OBJECTIVETo explore the perioperative cardiovascular dysfunction and its relevance to age in patients with silent coronary heart disease (or silent myocardial ischemia), and explore the clinical treatment and recovery of perioperative arrhythmias.

METHODSOne hundred and eighty cases were selected from selective surgery patients with silent myocardial ischemia (SMI). Among the cases, 130 patients older than 51 years old were divided into 51 - 60 year-old group, 61- 70 year-old group and 71 - 80 year-old group. Control group was set up by other 50 patients younger than 51 years old. Electrocardiogram data of 24 h before the operation, 24 h after the operation and 48 h after the operation were continuously monitored by dynamic electrocardiogram (DCG). The electrocardiogram data of ST shifting, arrhythmia incidences of different type and at different time were analyzed by professional doctors. At the same time, the treatment and recovery of perioperative arrhythmia were recorded.

RESULTSAs the age increase, the magnitude and duration of ST shifting appeared upward trend compared to the control group (P < 0.05, P < 0.01). The incidence of ST elevation in 71 - 80 year-old group was higher than the control group (P < 0.05). The ST depression duration in 61 - 70 and 71 - 80 year-old group and ST elevation magnitude in 71 - 80 year-old group were higher than 51 - 60 year-old group (P < 0.05). Compared to the control group, the incidence of accelerated idioventricular rhythm (AIR) in 61 - 70 year-old group and the incidence of sinus bradycardia (SB), ventricular premature beat (VPB), ventricular tachycardia (VT) in 71 - 80 year-old group were higher (P < 0.05, P < 0.01). Compared to the 51 - 60 year-old group, the incidence of atrial fibrillation (AF) in 61 - 70 year-old group and the incidence of VP, VT, AF in 71 - 80 year-old group were higher (P < 0.05, P < 0.01). The arrhythmia incidences in 24 h after operation were higher than 48 h after operation and 24 h before operation (P < 0.01). As the age increase, the recovery incidence by removing inducement was decreased, but the recovery incidences by drug and electric-shock treatment were increased (P < 0.05).

CONCLUSIONOld SMI patients have high levels of perioperative myocardial ischemia and arrhythmia, and 24 h after operation is the period of high incidence.

Aged ; Aged, 80 and over ; Cardiovascular System ; physiopathology ; Coronary Disease ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Perioperative Period

Aged ; Coronary Disease ; epidemiology ; Humans ; Myocardial Infarction ; epidemiology ; Perioperative Period

OBJECTIVETo explore an optimal anesthesia method with less impact on hemodynamics and electrocardiogram (ECG) of old patients with coronary artery disease (CHD) during abdominal operation.

METHODSThe 133 CHD patients waiting for abdominal operation were randomly divided into continuous epidural anesthesia (EA) group, general anesthesia group (GA) and combined spinal-epidural anesthesia (CSEA) group. Continuous monitoring was carried out during operation and mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SaO2), abnormal ECG were measured respectively at different time for comparison and the differences of the above hemodynamic parameters and abnormal ECG features were compared among the 3 groups.

RESULTSAt the 15 min and 30 min point after anesthesia, SaO2 in GA group was significantly increased compared to that in the EA group (P < 0.05). At 15 min, 30 min and 60 min point after anesthesia, MAP in CSEA group was significantly increased compared to that in the EA group (P < 0.05). At 30 min point after anesthesia, HR in CSEA group was increased significantly compared to the EA group (P < 0.05). At 15 min and 30 min point after anesthesia, SaO2 in the CSEA group was increased significantly compare to the EA group (P < 0.05). Compared with preanesthesia (T0) in EA group, MAP, HR and SaO2 decreased significantly at 15, 30 and 60 min after anesthesia (P < 0.05). The fluctuation of the three parameters in GA and CSEA groups were relatively small (P > 0.05). As well as the comparison of abnormal ECG among the 3 groups was concerned, the incidence of ST-T changes in GA and CSEA groups were significantly lower than that in EA group at the time of 15 min, 30 min and 60 min after anesthesia and at the time of surgery termination (P < 0.05, P < 0.01). The incidence of arrhythmia in GA and CSEA groups were significantly lower than that in EA group at the time of 15 min, 30 min and 60 min after anesthesia (P < 0.05, P < 0.01). Compared with T0 in the same group, the incidences of ST-T changes and arrhythmia in GA or CSEA group at the time of 15, 30 and 60 min after anesthesia and at the time of surgery termination were significantly lower than that before anesthesia (P < 0.05, P < 0.01).

