Objective To analyze perioperative process, oncologic state and prognosis of patients with rectal carcinoma treated by lapascopic abdominoperineal resection. Methods 9 cases of rectal carcinoma treated by lapascopic abdominoperineal resection were reviewed retrospectively from December 1993 to February 1996. Results The median age was 50y(30y～67y), median follow-up time 80 months(40m～90m) and median operative time 6h (4 5h～7 5h). 9 cases were operated on by standard radical operation, including abdominal procedures under laparoscope in 8 cases and under the help of mini-incision in 1 case.Complications occurred in 4 cases, including subcutaneous emphysema and urine detention, iliac vein injury, deep vein thrombosis and part mucous necrosis, and perineal wound infection in 1 case respectively. The median number of lymph nodes in the specimen was 13(4～25). 6 patients survived and 3 ones died with the survival rate at 5-year being 77.8%. Conclusions Lapascopic abdominoperineal resection in the treatment of rectal carcinoma is feasible, and it can meet the tumor resection requirements of open radical operation.

Objective To summarize surgical strategies and skills against aneurysms of posterior circulation .Methods Twenty-one cases of posterior circulation aneurysms who had undergone microsurgery between March 2008 and March 2013 were analyzed retrospectively .Two of these cases had their basilar artery aneurysms clipped via the pterion approach and five through the subtemporal approach .Five posterior cerebral artery aneurysms were clipped via the subtemporal approach , two anterior inferior cerebellar artery aneurysms were clipped via the retrosigmoid approach , three posterior inferior cerebel-lar artery aneurysms were clipped through the far lateral approach , and two vertebral artery aneurysms were clipped similar-ly approach.Results All the aneurysms were clipped successfully .According to Glasgow Outcome Scale (GOS), the cura-tive effect was poor in 3 cases(GOS 2-3 points), good in 16 cases(GOS 4-5 points) and 2 patients died(GOS 1 point). Conclusion Aneurysms of posterior circulation can be treated through microsurgery .Proper surgical strategies , operative ap-proach and delicate surgical skills are critical to the success of surgeries and curative effects .

Objective To evaluate the effectiveness of training management applying character color theory in patients with peritoneal dialysis on the compliance and dialysis effect. Methods Of 95 patients undergoing catherization for peritoneal dialysis from January 2013 to May 2014 in the peritoneal dialysis center,72 patients accepted character color psychological questionnaire designed by Le Jia for character color analysis.72 patients were divided into matched control group and experimental group according to their choice with red, yellow, blue, green character color, 36 cases in each group. The control group adopted the traditional training way of accepting 7 days′training course teached by the professional nursers,one follow- up management each month. According to the difference of character color,the experimental group were given different education training courses, interactive learning, and follow- up time. After 6 months′follow- up, the two groups adopted peritoneal dialysis self management behavior questionnaire designed by Liu Pengfeng and self- efficacy scale designed by education research center for chronic disease in Amercian Stanford University. The score of self management ability and self- efficacy and the change of load capacity, blood pressure, dialysis adequacy and biochemical indicators of the two groups were analyzed. Results In the control group and experimental group,the score of self management ability and self- efficacy and the level of dialysis adequacy were statistically significant, respectively, (5.64±1.57) points vs. (6.75±1.32) points;(5.22±1.48) points vs. (6.69±1.43) points; 1.64±1.64 vs 1.85±0.13.Z and P values were respectively -2.969, -3.828, -6.361, and 0.003, 0.000, 0.000.Edema happened in the control group was 24 cases, and 11 cases in the experimental group. P and χ2 values were 0.013 and 10.017.Systolic blood pressure and di-astolic blood pressure were respectively (147.78±15.69) mmHg (1 mmHg=0.133 kPa) vs.(135.39±9.01) mmHg,(95.86±7.50) mmHg vs. (83.94±7.46) mmHg in the two groups. Z and P values were respectively -3.843, -5.666, and 0.000, 0.000.There was significant difference between the experimental group and control group. Conclusion The education and training applying character color feature in patients with peri-toneal dialysis can mobilize the initiative of self management, improve the patients' self- care competency and self-efficacy, enhance patients′compliance, that can improve the effect of peritoneal dialysis.

