Objective To study the clinical significance of cryoanalgesia of intercostals nerves for relieving the chest pain and the stress after thoracotomy. Methods 166 patients undergone post-lateral thoracotomy were enrolled for study, including 107 cases of cryoanalgesia of intercostals nerves as cryo-group and 59 cases of non-cryoanalgesia as control group. The patients who had exploratory thoracotomy were excluded. The visual analogue scales (VAS), dosage of dolantin as well as the plasma levels of cortisol and ?-endorphin, and the complications after operation between the two groups were compared and analyzed. Results After operation, the VAS of cryo-group was much lower than that of control group for 7 days, so did the dosage of dolantin during the first 3 days. The complications in the control group were much more than that in the cryo-group who had lower levels of cortisol and ?-endorphin in plasma. Conclusion Cryoanalgesia of intercostals nerves was proved to be a simple, inexpensive, safe form for relieving post-thoracotomy pain. It could not only dramatically relieve the pain and stress level, but also reduce the risk of complications especially in elderly patients.

0.05).The effectual time for pain relief was2～17days(4.1days in av?erage).Serum calcium level declined after treatment and reduction of bone radioactive isotope collection was found in34pa?tients.The follow-up periods ranged from3months to30months.Fratures were found only in two patients.CONCLUSION:Domestic pamidronate disodium has satisfactory therapeutic effect on postoperative bone metastasis of non-small cell lung cancer.

Objective　To explore the effect of video-assi sted thoracic surgery (VATS) on common diseases of chest. Methods　Video-assisted thoracoscopic surgery was performed on 131 patients with ches t diseases from April 1994 to December 2000 in which 109 cases were spontane ous pneumothorax and hemothorax, 10 pulmonary tuberculoma, 5 pulmonary carcinoma , 3 esophageal carcinoma, 2 localized benign mesothelioma, 1 pulmonary hamartoma and 1 myasthenia gravis. Results　There was no operative death in all cases. Four patients with spontaneous pneumothorax complicated persist ent air leak(more than 7 d) and 1 patient with hemopneumothorax formed hemoth orax after the operation, which was stopped by the second VATS. The others recov ered well without any postoperative complications. Conclusion　 VATS is characterized by safety and mild tissue injury in the operation, and les s pain, fewer complications, rapid recovery and short duration of hospitalizatio n after the operation.

Objective Based on the analysis of relevant factors on scores of the first clinical dietitian post-training examination (CDPTE) in China,to explore the clinical dietitians' post competency evaluation basis.Method 108 students who completed the clinical nutritionist training (60 physicians,nurse or technician 48) were imposed comprehensive evaluation designed according to the concept of post competency.Through analysis and comparison,the correlation factors of the candidates' passing rate and their mastering rate of the module were studied.Results The results of all the candidates' comprehensive theoretical examination increased with the degree and the source of the candidates.Among them,the college students' pass rate was 76.47％,undergraduates' pass rate was 86.21％,Graduates' pass rate was 96.97％;the pass rate in western region was 85％,the central part was 85.71％,the eastern part was 89.55％.All the candidates' knowledge module mastery rate in the comprehensive examination of the theory from high to low in order was:for hospital diet (73.7％),enteral nutrition and parenteral nutrition (72.7％),public nutrition (70.7％),nutrition screening and assessment (66.7％),common nutrition related diseases (65.4％),clinical nutrition related health students regulations,medical psychology and ethics basic knowledge (40.0％).The examination pass rate was related to the educational level of the examinee and the source area,while the knowledge module mastery rate was closely related to the work of clinical nutrition.Conclusion We concluded that the CDPTE could objectively reflect the candidate's clinical competence and professionalism and it was designed on the basic principle of post competency.CDPTE has a positive significance for scientific assessment of clinical dietician,guide for training,and evaluation of training effects as well.The scores of CDPTE can objectively reflect the examinees' clinical competence and professionalism and CDPTE can achieve the goal of evaluating the candidates' competency,and it is of practical significance for scientific evaluation of clinical practice,guiding learning and evaluating the training effect.