CONCLUSIONGA and CSEA have less impact on hemodynamics and have smaller incidence of abnormal ECG of old CHD patients with abdominal operation.

Aged ; Anesthesia ; methods ; Coronary Disease ; physiopathology ; Electrocardiography ; Female ; Hemodynamics ; drug effects ; Humans ; Male ; Middle Aged ; Perioperative Period

Objective To summarize the management of scrotal gangrene.Methods Totally,14 male patients (mean age,48 years;age range,27-74 years) with scrotal gangrene were treated from August 2003 to June 2005.Among these patients,scrotal gangrene was complicated by perianal and penile gangrene in 2 cases;by perianal,penile and inguinal gangrene in 10 cases;by perianal,penile,inguinal gangrene and abdominal subcutaneous gangrene in 2 cases.Three cases had concomitantly necrosis of the penis;and 5 ca- ses,orchitis.Bacterial cultures were performed in all 14 cases with the positive results.All patients underwent surgical treatment,including PhaseⅠincisions,aggressive debridement,drainage,irrigation,and scrotoplas- ty.After operation they received antibiotic therapy and supporting treatment.Three cases of penile necrosis underwent complete penis amputation and transplanting the urethra before the anus.Five cases of orchitis un- derwent unilateral orchiectomy.Two cases of abdominal gangrene underwent surgical subcutaneous treatment, including incision,aggressive debridement,drainage,and irrigation.Results Twelve cases undergoing scrotoplasty achieved PhaseⅠhealing.Two cases undergoing urethral fistulation recovered well.Ten cases of penile skin gangrene received penile dermatoplasty 1 month later,and then recovered.Two cases who had al- ready had AIDS died 2 or 3 d after operation.Conclusions The management of scrotal gangrene primarily consists of early and aggressive debridement,antibiotic therapy and supporting treatment.The PhaseⅠde- bridement and scrotoplasty as well as drainage are effective for the treatment of scrotal gangrene.

Objective To review the surgical managements of patients with traumatic false aneu- rysms in the extremities.Methods From January 1990 to April 2006,17 patients with traumatic false aneurysms in the extremities were admitted into our hospital.Fourteen patients were treated by vascular repair including vascular repair in seven cases,end to end anastomosis in one,synthetic grafting in one, autogenous vein grafting in one,and direct ligation in four.Three patients were treated nonoperatively, but with local compressive dressing.Results There were no deaths or gangrenes in all cases.The clinical manifestations vanished after the treatment.The mean follow-up period was 13.2 months.The function of the injured extremities recovered satisfactorily.Conclusion Different types of traumatic false aneurysms should be managed by different therapeutic procedures after the diagnoses is made.

OBJECTIVETo study the inhibitory effect and reasons of liposomes survivin antisense oligonucleotides (ASODN) on growth of human gastric carcinoma transplanted subcutaneously in nude mice.

METHODSHuman gastric carcinoma transplanted subcutaneously in nude mice model was established, and subsequently was divided randomly into six groups: control group, liposome group, sense oligonucleotide (SODN) group, 100, 200 and 400 nmol/L ASODN group. Different treatments were given respectively. The weight and volume of subcutaneous tumors were measured, and tumor growth inhibitory rate and decreased rate was calculated. The morphological changes of transplanted tumor cells were observed under light microscope. The expression of survivin was detected by immunohistology (SP). Changes of survivin gene transcription and protein expression were determined by western blot and RT-PCR.

RESULTSGrowth of the tumors was significantly inhibited in all ASODN groups as compared with that in the control, liposome and SODN group. The highest growth inhibitory rate in the 400 nmol/L group is 93%. The number of apoptotic cells of ASODN group increased and expression of survivin became weaken under the microscope. Liquified necrosis regions could be seen in 6 cases (6/12) of tumor tissues. The content of survivin mRNA and protein decreased in all survivin ASODN groups. The survivin protein expression of 400 nmol/L group was about 36.8% of the control group.

CONCLUSIONSSurvivin gene ASODN can inhibit the growth of human gastric carcinoma in nude mice by inducing cells apoptosis and decreasing the expression of survivin mRNA and protein.

