Objective To study the sedation efficacy of propofol combined with midazolam and /or fentanyl in fibreoptic choledochoscope. Methods Ninty outpatients were randomly divided into three groups. Group PF (n=31)was given fentanyl 0. 05 m.g plus propofol 1 mg/kg intravenously, group PM (n=29) midazolam 2 mg plus propofol 1 mg/kg, and group PMF(n=30) fentanyl 0. 05 mg, midazolam 2 mg and propofol 1 mg/kg. Propofol 20 mg was used when needed. HR,MAP,SpO_2,sedation scores and amnesia were recorded. Results All patients were awakened in 20 minutes after procedures. The recovery time was shorter in group PF than that in the other two groups. There were 21(67. 70%) patients in group PF, who were aware of surgery. Fifteen(48. 4%) patients were satisfied in group PF. Conclusion Propofol combined with midazolam and /or fentanyl in fibreoptic choledochoscope has better sedation without any obvious side effects.

Objective To investigate the changes in cerebral cAMP and PKA levels during development of acute opioid tolerance induced by remifentanil and to determine whether post-receptor cAMP/PKA signaling pathway is involved in the process. Methods Fifty-six male Kunming mice weighing 25-35 g were randomly divided into 5 groups: group Ⅰ control (C) (n=8); group Ⅱ received morphine infused intraperitoneally (IP) at 0.6 μg'kg-1·min-1 for 120min(M) (n=8); group Ⅲ,Ⅳ,Ⅴ received remifentnil infused IP at 0.4, 0.8 and 1.6 μg·kg-1·min-1 for 120 min(R1=8, R2n=8; R3 n=24).Control group received IP infusion of normal saline. Tail-flick test was performed td measure the response of animals to a thermal nociceptive stimulus before IP infusion, at 30, 60, 90 and 120 min after beginning of IP infusion and at 15, 30, 45 and 60 min after termination of IP infusion. Eight animals were decapitated at 60 min after termination of IP infusion in all 5 groups and the other 16 animals in group R3 were decapitated at 30 and 45 min after termination of IP infusion (n=8 each) for determination of intracellular contents of cAMP and activities of PKA in cerebral cortex and inferior colliculus-striatum by ELISA or radioactive isotope [32p,] ATP-catalyzing assay. Results The tail-flick latency was significantly prolonged during IP infusion as compared with the baseline before infusion in group M, R1 , R2 and R3 but became significantly shorter at 30 and 45 min after infusion than the baseline values in group R1, R2 and R3indicating hyperalgesia after remifentauil infusion. The cerebral contents of cAMP and PKA activities at 60 min after termination of infusion were comparable or decreased in group M, R1, R2 and R3 as compared with group C. There was no significant difference in cerebral cAMP contents and PKA activities at 30, 60 and 45 min after IP remifentanil infusion in group R3. Conclusion Remifentanil can induce acute hyperalgesic effect on mice, and there is no up-regulation of post-receptor cAMP/PKA signaling pathway in the acute opioid tolerance, which is not similar to that chronic opioid tolerance.

Objective: To study the effects of the different doses of midazolam in fibreoptic gastroscopy on sedation, respiratory and circulatory function. Method: One hundred and four outpatients undergoing fibreoptic gastroscopy were randomly divided into four groups. The control group(N)was not given drugs, the other groups were intravenously given midazolam 0.07mg/kg(MS),0.05mg/kg(M),diazepam 10mg(D)respectively. The sedative scores, symptom, amnesia,HR,MAP and blood gases were observed. Result: The sedative scores of MS,M and D groups were much better than that of control group. There were significant differences in sedative scores,amnesia and sedative period between MS group and D group or M group. MAP decreased one minute after administering the drugs in MS,D and M groups significantly. The results of blood gases analysis of all groups were in normal ranges. Conclusion: Midazolam 0.07mg/kg can produce safe and effective sedation for fibreoptic gastroscopy.

