Objective To investigate the appropriate surgical approaches and microsurgical resection of communicative skull base chordoma. Methods Twenty two cases of communicative skull base chordomas were microsurgically treated from 1995 to 2005 and followed up. The tumors were removed with extended anterior skull base approach in eight cases, with modified Weber-Ferguson (transmaxillary) approach in eight cases, and with transmandibular approach in six cases. Some cases were resected with combined approaches including pterional approach in 3 eases, subtemporal-zygomatie approach in 1 case, and suboccipital-retromastoid approach in 2 cases. Results Total, subtotal and partial removal of the tumors were achieved in 10 cases, 7 and 5 cases respectively. No patients died and had severe nervous system dysfunction after surgery. However, one had CSF rhinorrhea, one with infection, three with cranial never dysfunction. Twenty patients were followed-up with average 3.4 years, 12 returned to normal or partial works, 5 took care by oneself, 1 needed help, 2 died from tumor recurrence. Conclusion The treatment of communicative skull base chordoma is a challenge to neurosurgeon. The key point is the total removal of the tumor with the microsurgical technique and the appropriate approach depend on the location of the tumor. Moreover, skull base reconstruction is also important to avoid the cerebrospinal fluid leak and infection.

Objective To evaluate the effect of various herniorraphy in treating inguinal hernia. Methods The clinical data of 108 patients who underwent conventional Bassini herniorraphy (BH), tension free herniorraphy (TH), or laparoscopic herniorraphy (LH),respectively were analysed and comparated. Results The operation time in TH was less than that in BH, and in LH was longer than that in TH. The ability recovery, hospita stay and postoperative complication in TH and LH were less than those in BH.All the patients were followed up for at least 1 year.Of them, 1 recurred after BH, but there was no recurrence after TH and LH. The blood neutrophils, serum level of fibrin, C-reactive protein and alpha-1 antitrypsin increased significantly in the patients undergoing herniorraphy, which were significantly higher in the patients underwent TH and LH. Conclusions The curative effect of TH and LH is much better than that of BH in treating ingumal hernia. Application of marlex for herniorraphy might increase inflammation response, but it will not increase the incidence of infection.

Objective To explore the effect of different temperature of the forced- air warming system on the prevention of hypothermia during laparotomy of infants. Methods A total of 60 infants undergoing laparotomy under general anesthesia were recruited and divided into three groups by random digits table method with 20 cases each according to admitting time; when used the force- air warming system intraoperatively, the three groups were respectively setting on 45℃(automatic adjustment for 43 ℃ after 45 minutes), 43 ℃ and 38 ℃.The core temperature were respectively recorded before anesthesia and 15, 30, 45, 60 minutes after anesthesia (every 30 minutes after 1 hour).The hypothermia incidence and anesthesia recovery conditions were recorded simultaneously. Results There was no significant difference on the core temperature among three groups before anesthesia (P > 0.05). 30 minutes after the anesthetic, the core temperature of 45 ℃ group was (36.31±0.20) ℃,43 ℃ group was (36.32±0.24) ℃ and 38 ℃ group was (36.08±0.21) ℃.The differences among three groups was statistically significant (F=8.12, P < 0.01), but there was no significant difference between 45 ℃ group and 43 ℃ group (P > 0.05). 60 minutes after the anesthetic, the core temperature of 45 ℃ group was (36.39±0.26) ℃,43 ℃ group was (36.19±0.22) ℃ and 38 ℃ group was (35.92±0.15) ℃. The differences among three groups was statistically significant(F=25.19, P<0.01).The hypothermia incidence of 45℃group, 43℃ group,38℃ group was 10.0%(2/20), 25.0%(5/20), 50.0%(10/20)respectively and the differences among three groups was statistically significant( χ2=8.04, P<0.05). The time to complete consciousness of 45 ℃ group was (15.40±5.09) minutes,43 ℃ group was (19.80±4.10) minutes and 38 ℃ group was (22.00±4.36) minutes. The differences among three groups was statistically significant (F=10.96, P<0.01). The time to tracheal extubation of 45 ℃ group was (18.10±5.97) minutes, 43 ℃ group was (21.85±4.02) minutes and 38 ℃ group was (24.90±5.54) minutes.The differences among three groups was statistically significant (F=9.83, P<0.01). Conclusions The forced-air warming system can increase the infants′peripheral tissue heat content and reduce the heat losing.So that it will help decrease the intraoperative hypothermia incidence and shorten the anesthesia recovery period.Meanwhile the higher temperature of the forced-air warming system is setted ,the better effect it is.

