Objective To explore the diagnosis of abdominal aortic aneurysm(AAA), operative opportunity, the way of operation selecting and the application of blood vessel prosthesis. Method The clinical data of 7 patients with AAA were analysed retrospectively.Results The type of DeBakey I thoracoabdominal aortic aneurysm patient was died of aortic aneurysm broke suddenly before operation, the other 6 patients with AAA underwent aortic aneurysm blooking, opening and replacement of blood vessel prosthesis. Dumbbell thoracoabdominal aortic aneurysm was operated by stayes. No complications of operation occurred. Conclusions Operation is a efficient way in treatment of abdominal aortic aneurysm. Diagnosis timely and definitly, selecting the way of operation in reason and blood vessel prosthesis are the keys to operation, while the correct treatment of perioperation period is the important guaranty of successful therapy.

Objective To evaluate the effect of dexmedetomidine on the efficacy of patient-controlled intravenous analgesia (PCIA) with morphine after elective radical gastrectomy. Methods One hundred and twenty ASA Ⅰ or Ⅱ patients aged 41-64 yr weighing 50-80 kg undergoing elective radical gastrectomy were randomly divided into 2 groups of 60 patients, according to the composition of PCIA solution:group I morphine (group M)and group Ⅱ morphine + dexmedetomidine (group MD). In group M the PCIA solution contained morphine 100 mg in 200 ml of normal saline (NS), while in group MD the PCIA solution contained morphine 100 mg+dexmedetomidine 200 μg in NS 200 ml. PCIA was started immediately after operation. A loading dose of 6 ml was given iv at the end of operation. PCIA setting was as follows:background infusion 1 ml/h, bolus dose 3 ml and lockout interval 10 min. VAS score was maintained at ≤4 and Ramsay score at 2-3. The total amount of morphine consumed, the number of attempts and successfully delivered doses within 24 and 48 h after operation were recorded. Postoperative complications including nausea, vomiting, bradycardia, hypotension, oversedation and respiratory depression were recorded. Results The total amount of morphine consumed, the number of attempts and successfully delivered doses within 24 and 48 h after operation were significantly smaller and the incidence of nausea and vomiting and pruritus was significantly lower in group MD than in Sroup M. No bradycardia,hypotension, oversedation or respiratory depression was observed in either group. Conclusion Dexmedetomidine added to intravenous morphine PCA can improve the analgesic efficacy after radical gastrectomy with less adverse effects.

Objective To investigate the sonographic features of follicular variant of papillary thyroid carcinoma (FV-PTC) and to decrease misdiagnosis rate. Methods Thirty-one patients with 35 FV-PTCs and 66 patients with 75 conventional PTCs (C-PTCs) were enrolled in this study. The sonographic features were reviewed retrospectively between the two groups with universally accepted standards. Results The sonographic features of 35 FV-PTCs included irregular shapes (6/35), anteroposterior to transverse diameter ratio A/T > 1 (7/35), spiculated margins (25/35), marked hypoechogenicity (0/35), hypoechogenicity (18/35), isoechogenicity (16/35), no calcification (15/35), microcalcifications (11/35), macrocalcification (9/35), color Doppler lfow patternⅠ(20/35), color Doppler lfow patternⅡ(10/35), color Doppler lfow patternⅢ(5/35). Irregular shapes, A/T>1, spiculated margins, marked hypoechogenicity, microcalciifcations, and color type Ⅱ were rarer in FV-PTCs than in C-PTCs, while isoechogenicity, no calciifcation, macrocalciifcation, and color type Ⅲwere more frequent in FV-PTCs than in C-PTCs. The differences of the above features were statistically significant [χ2=4.276, P=0.039; χ2=8.125, P=0.004; P=0.009 (Fisher′ s exact test); χ2=8.548, P=0.003;χ2=4.898, P=0.027,χ2=7.796, P=0.005;χ2=5.462, P=0.019;P=0.001 (Fisher′s exact test)] . During the preoperative ultrasonography, 20 of 35 FV-PTCs were diagnosed as malignancy, and others were misdiagnosed as benign nodules (misdiagnosis rate was 43%). The lymphatic metastasis rate of FV-PTCs was 29%(9/31), significantly lower than C-PTCs [62%(41/66),χ2=9.246, P=0.002]. In terms of the sonographic features of metastatic lymph nodes, there was no marked difference between FV-PTCs and C-PTCs. Conclusions Some FV-PTCs are lack of malignant features, and tend to be misdiagnosed frequently when coexisting with benign thyroid nodules. Observing the echogenicity, color lfow characteristics and other features of each thyroid nodule and cervical lymph node with multiple views may decrease the misdiagnosis rate.

