ObjectiveTo evaluate the significance of pirif orm aperture enlarge ment in transsphnoid approach microsurgery for pituitary macroadenomas.MethodsTranssphnoidal approach microsurgery through enlarged pyrifor m aperture was ca rried out in 96 patients with pituitary macroadenoma from March 1997 to October 2000.ResultsAmong the 96 patients, 65 (67 7%) underwent tot al removal of the tumor, 25 (26 0%) underwent subtotal removal (80%～90%), and 6 (6 3%) partial removal (

Objective: To compare the effects of deliberate hypotension and hemorrhagic hypotension on systemic and renal hemodynamics in dogs. Method: Twelve mongrel dogs were randomly divided into nitroprusside-deliberated hypotension group and hemorrhagic hypotension group. After surgical preparation, the MAP of the dogs was decreased to 8kPa either by infusing nitroprusside or by withdrawing arterial blood and was kept for 30 min. RBF, MAP, HR, CO and CVP were monitored continuously. Result: Hypotension induced by hemorrhage was associated with significant decrease in CO, SV and CVP compared with nitroprusside. There was no significant change in HR in both groups. Hemor rhage caused more decrease in RBF than nitroprusside did (59.0% vs 37.5%). In recovery period, RBF in both groups increased, but remained significantly less than baseline in hemorrhage group. Conclusion: Hemorrhage can cause more pronounced interference in hemodynamics and more decrease in RBF with a subsequent slower recovery than with nitroprusside at the same level of hypotension.

Objective:To compare the effects of induced hypotensions with sevoflurane and nitroprusside on hemodynamics in dogs. Method:Fourteen mongrel dogs were randomly divided into sevoflurane group and nitroprusside group. After experimental preparation,the MAP was decreased to 8kPa and was kept for 30min either with sevoflurane inhalation or with nitroprusside infusion. MAP, HR,CO,CVP,SV and SVR wrer monitored continuously. Result: During induced hypotension, CO in sevoflurane and nitroprusside groups decreased by 30.7% and 21.6% respectively; HR decreased significantly in sevoflurane group, but not in nitroprusside group; SVR in both groups showed reduction, but more pronounced in nitroprusside group. However,after the termination of sevoflurane or nitroprusside, MAP elevated over baseline with the significant increase of SVR,and CO remaining low. Conclusion:As compared with nitroprusside, sevoflurane has inhibitory effect on circulation,yet it is still efficient to induced hypotension.

Objective To observe the effects of propofol or thiopental on the changes of blood brain barrier (BBB) permeability in focal cerebral ischemia Methods Focal cerebral ischemia model was induced with occluding the middle cerebral artery (MCA) Sixty adult male SD rats were divided randomly into 5 groups: control group(group MC): without any anesthetics; propofol pretreated group (group MP1) or thiopental pretreated group (group MT1): intravenous bolus of propofol 20mg/kg or thiopental 40mg/kg, followed by intravenous infusion of propofol or thiopental at rate of 50 60 mg?kg 1 ?h 1 or 100 120 mg?kg 1 ?h 1 ,respectively ,to achieve and maintain the EEG burst suppression 30 min before MCA occlusion until the beginning of reperfusion; propofol therapy group (group MP2) or thiopental therapy group (group MT2): from the beginning to the end of the reperfusion , propofol or thiopental was administered at the same dose as group MP1 or group MT1; Blood pressure, P ET CO 2, ECG and EEG were monitored throughout the experiment Rectal temperature was maintained between 37 5℃ and 38 5℃ At the end of the experiment, after intravenous bolus of 2% evans blue dye(EB) 3ml/kg, the brain was taken out to check out the extends and areas of EB staining on the surface and standardized serial coronal sections of the brain ,under the optical microscope and electromicroscope Results 1 Both propofol groups did not alleviate BBB permeability changes and cerebral damage 2 Cerebral injury was most slightly in group MT1 3 BBB permeability and brain injury in group MT2 were slighter than those in group MC and MP1, MP2 Conclusions Thiopental at the dose maintaining EEG burst suppressioncan can reduce the brain injury induced with ischemia and reperfusion, with the better protective effects following the prophylactic administration Propofol at that dose can not improve the cerebral ischemic reperfusion injury