This paper is to report the result of the surgical treatment of 12 cases of carcinoma of the hypopharynx and cervical esophagus in a period of 3 years.Ten out of the 12 cases were explored and resection of the tumor was perforr med on 8 cases. In 7 cases out of the 8. the esophagus was stripped out and the stomach was transposed without thoracotomy and total pharyngolaryngectomy was performed in addition on 3 of them. In the 8th resected case, the pharynx, larynx and the cervical esophagus were resected and then a segment of jejunum was isolated ar.d transplanted to reconstruct an esophagus.All the cases stood the operation rather well. Postoperatively 3 cases developed serious complications; one died of cardiac failure, one developed salivary fistula and the third one developed partial ischemic necrosis of the transposed stomach. The last patient was treated with intraluminal intubation and he could take soft food when he was discharged. Six cases were followed up for years;two died one year after operation and 4 are living.The operative indications, the method of approach, and the postoperative complications were discussed. It is concluded that carcinoma of the hypopharynx and cervical esophagus is not an uncommon disease with high resectability and better survival rate as compared with carcinomas of other sites, but early detection and prompt operation are imperative for a cure.

Objective To evaluate the modularized operative process during video-assisted thoracoscopic esophagectomy for esophageal cancer.Methods The clinical data of 45 patients with esophageal cancer who were admitted to the Daping Hospital from December 2011 to December 2012 were retrospectively analyzed.The influence of modularized operative process on the intra-and post-operative condition and short-term complications after videoassisted thoracoscopic esophagectomy + esophagogastric anastomosis were analyzed to investigate the efficacy and value of modularized operative process.Patients received video-assisted thoracoscopic and laparoscopic resection of esophageal carcinoma or thoracoscopic resection of esophageal carcinoma + gastric mobilization.Thoracoscopic esophageal mobilization and mediastinal lymph nodes dissection were done according to the modularized operative process:(1) Pulmonary ligament mobilization and groups 8L and 9 lymph nodes dissection.(2) Mobilization of the esophagus under the arcus venae azygos.(3) Mobilization of esophagus above the arcus venae azygos.(4) Transection of the arcus venae azygos.(5) Complete removal of thorax esophgus.(6) Ligation of thoracic duct.(7) Dissection of groups 4,5,7,10 and 2L lymph nodes.All the patients were followed up via phone call or mail till February 2013.Patients received thoracoabdominal computed tomography and gastrofiberscopy to detect tumor recurrence or metastasis every 3 months within the first year after the operation,and they were re-examinated every half year at 1 year later.Results Of the 45 patients,29 received video-assisted thoracoscopic and laparoscopic resection of esophageal carcinoma and 16 received video-assisted thoracoscopic resection of esophageal carcinoma + gastric mobilization.The length of the tumor was (4.2 ± 2.5) cm.The numbers of patients in AJCC T1,T2,T3 and T4 stages were 7,14,15 and 9,and the number of patients with AJCC N0,N1,N2,N3 stages were 23,13,7,2,respectively.The intrathoracic operation time,total operation time,volume of intraoperative blood loss,number of lymph node resected and postoperative duration of hospital stay were (72 ± 13)minutes,(249 ± 39) minutes,(183 ± 62) ml,27 ± 7,(18 ± 7) days,respectively.Two patients were transferred to open surgery.No patient died postoperatively,and 11 complications were detected after the operation.Six patients were complicated with cervical anastomotic fistula,4 with anastomotic stricture and 3 with hoarseness.Forty-five patients were followed for 1.5-14.0 months with the median follow-up time of 8 months.One patient died of upper gastrointestinal hemorrhage at postoperative month 12,and 1 died of multi-organ dysfunction syndrome at postoperative month 8.The remaining 43 patients survived.Conclusions The modularized operative process for thoraeoscopic esophagectomy is safe and effective,its short-term efficacy is satisfactory.

Objective To review the outeonle of intrathoracic esophageal reconstruction using circular stapler after esophageal or cardiac cancer resection.Methods From June 1996 to April 2007,744 patients underwent tumor removal and intrathoracie esophageal reconstruction in Daping Hospital.Of all patients,658 suffered from thoracic esophageal cancer and the other 86 from cardiac cancer.The operative modalities consisted of gastroesophageal anastomosis at the top of tim thoracic cavity or above the aortic arch in 402 patients,gastroesophageal anastomosis below the aortic arch in 317,and total gastrectomy in 25(esophageal replacement with colon in 21 patients and esophagojejunostomy in 4).Results Anastomotie bleeding oecurred in 5 patients intraoperatively.One patient died of acute respiratory distress syndrome,1 of septic shock and 1 of hepatic failure postoperatively.Psychiatric disorder was observed in 5 patients,respiratory complications in 34,anastomotie fistula in 4,and anastomotic stricture in 20.Three weeks after the operation,the esophageal manometric examination in 25 patients showed that intraesophageal,anastomotie and intragastric pressures were(-0.2±2.0),(1 1.2±4.4)and(2.4±1.5)mm Hg(1 mm Hg=0.133 kPa),respectively.Twenty-four hour pH monitoring demonstrated that 13 patients had abnormal DeMeester score(＞14.72),3 of thenl developed reflux symptoms and got relieved after receiving acid suppression therapy for 1.0-2.2 months.The 13 patients with abnormal DeMeester score were followed up for 3-38 months,and the pH value of the esophagus was back to normal in 2 patients,and it almost remained the same in 9 patients.Two patients died of tumor reculTenee of metastasis.Conclusions Intratlmracic esophageal reconstruction with circular stapler is safe,reliable and able to reduce the postoperative complications such as anastomotic fistula.

