It is generally known that postoperative pain can cause many adverse clinical effects on the patients of orthopaedic surgery such as lack of exercises of the involved limb,atrophy of the related muscles,anchylosis,osteoparosis,et al,which will ultimately affect the patient's final recovery and living quality.This paper introduces some recent advanced theories about the orthopaedic postoperative pain diagnosis,evaluation and various kinds of treatments hoping to achieve more effective perioperative analgesia in orthopaedic surgery.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; Adult ; Aged ; Catgut ; utilization ; Female ; Humans ; Male ; Middle Aged ; Sleep Initiation and Maintenance Disorders ; therapy

Objective To investigate the clinical value of Holter monitor(DCG) in the diagnosis and treatment of dilated cardiomyopathy (DCM).Methods According to NT-proBNP ＞ 2 000pg/mL,left ventricular ejection fraction (LVEF) ≤40％,New York Heart Association (NYHA) rated Ⅲ-Ⅳ,67 patients with DCM were divided into the high risk group and nonhigh risk group.All kinds of arrhythmia patients proportion was compared between the two groups,in order to understand the risk factors of DCM and arrhythmias.Results In high risk group,18 cases had ventricular tachycardia,the incidence rate was 66.7％,which was significantly higher than that of non high risk group (2 cases,5.0％) (x2 =29.271,P ＜ 0.01).While other arrhythmia,atrial premature beats,single premature ventricular contraction,atrial fibrillation and so on,had no statistical difference (P ＞ 0.05).Conclusion The DCM patients with various types of arrhythmia,ventricular tachycardia in patients directly influence the severity and prognosis,Holter monitor has an irreplaceable role.

Animals ; Diazepam ; pharmacology ; Drug Antagonism ; Electroencephalography ; Female ; Male ; Pyrazoles ; poisoning ; toxicity ; Rats ; Rats, Sprague-Dawley

BACKGROUND: How to acquire high-purity epidermal stem cells (ESCs) and maintain ESC phenotype and in vitro proliferation characteristics are urgently solved problems in the in vitro culture of ESCs.OBJECTIVE: To establish methods to in vitro isolate and culture human ESCs.DESIGN,TIME AND SETTING: Cell observation was performed in the Department of Bum,First Affiliated Hospital of Nanchang University.MATERIALS: Foreskin was obtained front 2-12-year-old patients who were subjected to circumcision.These patients did not suffer from urinary system infection.METHODS: Keratinocytes and fibroblasts were isolated from foreskin using Dispase Ⅱ and trypsin.ESCs were isolated by rapidly adhering to type Ⅳ collagen.The supematant fluid of fibroblasts of passages 2-3,which were in the exponential growth phase,was collected.After screening,the supematant fluid was mixed with serum-free medium of keratinocytes at the proportion of 1:1.Simultaneously,fetal bovine serum,epidermal growth factor,and bovine pituitary extract were added to prepare medium of ESCs,which was used for in vitro proliferation of human ESCs.Homologous keratinocytes were used as controls.MAIN OUTCOME MEASURES: After 2 passages,cloning efficiency and cloning sustaining time were calculated by plate clone formation assay.Expression levels of β 1 integrin and keratin 19 were detected by immunohistochemistry.RESULTS: The cloning efficiency of human ESCs was significantly increased,and the cloning sustaining time was significantly prolonged as compared with homologous keratinocytes cultured in the same batch (P ＜ 0.01).lmmunohistochemistry results demonstrated that both β 1 integrin and keratin 19 were positive in the human ESCs.CONCLUSION: Keratinocytes could be successfully isolated by means of rapid adherence to type Ⅳ collagen and cultured with conditioned medium in vitro.

Objective To evaluate the technique of laparoscopic pyeloplasty. Methods 11 cases with ureteropelvic junction (UPJ) obstruction underwent laparoscopic pyeloplasty via post abdominal cavity approach. Results All the operations have been successful,the operating time being 2 to 4 h and the blood loss 40 to 90 ml. Ultrasound B investigation 3 to 24 months after the procedure showed no hydronephrosis in all and IVU analysis in 6 cases one year after the operation disclosed good outcome with less morbidity. Conclusions Laparoscopic pyeloplasty is an effective way to treat UPJ obstruction with minimal trauma to the patient.

