Objective To explore clinical indications and curative effects of microwave coagulation combined with submucous 5-fluorouracil (5-FU) injection in the management of early-stage lower rectal cancer. Methods Nine patients with early-stage lower rectal cancer underwent microwave coagulation with submucous 5-FU injection from January 1996 to December 2002. After the microwave treatment, a retention enteroclysis with 100~200 ml normal saline containing 1.0 g 5-FU was performed once daily for 3 days. Results In 3 patients, levels of carcinoembryonic antigen (CEA), which were preoperatively increased, were reduced below normal limits after microwave treatment. No hemorrhage or other intra- or post-operative complications was observed. Follow-up observations to January 2006 showed that all the 9 patients survived. One patient survived for 3 years and 5 months, 1 patient survived for 3 years and 8 months, and 1 patient experienced a tumor relapse at 1 year and 4 months and survived for 2 years and 9 months after a Miles procedure. Among 6 patients who survived longer than 5 years, 1 survived for 5 years and 1 month, 1 for 6 years and 3 months, 1 for 6 years and 8 months, 1 for 7 years and 6 months, and 2 for 9 years. Conclusions Surgical indications for microwave coagulation combined with submucous 5-FU injection for rectal cancer included early-stage cancer, lesions located within 7 cm away from the anus, the mass type cancer, tumor diameter at 0.5~3.0 cm or less than one third of the rectum’s circumference, well differentiated tumor, and patient’s strong anus-sparing demand. This method is minimally invasive, safe, reliable, and cost-effective.

ObjectiveTo explore the diagnosis and surgical treatment techniques for the patients with primary presacral tumor.Methods Data from 31 patients with primary presacral tumor admitted into our Department for Surgery from Jan. 1999 to Jar. 2009 were retrospectively analyzed.All patients underwent surgical treatment,among them,10 received per-sacroiliac or per-perineum approaches to remove the tumors,18 receivedper-abdomentumorectomy, and3receivedcombinedper-peritoneumandper-perineum tumorectomy.Results Patients visited the doctor while exhibiting the compression symptoms by the the tumors.Final diagnosis could be reached with the help of rectal touch,B-mode ultrasound,computerized tomography,or magnetic resonance imaging.Complete resection was performed in 28 patients.Partial resection was performed in 3 patients.Fractionated resection was successfully performed in 2 patients with chronic infection or sinus tract.ConclusionThe primary presacral tumor should be surgically resected once final diagnosised and without surgical contraindications.Pelvic plexus should be preserved and presacral hemorrhage should be prevented.The tumor should be resected as complete as possible.

Objective To investigate the difference of neuromuscular blocking effect of cis-atracurium under sevoflurane anesthesia between the genders. Methods 30 ASA Ⅰ or Ⅱ patients aged from 18 to 45 years who scheduled for laparoscopic operation were divided into two groups, male group( M group, n = 15 ) and female group ( F group,n = 15). After induction of Anesthesia all cases were maintained with remifentanyl 3μg/L(TCI) and sevoflurane.After 40 minutes of stable end-tidal anaesthetic concentration, a total dose of cisatracurium 45 μg/kg was divided into 3 equal doses( 15μ g/kg each) ,which was administered accumulatively in each patient. The next dose was given when the effect of the previous dose had reached its peak ( T1 was no longer depressed in the height of 3 successive stimuli).Neuromuscular block was monitored using accelograph(TOF GUARD,Denmark). The onset time and maximum depression of T1 of the initial dose and 2 incremental doses were recorded. The cumulative dose-response curves of the two groups were established. The effective dose to obtain 50% and 95% neuromuscular block( ED5o and ED95 ,respectively) were calculated from individual dose-response curves. After the lastincrement of 15 μg/kg, the time for T1 to return to 25% ,50% ,75% and TOF ratio(T4/T1 )to 70% were recorded. The recovery index( RI)was also calculated.Results The mean ED5o and ED95(95% confidence interval)of cisatracurium of women were 22.2( 15.8 ～27.2)and 38.4 ( 32.1 ～ 54.4) μg/kg during sevoflurane (1.3MAC) anaesthesia, while the data of men were 25.6 ( 19.7 ～30.8) μg/kg and 42.8 ( 36.3 ～ 58.2 ) μg/kg, the difference between groups had no statistical significance ( P ＞0. 05). There was no significant difference in the TOF ratio ( T4/T1 ) to 70% and recovery index between the two groups( P ＞0.05 ). The onset time of F group was shorter than M group. The time for T1 to return to 25% ,50% and TOFR 0.7 was significantly longer in the F group than in the M group (P ＜ 0.05). Conclusion The neuromuscular blocking effect of cis-atracurium under 1.3MAC sevoflurane anesthesia remained no difference between genders. But the onset time of women was much faster. Furthermore the effect on the time for T1 to return to 25% ,50% and TOFR 0.7 were greater than men.