Objective To explore the relationship between preoperative plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and recurrence of atrial fibrillation (AF) after cardiac valve replacement (CVR) combined with radiofrequency ablation.Methods Fifty-eight patients with AF undergoing CVR combined with radiofrequency modified Maze procedure were enrolled in this study.The patients were allocated to either AF recurrence group (AF group,18 cases) or AF no recurrence group (SR group,40 cases) according to whether patient's AF recurrence or not within 3 months after surgery.NT-proBNP were respectively measured in two groups in 1st day before operation and 9th day after operation by radioimmunoassay.Results All the 58 patients were involved in the final analysis.NT-proBNP levels in 1st day before operation and 9th day after operation in AF group was significantly higher than that in SR group (2061.30 ng/L vs.579.00 ng/L,996.60 ng/L vs.209.20 ng/L,P＜ 0.01 ).NT-proBNP levels in 1st day before operation in two groups was significantly higher than that in 9th day after operation (P ＜ 0.01 ).Conclusions There is a good relationship between preoperative plasma NT-proBNP levels and recurrence of AF.It has a clinical value in predicting of recurrence AF after CVR combined with radiofrequency modified Maze procedure.

Gastric cancer is one of the most common malignant tumors in China, and its pathogenesis is complex. At present, there is no good method for the diagnosis and treatment of gastric cancer. However, studies have shown that microRNA (miRNA) has abnormal expression in gastric cancer, which participates in the regulation of gastric cancer related genes, and has an impact on the occurrence, development, diagnosis and treatment of gastric cancer. This paper aims to review the relationship between miRNA and the diagnosis and treatment of gastric cancer, as well as the drug resistance in the treatment, so as to lay the foundation for the follow-up research and clinical diagnosis and treatment.

Objective To evaluate the value of ultrasonic Graf methods in screening developmental dysplasia of the hip (DDH)in infants .Methods 1 580 cases of 0-6 monthes old infants without severe limb anomalies were examined .Bilateral hip joints were examined mcluded analyzed according to Graf method .Results A total of 1 580 cases included 3 160 hip joints were analyzed ,827 were male (52 .34% ) and 753 were female (52 .34% ) among them .104 cases (6 .58% ) were diagnosed with abnormalities of the hip joints .Among the 104 cases ,88 cases (5 .57% ) were type Ⅱa hip joints ,9 cases (0 .57% ) were type Ⅱ b ,5 cases (0 .32% ) were type Ⅱc ,1 case (0 .06% ) and 1 case (0 .06% ) were type Ⅲ and type Ⅳ respectively .In each month of age abnormalities of the hip joints were diagnosed as followed :79 cases(9 .69% ) were one month old ,13 cases (3 .98% ) were two month old ,2 cases (2 .15% ) were three month old ,6 cases (2 .26% ) were four month old ,1 cases (2 .44% ) was five month old and 3 cases (7 .69% ) were six month old .Conclusion Ultrasonic Graf method can provide the basic data for incidence of developmental dysplasia of hip in infants in local region and may be helpful to offer the related standards for early screening the abnormalities of the hip joints .