Objective To evaluate laparoscopic radical prostatectomy for prostate cancer. Methods 8 patients presented clinical stages pT 1b to pT 2 prostate cancer.Laparoscopic radical prostatecomy was carried out transperitoneally with combining posterior and anterior approachs to the prostate,transecting the bladder neck,lateral dissection of the prostate and urethrovesical anastomosis. Results The operation time was 5 to 11 h with an average of 7.3 h and the blood loss 200 to 1 100 ml,averaged 620 ml.All the patients recovered well and uneventful with no complications such as urethral stricture or incontinence. Conclusions Laparoscopic radical prostatectomy is a better approach and least invasive.The procedure provides clear anatomic vision that facilitates operative performance and quicker recovery.

Objective To describe the ureteroplasty of congenital obstructive megaureter by laparoscopy and to evaluate the efficacy and feasibility of laparoscopic intervention for congenital obstructive megaureter. Methods Six patients with congenital obstructive megaureter were prepared for the laparoscopic surgery.The surgical procedure was briefly described as follows.The dilated ureter was dissected and cut off near the ureter orifice to the bladder by laparoscopy.Next,the free ureter was pulled out through the skin trocar site and was tailored as open surgery.After that,the ureter was placed back to the abdominal cavity and reimplanted laparoscopically into the bladder. Results The operation duration was 2 to 4 h (mean 2.4 h) and blood loss was very little (20～35 ml).No complication developed.The double J stent was removed at 3 months after the operation.Follow-up for half to 2 years showed that all the ureter drainage in the 6 cases was well without any infection. Conclusions Our preliminary result shows that laparoscopic surgery is a safe and effective method for treatment of megaureter.

Objective To study the anatomical feature s of the retroperitoneal cavity around kidney under laparoscope and to provide ana tomical guidance for laparoscopic surgery. Methods Lapar oscopic renal and ureteral operations were performed on 241 patients (145 men an d 96 women; age range,16-75 years;mean age,45.3 years).Through the videos and ph otographs of these operations,the anatomical features were analyzed.The atlas wa s drawn and surgical access was designed. Results Under laparoscope lateral conal fascia continues from the fascia of quadratus lumborum at its lateral border.This fascia covers posterior lamella of Gerota’s fascia and fuses into transversalis fascia beneath peritoneum. Fusion fascia lies befor e anterior lamella of Gerota’s fascia. It extends laterally and disappears grad ually to the lateral reflexion of peritoneum.The plane between fusion fascia and anterior lamella of Gerota's fascia, the plane between lateral conal fascia and posterior lamella of Gerota’s fascia, the plane before the quadratus lumborum and psoas major, are all vessel-free planes.Lateral border of colon,peritoneum and fusion fascia form a triangle lateral to colon.Fusion fascia,lateral conal f ascia and Gerota’s fascia form a vessel-free triangle. Conclusions Dissection through the vessel-free planes prevents laparoscopic op erations from bleeding and organ injury.Full understanding of the laparoscopic a natomical features of the retroperitoneal cavity around kidney provides the anat omic theoretical basis for laparoscopic operations.

Objective To evaluate the therapeutic effects of functional reconstructive technique of laparoscopic radical prostatectomy (LRP) for organ confined prostate cancer. Methods From October 2000 to September 2004,54 patients with organ confined prostate cancer (TNM stage of T 1b-T 2) underwent LRP.After completion of the first group of 15 consecutive cases (group A) by Monstouris techniques, the functional reconstructive surgical technique, which is basically composed of anatomical radical prostatectomy,was introduced to LRP in the second group of 39 consecutive cases (group B).These techniques mainly consisted of preservation of urethral and bladder outlet sphincter muscles,reconstruction of bladder neck,and fine anastomosis between urethra and bladder neck with fixation of anterior wall of anastomotic stoma and retropubic vascular complex.The operative time, bleeding volume,complications,continence recovery time and PSA level were comparatively analyzed between the 2 groups. Results All the operations were successful in 54 patients.In group A and group B,the mean operative time was 390 min(range,270-660 min)vs 240 min(range,180-360 min);the mean bleeding volume was 430 ml(range,200-1100 ml) vs 160 ml(100-400 ml);the complication rate was 40% (6/15) vs 13% (5/39) and the continence recovery time was on average 6 months vs 3 months,respectively. There were statistically significant differences in these parameters between the 2 groups (P