Objective To assess the usefulness video-assisted mediastinoscopy (VM) for diagnosis of disease characteristic with mediastinal mass. Analyze the correlations of clinical features of the disease with the pathologic diagnosis. Methods Between July 2000 and March 2006, 97 undiagnosed patients with mediastinal mass in chest radiography underwent biopsy of mediastinal lesions by either cervical mediastinoscopy (n=69) or parasternal mediastionoscopy (n=28). We also analyzed the correlation of symptoms, location and extent of the lesion with the pathologic diagnosis. Results All 97 patients recovered smoothly without postoperative complications. Histologic diagnosis was obtained in 96 patients. Patients with hoarse, dysphagia and superior vena cava obstruction syndrome indicate malignant lesions (26/26). The most common diseases in the super-anterior mediastinum are lymphoma(7/19), thymoma(4/19) and small cell lung cancer(SCLC) (4/19);The most common disease in the middle mediastinum are metastasis of non small cell lung cancer(11/37), sarcoidosis (9/37)and SCLC(7/37); The most possible disease involved both mediastinum and lung hilar lymph-node are scalerdosis(32/41) and SCLC(5/41). Conclusion Mediastinoscopy is effective and safe methods to establish a histologic diagnosis in patients with mediastinal mass. It is possible to make primary evaluation on some of these patients according to the typical symptoms and location, extent of the mass involvement.

Objective To evaluate the practicability of video-assisted thoracoscopic lower esophageal myotomy in the treatment of achalasia. Methods A series of 21 consecutive patients with achalasia received video-assisted thoracoscopic lower esophageal myotomy between June 1997 and June 2005. The operation was performed under general anesthesia with double-lumen endotracheal intubation. The patient was positioned in the right lateral decubitus. Four thoracoscopic ports were introduced into the left hemithorax. A 6~11 cm incision at the lower esophageal sphincter with an extension to the gastric wall for 0.5~1 cm in length was made, to the depth of the submucous layer. A flexible gastroscope was inserted to check the integrity of the esophageal mucosa intraoperatively. No anti-reflux procedures were conducted. Results All the procedures were accomplished smoothly. The intraoperative hemorrhage volume was 50~100 ml (mean, 58 ml) and the operation time, 60~270 min (mean, 137 min). Esophageal mucosal perforation occurred in 3 patients, in 2 of whom the perforation was repaired thoracoscopically and in 1 of whom, through open thoracotomy. All the patients were recovered uneventfully, without severe complications. Follow-up checkups for 1~80 months found recurrence of dysphagia in 2 patients at 2 and 4 months after operation, respectively. Out of the 21 patients, the relief of dysphagia was classified as “excellent” results in 8 patients, “good” in 10 patients, “fair” in 1, and “poor” in 2, respectively. Conclusions Video-assisted thoracoscopic lower esophageal myotomy is a surgical approach with simple performance, minimal invasion, quick recovery and good efficacy. It can be employed as the first of choice for the management of achalasia.

Objective To elucidate the molecular basis for induced resistance of N. gonorrhoeae to ceftriaxone in vitro. Methods The reference strain ATCC49226 and clinical isolate ZSSY00205 of N. gon-orrhoeae were exposed to subinhibitory concentration of ceftriaxone for the induction of resistance. Then,suppression subtractive hybridization was performed with the pre-induction parent strains as drivers and post-induction mutant strains as testers to create a subtractive cDNA library. Following that, a total of 192 clones were randomly selected from the library, and arrayed by spotting onto nylon membranes. Finally, dif-ferentially expressed genes were screened by hybridization with labeled-RsaI restriction fragments from the sensitive and resistant N.gonorrhoeae strains respectively, and analyzed by sequencing and homology research using Blast program. Results A subtractive library for these resistant N.gonorrhoeae strains was generated by SSH technique. Microarray analysis and homology research confirmed 5 genes related to ceftriaxone resistance, i.e. mtrR, mtrC, gyrB, rpsJ and PJD1. Conclusions The induced resistance of N. gonorrhoeae to ceftriaxone may be associated with mtrR, mtrC, gyrB, rpsJ and PJD1 genes which probably mediate the resistance by enhancing the activity of efflux pump system.

Objective To explore the clinical new ways to repair the soft tissue defect of upper lip.Methods The soft tissue defect of upper lip caused by various reason were repaired with the buccal region of nasolabial groove flap.The size of flap was designed based on the range of soft tissue defect and located in the buccal region along nasolabial groove.The maximum scale of flaps between the length and width were 2∶1 and slit to the SMAS layer.The soft tissue defect of upper lip was repaired by direct vicinity aversion of the flap.The wound after the flap diversion was direct sut in favour of propulsion of the flap and relief the tension of flap pedicle.Results The flaps completely survived in 15 cases without obviously scar accrementition.The cosmetic result were satisfactory.Conclusion The buccal region of nasolabial groove flap is characterized by simple designation,easy dissection,reliable blood supply with the vascular net of fascia without well-known blood vessel damaged and repaired by direct vicinity aversion.Therefore,it is an ideal new method to repair the soft tissue defect of upper lip.