Objective To discuss rational diagnosis and treatment of acute infrarenal abdominal aortic occlusion. Methods Retrospective analysis was made on 6 cases with acute infrarenal abdominal aortic occlusion from January 2005 to December 2008. Emergency operations of retrograde catheter were done on 3 cases, 2 cases received transaortic embolectomy, 1 case received anticoagulation therapy successfully. Results Two cases were cured, 2 cases with 3 legs received amputation, 2 cases died. The time in hospital was 4 hours to 122 days, averaged (24±55) days. Conclusions A prompt thrombolytic, anticoagulation therapy and operation are suggested. It is emphasized to prevent reperfusion injury after arterial ischemia during the peri-and post-operation. Conservative treatment may be used in the patients incorporated with seriously multiple organ failure.

Background and purpose:It was reported that erythropoietin may directly or indirectly induce the tumor cells to proliferate and result in diseases progression when recombinant human erythropoictin is used clinically in cancer-related anemia.Recently,the expression of erythropoietin-receptor(Epo-R)was detected in breast cancer.This study was done to detect the expression of Epo-R,estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor 2(Her-2)in breast cancer,and to investigate the relationships between these indexes and the clinical significance.Methods:Sixty breast cancer patients were analyzed,the expression of Epo-R and microvascular density(MVD)were detected by immunohistochernistry,in order to clarify the relationships between the expression level of Epo-R,MVD and ER,PR,Her-2.Results:The rate of Epo-R expression was 78.3%,the mean number of positive tumor cells was 39±24,while the tissue MVD was 25±9.The expression level of Epo-R was positively correlated with the MVD.Also,the level of MVD was higher in the group of Epo-R positive than the negative,which has significant difference(t=3.4252,P＜0.001).The expression level of ER,PR has no definite relationships with Epo-R,MVD.The expression level of Her-2 was both closely associated with Epo-R,MVD.The expression level of Epo-R has an obvious relationship with clinical stage,lymph node status and the size(P＜0.001).The value of MVD was positively correlated with lymph node status,while not with clinical stage and the size.Conclusion:The expression level of Epo-R was markedly higher in breast cancer,and has a positive correlation with the tissue MVD.The expression level of Epo-R and MVD were significantly associated with Her-2,but not with ER and PR.It may contribute to clarifying the clinicopathological characteristics and prognosis of breast cancer by detecting both the expression level of Epo-R and MVD.

Objective To explore a new surgical procedure for phallic reconstruction. Methods Since Dec 2003 to Nov 2006,4 patients with penile loss were reconstructed by transferring a deep in-ferior epigastric perforator(DIEP)flap with implanting the 12th costal cartilage. Results All of the flaDs survived successfully.With the follow-up from 5 months to 3 years,the appearance oi the neope-nis and donor-site scar was satisfactory. No one developed fistula or urethral stenosls, All patients were reported the return of erogenous sensibility of the neopenis leading to orgasm and achmving Pene-tration during sexual intercourse. Conclusions This new procedure may provide an esthetlcaIlY ac-ceDtable and functional neophallus.It might be a new alternative in penile reconstruction.

Objective To explore the effect and technical consideration of placement of inferior vena cava filter (IVCF) in the treatment of low extremity deep venous thrombosis (DVT).Methods From Jun 2011 to Jun 2013,73 consecutive DVT cases were for IVCF placement.There were 47 males and 26 females with a mean age of (51 ± 23) years (ranging from 36 to 80 years).Results Procedures were successful in 70 out of 73 cases.There were 18 permanent and 52 temporary IVCFs deployed.The indications for filter insertion were pulmonary embolism (PE) (25 cases,34％),perioperative prophylactic implantation (18 cases,24％),contraindication to anticoagulation therapy (15 cases,20％) and iliofemoral vein thrombosis(10 cases,13％).17 filters were successfully removed with a successful rate of 33％.After the follow-up of mean 24 months (4 to 36 months) of 68 patients,no pulmonary embolism occurred,but symptomatic DVT recurred in 5 patients,and the conditions were improved after anticoagulation treatment.No serious complication of post thrombotic syndrome occurred.Conclusions IVCF placement is effective for prevention of PE,when the therapeutic indications and contraindications are properly controlled.

