Objective To approach the hemodynamic effects of combined spinal-epidural anesthesia in 65 years or older patients. Methods In a prospective study, 60 American Society of Anesthesiologists Ⅱ～Ⅲ patients (aged 65 yr or older), undergoing elective TKR surgery were randomLy assigned to either CSE an-esthesia (CSEA, n=30) or epidurai anesthesia alone (CEA, n=30). The age, sex, duration of surgery, blood loss, fluid infusion during the surgery and main complications were recorded. Hemodynamic measure-ments included invasive or non-invasive mean arterial blood pressure (MAP), heart rate (HR) before an-aesthesiaufe, 15 wins after anaesthesia and the end of surgery. Our primary endpoint (outcome) was the number of hypotension and bradycardic episodes (defined as MAP<70 mmHg and HR<50 beats per mi-nute). Cases of blood bandage were also recorded. Results There was no significant difference between two groups in the age, sex, duration of surgery, blood loss, fluid infusion and main complications. Using univariate analysis, we found no significant differences between the groups in regards to MAP, HR during the perioperative period. The incidence of hypotension was similar in both groups (7 patients in CSEA and 6 in CEA group, P=0.704), as of bradycardia (3 patients in CSE, 5 in epidural, P=0.754). The inci-dance of blood bandage pain of CSE group was higher than CSEA group. Conclusion Combined spinal-epi-dural anesthesia and epidural anesthesia alone during TKB surgery are associated with the same incidence of hypotension with statistically and clinically similar hemodynamic responses.

Objective Investgate the anesthetic management of patients with brachiocephaliic arteritis.Methods Review and analysis the clinic data of eleven cases of brachiocephaliic arteritis.Results The process of anesthesia is smooth,and haemodynamics is stable during peri-operation.Two patients was dead of MODS.Conclusion The keys of anesthstic management of brachiocephaliic arteritis are maintaining the haemodynamics steady and the blood supply to the brain,and the protection of the brain function.

Objective To summarize the methods of diagnosis and results of surgical treatment of pancreatic insulinoma. Methods The clinical data of 137 patients with insulinoma treated in our hospital during the past twenty-six years were reviewed retrospectively.Results There were 77 males and 60 females. All of them were characterized by the Whipple′s triad. The sensitivity of ultrasonography, CT and MRI for localization was 35.1%, 67.9% and 58.1% respectively. One hundred and tweenty-six patients underwent operation. Of them, 102 cases had tumor enucleation, 4 cases had pancreaticoduodenectomy, 16 cases had distal panreatectomy, and the other 4 cases had only laparotomy. Of the 122 patients, who underwent resection, the tumor was benign in 118(96.7%) and malignant in 4(3.3%). The diameter of the tumor was less than 2cm in 86.9% of cases. In 98.4% of cases the tumors were single and in 1.6% of cases were multiple. 13.1% of the tumors located in the head, 46.7% in the body, and 40.2% in the tail.Conclusions Whipple′s triad and the measurement of fasting glucose, IRI, IGR, C-peptide, and proinsulin levels contribute to the diagnosis of insulinoma. However, the preoperative tumor localization is still difficult. Tumor enucleation is the technique of choice when feasible. Patients in whom tumor localization is unsuccessful at operation should be carefully evaluated to be certain of the diagnosis, and in general should not undergo blind resection.

Objective To evaluate the feasibility and clinical significance of radical nephrectomy with en bloc resection of involved adjacent organs.Methods Totally,24 cases of renal cancer invading adjacent structures underwent radical nephrectomy with en bloc resection of involved adjacent organs.Among the 24 cases,left radical nephrectomy with en bloc resection of splenic flexure and descending colon was performed in 7,partial resection of corpus and cauda pancreatis and spleen in 5,solitary splenectomy in 3;right radical nephrectomy with en bloc resection of hepatic flexure of the colon in 4,partial hepatectomy of right lobe and end-piece in 4,duodenectomy of pars descendens in 1.Of these cases,partial resection of the psoas muscle was performed in 5,and partial resection of mesocolon in 7.Postoperatively,9 cases received immunotherapy.Results There was no intraoperative mortality or severe posuoperative complication.Follow-up of 3-240 months was available in 21 cases.The follow-up showed that 1-,3-,5-and 8-year survival rates were 90.5%(19/21),42.9%(9/21),33.3%(7/21) and 19.0%(4/21),respectively.Conclusions Radical nephrectomy remains the treatment of choice in organ-confined stage of renal carcinoma.With careful selection,radical nephrectomy with en bloc resection of adjacent structures is technically feasible.It can obtain the radical excisional effect.Based on our experience,the operation is relatively safe.Complete surgical extirpation can lead to prolonged disease-free survival.It may also offer beneficial foundation for the subsequent systematic therapy.

