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Sleep Wake Disorders*

3 d) were noted.CONCLUSION:The Clindamycin should be used in line with the perioperative preventive medication principle by strictly following its indications to ensure the safety and rationality of its clinical use.

Objective To study the operative method for severe duodenal trauma.Methods The clinical data of 38 cases of severe duodenal trauma complicated with pancreatic injury who underwent different operations between 1992—2006 year were reviewed.Results In 8 cases duodenal diverticulization was performed,of which 5 cases were cured,2 cases developed intestinal fistula,and one died.Of 9 cases who underwent panceaticoduodenectomy(PD),3 were cured but 6 had pancreatic leakage,and 3 of them died.Of 16 cases who had primary repair of ruptured duodenum with simple suture or patch suture,13 cases cured,2 cases developed intestinal fistula and one patient died.Five patients underwent duodenal repair and excision of head of pancreas plus pancreaticojejunostomy(PD with preserved duodenum),4 cases recovered and 1 had pancreatic leakage,but 3 with wrap-type pancreaticojejunostomy had no complications.Conclusions The repair of ruptured duodenum with simple suture plus duodenostomy and jejunostomy is preferential option for majority of cases of duodenal trauma.This procedure plus removal of head of pancreas and pancreaticojejunostomy(PD with preserved duodenum) can be used for severe pancreatic injury with excellent result,but duodenal diverticulization or panceaticoduodennectomy must not be undertaken lightly.

Objective To evaluate the value and limitation of CTA, MRI and DSA in the diagnosis of the cerebral venous malformation. Methods CT angiography in 8 cases and MRI in 10 cases were performed among 12 cases of cerebral venous malformation confirmed by carotid angiography . Results All cases had typical DSA appearance and it could be seen both the number and the direction of the guide vein. The typical “Medusa-head” sign could be seen on MRI and could be more obvious after contrast enhancement.The other complications might be seen on the postcontrast. On CTA,both the lesion itself and the “caput medusae”sign could be displayed.Conclusion In diagnosis of cerebral venous malformation,DSA is the gold standard,CTA is the significant method in diagnosing and following up,while MRI is the most useful method.

Pancreaticoduodenal anastomotic dehiscence complicated with peritoneal hemorrhage following pancreaticoduodenectomy is a serious complication which threatens patients'life.Prevention and mangement of pancreaticoduodenal anastomotic dehiscence and peritoneal hemorrhage is the focus in the surgical treatment.Operation is the most reliable treatment for bleeding.While reoperation is difficult for most surgeons and the risk of fistula and rebleeding after reoperation exist.Some procedures will affect the endocrine and exocrine function of pancreas.We applied pancreaticojejunal bridge drainage for most patients with hemorrhage after pancreaticoduodenectomy.This procedure is easy,safe,and can protect the pancreatic function.

Objective To investigate the efficacy of intravenous iron sucrose combined with psychological intervention in the treatment of gynecological anemia. Methods A total of 76 patients with gynecological anemia admitted in our hospital from September 2000 to March 2017 were randomly divided into study group and control group, 38 cases in each group.The control group and gynecological anemia patients were treated with intravenous sucrose iron, the study group was treated with intravenous iron sucrose, and the corresponding psychological intervention measures were used. Results There was no significant difference in HGB and SF between the two groups before treatment., the study group after treatment HGB, SF detection value is higher than that of control group (P<0.05); study group increased to HGB for normal values of time required significantly less than the control group (P<0.05); two gynecological patients with anemia treatment in the process of research the rate of adverse reactions was 13.16%, the control group is as high as 28.95% (P<0.05). Conclusion Intravenous iron sucrose based treatment combined with psychological intervention can significantly improve the index of gynecological patients with anemia effect, reduce adverse drug reactions, to ensure the effectiveness and safety of patients are of positive significance.

OBJECTIVE:To standardize and improve the package inserts of Traditional Chinese medicine injections,and to guide clinical rational drug use and reduce incidences of adverse drug reactions(ADRs).METHODS:The package inserts of 34 kinds of traditional Chinese medicine injections commonly used in the clinic were subjected to an analysis.RESULTS & CONCLUSION:Part of the package inserts were not standard in writing contents in that they are unscientific and incompact,which thus remain to be improved.

Objective To explore the characteristics of occult damage of cerebral white matter in patients with small vessel disease by using diffusion tensor imaging (DTI)technology,and its relationship with cognitive impairment.Methods Twenty-eight patients with CSVD and twenty-three matched volunteers all received T1 WI,T2 WI,DTI examination and montperllier cognitive function scale (MoCA).Then compare the difference between the two groups,and analysis the correlation between ADC and FA value of each re-gion of interested and MoCA score in CSVD group.Results ①FA values on bilateral frontal white matter in CSVD group were lower than control group,and ADC values were higher than control group,the difference was statistically significant (P <0.05 ).There were no significant differences in FA and ADC values on corpus callosum genu and splenium between two groups (P >0.05 );②In CSVD group,the FA value of bilateral frontal lobe white matter were positively correlated with the MoCA score (P <0.05 ),and the ADC value were negatively correlated with the MoCA score (P <0.05 ).there were no significantly correlations between FA and ADC values on corpus callosum genu and splenium and MoCA score (P >0.05 ).Conclusion Bilateral frontal white matter exist fi-ber occult damage in patients with CSVD,and the change of FA and ADC value can reflect the severity of cognitive impairment on a certain degree in patients with CSVD.

Accessory pathway-induced dilated cardiomyopathy is a new diagnosis proposed recently.Pre-excitation of part of the myocardium may mediate electrical and mechanical dyssynchrony,which will result in decreased left ventricular systolic function and increased diameter of left ventricle in patients with right-sided overt accessory pathways (type B ventricular preexcitation).Its features are listed as follows:(1) Incessant and prolonged tachyarrhythmia never happened.Tachycardiomyopathy and other causes of dilated cardiomyopathy are excluded.(2) Right-sided overt accessory pathways are shown by electrocardiogram.(3)Echocardiography indicates dyssynchronous left ventricle contraction,decreased left ventricular systolic function and increased diameter of left ventricle.Normal interventricular septal motion,recovered left ventricular and reversed left ventricular remodeling can be realized by radiofrequency ablation with a good prognosis.To infant patients,taking anti arrhythmia drugs to inhibit the conduction of the accessory pathway was recommended.

Objective To review the experience in perioperalive management of 324 consecutive cases of pancreatico-duodenectomy(PD).Methods The clinical data of 324 cases of PD were analyzed retrospectively.All underwent PD successfully,275 cases received the standard PD,while,49 cases had pylorus preserving PD.Digestive tract reconstruction was done by Child method.Pancreatointestinal anastomosis was performed by pancreas stump intussussception in 303 cases,and end-to-side anastomosis in 21 cases.Results The 30 day mortality rate was 0.3%(1/324).Complicalion rate was 8.0%,included one case of liver dysfunction,7 cases with pancreatic fistula and intraabdomind bleeding,1 case of stenosis of pancreaticoenteral anastomosis,3 cases with pancreatic dysfunction,4 cases with gastroenteral anastomosis ulcer,6 cases with delayed gastric emptying,1 with reflux of bile and 3 with lymphatic fistula.Conclusions Perioperative managemen for pancreaticoduodenectomy is crucial for patient prognosis.Carful perioperative management can decrease postoperative complications and ensure smooth recover of these patients.