Objective To test the efficacy of low-frequency electrical acupoint stimulation plus rehabilitation training in improving swallowing function after stroke. MethodsEighty dysphagic stroke patients were randomly allocated into 2 groups of 40.Patients in the experimental group received low-frequency electrical acupoint stimulation plus 2 courses of rehabilitation training.Control group patients received the same protocol,but the electrical stimulation was not over acupoints.Their swallowing function was assessed using the Kubota water drinking test.ResultsAfter treatment,both groups showed significantly lower Kubota scores compared with pre-treatment.Prepost test difference was 1.25 ± 0.78 in the experimental group and 0.70 ± 0.72 in the control group,a significant difference.The total recovery rate in the experimental group was 87.5％.In the control group it was 55％.The improvement in swallowing function was significantly better in the experimental group.Conclusion Both groups showed a significant improvement in swallowing function,but low-frequency electrical acupoint stimulation increased the effectiveness of the rehabilitation training.

BACKGROUND:Ultrasonic therapy is one of several physical therapy modalities suggested for the management of pain and loss of function due to osteoarthritis. However, its effectiveness stil remains controversial in the previous studies.
OBJECTIVE:To analyze the effect of ultrasonic therapy for the treatment of relieving knee osteoarthritis pain.
METHODS:A retrieval of Pubmed, Ovid/Medline, Ovid/EMBASE, and Cochranee database was performed. The relevant literatures were manual y retrieved. The retrieval deadline was set on March 31, 2014. Randomized control ed trials on ultrasonic therapy of knee osteoarthritis were col ected.
RESULTS AND CONCLUSION:A total of eight studies of meta-analysis were accumulated. Among them, six studies adopted visual analog scale and Western Ontario and McMaster Universities Arthritis Index, one study adopted visual analog scale only, and one study adopted Western Ontario and McMaster Universities Arthritis Index. Then the Western Ontario and McMaster Universities Arthritis Index scores were transformed into visual analog scale scores for data analysis. There was a statistical difference between the groups in the visual analog scale pain score (standardized standard deviation:-0.51;95%confidence interval:-0.68,-0.33;P=0.05). Ultrasonic therapy is an effective method for knee osteoarthritis pain.

BACKGROUND:Several reports have demonstrated that metabolic disorders and physiopathologic changes accompany with urinary diversion.But these metabolic disorders caused by bladder reconstruction using intestinal tract are related to type and length of intestinal canal.OBJECTIVE:To investigate the histological change of reservoir mucosa and to assess effects on metabolic state in patients with a Roux-y sigmoid neobladder.DESIGN,TIME AND SETTING:A retrospective case analysis was performed at the Department of Urinary Surgery,the 184 Hospital of Chinese PLA between June 2000 and November 2008.PARTICIPANTS:The experimental group comprised 33 bladder carcinoma patients,21 males and 12 females,averaging 64 years of age.The control group consisted of 25 subjects who had no sigmoid colon diseases confirmed by gastroenterological endoscopy.METHODS:Patients with bladder carcinoma received radical cystectomy and bladder reconstruction using Roux-y sigmoid neobladder which controlled urination with anal sphincter.Prior to and after neobladder drainage tube removal,serum levels of electrolyte,creatinine,and urea nitrogen were detected.Before and 36 months after surgery,reservoir mucosa from 13 patients with bladder carcinoma was pathologically examined.For the control group,the thickness of sigmoid colon mucosa and the numbers of intestinal glands were determined.MAIN OUTCOME MEASURES:Electrolyte,renal function,acid-base balance,mucosal layer thickness,numbers of intestinal glands prior to and after surgery,as well as prior to and after drainage tube extraction.RESULTS:After surgery,electrolyte,creatinine,and urea nitrogen were all normal in 30 patients.There was no significant difference in serum electrolyte,creatinine,and urea nitrogen between prior to and after surgery.Mild acid poisoning was found in 3 patients.Microscopic observation results revealed that sigmoid colon mucosa in the control group did not change significantly after surgery,and it basically kept the normal tissue structure;in the experimental group,sigmoid colon mucosa that was(577.6±169.4)μm prior to surgery was thinned(412.5±114.7)μm(P＜0.05),intestinal glands were loosely arranged,interstitial substance became less,and the number of intestinal glands per high-fold visual field that was(26.4±3.5)/high-fold visual field prior to surgery was decreased(15.2±2.7)/high-fold visual field(P＜0.05),after surgery.In addition,intestinal villus in the neobladder was gradually atrophied,and no enterocyte proliferation and malignant changes were found after surgery.CONCLUSION:After Roux-y sigmoid neobladder application,colon mucosa was gradually thinned,intestinal glands were loosely arranged,interstitial substance became less,the number of glands per high-fold visual field was decreased,and body metabolism produced no changes.