[Objective]This study was designed to investigate the effects of small volume resuscitation with different fluids on the lung of endotoxie rats.[Methods]Thirty SD rats weighting 180-250 g were divided randomly into 5 groups(n=6):Group C[lipopolysaccharide(LPS)negative control group],Group E(LPS+4 mL/kg physiologic saline),Group HSS(LPS+4 mL/kg 75 g/L hypertonic saline solution),Group HES(LPS+4 mL/kg hydroxyethyl starch 130/0.4),Group HSH(LPS+4 mL/kg 75 g/L hypertonic sodium chloride hydroxyethyl starch 40).Resuscitation was administrated 30 min after LPS injected.Pathological examination and score were made under optical microscope.Dry/wet ratios were observed.Levels of total protein of bronchoalveolar lavage fluid(BALF)were measured.Thibabituric acid(TBA)was used to measure tissue malonaldehyde(MDA)levels.Xanthine oxidase(XO)was employed to measure the tissue activity of superoxide dismutase(SOD).[Results]Compared with group C,in the other 4 groups,pathological changes were server.Levels of total protein of BALF were higher(P＜0.05).Pathological score of group E was significantly higher(P＜0.01).Dry/wet ratio of group E was lower(P＜0.05).Tissue activity of SOD of group E was lower(P＜0.01).Levels of tissue MDA in group E and HSS were significantly higher.Compared with group E,in group HSS,HES and HSH,pathological changes were slighter(P＜0.01).Pathological scores and tissue MDA levels were lower(P＜0.01).Dry/wet ratios were higher(P＜0.05).Tissue activity of SOD were higher(P＜0.01),levels of total protein of BALF were lower(P＜0.05,P＜0.01).[Conclusion]Small volume resuscitation with HSS,HES,and HSH had protective effects on the lung of endotoxie rats.HES and HSH had better effect on decreasing the capillary permeability of the lung of endotoxic rats lung compared with HSS.

AIM: To investigate the effects of non-ventilated lung with N_2O on systemic oxygenation and lactic acid level in arterial blood during one lung anesthesia. METHODS: Twenty-two patients, ASA Ⅰ-Ⅲ, scheduled for selective pulmonary surgery, were randomly divided into two groups: control group (group A, n=11) and observation group (group B, n=11). Group A: the non-ventilated lung was kept open to the air; group B: N_2O 2 cmH_2O through CPAP system was insufflated into the non-ventilated lung during one lung ventilation. The anesthesia was induced with intravenous midazolam (0.05 mg?kg~(-1)), propofol (0.5-1.0 mg?kg~(-1)), fentanyl (4 ?g?kg~(-1)), and vecuronium (0.1 mg?kg~(-1)) and was maintained with inhaling isoflurane. Blood gas analysis and lactic acid was recorded 20 min after two-lung ventilation (TLV) in the supine position, 20 min after one-lung ventilation (OLV) in the supine position, 20 min and 40 min after OLV in the lateral position and at the end of operation and the shunt fraction was calculated. RESULTS: PaO_2 in group B was significantly higher than that in group A (P

Objective To explore the effects of preoperative neoadjuvant endocrine therapy on expression and significance of ER, PR, C-erbB-2 in pestmenopause breast cancer patients over 60 years old. Methods 36 patients were treated with endrocrine therapy by oral tamoxifen for 60 ～ 90 days, and the expression of ER, PR and C-erbB-2 was examined before and after the endrocrine therapy. Results In 36 patients the negative expres-sion rate of ER, PR was 16.78% and 11.11% respectively before the endrocrine therapy, compared to 50% and 33.33% after the endrocrine therapy. There was significant difference(P<0.05). The expression of C-erbB-2 was 13.8% and 16.67% before and after the endrocrine therapy, and there was no significant difference between the two figures. Conclusions The neoadjuvant endocrine therapy by tamoxifen alone can down-regulate the ex-pression of ER, PR, and can inhibit tumor growth. Some patients may get partially relieved.

Objective To study the preoperative application value of the three-dimensional angiography in surgical strategy for the elderly patients with meningioma. Methods Forty-two elderly patients aged 60 years and over with meningioma were examined preoperatively with multi-slice spiral CT angiography(MSCTA) and (or) 3 dimensional contrast-enhancement MR angiography(3D CE-MRA)as simulation group.In three-dimensional post-processing workstation,the oppression and invasion degree of the intracranial important blood vessels,nervous running zone and sinus,as well as surgical risks were evaluated. 28 elderly patients without the above examination were as control group. The operation time, blood transfusions and postoperative complications were compared between the two groups. Results All 42 cases of simulation group completed reasonable surgical plan and approach.The incidence of postoperative complications were lower in simulation group than in control group (35.7％ vs.50.0％,P＞0.05),intra-operative blood transfusion were significantly decreased in simulation group as compared with control group [(5301.0± 150.6) ml vs.( 621.4±226.7)ml,t=2.01,P=0.049],operation time after three-dimensional simulation were reduced as compared with control group [(257.1 ±72.6) min vs.(307.5±88.2)min,t=2.61,P=0.011].Conclusions Application of three-dimensional angiography in elderly patients with meningioma to evaluate the operative risk may help make reasonable surgical strategy,thus reducing the surgical trauma and complications.