Objective To investigate the operative techniques of microsurgery treatment of M1 segment of middle cerebral artery (MCA) aneurysms via pterional approach in 132 cases.Methods Retrospectively analyzed the clinical manifestation,angiograms,and surgical operation data of 132 patients with M1 segment of MCA aneurysms who underwent microsurgery through pterional approach.Results Preoperative digital subtraction angiography (DSA) was conducted in 121 cases to identify the size,shape,orientation and relationship with blood vessels around the MCA aneurysms.The other 11 cases underwent emergency operation.Among the 132 cases,72 patients were discharged in good condition according to Glasgow Outcome Scale; 41 patients were in poor condition; 19 cases were dead or in predying state.Postoperative CT showed that49 cases occurred new infarction and 7 cases developed hydrocephalus or enlargement of ventricles.Ventriculoperitoneal shunt was conducted in 2 cases.Intraoperation rupture and bleeding of aneurysms occurred in 17 cases.Conclusion The aneurysms in M1 segment of the middle cerebral artery are mostly located in the bifurcation of M1 segment.Most branches and perforating arteries stem from middle cerebral artery trunk.Patients with Hunt-hess grade Ⅰ-Ⅲ MCA aneurysms or with Hunt-hess grade Ⅳ,Ⅴ should be treated with microsurgery as soon as possible.Inside Sylvian fissure approach is the most frequently adopted in microsurgery via pterional approach.It is key for the success of the operation to preoperatively understand the anatomy surrounding the aneurysms,have good microsurgical skills and employ correct methods of preventing and managing of rupture of aneurysm.It can relieve the secondary cerebral vasospasm to clear up hematocele in the cisterns or to wash the cisterns or use adhesive wound dressing on blood vessels during operation using papaverine.

OBJECTIVE To compare three surgical hand preparations for their effects on hand skin conditions.METHODS Three surgical hand antisepsis methods were selected to compare their immediate antimicrobial(efficacies) and effect on skin conditions,including 1% chlorhexidine gluconate(CHG)and 61% ethanol(pre-surgical) waterless,scrubless hand preparation,iodophor surgical scrub with sponge,and iodophor surgical scrub with brush.RESULTS All of the three methods could achieve satisfying immediate reduction in the normal(bacterial)(flora) of the hands.The alcohol-based surgical hand rub method was gentler to skin than the other two.(CONCLUSIONS) The alcohol-based surgical hand rub is recommended for surgical hand antisepsis.

Objective To enhance therapeutic effects of hepatolithiasis by improving surgical procedures. Methods Forty eight patients suffering from hepatolithiasis with bile duct stricture were treated in this study, in whom 27% (13/48) of the stone was located in the left lobe, 19% (9/48) in the right, and 54% (26/48) in bilateral lobe. Stone coexisted with stricture in 71% (34/48). Hepatic duct and stricture were opened, making a basin at the porta, and repaired by one end of a segment of jejunum. The other end was set subcutaneously. At the same time, a portion of the liver habouring stone was resected. Results Forty four out of 48 patients were followed up (92%) with an average of 5 years. The rate of recurrent stone was 20% (9/44), the rate of cholangitis was 16% (7/44), and 84% of cases fared very well. Postoperatively, 7 cases underwent lithotomy by choledochoscope through the subcutaneous blind loop. Conclusion This procedure decreases the relapsing cholangitis effectively.

Objective To summarize the experience of surgical strategies and operational skills on multiple intracranial aneurysms of anterior circulation.Methods The clinical data of 85 patients with multiple intracranial aneurysms of anterior circulation,admitted to our hospital from October 2010 to March 2011,and the surgical strategies and operational skills on the aneurysms were retrospectively analyzed.According to Glasgow outcome scale (GOS) scores,the curative effects in these patients were rated.Results One-stage surgery was performed in all aneurysms of 79 patients and staged surgeries in 6 patients.Bilateral aneurysms were treated through unilateral craniotomy in 7 patients and bilateral craniotomy in 26 patients.One hundred and eighty-three aneurysms were clipped and 5 were wrapped.According to GOS scores,the curative effects were poor in 7 patients (GOS 2-3) and good in 76 (GOS 4-5),and 2 patients died.Conclusions Multiple intracranial aneurysms of anterior circulation should be treated as soon as possible.The reasonable surgical strategies and delicate surgical skills are critical to the success of surgeries.