Acute Coronary Syndrome ; chemically induced ; Anesthetics, Dissociative ; adverse effects ; Humans ; Ketamine ; adverse effects

BACKGROUND:Because of osteoporosis, short-segment transpedicular fixation or screw-rod system fixation is prone to screw loosening depending on its poor anti-pul-out strength in patients with thoracolumbar fracture with ankylosing spondylitis.
OBJECTIVE:To probe the clinic outcomes of multi-segment transpedicle spinal fixation for thoracolumbar fractures with ankylosing spondylitis.
METHODS:Eleven patients with ankylosing spondylitis combined with thoracolumbar fracture in the Fourth Department of Orthopedics, Meizhou Hospital, Sun Yat-sen University, China from January 2009 to December 2012 were selected. Al the patients underwent posterior reduction and multi-segment transpedicle spinal fixation, among whom, six cases were subjected to internal fixation through the pedicle of fractured vertebra.
RESULTS AND CONCLUSION:Al of the 11 patients were fol owed up for 13 to 36 months. Solid bone healing was achieved in al of the patients, and there were no complications related to the internal fixation systems such as loosening or breakage. Three cases of spinal cord injury achieved Frankel’s class E from class C recovery. Lumbodorsal pain rate achieved 100%according to the Japanese Orthopaedic Association scoring. Results confirmed that it is effective to treat thoracolumbar fractures with ankylosing spondylitis by posterior reduction and multi-segment transpedicle spinal fixation. Strong internal fixation and fracture union can be achieved by operation.

Objective To analyze the delay in diagnosis and treatment lung cancer expressed as solitary pulmonary nodules (SPN) found by physical examination,and to discover the relative reasons and consequence for future improvement.Methods From January 2000 to August 2011,162 patients (93 males,69 females,ranging 33-82 years,median age 63.9 years) with SPN found by physical examination and diagnosed lung cancer by surgical pathology subsequently were enrolled to this study.Depending on the interval between the date when finding SPN and the date of surgery,these cases were divided into 6 groups,including the group with interval less than 1 month (74 patients),1-3 months (48 patients),3-6 months (10 patients),6-12 months (7 patients),12-24 months (8 patients),and more than 24 months (15 patients).Factors which impact the delay interval between SNP finding and surgery were discussed.The change of tumor' s diameter during observation period,and the pathological characters were also analyzed among each group.Results Of all the delay cases,30.2％ were attributed to doctor,30.9％ attributed to patients themselves,and 38.9％ attributed to hospitals.51.0％ (25/49) of the cases delayed by doctors were misdiagnosed as inflammation,16.3％ (8/49) misdiagnosed as tuberculosis,and 16.3％ (8/49)misdiagnosed as old lesions,which were three common reasons.Patients delayed more than 3 months were more likely to be related to doctor's misdiagnosis than those delayed less than 3 months[70.0％ (28/40) vs.36.8％ (21/57),x2 =10.338.P =0.001].Moreover,the possibility of SPN enlargement was positively correlated with the delay interval.In groups with delay interval more than 24 months or between 12 and 24 months,the percentage of SPN enlargement were 73.3％ (11/15) and 87.5％ (7/8) separately.The proportion of patients with stage IV disease in groups whose delay interval exceeded 12 months (13.3％ for more than 24 months and 12.5％ for 12-24 months) also significantly surpassed others groups with shorter delay interval.Conclusion There exists obvious delayed diagnosis and treatment in lung cancer initially expressed as solitary pulmonary nodules (SPN) during physical examination.Nearly 1/3 patients were delayed by doctors and half of them were misdiagnosed as inflammation.Increase of observation time could result in enlargement of SPN and advancement of disease staging.Thus,patients and doctors should pay more attention and clarify the diagnosis through surgery in less than 3 months after finding SPN,which could remarkably benefit early treatment.

ObjectiveTo investigate the diagnosis value of intracardiac echocardiography in cesarean section scar pregnancy. MethodsCavity ultrasound was applied in patients of cesarean scar pregnancy with sonographic features and treatment. ResultsIn 52 patients, ultrasound diagnosed accurately in 45 cases, diagnosis accurate rate was 86.5％ (45/52). Sonogram showed gestational sac simply type in 16 cases, mixed echo-type( or mass-based) of 36cases. In 52 cases of CSP, according to their clinical and sonographic features ,2 cases of uterine scar lined laparotomy and the uterus excision repair;three cases of laparoscopic removal of uterine scar pregnancy lesion repair. 6 patients to methotrexate;five cases of abdominal surgery;36 routine uterine arterial embolization in the ultrasound monitor after curettage. ConclusionUltrasound could apply in cesarean scar pregnancy timely,and accurate diagnosis was made;sonographic features according to the patients,help choose the appropriate clinical treatment,and assess efficacy.

In recent years, Shenyi Capsule has been proven to have certain anti-angiogenic effects, and to be effective to many cancers, but its effects on advanced esophageal cancer are scarcely studied.

Objective To explore the clinical manifestation of a patient with hypoparathyroidsmsensorineural deafness-renal dysplasia (HDR) syndrome and to sequence the related GATA3 gene of the patient.Methods A 22 year old person with HDR syndrome was reported in regard to clinical manifestation,laboratory examination,and genetic mutation.Some related literatures were reviewed.Results The patient showed tetany,deafness,and positive Chvosteks' and Trousseau' s signs.The initial laboratory studies showed that serum concentration of calcium was lowed and the iPTH level were lower than normal.Binaural pure tone audiometry showed Binaural sensorineural deafness.Colour doppler ultrasound revealed that his right kidney was not observed and the level of creatinine was increased,indicating renal insufficiency.GATA3 mutations on DNA sequence analysis indicated that the 6 exon IVS6-1G-A (G/A heterozygosis splicing),showed the mutation of G to A is in the upstream of the first base in the six exon.After treating with calcium carbonate and vitamin D,the symptoms and signs were improved.Conclusion HDR syndrome is a rare endocrine disease,that should receive more attention in order to avoid missing diagnosis;The IVS6-1G-A as a novel mutation of GATA3 gene,has not been reported so far.