.[Conclusion]The primary tumor can be diagnosed in most bone metastasis patients with no cancer history after careful examination,and patients will get benefit on survival time for targeted treatment.

Objective The patients with metastatic spinal tumors often suffered from severe back pain and spinal cord compression directly caused by tumor tissue or severe spine kyphosis.In order to treat or prevent spinal cord paralysis,decompression and stabilization should be performed on the patients with spinal pain and /or severe spinal cord compression.Methods From July1998through July2001,62patients(27women and35men)with metastatic spinal tumors had been treated at our department.Of 62patients,the thoracic vertebrae were involved in37cases,lumbar vertebrae in19and cervical vertebrae in6.Among43of 62patients who pre sented with neurological dysfunction,24patients were incompletely para plegic and the others were completely paraplegic.The fol low-up ranged from8to36months.Results Pain relief was ob-tained in58of 62patients(94%),and good neurological recovery was obtained in33of the43patients.Improved bowel and bladder function was obtained in12of 25patients who presented with bowel and blad der dysfunction.After decompression,neurological function,evaluated as Frankel grade E or D,was ob-tained in5patients whose neurological function had been evaluated as Frankel grade A or B,and other9pa-tients ex perienced a neurological recovery from Frankel grade A or B to C or D.Conclusion The time developing from neurological dysfunction to complete para plegia is the most important prognostic factor.Poor prognosis is often inevitable when complete paraplegia appeared less than48hours.Complete loss of bowel and bladder function is also a factor for poor prognosis.Decompression should be performed immedi -ately if the patient is presented with neurological dysfunction.Spinal metastasis of thyroid or breast cancer has a rela tive good prognosis.However,metastasis of lung or liver cancer is associated with a short-term survival.Neu rological function of patients with spinal metastasis at thoracic region is more difficult to recover.Com-mon motor and sensory functions are often improved earlier than bowel and bladder function.Thorough re-section of metastatic tumor and stable in ternal fixation should be performed when single vertebra is involved.Conservative tumor resection,decompression and posterior internal fixation should be performed when two or more seg ments are involved in order to alleviate paraplegia,improve spinal stability and the quality.[

Objective To anatomically reconstruct massive bone deficiency w it h prosthesis-devitalized bone composites after bone tumor resection. Methods Fr om July 1997 to December 2000, twenty-four patients with malignant bone tumor we re treated with a limb salvage procedure including wide tissue resection and rec onstruction. The resected bone were debrided of gross tumor tissues, and treated with 200 g/L saline for 30 minutes and 95% alcohol for 20 minutes, then the dev italized bone was implanted back to resection sites. Eleven diaphysis defects we re reconstructed with devitalized bone fixed with interlocked intramedullary nai ling, the other 13 defects were reconstructed with prosthesis-devitalized bone c omposites. Results The mean follow-up period was two and half years. One patient s had nonunion at the graft-host junction. There were only two patients(9%) dev eloping local recurrence in half to two years after the surgery. These indicate that this method can be accepted by the limb salvage protocol. Conclusion Prosth esis devitalized bone composite enabled surgeons to reconstruct massive bone def iciency after bone tumor resection. Compared with allografts, devitalized bone h as the following advantages: 1) This technique reduces the rate of nonunion; 2) This technique also reduces the rate of local infection; 3) This technique reduc es the cost; 4) Few absorption has been found in devitalized bone at the last fo llow up. Immersion within 200 g/L saline then after 95% alcohol provides thoroug h devitalization of tumor hosting bone.