Objective To observe the relationship of awake bispectral index (BISawake) and the postoperative cognitive dysfunction (POCD). Methods 100 patients aged 60~75 years with ASA status Ⅰ~Ⅱ, underwent elective lower abdominal surgery with intravenous anesthesia (propofol, remifentanyl and rocuronium). The BIS was adjusted in 40~60 during the surgery. Their cognitive function was assessed with the neuropsychological test battery commended by International study of postoperative cognitive dysfunction (ISPOCD). Results 8 patients withdrew for unwilling or serious complications. The BISawake was more than 65 in 68 patients (group A), and less than 65 in 24 patients (group B). The difference of the verbal learning immediate and delayed of Hopkins Verbal Learning Test-Revised was more in the group B than in the group A. Conclusion Lower BISawake may be associated with the decline of postoperative cognitive function.

Postoperative pancreatic leakage remains a persistent problem after pancreaticoduodenectomy.For patients with a soft and nonfibrotic pancreas,double binding continuous hemstitch suture is an optimal method for anastomosis.From January 2011 to June 2012,92 cases of periampullary carcinoma with a soft pancreas underwent pancreaticoduodenectomy,and then a modified technique of pancreaticogastrostomy was performed with 2 continuous hemstitch sutures placed in the mucosal and seromuscular layers of the posterior gastric wall,respectively.The median time for pancreaticogastrostomy was 12 minutes,and only 15 patients had postoperative complications.Two patients developed pancreatic leakage(1 grade A and 1 grade B)postoperatively.Pancreaticogastrostomy with double binding continuous hemstitch sutures is a simple and safe reconstruction procedure for patients with a soft and fragile pancreas who received pancreaticoduodenectomy.

Objective To investigate the clinical characteristics and surgical treatment of gastrointestinal stromal tumors (GIST) of the duodenum.Methods The clinical data of 39 patients with duodenal GISTs from 1992 to 2010 were analysed retrospectively.Results The most common symptoms of duodenal GISTs were alimentary tract hemorrhage,occuring in 18 cases of the 39 cases (46％).Clinical diagnosis established by CT in 22 cases (69％).Duodenoscopy performed in 18 cases established the definite diagnosis of GIST in 15 (83％).Duodenal GISTs were most commonly located in the descending portion of the duodenum in 27/39 cases (69％).All 39 cases received surgical treatment,with R0 resection in 34 cases,including partial resection of the duodenum in 47％ (16/34),pancreaticodenectomy in 35％(12/34),segmental resection of the duodenum in 3 cases,subtotal gastrectomy in 3 cases; One died perioperatively and postoperative complications developed in 9 cases,which were cured by conservative therapy.The 1,3,5 year survival rate was 90％,72％,41％ for those receiving R0 resection.Conclusions The abdominal CT scan with contrast and duodenoscopy are helpful to establish the diagnosis of duodenal GISTs.Surgical procedures depend on the size and site of the lesion for R0 resection.To decrease postoperative recurrence and prolong survival adjuvant therapy with Imatinib is necessary.

AIM: To investigate the changes of the L-type calcium channel subunit expression and calcium currents (I_~Ca -L) in cultured rat ventricular myocytes infected by coxsackie virus B_3 (CVB_3). METHODS: Primary cultured neonatal rat ventricular myocytes were infected with CVB_3. The changes of L-type calcium channel subunits mRNA in normal and infected myocytes were measured by semi-quantitative reverse transcription-polymerase chain reaction. I_~Ca -L was recorded in two groups respectively using whole cell patch-clamp techniques. RESULTS: The expression of ?_1 and ? subunits of L-type calcium channel mRNA increased in the infected group compared with the normal one (4.00?0.07 vs 2.21?0.41, P0.05). The average current density of I_~Ca -L significantly increased by CVB_3 infection [(-8.66?0.99) pA/pF vs (-6.97?1.75) pA/pF, P

Objective To evaluate the diagnostic value of US, ECT, CT and MRI in primary hyperparathyroidism (PHPT). Methods Data of 34 PHPT patients with diagnosis confirmed by postoperative pathology were retrospectively reviewed from January 1, 1990, through March 31, 2004. Results The preoperative diagnosis in 22 out of 25 cases (88%) undergoing preoperative ultrasonography of the neck with a positive result was verified by intraoperative findings. For 99m Tc-MIBI, CT and MRI, the positive results were 95%, 69% and 100% respectively. Conclusion Ultrasonography and 99m Tc-MIBI should be considered as the first choice for preoperative loci localization in patients with PHPT. Ultrasonography and 99m Tc-MIBI in combination is more sensitive and accurate for the localization of PHPT.

5 years, 1 for 3 years, 4 for less than 1 year. In addition, metastatic tumors to the spleen were found in 5 patients, splenectomy with or without combined resection of other organs was performed in all 5 patients. Conclusions Imaging examination is the main method of diagnosis for splenic tumors. Partial splenectomy is recommended for benign tumors. For malignant splenic tumors, surgery, as the main aspect of combined therapy, is required.