Objective To investigate a minimal invasive surgical therapy for tumors in the an terior wall close to bladder neck. Methods A 5～10 mm incision was made in abdominal wall below the umbilicus and laparoscopic devices were introduced into the bladder.Tumors were excised and coa gulated under the monitoring of cystoscopy. Results Tumors at the anterior wall of bladder were easily exposed and removed.The recovery time was nearly the same as that of TURBT.No tumor recurrence was observed in 3～10 months period. Conclusions Tumors at the anterior wall of bladder could be easily removed by the combined use of cystoscopy and laparoscopy and open surgery might be avoided.

Thoracic vascular ultrasound was used to evaluate left internal mammary artery to left anterior descending artery (LAD) bypass (LIMA) blood flow pattern in CABG patients. A transthoracic vascular transducer (5～10 MHz) was placed in the second rib space left to the sternum. Doppler spectrum was obtained under 2 D color Doppler image guide. Systolic and diastolic flow was analysed as systolic peak velocity (SPV), systolic velocity time integrate (SVTI), diastolic peak velocity (DPV) and diastolic velocity time integrate (DVTI). Successful examination was done in 106 patients ( 106/110, 94% ) , In patients with patent LIMA, Doppler spectrum showed a notable diastolic flow spectrum. The results of this study suggested that trans thoracic echocardiographic examination could provide avaluable blood flow information. A notable diastolic flow spectrum can be taken as a sign of satisfactory LIMA coronary diastolic myocardium perfusion.

Objective To measure Tei index in patients with idiopathic or ischemia dilated cardiomyopathy, and to evaluate its correlation with other conventional indexes of echocardiography of left ventricular(LV) function,and its applicability in assessing cardiopulmonary exercise capacity in those patients.Methods Seventy consecutive patients (53?14 years) with heart failure(New York Heart Association [NYHA] class, Ⅱ to IV) who had received echocardiographic diagnosis, and believed to be suffering from dilated or ischemia cardiomyopathy were studied. Echocardiography were performed; LV volume as well as ejection fraction were measured from the apical view of the two-dimensional echocardiogram using a modified Simpson’s rule algorithm in all patients. The following variables: peak early transmitral filling velocity (E), late transmitral filling velocity (A), their ratio (E/A), the deceleration time of E (DT), and Tei index were measured by spectral Doppler echocardiography. Furthermore, all patients underwent a cardiopulmonary exercise using 6min walk test. Results Advanced NYHA class was associated with higher Tei index values. A positive correlation was found between Tei index and early /late filling velocity ratio, while a negative correlation was found between Tei index and A wave, E wave, DT, and LV EF. Tei index showed no correlation with heart rate, blood pressure or age. Compared with the parameters of left ventricular function Tei index had a closer relation to the distance of 6min walk. Stepwise regression analysis revealed that the Tei index and the late LV filling velocity were the only independent predictors for cardiopulmonary exercise capacity.Conclusion Tei index correlates inversely with LV performance and reflects disease severity, which is a useful complimentary variable in the assessment of cardiopulmonary exercise performance in patients with heart failure.

To investigate the methods of learning coaxial microincision phacoemulsification and assess the related complications.METHODS:The clinical data of 1 080 eyes of coaxial microincision phacoemulsification performed by beginners from October 2011 to December 2013 was retrospectively analyzed. ln order of surgery dates, the patients were equally divided into groups A, B, C and D, 270 eyes in each group. Comparisons were made among the four groups in operation time, cumulative dissipated energy (CDE), rate of intraoperative, and postoperative complications at 1d; and best corrected distance visual acuity (BCDVA) at 1mo postoperatively.RESULTS:No significant differences were found in age, sex, lens grading, BCDVA at 1mo postoperatively among the four groups ( P> 0. 05 ). The operation time was significantly longer in group A than in groups B, C and D (25. 15 ± 3. 11min vs 15. 20 ± 3. 40min, 14. 71 ± 3. 02min and 14. 41±2. 91min, P<0. 05). No significant differences were found in the operation time among the other three groups (P>0. 05). The CDE of grade ‖ and Ⅲ was significantly higher in group A than that in groups B, C and D (95. 9%, 97. 8% and 98. 5%) (P<0. 01). The number of continuous curvilinear capsulorhexis ( CCC ) were performed successfully was significantly less in group A ( 80. 7%) than the other three groups (95. 9%, 97. 8% and 98. 5%) (P<0. 01). The incidence of posterior capasular rupture of group A (7. 8%) was higher than that of group B (3. 7%), group C (1. 1%) and group D (0. 4%) (P<0. 05), but there was no significant difference between group C and group D (P>0. 05). There were no significant differences both in the number of corneal edema and BCDVA at 1d between group A and group B. (P=0. 66, P=0. 53).CONCLUSlON: With learning step by step, appropriate training program, careful case selection, and accurate managing complications, coxial microincision phacoemusification can be safe for a beginner.

