Objective A 23-year-old female patient who had a past history of sexual - precocity and fracture developed hyperhyroidism 8 months ago. Radiological examination revealed enlargement of sella turcica and a adrenal gland nodule. The patient was diagnosed to have McCune -Albright syndrome and scheduled for resection of left subtotal adrenalectomy under general anesthesia. The patient was taking (1) thiamazole 5 mg t. i. d. and propranolol 10 mg q. d. for hyperthyroidism; (2) adalat 10 mg t. i. d. and potassium citrate 20 ml t. i. d. for Cushing syndrome and (3) calcium tablets for osteoporosis. Anesthesia was induced with intravenous midazolam 1 mg, fentanyl 50 ?g and vecuronium 1 mg followed by propofol 150 mg and succinyl choline 100 mg. The patient was intubated and mechanically ventilated (VT = 500 ml, RR =10 bpm, I: E = 1 :2) . PET CO2 was maintained between 35 - 45 mm Hg. Anesthesia was maintained with inhalation of isoflurane and N2O - O2 (1:2) and intermittent i.v. boluses of fentanyl and vecuronium. The BP was increased to 180/110 mm Hg after induction of anesthesia. Urapidil 10 mg was given intermittently i.v. During the exploration of adrenal gland BP was again increased to 200/140 mm Hg. Nitroglycerin was infused i.v. and BP was decreased to 120-130/80-90 mm Hg and was kept at this level till the end of operation. Hydrocortisone succinate 100 mg was infused i.v. slowly after operation. The operation went smoothly. The patient was extubated and the postoperative course was uneventful.

Objective To compare the effects of desflurane, enflurane and isoflurane on onset time,duration of action and recovery time of pipecuronium. Methods Thirty ASA Ⅰ-Ⅱ patients aged 18-60yr weighing40-80 kg were randomly divided into 3 groups: (1) desflurane group (n = 10); (2) enflurane group(n = 10) and(3) isoflurane group (n = 10). The patients were premedicated with intramuscular pethidine 1 mg?kg~(-1) andatropine 0 .01 mg?kg. Anesthesia was induced with midazolam 0. 03 mg?kg~(-1), propofol 0.5-1 .0 mg?kg~(-1)andfentanyl 2?g?kg~(-1) .When the patients fell asleep neuromuscular function was monitored by accelerography usingTOF stimulation. Pipecuronium 0.045 mg?kg~(-1) was given i. v. as soon as T_1 was 100 % blocked (T_1= 0), anotherdose of propofol was given, making the total dose of propofol amount to 2.5 mg' kg?kg~(-1).Tracheal intubation wasperformed. The patients were mechanically ventilated and P_(ET) CO_2 was maintained at 35-45 mm Hg. Desflurane oreaflurane or isoflurane was inhaled with N_2O-O_2(2: 1) .The end-tidal desflurane, enflurane or isofluraneconcentration was maintained at 0. 65 MAC(desflurane= 3. 9 %, enflurane = 1. 1 %, isoflurane = 0. 75 % ). Duringoperation when deeper anesthesia was needed intermittent i. v. blouses of fentanyl were given. The onset time, thetime needed for T_1 to return to 5 %, 10 %,25 %, 50 %,75 % of control and recovery index were recouled andcompared among the three groups.Results The demographic data including age, weight, sex and types ofoperation were not significantly different among the 3 groups. Three were no significant differences in onset time,recovery time (time for T_1 to return to 5 %, 10 %,25 %,50 % and 75 % of control) and recovery index amongthe 3 groups. Conclusion Desflurane can prolong the duration of action and recovery time of pipecuronium justlike enflurane and isoflurane but there were no significant differences among the 3 groups.

