Objective To study the effect of preemptive analgesina of morphine injected to subarachnoid space on postoperative epidural analgesia with morphine. Methods Sixty ASA Ⅰ-Ⅱ patients were randomly divided into two groups. All patinents received combination spinal-epidural anesthesia(CSEA). In experimenta group (n=30), 0 5% bupivacaine 2ml and morphine 0 5mg were injected into the subarachnoid space of the patients for CSEA, and morphine 2 8mg was used for postoperative epidural analgesia. In control group (n=30),0 5% bupivacaine 2ml was injected into the subarachnoid space of the patients for CSEA, and morphine 3 3mg was used for postoperative epidural analgesia. The numerical rating score (NRS) and Ramsay sedation scores were performed after operation. The postoperative analgesic duration and frequency of side effect were recorded. Rusult NRS was significantly less and postoperative analgesic duration was obviously longer in experimental group compared with control group. Ramsay sedation scores and the frequency of side effect significantly increased in the experimental group compared with the control group. But the shaking frequency in experimental group was significantly less than that in the control group. Conclusions Preemtive analgesia of morphine injected to subarachnoid space could improve postoperative epidural analgesia with morphine and increase analgesia time. But it had more side effects.

Objective To introduce a new method of septal cartilage augmentation for hump nose plasty. Methods The section of septal cartilage was collected and divided into two or three parts. The grafts were sutured by means of a mattress suture, and placed over the dorsum of superior and inferior hump. The dorsum became flat and straight immediately afterward. Results After a short term and long term follow up, 30 patients who underwent this operation were satisfied the operative results. Conclusion Septal cartilage augmentation for hump nose plasty is an efficient new method.

Objective To introduce a method of dorsal augmentation rhinoplasty using autogenous septal cartilage. Methods Autogenous septal cartilage was obtained through a standard septoplasty approach. Graft was cut into single oval, or divided into two or three parts, then the cartilage was sutured by means of a mattress suture; or graft was made into an inverted V frame, depending on size and shape of dorsal depression, and finally graft was inserted for augmentation of dorsum. Results Since May 1989 to Dec. 2001, this technique was performed in 43 patients, 6 men and 37 women, with a range of 17-35 years and a mean age of 24 years. Follow-up ranged from 6 months to 5 years. The authors asserted the sustained satisfactory outcomes. Conclusion Autogenous septal graft is technically simple and relatively free of complication. Long-term evaluations show no absorption of grafts and preservation of desired shape.

Objective To introduce a new method of recombinative repair for the old malunion of the fracture of nasal bone. Methods Since 1996.5 to 2001.12, this technique was performed in 28 patients, 23 men and 5 women, with a range of 18～45 years, a mean age of 29 years. The nasal skin was protected with a rubber pad, and malformed nasal bones were beat out with a small hammer, so as to create a new refracture, then manual reduction was performed with finger and the septal periosted elevator. Results Follow-up ranged from 3 months to 5 years. Of all the patients, 23 cases were cured, 5 cases improved, and the overall effective rate was 100 %. Most of them were satisfied with the successful operation. Conclusion The operative procedure of recombinative repair is technically simple and easy, and the patients suffer little. It is an update and efficacious therapeutic method.