Animals ; Antineoplastic Agents ; pharmacology ; Apoptosis ; drug effects ; Humans ; Inhibitor of Apoptosis Proteins ; Liposomes ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Microtubule-Associated Proteins ; biosynthesis ; genetics ; Neoplasm Proteins ; biosynthesis ; genetics ; Neoplasm Transplantation ; Oligonucleotides, Antisense ; genetics ; pharmacology ; RNA, Messenger ; genetics ; Stomach Neoplasms ; metabolism ; pathology ; therapy

OBJECTIVETo investigate the inhibitory effect and mechanism against the growth of human gastric carcinoma cell line HS-746T by the combination of the survivin antisense oligonucleotide (ASODN) and P53 gene and its mechanism.

METHODSGastric carcinoma cell line HS-746T was treated by P53 gene and survivin antisense oligonucleotide was designed. There were four regimen groups treated by different agents:ASODN alone, P53 gene alone and the combination of ASODN and P53 gene, blank control. Cell proliferative ability and cell growth were determined by cells counting and MTT. The expression of survivin mRNA and protein was detected by RT-PCR and Western blot respectively. Cell apoptotic index was detected by TUNEL.

RESULTSASODN alone, P53 alone and the combination of ASODN and P53 could inhibit not only the growth of gastric carcinoma cell, but also down-regulate the survivin mRNA and protein expression. The inhibitory effect was stronger, and the apoptosis index was higher in the combined transfection group than those in the other two single transfection groups.

CONCLUSIONThe combination of survivin ASODN and P53 gene is more efficient to inhibit cell growth and induce apoptosis than that of agent alone.

Apoptosis ; Cell Line, Tumor ; Cell Proliferation ; Humans ; Inhibitor of Apoptosis Proteins ; Microtubule-Associated Proteins ; genetics ; Oligonucleotides, Antisense ; genetics ; pharmacology ; Stomach Neoplasms ; genetics ; pathology ; Transfection ; Tumor Suppressor Protein p53 ; genetics

AIM: To investigate the curative effect of phacoemulsification and intraocular lens ( IOL ) implantation combined with goniosynechialysis in the treatment of age-related cataract merging with primary angle-closure glaucoma ( PACG) . · METHODS: Totally 80 patients with age-related cataract merging with PACG were in our hospital from January 2014 to January 2016. The preoperative average intraocular pressure ( IOP) was 33. 22 ± 3. 17mmHg; the average depth of anterior chamber was 2. 07 ± 0. 15mm;the dynamic situation of primary angle closure ≤1/2 cycle by gonioscope. They were randomly divided into Group A and B for doing a study. All the two groups were treated with phacoemulsification and intraocular lens implantation. And the Group A was with goniosynechialysis. The following up period was 2mo, and we observed the IOP, chamber depth and the anterior chamber angle. · RESULTS: The change of chamber depth and intraocular pressure about the two groups: the average intraocular pressure of the Group A was 15. 11 ± 3. 67mmHg,the chamber depth was 3. 11±0. 08mm;those of the Group B were 17. 24 ± 1. 67mmHg, 2. 76 ± 0. 15mm respectively; the differences had statistical significance (P<0. 05). Postoperatively, there were 28 eyes (70%) in Group A with fully open anterior chamber angle, and 18 eyes (45%) in Group B (P<0. 05). · CONCLUSION: The phacoemulsification and intraocular lens implantation combined with goniosynechialysis in the treatment of age-related cataract merging with primary angle-dosure glaucoma is safe and reliable. It's simple to operate, and do not increase the risk of surgery.

This case report we presented is that the anomalous left main coronary artery (LMCA) originates from the proximal segment of right coronary artery. In order to confirm the origin and course of the anomalous LMCA, a multi-slice computed tomography (MSCT) of the heart was performed on a 64-slice machine (Philips 64 Slice, Philips, USA) after 6 months of coronary angiography operation. The results showed that the anomalous LMCA originates from the proximal segment of right coronary artery, lies posteriorly to the aorta before taking acute sharply to go between the aorta and left atrium. It was classified as R-II P subtype according to Lipton’s classification. It is a rare case in the clinical practice.
Aged ; Coronary Vessel Anomalies ; diagnosis ; Coronary Vessels ; pathology ; Humans ; Male

Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; therapy ; Coronary Vessel Anomalies ; diagnosis ; therapy ; Female ; Humans