Endoscopy ; Humans ; Myringoplasty ; Tympanic Membrane ; Tympanic Membrane Perforation ; surgery ; Wound Healing

Objective To evaluate the clinical effect and safety of the occiput-cervicle or C1-C2 internal fixation and bone graft fusion in treatment of the unstable atlas fracture.Methods A retrospective study was performed in 38 patients with unstable atlas fractures treated by the occiput-cervicle or C1-C2 internal fixation and bone graft fusion from October 2004 to March 2009.Six patients with comminuted atlas fracture combined with instability of the occipito-atlantoid articulations were treated with occiput-C2 fusion(five patients)and with occiput-C3 fusion(one patient).There were seven patients with typical Jefferson fractures,three with semiring fractures,eight with atlas fractures combined with Anderson type Ⅱ odontoid process fractures,three with atlas fractures combined with Hangman's fractures (two patients with Levine and Edwards type Ⅲ Hangman's fractures were treated with occiput-C3 fusion and one patient Levine and Edwards type Ⅱ Hangman's fracture was treated with C1-C2 fusion),three with atlas fracture combined with lower cervicle injury,six with rupture of transverse ligament combined with instability of atlanto-axial joint(Dickman transverse ligament type Ⅰ injury)and two with comminuted fracture of the lateral mass associated with bony avulsion of the medial tubercle and transverse ligament(Dickman transverse ligament type Ⅱ injury).Of all,five patients were treated with occiput-C2 fusion,three treated with occiput-C3 fusion and 30 treated with C1-C2 fusion.Results All the patients were followed up for a range of 12-46 months(average 28 months),which showed improvement of clinical symptoms in some extent postoperatively.The operation time ranged from 80 to 190 min ates(average 135 minates),with intraoperative blood loss for 200-3 300 ml(average 460 ml)and average fluoroscopic time for 60 seconds.There were no neurological deficits,vertebral artery related complications or other complications in all the patients during the surgical operation.No neurological deficit was aggravated after the patient's mobilization with brace three days after operation.The enous plexus of blood vessel at C1-C2 rupture induced by the use of electrocautery was found in three patients who showed no cerebral hemodynamic deficit after hemostasis with hemostatic sponge and cotton piece.The follow-up X-ray and CT manifested osseous fusion in all the patients,with no looseness or breakage of the screws.The late follow-up showed pain associated with movement and limited range of motion in four patients(11%)and occipital neuralgia in one.Conclusions An occiput-cervicle fixation fusion or a C1-C2 fixation fusion combined with short external fixation can reestablish the upper cervical stability and prevent further injury of the spinal cord and nerve function and hence is an ideal option for C1 burst fracture with or without rupture of the transverse ligament.

