CTICU is a place in which many patients with critical cardiothoracic and vascular disease are centered. Owning skillful medical underwent complex and dangerous cardiopulmonary operation and the patients underwent complex and dangerous cardiopulmonary operation and the dying can get immediately effective treatment and intensive care as well as good effects. HOwever, We often face some new ethical challenge in which ethical conflicts about use of high-new technology and abandoning treatment or surgery are the most typical while we hae gotten interests in CTICU. This paper is to do somw discussion about the ethical problem and the ethical criterions according to clinical characteristics in CTICU.

Objective: To investigate the effects of adrenomedullin1-50 (Adm1-50) on vascular cell adhesion molecule-1 (VCAM-1) expression in isolated rat heart. Methods: Twenty-four male Sprague-Dawley rat, weighting 300 to 350g, were randomly divided into A, B, C, D group (n=6 for each group). The isolated rat hearts were perfused in a Langendorff mode for 20 min and followed by 60 min of global ischemia. Then, all groups were reperfused with Kerbs-Henseleit bicarbonate for 60 min, but group B, C, D were perfused with buffer in the presence of Adm1-50 10-9mol/L, 10-8mol/L, and 10-7mol/L respectively for 15 min after the onset of reperfusion. The post-ischemic change of creatine kinase-isoenzyme (CK-MB) in coronary effluent and the expression of myocardial VCAM-1 mRNA were measured. Results: After I/R, Adm1-50 dose-dependently decreased the expression of VCAM-1 and the CK-MB activity, The ratio of VCAM-1/GAPDH mRNA were 1 20?0 52, 1 10?0 45, 0 60?0 31, 0 50?0 36 for group A, B, C, D, respectively (P

Objective: To review the experience of the esophageal replacement with colon. Methods: The data from 548 patients were summarized and analyzed, including the diseases type, operations type, selection of the colon segment, colon blood supply and pathway for pulling-up of transplanted colon. Results: Postoperative complications occurred in 86 cases (15。69%), with 10 deaths (mortality rate 1。82%). The 1,3,5 years survival rate were 85。6%, 60。8% and 32。4%, respectively. All the patients in the group of benign esophageal diseases survived well with normal lives and activities, after 2～25 years of follow-up. Conclusion: There are several keys to ameliorate the results and reduce the complications rate to 15。69% and mortality rate to 1。82%. The keys are choosing of isoperistaltic transposition, ascending branch of left colica artery, retrosternal tunnel, a single-row suturing by cervical esphagocolostomy and prevention of complications (injury of recurrent laryngeal nerve, thoracic colon syndrome and esophageal pouch syndrome).

Objective To compare the myocardial protective effect between off pump coronary artery bypass(OPCAB) and on pump coronary artery bypass in the aged. Methods Four five patients were randomly divided into 3 groups:off pump coronary artery bypass (n=15),tepid blood cardioplegia group(n=15) and cold blood cardioplegia group (n=15).There was no statistical difference in heart function,sex,age and lesion of coronary artery .Venous blood samples were taken for determineing the serum concentration of creatine kinase MB isoenzyme(CK MB),troponin I perioperatively and the clinical situations were observed postoperatively. Results CK MB,troponin I release in beating group during and after bypass was lower than that in on pump groups( P