Objective To evaluate the effect of preoperative intramuscular injection of of dextromethorphan in three dosages on fentanyl consumption in postoperative PCA in order to optimize its pre-emptive analgesia dose. Methods 80 ASA Ⅰ-Ⅱ patients underwent spine operations under general anesthesia were randomly divided into four groups, who respectively received intramuscular dextromethorphan 10mg (DM10 group), 20mg (DM20 group), 40mg (DM40 group), or normal saline (CON group) respectively. The PCA fentanyl consumption as well as VAS pain scores were observed 4h, 24h, and 48h after the operation. Results Although there was no significant differences in pain VAS score between the four groups, the fentanyl consumption was significantly lower in groups DM20 and DM40 compared with group CON and DM10. However, there was no significant difference between group DM20 and group DM40. Conclusion Preoperative IM dextromethorphan shows a dose-dependant fentanyl spare effect on postoperative PCA, and a dose of 20mg seems to be optimal for preoperative use.

BACKGROUND:Natural biologic bone-derived products have been prepared by raw ox bone but not by swine vertebra. Previous research has indicated that biphasic ceramic-like biologic active bone made by swine vertebra has osteoinductive ability. OBJECTIVE:To investigate the feasibility of biphasic ceramic-like biologic active bone and biphasic ceramic-like biologic bone (BCBB) to repair the segmental defect in radius of rabbits. DESIGN,TIME AND SETTING:A randomized controlled animal experiment was performed at Institute of Orthopedics,the Fourth Military Medical University of Chinese PLA and Central Laboratory of Qingdao Medical College from October 2004 to October 2005. MATERIALS:Biphasic ceramic biologic bone was made of swine vertebra and sodium pyrophosphate after two calcinations at low temperature. The mixture which consisted of hydroxyapatite and tricalcium phosphate,sizing 0.3 cm ? 0.3 cm ? 1.5 cm was combined with type I collagen to make BCBB. Bone morphogenetic protein was mixed with type I collagen,and then the mixture was combined with biphasic ceramic biologic bone to make biphasic ceramic-like biologic active bone. METHODS:A total of 48 healthy Japanese rabbits were randomly divided into biologic active bone group,biologic bone group,and blank control group,with 16 rabbits per group. A segmental defect which was 15 mm along bilateral radius was established. Biphasic ceramic-like biologic active bone and BCBB were implanted into defect region,respectively,but implantation was not treated in the blank control group. MAIN OUTCOME MEASURES:Materials were harvested at weeks 2,4,8,12 for the gross observation under microscope. Tissue sections were selected for hematoxylin-eosin (HE) staining and Masson staining. RESULTS:① Gross observation:At 2 weeks,there were no differences between the two groups,and the materials were connected to bone bed with fibrous tissues. At 4 and 8 weeks,there was more new callus in biologic active bone group than in biologic bone group. At 12 weeks,some bionic biphasic ceramic-like biologic active bone were absorbed and new bone regenerated in biologic active bone group,being similar to appearance of host bone,but there were few callus in biologic bone group. In blank control group,bone defect could not be repaired and there were fibrous tissue in bone defect. ② Staining results:At 2 weeks after operation,there were no differences between the two groups,and the materials were connected to bone bed with fibrous tissues. At 4 and 8 weeks,more vessels and fibrous tissues grew into BCBB,new bone was formed,and bone connect was found between BCBB and bone bed in the biologic active bone group. At 12 weeks,in the biologic active bone group,more materials degraded,new bone was integrated with bone bed,and bone marrow-like structure was formed. At 12 weeks,the broken ends were sclerosis and blocked in the blank control group. CONCLUSION:Bionic biphasic ceramic-like biologic active bone characterizing by good bone induction and biocompatibility can remarkably repair the segmental defect in radius of rabbits. BCBB is perspective for repairing the segmental bone defect.

