Objective To discuss the effectiveness of heart operation through subaxillary minithoracotomy.Methods Subaxillary minithoracotomy heart operation was carried out in 378 cases between March 1995 and October 2004.The operation was performed under beating heart and without the occlusion of the ascending aorta in 81 cases of atrial septal defect, 32 cases of ventricular septal defect,and 16 cases of other diseases.The operation was completed under low temperature and extracorporeal circulation in other 249 cases.Results The operation was accomplished smoothly in all the cases.The operation time was 167?2.0 min,and the extracorporeal circulation time was 28.1?16.6 min.Postoperatively,1 patient with double-chamber anormaly of the right ventricle was given a tracheotomy because of an acute laryngeal edema,1 patient with tetralogy of Fallot died of low cardiac output syndrome,1 patient had a cerebral embolism,2 patients experienced an incision fat liquefaction,and the remaining patients recovered uneventfully.A follow-up for 2 months ~ 10 years(mean,5.1 years) in 366 patients revealed a full range of physical activities.One case of ventricular septal defect with residual shunt and 1 case of cerebral embolism were fully recovered.Conclusions Subaxillary minithoracotomy open heart operation has advantages of minimal invasion,quick recovery,simplicity of performance,and good cosmetic results.

[Objective]To evaluate the value of diffusion weighted imaging(DWI)in breast disease.[Methods]7 cases suspected by molybdenum target and clinic were detected by MRI.we calculated ADC through two different b,also make time-signal plot.Then we compared the diagnostic conclusion to the normal MRI conclusion acquired with histopathological demonstration.[Results]3 cases were malignant,2 cases were benign and 2 cases were normal.The diagnostic coincidence rate of DWI and normal MRI was 100%.[Conclusion]DWI is a rapid and feasible method in detecting breast lesions.ADC is an effective parameter in discriminating malignant and benign breast lesions.

Objective To summarize the surgical treatment of heart disease in patients aged 70 years and over. Methods From May 1995 to July 2000, 23 patients aged 70 years and over underwent cardiac operation at our department. Thirteen cases underwent isolated coronary bypass grafting, 5 had isolated valve operations , 3 had combined valve operation and coronary bypass grafting, 1 had excision of left atrial myxomas, 1 had combined pericardiectomy and coronary bypass grafting .Results Postoperative complications occurred in 5 cases (21.7%). The hospital mortality rate was 4.3% (1 case) . All of the 22 cases survived showed improvements in cardiac function and quality of life during a follow up of 1 month to 5 years.Conclusions Cardiac operations can be performed in patient saged 70 yeas and over with a satisfactory outcome,earlier referral and intervention is mandatory to improve results in this patients.

Objective To observe the effects of 6%hydroxyethyl starch(Volven 130/0.4)infusion on hemodynamics and coagulation.Methods 60 cases of open heart surgical children under cardiopulmonary bypass were randomly divided into two groups(30 cases for each):The control group(group C)were infused with 400 ml plasma and volven group(group V)were infused with 400 ml Volven before cardiopulmonary bypass.Then mean aterial pressrue(MAP),heart rate(HR),and central venous pressure(CVP)were measured.The venous blood samples were collected before and after infusion for the measurements of the following parameters:haematocrit(HCT),blood sedimentation(BSR),platelet count(PLC),prothrombin time(PT),and activated whole blood clot time(ACT).Those indexes before operation,15 min after bypass,after returning to ICU,and 24 hours after operation were observed.Results HCT and PLC after infusion were significantly lower than that before infusion.BSR after infusion was significantly faster than that before infusion.There were no significant changes in MAP,HR,CVP,PLC,ACT and PT.Conclusion 6%Hydroxyethyl starch infusion is safe and beneficial during cardiopulmonary bypass.

Objective To explore the mechanism of ischemic postconditioning in relieving cerebral ischemia reperfusion (IR) by regulating autophagy through P38MAPK pathway.Methods Cerebral ischemia reperfusion model was established by using modified Pulsinelli four-vessel occlusion (4-VO).Totally 128 male SD rats were divided into 4 groups randomly:control group (sham),cerebral ischemia reperfusion model group (CIR),cerebral ischemic postconditioning group (CIP),and cerebral ischemic postconditioning + P38MAPK inhibitor group (SB203580 group).Each group was subdivided into four time points:6 h,24 h,48 h,and 72 h.The morphological changes of the hippocampus CA1 area neurons at each time point and the number of surviving nerve cells were detected with HE staining.The expression of the hippocampus CA1 area phosphorylated P38MAPK and the autophagy-related genes of Beclin-1 and LC3-Ⅱ were detected with immunohistochemistry.The protein content of the hippocampus phosphorylated P38MAPK and autophagy-related genes of Beclin-1 and LC3-Ⅱ were detected with Western blotting.Results Compared with those in sham group,the damage of rats' hippocampal neuron structure and the survival rate of neurons at each time point decreased in CIR group,the expressions of p-P38MAPK,LC3-Ⅱ and Beclin-1 increased.Compared with those in CIR group,in CIP and SB203580 groups the structure of rats hippocampal neurons was improved,the survival rate of neurons increased,the expression of p-P38MAPK decreased and the expressions of LC3-Ⅱ and Beclin-1 increased at each time point.Compared with CIP group,SB203580 grouphad improved structure of rats' hippocampal neurons,increased survival rate of neurons,decreased expression of p-P38MAPK,and increased expressions of LC3-Ⅱ and Beclin-1 at each time point.Conclusion Cerebral ischemic postconditioning through inhibiting P38MAPK pathway can regulate autophagy and exert its nerve-protective effect.