Objective To analyze the correlation of visual acuity and metamorphopsia with foveal morphology before and after vitrectomy with internal limiting membrane peeling (ILMP) in idiopathic macular epiretinal membrane (IMEM) eyes.Methods This is a retrospective case series of 47 IMEM patients (49 eyes).All the patients underwent 25G pars plana vitrectomy with IMEM removal and ILMP.The best corrected visual acuity (BCVA) was measured using the international standard visual acuity chart,and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity.The severity of metamorphopsia was measured using M-charts.The central macular thickness (CMT),inner nuclear layer thickness (INT),inner retinal layer thickness (IRT),outer retinal layer thickness (ORT),the status of ellipsoid zone (EZ) were assessed with spectral-domain optical coherence tomography at baseline and each month postoperatively.The differences in BCVA,CMT,INT,IRT,ORT and status of EZ before and after surgery were analyzed,so did the correlations between these indexes at the same time.Results Compared with baseline,the postoperative BCVA was significantly increased (F=6.133,P＜0.001),but the M value,CMT,INT,IRT,ORT were significantly decreased (F=12.481,10.565,15.739,6.046,10.569;P＜0.001);the integrity of EZ was improved significantly (x2=12.309,P＜0.001).Preoperative BCVA was positively related to the CMT (r=0.720) and ORT (r=0.720,0.887;P＜0.05),while negatively related to preoperative integrity of EZ (r=-0.295,P＜0.05).The postoperative BCVA was positively related to the preoperative BCVA and postoperative CMT,ORT (r=0.774,0.754,0.842;P＜0.05),while negatively related to postoperative integrity of EZ (r=-0.676,P＜0.05).The preoperative M value was positively related to the preoperative CMT,INT,IRT,and ORT (r=0.931,0.668,0.840,0.637;P＜ 0.05).The postoperative M value was positively related to the preoperative M value and postoperative CMT,INT,IRT,and ORT (r=0.723,0.722,0.767,0.825,0.387;P＜0.05).Conclusions Vitrectomy with ILMP for IMEM can improve the visual acuity,metamorphopsia and foveal morphology.Both visual acuity and metamorphopsia correlate with foveal morphology.

Objective To evaluate the safety and effectiveness of vitrectomy combined with internal limiting membrane (ILM) tamping on macular hole and retinal detachment (MHRD) in highly myopic eyes.Methods 23 patients (23 eyes) were retrospectively reviewed,who were diagnosed as MHRD through examination of the ocular ftmdus,optic coherence tomography (OCT) and B-mode ultrasonography.There were 5 males (5 eyes) and 18 females (18 eyes).The mean age was (62.35 ± 8.28) years.The mean course of disease was 1.1 months.The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 2.31 ± 0.72.The mean axial length was (28.66 ± 1.99) mm.All patients underwent 23G microincision vitrectomy.After vitreous gel and cortex were gently resected,the ILM around the edges of the macular hole was stained with indocyanine green,and was folded and pushed to fill the macular hole gently.Then silicone oil or C3F8 gas tamponade was applied in 18 eyes and 5 eyes,respectively.The silicone oil was removed after 3 months.The follow-up was 6 months.The BCVA,macular hole closure,retinal anatomical reattachment were retrospectively observed,and were used to evaluate the safety and effectiveness of the surgery.Results At the 6 months after surgery,the logMAR BCVA was improved to 1.13 ± 0.38,the difference was significant (t=l 5.33,P=0.00).The postoperative macular hole closure rate and retinal anatomical reattachment rate were 100％.There were no ocular or systemic adverse events observed in all patients.Conclusion Vitrectomy combined with ILM tamping is an effective and safe treatment for the high myopic eyes with MHRD.