Objective: To evaluate the effect of concomitant chemoradiotherapy for the prevention of recurrence and metastasis of postoperative salivary adenoid cystic carcinoma(SACC).Methods: 14 cases of salivary adenoid cystic carcinoma after operation were treated with concomitant chemoradiotherapy. Regular radiotherapy of 60 Gy and chemotherapy with hydroxycamptothecin (HCPT) at 10 mg/m 2 , 3 times a week, were administered. HCPT was given in 1st, 2nd, 4th and 5th week. Recurrence and metastasis of SACC after operation were observed using CT, MRI, ultrasonography and X ray. Results: After 3～17 months' follow up, relapse free survival was 100%. No recurrence and metastasis of SACC after operation were found. Adverse reactions of the chemotherapy were nausea, vomiting and leukopenia. After suspended in a short time and using ondansetron and /or G CSF the chemotherapy of HCPT was continued and completed. Conclusion: concomitant chemoradiotherapy of HCPT and radiotherapy can prevent recurrence and metastasis of SACC after operation. The efficacy of long term needs further observation.

Objective:For further exploring the feasibility,we have treated the middle and infe- rior femoral bone fracture nonunion by the transplantation of bone flap with ascending and transvers branch of the lateral femoral circumflex vessels.Method:The technique,on the basis of anatomical study have been designed to treat the femoral bone fracture nonunion by the transplantation of bone flap with ascending and transvers branch which pedicle was descendant branch of the lateral femoral circumflex vessel.Results:8 cases of middle and inferior femoral fracture nonunion had been treated by this method.At follow-up of 1 year 5 months to 4 years 6 months,the results have been satisfacto- ry.Conclusions:The method of the transplantation of the bone flap with ascending and transvers branch of the lateral femoral circumflex vessel for the treatment of middle and inferior femoral fracture nonunion has the adventages of simplicity,easiness,reliability.

Humans ; Laryngeal Diseases ; surgery ; Laryngoscopes ; Polyps ; surgery ; Vocal Cords ; surgery

Objective:To investigate the infusion methods of postoperative enteral nutrition in patients with gastric cancer.Methods:86 patients with gastric cancer received radical operationin our hospital from January 2014 and December 2015 were enrolled for the study and randomly divided into continuous infusion group and periodic infusion group,each group with 43 cases.Patients in continuous infusion group were given postoperative continuous enteral nutrition for 24 h in one day,while cases in periodic infusion group were given postoperative continuous enteral nutrition for 15-17 h in one day.Results of enteral nutrition,physical indicators including upper arm skinfold,diameter of midpoint of upper arm and grip strength,nutritional indexes including total protein (TP),hemoglobin (Hb),albumin (AIb),prealbumin (PA) and transferrin(TF),immune indicators including immunoglobulin G(IgG),immunoglobulin M (IgM),immunoglobulin A (IgA),CD4+,CD8+ and CD4+/CD8+were compared between two groups before and after operation.Results:Intolerance of enteral nutrition occurred in 1 case(2.3％) of continuous infusion group and 3 cases(7.0％) of periodic infusiongroup,and there was no significant difference between them (P＞0.05).Time of transition to full enteral nutrition and taking off the tube to self-feeding incontinuous infusion group were significantly smaller than that in periodic infusion group (P＜0.05).There were no significant difference in baseline data,physical indicators,nutritional indexes and immune indicators between them before operation (P＞0.05).PA level at 5 d,10 d after operation in continuous infusion group were significantly higher than that in periodic infusion group (P＜0.05),and there were no significant difference in physical indicators,other nutritional indexes and immune indicators between them after operation(P＞0.05).Conclusion:Compared with periodic infusion,continuous infusion method could shorten the time of transition to full enteral nutrition and taking off the tube to self-feeding in patients after radical operation of gastric cancer,and had more significant effect of improvement of nutritional status,worthy of clinical popularization and application.

Objective To evaluate the efficacy of quadriceps femoris fasciculation induced by lowcurrent nerve stimulation when used to assist ultrasound-guided lumbar plexus block.Methods One hundred patients of both sexes,aged 18-45 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,weighing 50-85 kg,scheduled for elective unilateral knee arthroscopy,were selected and randomly divided into 2 groups (n =50 each) using a random number table:ultrasound assisted by nerve stimulator group (group SU) and ultrasound group (group U).The shamrock method was used to perform the ultrasound-guided lumbar plexus block in two groups.In group SU,the nerve stimulator with current 0.35 mA and frequency 1 Hz was used in the process of puncture,and 0.5％ ropivacaine 0.4 ml/kg was administrated when quadriceps femoris fasciculation was induced.In group U,when the tip of the nerve stimulating needle was located around the lumbar plexus,which was confirmed by ultrasound,0.5％ ropivacaine 0.4 ml/kg was administrated.The time of puncture,depth of needle insertion,onset time of block and effective block were recorded.Motor block was assessed using the modified knee score,and the development of complications was recorded within 24 h after block.Results Compared with group U,the onset time of block was significantly shortened,the rate of effective block was increased,the degree of motor block was aggravated (P＜0.05),and no significant change was found in the time of puncture or depth of needle insertion in group SU (P＞0.05).No complications were observed in two groups.Conclusion Low-current (0.35 mA) nerve stimulation-induced quadriceps femoris fasciculation when used to assist location can improve the efficacy of ultrasound-guided lumbar plexus block.