Objective To observe the changes of haemodynamics and cerebral state index during double-lumen endobronchial intubation with glidescope ranger video laryngoscope (GSVL) and macintosh direct laryngoscope (MDLS). Methods Forty-eight ASA Ⅰ or Ⅱ patients aged 35 ～ 67 yrs were enrolled in this study, who were scheduled for elective pulmonary cancer or cancer of esophagus radical correction tients were random divided into 2 groups( n =24 each), GSVL group and MDLS group. After anesthesia was induced, all patients were given a score of Cormack grading under MDLS and GSVL, and then endobronchial intubation was performed. Noninvasive BP and HR were recorded before and after induction of anesthesia, during endobronchial intubation and after endobronchial intubation was completed for 1,2, 3, 4,5 min. The CSI was continuously monitored and recorded before and after induction of anesthesia, and after endobronchial intubation for 1 ～ 2 min and 3 ～ 5 min. Results Compared with MDLS group, the rate of Cormack grade 1 was significant higher in GSVL group (91% vs 58% ) ( P ＜0. 01 ). BP of two groups at T1 and T5 ～ T7 were significantly decreased compared to T0 values ( P ＜0. 01 ). Endobronchial intubation (T2 ～T4) caused significant increase in BP and HR compared to post-induction values(T1 ) ( P ＜0. 01).The highest values of HR after intubation exceeded even their baseline values before induction of anesthesia.The haemodynamic responses to endobronchial intubation in GSVL group at T2 ～ T4 were significantly different from those in MDLS group( P ＜0. 05). CSI of two groups at T1 was significantly decreased compared to To values( P ＜0. 01 ), CSI of two groups at T2 induced significant increase compared to T1 values, and the increase of CSI in MDLS group was stronger than that in GSVL group( P ＜0.01). Condusion The haemodynamic responses produced by orotracheal intubation using GSVL had more obvious advantages than MDLS, but GSVL seemed to provide a clear view of glottis and a little change CSI effect.

Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCEUS) in assessing the peripancreatic vascular invasion of pancreatic carcinoma.Methods Twenty-eight patients with pancreatic cancer confirmed by postoperative pathology were examined by DCEUS preoperatively.The relationship between neoplasms and peripancreatic vessels was analyzed for assessing whether vascular invasion of pancreatic cancer had occurred.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of DCEUS in evaluating vascular involvement were calculated by using the surgical results as a gold standard.Kappa test was used for assessing the intra- and interobserver reliability of DCEUS.Results In total 28 patients,21 cases were diagnosed as vascular invasion,whereas,7 cases were noninvasive by surgical results.By DCEUS,18 cases were assessed as positive involvement of vessels,whereas,10 cases were negative.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of DCEUS in evaluating vascular involvement were 85.71 ％,100％,100 ％,70.00 ％ and 89.29 ％ respectively,and with higher reliability (Kappainter =0.75,Kappa =0.80).Conclusions DCEUS could be considered as a novel method to assess vascular invasion of pancreatic carcinoma accurately and reliably.

Objective To investigate the prenatal emotional disorder of the primipame and the related factors,and to analyze its influence on the delivery mode.Methods In the prospective cohort study,590 healthy primiparase were asked to complete a self-compiled questionnaires for their general social mental state,state-trait anxiety inventory(STAI)and self-rating depression scale(SDS).Results Questionnaires of 159 patients were selected and these patients were divided into the anxiety group(114 cases)and the control group(455 cases),the depression group(159 cases)and the control group(410 cases).The ratio of selective cesarean section in the anxiety group was significantly higher(45.61%,32.53%,X2=6.85,P＜0.01),while the successful trial of labor were less than that of the control group(19.35%,47.88%,X2=26.30,P＜0.01).The ratio of selective cesarean section in the depression group was significandy higher than that of the control group(46.54%,31.95%,X2=10.21,P＜0.01),while the successful trial of labor were less than that of the control group(31.76%.46.59%,X2=9.13,P＜0.01).Single-factor analysis showed that prenatal anxiety related to the following factors:fear of childbirth,worried about their children,knowledge for childbirth,high economic status,maternal age and their own economic situation.Conclusions Higher incidence and risk factors of anxiety or depression before delivery,such as advanced delivery age,bad economic condition,weak family support,worrying about the safety of babies and themselves,are found in our study.Prenatal emotional disorder would affect the quality of labor and delivery options,and lead the high risk of cesarean section.

Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCUS) in diagnosing lymph nodes metastasis of gastric carcinoma.Methods One hundred and sixteen patients with gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined by DCUS preoperatively.The enhanced characteristic of gastric carcinoma tissues was assessed by autotracking contrast quantification(ACQ) software.The baseline intensity(BI), peak intensity(PI), arrival time(AT) and time to peak(TTP) of gastric cancer was measured automatically,and the enhanced intensity (EI) and wash-in time(WIT) of gastric cancer was calculated manually (EI=PI-BI; WIT=TTP-AT).All of the subjects were divided into two groups according to their lymph nodes status postoperatively:group N1,sixty-nine patients with lymph nodes metastasis; and group N0, forty-seven patients without lymph nodes metastasis.The DCUS quantitative analysis and pathological results of these two groups were compared each other.The Kappa's test was used for inter-rater reliability.Results BI of group N1 in the gastric carcinoma tissues was lower than that of group N0 significantly [(1.41 ± 1.56)dB vs (3.92 ± 2.82)dB, t = - 4.81, P = 0.000].EI of group N1 in the gastric carcinoma tissues was higher than that of group N0 significantly [(20.67±3.71)dB vs (14.12±3.75)dB, t=7.31, P=0.000].Moreover, there was a significant difference of WIT in the gastric carcinoma tissues between these two groups[(9.12±2.99)s vs (10.88±3.05)s, t =-2.43, P=0.018].The WIT in patients with lymph nodes metastasis was shorter than that without it. A cut-off value ＞17.05 dB of EI in gastric cancer tissues for assessing the lymph nodes metastasis had a sensitivity of 80.50% and specificity of 76.70% respectively obtained by the area under the ROC curve. The Kappa value of this method was 0.88.Conclusions EI of gastric cancer tissues can be considered as a new potential index to evaluate the lymph nodes metastasis of gastric cancer.

Objective To assess the changes of right atrial size and mechanical function after radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation using real-time threedimensional echocardiography(RT-3DE), and to study the correlation between the changes of left atrial(LA)and right atrial(RA) volume and function. Methods Thirty-five patients with paroxysmal atrial fibrillation were undergone radiofrequency catheter ablation (RFCA) successfully. Transthoracic echocardiography (TTE),tissue Doppler imaging(TDI) and RT-3DE were performed before, 1 month and 3 months after procedure respectively. Late systolic volume and area of RA and LA,ejection fraction(EF) of RA and LA,late diastolic peak velocity of mitral valve inflow, tricuspid valve inflow and late diastolic peak velocity of mitral annulus and tricuspid annulus were recorded. Results The 3DE images of all patients were satisfied.LA max area and 3DE LA max volume were significantly reduced at 1 months and 3 months after procedure compared with basic stage [ ( 18.8 ± 6.3) cm2 vs (21.5 ± 6.2) cm2 , (38.8 ± 17.0) ml vs (46.1 ± 20.0) ml,P ＜ 0.05]. 3DE LA EF also declined markedly at 1 month after RFCA, and restored at 3 months later compared with baseline [(41.1 ± 13.7) % vs (51.7 ± 15.9) %, (41.1 ± 13.7) % vs (45.6 ± 18.3) %, P ＜0.05]. The size and mechanical function of the right atrial after procedure were no obvious changes. There were no evidently correlation between the changes of LA and RA volume and function. Conclusions RT3DE can provide a precise method to quantify the value of atrial volume and function. The LA size and volume are significantly reduced after RFCA in patients with paroxysmal atrial fibrillation, however, the RA size and function are no obvious changes.

Objective To analyse the rate of coincidence to suspected coronary artery disease (CAD) patient between positive exercise treadmill testing (TET) and coronary angiography (CAG) test.Method Two hundred and sixty-eight chest pain patients positive in TET were performed CAG test,coronary stenosis exceed 50% was diagnosed CAD. Results One hundred and seventy-six patients (65.67%) was diagnosed by CAG, 105 male and 71 female in them. Ninety-two (34.33%) patients was negative in CAG test. The false positive rate of TET between post-menopause patients (30.12%, 25/83 ) andmale patients (28.08%, 41/146) was no significant difference(P > 0.05 ); the difference of false positive rate between pro-menopause patients (66.67%, 26/39) and male patients (28.08% ,41/146) was statistical significance (P < 0.01 ). Conclusions The positive rate of CAG can be greatly improved by screening the chest pain patients though TET before CAG, if the positive in TET performed CAG only. TET false positive rate of pro-menopause female is significantly higher than post-menopause female or male.