Laparoscopic anatomical hepatectomy of segment 7 is recognized as one of the most difficult hepatectomies. Because of its location and anatomic characteristics, the resection of hepatic segment 7 has the difficulties of poor surgical view, instrumental accessibility, hepatic pedicle anatomy, confirmation of dividing line and secure hemostasis. When performing laparoscopic anatomical hepatectomy of segment 7, the authors routinely put patient at left semi-decubitus position, set all trocars at the right upper quadrant of the abdomen, and select proper approach for hepatic pedicle anatomy according to the results of individualized preoperative three-dimensional reconstruction. The authors use to transect the liver parenchyma at the plane between hepatic segment 6 and segment 7, with the direction perpendicular to the right hepatic vein, and then finish parenchymal dissection using right hepatic vein as the intrahepatic landmark. According to the authors experiences, choosing appropriate tactics can effectively reduce the difficulty of laparoscopic anatomical hepatectomy of segment 7, improve the safety and controllability of operation, and ensure the oncological radical effects.

Objective To explore the application of left posterior lateral thoracotomy in the reoperation of mitral vavle. Methods Between April 1995 and April 2003, 11 cases of postoperative recurred mitral valve diseases received reoperation through a left posterior lateral thoracotomy under cardiopulmonary bypass via descending aorta for artery line and main pulmonary artery cannulation for venous line. Results There were no operative and post-operative deaths. The mean CPB time was 138 min. Blood loss of postoperation was less than 300ml in each patient. Conclusion Left posterior lateral thoracotomy in the reoperation of postoperative recurred mitral valve diseases had a minimal adhesiotomy. Extracorporeal circulation via descending aorta and main pulmonary artery cannulation proved easy to do and reliable. This operative approach was simple and safe.

Objective To explore the diagnostic value of helical CT in superior mesenteric vein(SMV) thrombosis.Methods Characteristic CT appearances of SMV thrombosis verified by clinic in 13 patients were retrospectively analysed.Precontrast and postcontrast CT scan were performed in all patients.After the data were acquired,they were transferred to workstation for maximum intensity projection of muti-plane.Results Hyperaemia and edema of the mesentery could be seen in all patients.After administration of contrast material,the filling defects of SMV could be showed in 8 cases,and the distal SMV was occluded in other patients.The thrombi could be directively showed by CT,but distended bowel loops,bowel wall thicking with or without the target sign,absent or poor enhancement of the bowel wall,and the pneumatosis at interbowel were showed by CT,the later two findings were more important and specific signs of ischemic bowel.There was not directively relation between bowel necrosis and the thrombus was whether or not localized at main SMV.Conclusion Helical CT is a important modality for the diagnosis of SMV thrombosis.

ObjectiveTo summarize the curative effect of l aparoscopic cholecys tectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) for cholelithiasis concurrent with choledoc holithiasis.MethodsERCP and EST were applied in 210 patients suspected for c holedocholithiasis before (164 cases) or after (46 cases)LC.Results ERCP dis closed choledocholithiasis in 69 patients before LC, and then stones were comple tely removed by EST in 63 patients, with a clearance rate of 91 3% (63/69); ERC P revealed residual cholelith in 9 patients after LC, and 8 of them were cured by EST, with a clearance rate of 88 9% (8/9).ConclusionsLC co mbined with ERCP and EST for cholelithiasis concurrent with choledocholithiasis is safe and effec tive, keeping patients free from open surgery.

0.05). HRF couldn′t be detected in 28 ankylosing spondylitis patients. The correlation was found between the serum levels of HRF and CRP in active RA patients (r=0.331,P

Objective To study the difference of Han male children and adolescent bone age of wrist-hand in Beijing and Guangzhou.Methods Bone age (BA) of left hand-wrist was assessed using X-ray by two radiologists based on CHN atlas method in 993 healthy children and adolescents (age range:1.0-19.0 years).The radiologists were blinded to the chronological age (CA) of those children.The interobserver variations were analyzed for evaluating the reliability of CHN Atlas method.The difference between CA and BA were separately assessed,and were analyzed by t test.Results Close correlation was found between BA and CA (r =0.969,0.957,P ＜ 0.01) in both two regions.The bone age was advanced at 1.0-3.9,and 7.0-15.9 years in Beijing boys,and at 1.0-2.9,6.0-7.9 years in Guangzhou bpys.There was significant difference at 1.0-1.9,9.0-14.9 years between Beijing and Guangzhou.Conclusions The bone age of Han male children adolescent in Beijing and Guangzhou area has the characteristic of acceleration.There is significance difference at some years between Beijing and Guangzhou,and the results can provide potential value for the further study of BA and clinical medicine.