Objective: Breast augmentation by polyacrylamide hydrogel(PAHG) injection has resulted in a series of adverse events in many female patients.This article summarizes the authors' experience in the diagnosis and treatment of lactational infection after breast augmentation by PAHG injection and discusses related preventive measures.Methods: This study included 2 patients who had developed infection during lactation 5 years after breast augmentation with PAHG.We identified the exact position of the PAHG and vomica by color Doppler,computerized tomography and magnetic resonance.We made incisions in the submammary fold or mammary areola to take out the PAHG,drain the pus and place the vacuum pressure tube,followed by application of pressure bandages.Results: One of the patients healed without any complication,while the other developed latex leak in both breasts,but finally cured after milk regurgitation and repeated changing of dressings.Conclusion: Lactational infection after breast augmentation by PAHG injection is detrimental to female patients.Preventive measures should be taken as early as possible.For patients with this infection,operation should be performed to take out the PAHG and drain the pus.Sufficient draining and milk regurgitation are necessary to avoid latex leak.

The femora! arteries in 38 rabbits were transected and repaired with autogenous venous grafts with different diameters. The measurements of blood flow, patency rate and thrombosis rate, and scanning electron microscopic examination were made over a period of 14 days. The result showed that a venous graftl with a diameter 20 per cent less than that of the recipient artery was most satisfactory.

Objective To study the pathogenesis, the diagnoses and the pre-hospital emergency treatment of comatose patients. Methods 314 comatose patients admitted to our hospital from September 2003 to September 2004 were analyzed retrospectively and followed in the hospital. Results Among 314 comatose patients, 119 had cerebrovascular accidents, 91 with poisoning, 42 with metabolic diseases, 37 cardiovascular diseases and 25 others. After pre-hospital treatment, 68 patients were recovered, 199 with stable conditions, 31 deterioated and 16 died. Conclusion Among the comatose patients, cerebral diseases and poisoning accounted for the most. The pre-hospital treatment could improve the successful rate of rescue.

Objective To investigate the changes of plasma thrombomodulin (TM),tissue factor (TF),tissue factor pathway inhibitor (TFPI),P-selectin (P sel),von Willebrand factor (vWF) and D-dimer (D-D) levels in patients with hemorrhagic fever with renal syndrome (HFRS) and its clinical significance.Methods Twenty-three cases of HFRS were divided into two groups according to the severity of disease (12 cases in mild group and 11 cases in severe group),and 20 healthy individuals served as control group.Blood samples were collected at every stage of the disease.Plasma TM,TF,TFPI,P-sel and vWF were measured by enzyme-linked immunosorbent assay (ELISA); plasma D-D was detected by nanoparticles enhanced turbidimetric immunoassay; creatine kinase MB isoenzyme (CKMB) was tested by immunosuppression assay; blood clotting time was recorded for blood coagulation functions; blood urea nitrogen (BUN),creatinine (Cr),alanine aminotransferase (ALT),aspartate aminotransferase (AST),and platelets (PLT) were also routinely tested.The comparison between groups was done by analysis of variance and two sided t test.Results During the acute phase of HFRS,the plasma levels of TM,TF,P-sel,vWF and D-D were significantly increased,activated partial thromboplastin time (APTT) was prolonged,international normalized ratio (INR) was elevated,while fibrinogen (Fn) and PLT were decreased markedly as compared to control group.In febrile phase,there were significant differences between severe group and mild group in plasma TM [(1.78±1.00) μmol/L vs (1.33±0.35) μmol/L,t=2.600,P＜0.01],TF [(36.63±8.48) ng/L vs (32.93±10.61) ng/L,t=3.423,P＜0.01],vWF [(327.1±57.2) μg/L vs (260.3±63.2) μg/L,t=2.257,P＜0.01],APTT [(63.9±20.5) s vs (48.7±18.6) s,t=4.920,P＜0.01],and INRlevels(1.8±0.6 vs 1.5±0.4,t=2.276 P＜0.05).The variation curves of TM,P sel,APTT,INR and D-D were similar to those of BUN and ALT,but contrary to PLT count.Conclusions There are significantly elevated plasma levels of TM,vWF,P sel and D-D,prolonged APTT,increased INR,and much decreased plasma Fn and PLT in the acute phase of HFRS,suggesting the presence of extensive capillary injuries and activation of platelet and coagulation system,which is closely associated with kidney,liver and cardiac muscle damage.Hence,it is essential to use antiviral agents,anticoagulants and fluid resuscitation in the early stage of the disease.