Objective To investigate the effect of preoperative administration of Dextromethorphan (DM) on cough reflex of patients during tracheal extubation under general anesthesia after obstructive sleep apnea syndrome (OSAS) operation. Methods Forty ASA Ⅰ-Ⅱ adult patients scheduled for uvulopalatopharyngoplasty (UPPP) under general anesthesia were randomly divided into control group and DM group (n=20 in each group). Patients in DM group received 0.3 mg/kg DM and control group took 5 ml normal saline preoperatively. Cough reflex of patients and adverse effects were recorded during tracheal extubation. Results Cough reflex during tracheal extubation was remarkably suppressed in DM group as compared with control group (P

Objective·To explore the diagnostic value of 9 mTc-sestamibi (9 mTc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT) and ultrasonography in hyperparathyroidism. Methods·Fifty patients with hyperparathyroidism were included. 9 mTc-MIBI SPECT/CT was performed before operations in all patients, while ultrasonography was performed in 33 patients. The diagnostic efficiency was calculated for both imaging methods in comparison to pathological data. Results·Serum parathyroid hormone (PTH) levels were 352.0 (141.5-846.0) pg/mL and 1792.0 (1018.5-2358.5) pg/mL, respectively, in primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT), while maximum diameters of lesion were 14.5 (9.0-20.9) mm and 10.0 (8.0-12.6) mm, respectively (both P<0.01). The accuracy of SPECT/CT were 97.7% and 62.5%, respectively (P<0.01), in PHPT and SHPT. In 33 patients, the sensitivity and accuracy of SPECT/CT were 66.3% and 74.2%, respectively, whereas the sensitivity and accuracy of ultrasonography were 45.7% and 61.4%, respectively (both P<0.05). Conclusion·Serum PTH levels were higher, while maximum diameters of lesion were longer in PHPT than that in SHPT, and the diagnostic efficiency was also higher in PHPT than that in SHPT. In the other hand, the sensitivity and accuracy of SPECT/CT were higher than that of ultrasonography.

OBJECTIVETo compare the clinical efficacy differences between Zheng's gold hook, fishing acupuncture and electroacupuncture (EA) for lumbar disc herniation (LDH).

METHODSSixty patients of LDH were randomly allocated to a gold hook fishing acupuncture group and an EA group, 30 cases in each one. Lumbar Jiaji (EX-1 B 2), Yaoyangguan (GV 3), Shenshu (BL 23), Dachangshu (BL 25), Guanyuanshu (BL 26) and ashi points were selected in the gold hook fishing acupuncture group; after the needles were inserted, the manipulation of gold hook fishing acupuncture was applied at tendon junction points and ashi points. The identical acupoints were selected in the EA group and patients were treated with EA. The treatment was both given once a day; ten days of treatment were taken as one session, and totally 3 sessions were given. The clinical effective rate, visual analogue scale (VAS), low back pain score and Oswestry disability index (ODI) were used for efficacy evaluation.

RESULTSThe effective rate was 93.3% (28/30) in the gold hook fishing acupuncture group, which was superior to 86.7% (26/30) in the EA group (P < 0.05). The VAS, low back pain score and ODI were both significantly improved after treatment (all P < 0.05), which were more significant in the gold hook fishing acupuncture group (all P < 0.05).

CONCLUSIONZHENG's gold hook fishing acupuncture could effectively improve the symptoms and sings of LDH, reduce the disability index and improve the quality of life, which is superior to EA.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Electroacupuncture ; Female ; Humans ; Intervertebral Disc Displacement ; therapy ; Low Back Pain ; therapy ; Male ; Middle Aged ; Quality of Life