Objective To compare the hemodynamic responses to orotracheal intubation during emergency operation with the proseal laryngeal mask airway and endotracheal Intubation.Methods Fifty six patients who were ASA GRADE Ⅰ-Ⅱ before onset undergoing orotracheal intubation were randomly dirideed into either without laryngoscope direct proseal laryngeal mask intubation(PLMA) group or direct laryngoscope endotracheal intubation(TT) group.SBP、DBP、HR and SpO2 were recorded before,durring and 5 minutes after intubation.Intubation time and first attempt insertion success rate were recordeddso.All patients were followed up postoperatively for adverse effects like sore throat or hoarseness.Results In intubation time、first attempt insertion success rate and adverse effects like sore throat or hoarseness,PLMA group was 96.43%,(19.7?5.7)s and 7.1%,TT group was 100%,(27.9?11.3)s and 39.29%.Intubation time was significantly shorter and adverse effects like sore throat or hoarseness were lower in the PLMA group than TT group(P

Objective To study the influence of the surgical glue on anastomosis scar formation after bilioenterostomy Methods Seventy-two hybrid canines were randomly assigned into group A (OB glue plus persistent T tube stent ), group B (OB glue plus T tube drawn out at different postoperative time), group C ( FG plus persistent T tube stent ) and group D (FG plus T tube drawn out at different postoperative time). The surgical glue (OB glue or FG) was used instead of silk thread in biliointestinal Roux-en-Y anastomosis, and T tube was placed as indwelling stent. The collagen content (BCC) of anastomotic specimen was measured in 3 weeks and 3 , 6 , 9 ,12 months after the operation. Results Three months after the operation, BCC in group B was significantly higher than that in group A (P0.05). Conclusions The surgical glue can promote anastomosis healing with less scar formation, and accelerate scar softening and maturation, which suggests that surgical glue should be effective in the prevention of anastomotic stricture.

Objective To study the complications after laparoscopic bile duct exploration.MethodsTwo approaches for bile duct exploration were used in 105 patients: (1) laparoscopic transcystic common bile duct exploration (LTCBDE) was used for patients with gallstones with choledocholithiasis and cystic duct dilation. No T tube was used for drainage, (2) Laparoscopic common bile duct exploration (LCBDE) was used for patients with gallstones with choledocholithiasis but without cystic duct dilation. The common bile duct was sutured primarily without T tube drainage in those patients with a small number of stones. T tube drainage was used in those patients with many stones or severe edema at the lower end of the common bile duct. ResultsWe carried out LTCBDE+ LC in 70 patients and LCBDE+LC in 35 patients, 14 patients had T tube drainage and 21 patients had no T tubes in the latter group of patients. Postoperatively, there were ascites in 17 patients (LTCBDE 6 and LCBDE 11 ), biliary peritonitis in 5 patients (1 LTCBDE and 4 LCBDE), abdominal pain in 13 patients (LTCBDE 4 and LCBDE 9), and fever in 11 patients (LTCBD 3 and LCBDE 8). All the complications responded to conservative treatment. 14 patients in the LCBDE group had residual stones.Choledochoscopy was used to remove the residual stones.There was no pancreatitis. Conclusions Adequate preoperative workup, good clinical judgment and precise treatment skill help to reduce complication rates after operation for gallstones with choledocholithiasis.

Objective To study the application of cyctic duct dilatiion in bile duct exploration through the cystic duct by laparoscope combined with choledochoscope.Methods LC + laparoscopic transcyctic common bile duct exploration were performed in gallstones combined choledocholithiasis in 70 cases.The dilation of cyctic duct was performed by gas-baloon or metal dilator in 39 cases.The dilation of cyctic duct was not performed in 31 cases.Results There was one case of bile leakage and one case of cystic duct damaging in cystic duct dilation group.One case was found bleeding in abdomen postoperation in non-dilation group.Abdominal drainage was(60 ±11)mL and(55 ±8)mL in dilation group and non-dilation group,respectively.Conclusions The dilation of cyctic duct is simple and safe to create the tunnel for common bile duct exploration through the cystic duct by choledochoscope.

Objective To study the morphological changes of the cyctic duct in bile duct stones secondary to choledocholithiasis.Methods The results of imaging examinations before cholecystectomy and biliary exploration with laparoscopy and cholechodoscopy were respectively analyzed in 108 patients.Meanwhile, the cystic duct morphology, diameter and dilatation during the operation were determined to investigate the features of changes in its morphology.Results Gallstones were confirmed in all of the 108 cases by B-model ultrasonography preoperatively.The gallstone was positive in common bile duct in 76 cases.Common bile duct dilatation was seen in 75 cases and cystic duct dilatation in 21.Common bile duct dilatation was found in 81 cases by MRCP and in 45 by CT.Cystic duct dilatation was found in 36 cases by MRCP and in 19 by CT.Cystic duct variety was found in 9 cases by MRCP.Laparoscopic transcyctic common bile duct exploration(LTCBDE)was performed in those patients with short and wide cystic duct.Conclusion MRCP is the effective method for considering the outlooks of the cystic duct in bile duct stones secondary to choledocholithiasis.