OBJECTIVE3β- hydroxysteroid dehydrogenase deficiency (3βHSD), a rare form of congenital adrenal hyperplasia (CAH) resulted from mutations in the HSD3B2 gene that impair steroidogenesis in both adrenals and gonads. We report clinical features and the results of HSD3B2 gene analysis of a Chinese pubertal girl with salt wasting 3βHSD deficiency.

METHODWe retrospectively reviewed clinical presentations and steroid profiles of the patient diagnosed in Guangzhou Women and Children's Medical Center in 2013. PCR and direct sequencing were used to identify any mutation in the HSD3B2 gene.

RESULTA 13-year-old girl was diagnosed as CAH after birth because of salt-wasting with mild clitorimegaly and then was treated with glucocorticoid replacement. Breast and pubic hair development were normal, and menarche occurred at 12 yr, followed by menstrual bleeding about every 45 days. In the last one year laparoscopic operation and ovariocentesis were performed one after another for recurrent ovary cysts. Under corticoid acetate therapy, ACTH 17.10 pmol/L (normal 0-10.12), testosterone 1.31 nmol/L (normal <0.7), dehydroepiandrosterone sulfate 13.30 µmol/L (normal 0.95 - 11.67), cortisol 720 nmol/L (normal 130-772.8), androstenedione, 17-hydroxyprogesterone and progesterone were normal. Estradiol 461 pmol/L, follicle-stimulating hormone 3.04 IU/L, luteinizing hormone 8.52 IU/L in follicular phase. A pelvic ultrasound showed lateral ovaries cysts (58 mm × 50 mm × 35 mm) and a midcycle-type endometrium. A novel nonsense mutation c.73G >T (p.E25X) was identified in HSD3B2 gene. The girl was homozygous and her mother was heterozygous, while her father was not identified with this mutation.

CONCLUSIONA classic 3βHSD deficiency is characterized by salt wasting and mild virilization in female. Ovary cysts may be the one of features of gonad phenotype indicating ovary 3βHSD deficiency. A novel homozygous mutation c.73G >T(p.E25X) was related to the classical phenotype.

17-alpha-Hydroxyprogesterone ; Adolescent ; Adrenal Hyperplasia, Congenital ; diagnosis ; genetics ; Androstenedione ; China ; Codon, Nonsense ; Delayed Diagnosis ; Female ; Follicle Stimulating Hormone ; Homozygote ; Humans ; Hydrocortisone ; Luteinizing Hormone ; Mutation ; genetics ; Ovarian Cysts ; genetics ; Progesterone Reductase ; genetics ; Recurrence ; Retrospective Studies

Objective To explore the association of MTHFR C677T polymorphism and birth body mass with the vulnerability of autism in Chinese Han population. Methods Totally 1 505 children with au-tism have been recruited,using the diagnosis and statistical manual,4th revised version ( DSM-IV-R) diag-nostic criteria for autism. And 1 308 healthy control subjects sex matched with the children with autism were enrolled for the study. All the participants were identified the birth body mass ( kg) according to the birth medical recording. All the subjects were examined the MTHFR C677T genotypes,using the polymerase chain reaction- restrict fragment length polymorphism (PCR-RFLP) methods. The frequencies of genotypes,alleles and birth body mass were compared between autism and healthy control groups using the chi-square and other tests. Results The MTHFR C677T (P=0. 004,OR=1. 18,95% CI=1. 02-1. 29),low birth body mass (<2. 5 kg) (P=0. 001,OR=1. 04,95%CI=1. 02-1. 06),and their interactive effects ( P=0. 0001,OR=2. 18,95%CI=1. 44-3. 32) were associated with the vulnerability of autism. Conclusions The MTHFR C677T polymorphism,low birth body mass and their interactive effects might be associated with susceptibility of autism in Chinese Han population.