Objective To evaluate the short-term outcome of side-to-side staple cervical esophagogastrostomy after esophagectomy. Methods The clinical data of 105 patients with esophageal cancer who were admitted to the Daping Hospital from January 2006 to March 2009 were retrospectively analyzed. Of the 105 patients, 97 received side-to-side stapled cervical esophagogastrostomy and eight received traditional hand-sewn end-to-end cervical esophagogastrostomy. Nine patients were selected from the 97 patients who received side-to-side stapled cervical esophagogastrostomy to conduct matched pair analysis. The efficacy of the two methods was analyzed using the t test. Results No postoperative death was observed. The mean operation time of side-to-side staple cervical esophagogastrostomy was (21 ± 3 )minutes (range, 15-30 minutes). Postoperative complications were observed in 16 patients, including pulmonary complications in seven patients, vocal cord paralysis in four patients, anastomotic leakage in three patients and anastomotic stricture in two patients. The mean anastomotic diameter of patients who received side-to-side staple cervical esophagogastrostomy was ( 3. 01 ± 0. 17 ) cm, which was significantly longer than ( 1.69 ± 0. 26) cm of patients who received traditional hand-sewn end-to-end cervical esophagogastrostomy (t =2. 093, P ＜0.05 ). Dysphagia occurred in two patients who received side-to-side stapled cervical esophagogastrostomy and in four patients who received traditional hand-sewn end-to-end cervical esophagogastrostomy.Conclusions Side-to-side stapled cervical esophagogastrostomy is simple, safe and effective for patients with esophageal cancer after esophagectomy. This technique could decrease the incidence of postoperative dysphagia and improve the pharyngo-esophageal motor function.

Objective　To study the effect of epidermal growt h factor receptor(EGFR) on the development and progress of thymoma. Me thods Expression of EGFR was detected by immunohistochemical stain in t he tissues of 11 cases of normal thymus and 29 cases of thymoma. Result s　 The positive expression of EGFR was 75.9%(22/29) in thymomas and 18.2%(2/11) in normal thymus. The difference was significant(P<0.01). The positive rate of EGFR was higher in invasive thymomas than in non-invasive ones (P<0.01). T he positive rate of EGFR increased with Masaoka stage with a significant increm ent in Ⅲ-Ⅳ stage compared with I stage (P<0.01). EGFR was strongly expre ssed in 5 cases of invasive thymomas, in which recurrence or metastasis occurred in 3 during the follow-up period after operation. But there was no statistical correlation with whether complicated with myasthenia gravis (MG) and histolog ical type. Conclusion　EGFR might be related to the tumori genesis and development of thymoma. There is high risk of recurrence and metast asis in case of EGFR over-expression and radiotherapy, chemotherapy and follow up should be enhanced.

Objective To investigate the value of carotid and lower limbs arteries atherosclerosis in prediction of intracranial atherosclerosis combined with type 2 diabetes (T2DM). Methods Seventy-four patients with T2DM received the carotid artery , lower limbs arterial color Doppler ultrasound and cranial MRA examination. The data was analysised by Pearson correlation and Binary Logistic methods. Results With the increasement of degree of peri-arterial atherosclerosis , the intracranial arteriosclerosis was in a trend of increase. The correlation coefficients, OR values and AUC of LLAS and CAS + LLAS for intracranial atherosclerosis were 0.28 (P < 0.05) and 0.33 (P < 0.05), 0.14 (P < 0.05) and 9.28 (P < 0.05), 70.30% (P < 0.05) and 70.60% (P < 0.05), respectively. The cut-off point of LLAS and CAS + LLAS was lever 2. Conclusion The LLAS and CAS + LLAS with T2DM are independent risk factors for intracranial atherosclerosis , owning certain forecast values.