Objective To evaluate the effect of the combination of dexmedetomidine and sufentanil on monitoring anesthesia care during burr-hole surgery for patients with chronic subdural hematoma. Methods 96 pa-tients underwent burr-hole surgery for chronic subdural hematoma with MAC were randomly divided into two groups:Group D and Group DS (n=48 in each group). Local anesthetic block was started at least 10 min after DEX and sufentanil infusion. Ramsay sedation scale of the two groups was maintained to 3. Anesthesia onset time, hemo-dynamics, the amount of rescue midazolam or fentanyl, the time to first dose of rescue midazolam or fentanyl, the to-tal number of intraoperative patient movements, postoperative recovery time, patient and surgeon satisfaction scores, and the adverse events were recorded. Results Compared with group D, anesthesia onset time was significantly less in group DS (13.68 ± 3.13 vs. 11.82 ± 2.43 min, P=0.002). More patients in group D required rescue midazol-am to achieve RSS=3 compared with group DS (31.25%15/48 vs. 12.50%6/48, P=0.023). Compared with group D, significantly fewer patients in group DS required rescue fentanyl to relieve pain (10.42%5/48 vs. 27.08%13/48, P = 0.036). Additionally, the total dose of rescue fentanyl in group DS was significantly higher (89.48 ± 23.27 vs. 125.28 ± 33.52μg, P=0.000), and the time to first dose of rescue fentanyl was longer than group D(18.34 ± 4.45 vs. 14.34 ± 3.63 min, P=0.000). The total number of patient movements during the burr-hole surgery was higher in group D than group DS (35.42%17/48 vs. 16.67%8/48, P=0.036). The time to recovery for discharge from the PA-CU (time to an Aldrete score ≥ 9) was significantly shorter in group DS compared with group D (17.54 ± 5.92 vs. 12.57 ± 5.28 min, P=0.000). Results from the patient and surgeon satisfaction scores showed significant differenc-es favoring group DS (P<0.05). More patients in group D showed higher levels of the overall incidence of bradycar-dia (37.50% 18/48 vs. 18.75% 9/48, P = 0.041) and hypotension(37.50%18/48 vs. 14.58%79/48, P=0.011)com-pared with group DS. Conclusions Compared with DEX alone, DEX-sufentanil associated with fewer number of in-traoperative patient movements, less amount of rescue scheme, could be safely and efficiently used for MAC during burr-hole surgery for patients with chronic subdural hematoma.

Objective To verify the best treatment strategy in reducing prostate specific antigen (PSA) progression and death rate in patients with locally advanced prostate cancer by a meta-analysis. Methods The literature search strategy was followed according to the Collaborative Review Group search strategy. Published data of randomized clinical trials comparing radical prostatectomy (RP) plus adjuvant therapy to either RP alone or other treatment were analyzed. Both fixed effect model and randomized effect model were applied and odds ratio (OR) with its 95% confidence interval (95% CI) was also used as the effect size 'estimate. Results Eight clinical trials were chosen with total in-volved cases of 3826. There were 5 trials compared post radical prostatectomy plus adjuvant hormonal therapy with radical prostatectomy alone. PSA progression was used as the indicator of progression and the combined OR was 0.86 (95%CI 0.48-1.56). There were 3 trails compared the combination of radical prostateetomy with hormonal therapy and radical prostatectomy alone. Disease specific death rate was used as the evaluating criteria and the OR was 0.72(95%CI,0.51-1.02). Conclusion RP plus adjuvant hormonal therapy can reduce PSA progression of patients with locally advanced pros-tate cancer, but it has no significant effect on disease specific death rate.

Objective To investigate the therapeutic effieacy and safety of 18 α-Diammonium glycyrrhizinate phosphatidylcholine complex (DGPC) in patients with chronic hepatitis B and or C with elevated aminotransferase. Methods 55 patients with chronic hepatitis B and or C, with serum alanine aminotransferase (ALT) of 2 to 10 times the upper limit of normal were randomly assigned to receive DGPC or Diammonium glyeyrrhizinate (DG) for 12 weeks. Then they were followed up for an additional 4 weeks. From week 1 to 10, DGPC or DG was given as 150 nag,three times a day (TID). At the 11th week,the drug was given as 100 mg,TID. Then 50 mg,TID for the 12th week. Results ALT was markedly decreased after receiving DGPC 4,8,12 weeks (P=0.00). ALT normalization rate at the end of therapy was similar (38.5% vs 34.5% ,P =0.76). Drug-related adverse events were similar. Conclusion DGPC can rapidly and safely decrease aminotransferase in patients with chronic viurs hepatitis.

Objective To investigate the value of contrast enhanced ultrasonography in evaluating cystic renal mass. Methods According to the imaging diagnosing standard, 29 cystic renal mass lesions were studied with contrast enhanced ultrasonography(CEUS), unenhanced ultrasonography (US), contrast enhanced CT(CECT) and then correlated their results with final histopathological results. The data were tested by receiver operating characteristic(ROC) curve. Results The area under ROC curve of CEUS and US was 0. 721, 0. 997, respectively. There was significant difference between the 2 groups (P=0. 003). The area under ROC curve of CEUS and CECT was 0. 997, 0. 997,respectively. There was no significant difference between the 2 groups (P= 1. 000). Conclusions CEUS is better than US and similar to CECT in evaluating cystic renal mass. CEUS with the Bosniak classification is useful for evaluating cystic renal mass.