Objective To investigate the effect of capecitabine on serum tumor necrosis factor α( TNF-α) , interleukin-6 ( IL-6 ) , vascular endothelial growth factor (VEGF) and tumor biomarker (CEA,CA19-9 and CA125)levels in patients with advanced gastric cancer (AGC) and its efficacy and adverse reactions.Methods One hundred and sixty-one AGC patients from October 2012 to October 2014 in the hospital were randomly divided into control group (n=78) and observation group (n=83).The control group were treated with cisplatin in combination with docetaxel, while the observation group were treated with capecitabine on the basis of control group.The efficacy, adverse reactions and serum levels of TNF-α, IL-6, VEGF and tumor biomarkers were compared between two groups.Results There was no significant difference in effective rate between observation group and control group (50.6%vs.43.6%,χ2 =0.793,P=0.373) and disease control rate (78.3%vs.69.2%,χ2 =1.720,P=0.190).The half a year,1-year and 2-year survival rates in observation group were significantly higher than those in control group (90.4%vs.71.8%,78.3% vs.57.7%,60.2%vs.41.0%,all P<0.05).The gradeⅠ-Ⅱ adverse reactions of gastrointestinal tract in observation group was significantly higher than control group(P<0.05).After treatment, serum VEGF level in observation group was lower and serum TNF-α,IL-6 levels were higher than those in control group (P<0.05).The serum levels of CEA, CA19-9 and CA125 in observation group were lower than those in control group ( P <0.05 ) .Conclusion Capecitabine could improve immunologic function and inhibit tumor angiogenesis, which has an exact effect and increase survival rate of advanced gastric cancer patients with minor adverse reactions.Its mechanism may be regulating serum VEGF, TNF-α, IL-6 and tumor biomarkers of CEA, CA19-9 and CA125.

Objective Anti-N-methyl-D-Aspartate (NMDA) receptor encephalitis is a rare disease,recently described as autoimmune disorder of paraneoplastic limbic encephalitis,which is related to the NMDA receptor antibodies and frequently develops in young women with ovarian teratoma.The disease is usually accompanied by symptoms of psychosis and abnormal behaviors,autonomic nervous system dysfunction,central hypoventilation,and hyperthermia.During induction and maintenance of general anesthesia,we should be aware of adverse reactions such as cardiovascular events,hyperthermia and respiratory insufficiency.In order to maintain vital signs stable,pharmacological agents including vasopressors,β-blockers,antihypertensives,and anticholinergics should be prepared before the surgery.Invasive monitoring for blood pressure can be set if necessary.This study described the method for anesthetic management of 3 patients with anti-NMDA receptor encephalitis undergoing resection of ovarian teratoma under general anesthesia.Preoperative treatment included antipsychotic,anti-infective and immune therapy.General anesthesia was induced with propofol,rocuronium,fentanyl and midazolam to facilitate tracheal intubation and was maintained with inhalation of sevoflurane (mixed with oxygen and air) and intermittent iv boluses of fentanyl and rocuronium during the surgery.All the drugs mentioned above had no interaction or had slight indirect action on anti-NMDA receptors to avoid NMDA-related adverse reactions.In conclusion,the adequate preparation for the surgery should be done in this kind of patients,we should avoid using anesthetics having NMDA receptor antagonism (such as ketamine,N2O,methadone,dextromethorphan,phencyclidine) or other anesthetics acting indirectly (such as pentobarbital) on the NMDA receptors during anesthetic management in the patients with anti-NMDA receptor encephalitis.

Objective To evaluate the topical anesthetic effects of compound lidocaine cream ( CLC) coated endo-tracheal tube on the prevention of cough/agitation during extubation in thyroidectomy under general anesthesia . Methods 42 patients scheduled for thyroidectomy in Peking Union Medical College Hospital were continuously en -rolled in this prospective double-blinded randomized controlled trial .Patients were randomized into two groups . Group L were intubated with endotracheal tube coated with CLC , while the control group , group C with liquid par-affin .The end point of study was spontaneous or induced cough /agitation during extubation .Hemodynamic parame-ters and the consumption of opioids were recorded .Patients were followed for major complications during their stay in hospital .Results Spontaneous cough/agitation rate was lower in group L than group C ( 15% vs 65%, P<0.01 );so was induced cough/agitation (35%vs 90%, P<0.001 );the value of SBP ×HR was lower in group L at 1 min after extubation ( P<0.05 ) .Conclusions The topical anesthetic effects of CLC coated endotracheal tube could prevent cough and agitation during extubation in thyroidectomy under general anesthesia .