Objectlve investigate the role of Toll-like receptor 2 (TLR2) on polymorphonuclear neutrophil (PMN) during perioperative period in the development of postoperative systemic inflammatory response syndrome (SIRS) in patients undergoing orthotopic liver transplantation (OLT).Methods Twenty patients (18 male and 2 female, aged 33-58 yr and weighing 52-73 kg) with ASA Ⅲ or Ⅳ (NYHA Ⅱ or Ⅲ )undergoing OLT were studied. Blood samples were collected from the central vein for determination of TLR2 expression on PMN and plasma TNF-α, IL-1β and IL-8 concentrations before induction of anesthesia (T1, baseline), at 25 min of anhepatic phase (T2), 3 h (T3) and 24 h after beginning of reperfusion of the allograft (T4). The expression of TLR2 was measured by flow cytometry and the serum concentrations of TNF-α, IL-1β and IL-8 were measured by enzyme linked immunosorbant assay (ELISA). The patients were divided into SIRS and non-SIRS group depending on whether the patients developed SIRS or not within 7 days after operation. The diagnosis of SIRS was based on the criteria laid down by ACCP and SCCM in 1992.Results Ten patients developed SIRS within 7 days after operation. There was no significant difference in Child-Turcotte-Pugh (CTP) scores between the two groups. Compared with non-SIRS group, the TLR2 expression on PMN and the serum IL-1β concentration were significantly increased at T4 and the serum IL-8 concentration was significantly increased at T3 in SIRS group.There was positive correlation between serum TNF-α concentration and TLR2 expression on PMN in SIRS group ( r= 0.607, P ＜0.05).Conclusion The expression of TLR2 on PMN increases significantly at 24 h after beginning of reperfusion of allograft and may play an important role in the development of postoperative SIRS.

Objective To study the reasons and prevention of the hoarse voice after continuity-intact recurrent laryngeal nerve (RLN)operation without damage of RLN under naked eyes.Methods Data of 1871 patients undergoing thyroid surgery from Jan.2001 to Jan.2011 were retrospectly analyzed.919 patients had their RLN exposed,among whom 757 patients had bilateral RLN exposed.952 patients didn't have their RLN exposed in the surgery.Results A total of 1676 RLNs were exposed by the routine method and minimally invasive method.All the nerves were confirmed no damage and continuity intact under naked eyes.Hoarse voice occurred to 19patients after surgery,with the percentage of 2.12％ (19/897).The rate of hoarse voice in the non-exposed group was 5.46％ (52/952).The difference of horse voice between the RLN exposed group and non-exposed group had statistical significance(P ＜ 0.05).Conclusions RLN without damage under naked eyes and continuity intact doesn't mean no damage of electroneurophysiology.The rate of RLN damage in the exposed group was less than that in the non-exposed group.The major causes of hoarse voice may include misoperation,heat conduction and postoperative scar adhesion.The key to avoid RLN damage is prevention.

Objective To probe the value of multi-slice spiral CT angiography (MSCTA) in decreasing surgical trauma of the cranial base meningioma. Methods Thirty-two patients with cranial base meningioma were examined preoperatively with MSCTA to observe the shape and the relationship with the adjacent vessels and the skull base. Three-dimensional images were reconstructed to imitate the approach of operation and compared with surgical findings. Meanwhile, 22 patients withnot MSCTA were selected randomly as control group. The amount of blood transfusion and the occurrence rate of complications were compared between the two groups. Results MSCTA depiceted clear three dimensional images of the meningioma and the relationship with the adjacent vessels and the skull base, corresponded very well to the surgery. By imitating the operation, all patients were designed the incision size of bone appropriately, the vessels of peritumoral were kept off effectively and the risk of the embedded vascular were assessed accurately. The conventional surgical approach and method were changed in 9 patients, 4 formulated the planning of the sub-total resection and radiotherapy preoperatively. Compared with control group, the amount of blood transfusion reduced significantly (P<0.05) and postoperative complications decreased. Conclusion MSCTA can imitate the surgical operations in multi-angle and supply the vital information for choosing the proper surgical approach, thereby reducing surgical trauma and postoperative complications.