Objective Acute type A aortic dissection associated pregnancy severely threatens the lives of both the mother and her ferus.We retrospectively reviewed our clinical experience with this life-threatening condition in six cases.Methods Between January 2007 and February 2012,6 women with acute type A aotic dissection associated pregnancy were treated by our group,with an average of 3 1 years (range 24 -37 weeks)and a mean gestation weeks of 24.5 (range,12 -38 weeks ).The etiology was Marfan syndrome in 4 cases and gestational hypertension in 2.The pathology was the modified Stanford type A3S in I case,A2C in 2 and A3C in 3.- Five patients were treated surgically and 1 medically.Surgical operations were performed under hypothermic cardiopulmonary bypass or deep hypothermic circulatory arrest,including Bentall procedure in 1case,Bentall + Sun's procedure in 2,ascending aortic replacement + Sun's procedure in 2.Results The woman treated medically and her fetus died from aortic rupture 9 days after admission.The cardiopulmonary bypass and cross clamp time and circulatory arrest time averaged 167 rninites(range,75 -210 minites) and 98 minites(range,83 - 145 minites) and 23.5minites(range,19 -27 minutes),respectively.Five patients treaed surgically survived the operation.Three fetuses survived rand two fetuses died.After a mean follow-up of 2.2 years (range,1 - 3.5 years ),5 patients were doing well.CT angiogram detected nonmal aortic and valvular structures,with no signs of distal dilation.Three babies were normal in development and neurocognitive functios.Conclusion Palients with aortic dissection associated with pregnancy should be operated on ugently and medical treatment carries high risks of aortic rupture and maternal and fetal death.Methods of surgical repair,peffusion techniques and delivery should be chosen based on the underlying aortic pathology and gestational age,so as to maximize the safety of the mother and her baby.

Objective To report a pedigree with late-onset Pompe' s disease complicated with cerebral vascular diseases as to summarize their clinical,pathological and molecular genetic characteristics.Methods We investigated the clinical and pathological data of the two affected siblings with late-onset Pompe' s disease complicated with cerebral vascular diseases.All the 5 members of this pedigree accepted the GAA gene analysis.ResultsBoth affected siblings had progressive pelvic girdle muscle weakness from young adult age,and recently developed vertigo and ataxia.Brain imaging of them revealed multiple cerebral hemorrhage,infarction and diffuse ischemic white matter lesions.The brother had multiple aneurysms and stenoses of cerebral arteries revealed by brain CTA.However,his sister was only found to have multi-beaded stenoses of cerebral arteries.The muscle pathology of the brother showed typical vacuolar degeneration and glycogen storage in muscle fibers. The GAA enzyme activity of 2 siblings were dramatically lower than normal.A heterozygous 19 bp-deletion (c.1388-c.1406,exon 9) were found in GAA gene in the 2 siblings and their healthy mother. Conclusions Cerebrovascular involvement should be a special phenotype of Pompe' s disease.A novel heterozygous mutation c.1388del19 in GAA gene was found in this pedigree,but the relationship between the mutation and the rare clinical phenotype needs further study.

Objective To investigate the incidence, diagnosis and treatment of complications after endoscopic retrograde cholangiopancreatography (ERCP), and to explore the ways of prevention. Methods Clinical data of 930 subjects, in which 510 were older than 60, with cholangiopancreatic diseases who underwent ERCP in the past 2 years were retrospectively analyzed. Results Success rate of ERCP was 96.34% (896/930),and the postoperative complication incidence was 7.85% (73/930). Of all the complications, there were 42 cases of acute pancreatitis, among which 1 was accompanied with biliary tract infection, 4 cases of duodenum perforation, 6 delayed hemorrhage, 2 cardiac dilacerations bleeding, and 19 biliary tract infection (5 combined with infectious shock). All subjects with complications were cured except for 2 deaths. Conclusion ERCP is a safe and effective method for elderly patients. However, due to decreased organ functions and other underlying diseases, complications after ERCP in elderly patients are usually difficult to manage. The key factors in prevention of complications after ERCP includes in obedience to indications, improvement in procedure skills, treatment of accompanied diseases before and after ERCP, and active management of complications.

Adolescent ; Adult ; Arthroscopy ; methods ; Humans ; Knee Injuries ; surgery ; Male ; Menisci, Tibial ; surgery ; Middle Aged ; Tibial Meniscus Injuries ; Young Adult