Objective To evaluate the effects of different sequences of intravenous administration on fentanyl-induced cough during induction of general anesthesia.Methods One hundred patients of both sexes,aged 18-70 yr,weighing 42-88 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia,were equally randomized to 2 groups using a random number table:fentanyl-propofol group (group FP) and propofol-fentanyl group (group PF).In FP group,fentanyl 3 μg/kg was injected intravenously over 3 s,and then propofol 1.5 mg/kg was injected intravenously.In PF group,propofol 1.5 mg/kg was injected intravenously,and then fentanyl 3μg/kg was injected intravenously over 3 s.The development,intensity and onset time of cough were recorded within 1 min after fentanyl injection.Results Compared with FP group,the incidence of cough was significantly decreased,and no significant change was found in the intensity and onset time of cough in PF group.Conclusion Administration in the propofol-fentanyl sequence can reduce the development of fentanyl-induced cough as compared with that in the fentanyl-propofol sequence during induction of general anesthesia.

Objective To develop a HPLC method for determining the contents of lobetyolin and gallic acid in Eighteen Flavors Dangshen Pill(EFDSP) produced by different factories.Methods The HPLC analysis was performed on a VP-DOS C18 column (4.6 mm×150 mm,5 μm).The mobile phase was acetonitrile and 0.4% glacial acetic acid(21∶79) in the determination of lobetyolin content.The detection wavelength was 267 nm and the flow velocity was 1 mL/min.the column temperature was25 ℃ and the sample size was10 μL.The mobile phase was methanol and 0.4% glacial acetic acid(1∶99) in the determination of gallic acid content.The detection wavelength was 280 nm.The column temperature was 25 ℃ and the sample size was 10μL.Results The contents of lobetyolin and gallic acid in EFDSP were 1.0835mg·g-1and 15.334 0 mg/g for Qinghai Gela Dandong Tibetan Pharmaceutical Factory;0.628 9 mg/g and 15.159 5 mg/g for Changdu Tibet Medicine Factory;0.306 5 mg/g and 8.762 7 mg/g for Tibetan Hospital of Tibet.Conclusion This method has the advantages of good reproducibility,good accuracy,simple and fast operation.The contents of lobetyolin and gallic acid in EFDSP produced by different manufacturers are significantly different.The gallic acid content has greater difference.It provides the reference for quality control of EFDSP

Objective:To combine human anatomy preferably with Tibetan medical anatomy,thus,teaching quality and level of human anatomy has been improved.Method:To explain the major terms of Tibetan medical anatomy;combining with the Tibetan medical anatomy,to write the human anatomy teaching materials that fit the anatomy teaching of the Tibetan medical specialty to improve the teaching method;at the same time,to observe the teaching effects through the analyses of the questionnaire and exam results.Result:Shown as the investigation,those who think that the teaching materials have helped more to study human anatomy are taking 90.6%.After using this teaching material,people who think that those teaching materials has helped more tostudy Tisetan medical anatomy are taking 79.2%;Examination result analysis shows that,in two classes,before the teaching reform was implemented,students of above 80 marks were 12.5%,but after the teaching reform was implemented,those were 57.8%.Conclusion:The teaching material construction and teaching method reform brought into positive effects in the anatomy teaching quality improvement of the Tibetan medical specialty.

OBJECTIVE: To describe and analyze the clinical features of nasal respiratory epithelial adenomatoid hamartom and improve the levels of diagnosis and treatment. METHOD: Fourteen cases of nasal respiratory epithelial adenomatoid hamartom confirmed by pathology were collected and analyzed. RESULT: In 14 cases, primary complaint of Hyposmia(or Anosmia)and nasal obstruction were occured in 13 and 11 cases respectively. Four cases had past history of endoscopic sinus surgery because of the diagnosis of nasal polyps. Polypoid neoplasms could be seen in the bilateral olfactory clefts. Sinus CT showed soft tissue shadows in bilateral nasal cavity and mucous membrane thickening in different sinus. Endoscopic sinus surgery were utilized to eliminate focus in all cases. All cases weren t recurred after 2-20 months' following-up visitings. CONCLUSION Nasal respiratory epithelial adenomatoid hamartom is so rare that clinical and pathological doctors have limited knowledge of it. It has its own characteristics from the clinical symptoms, signs to sinus CT although they are nonspecific. So we should improve the understanding about it to avoid misdiagnosis or missed diagnosis.
Diagnosis, Differential ; Endoscopy ; Hamartoma ; diagnosis ; pathology ; surgery ; Humans ; Nasal Cavity ; Nasal Obstruction ; Nasal Polyps ; Neoplasm Recurrence, Local ; Nose Neoplasms ; diagnosis ; pathology ; surgery ; Paranasal Sinuses