10.3969/j.issn.1000-3606.2013.06.001

Objective To investigate the analgesic efficacy of intravenous administration of lidocaine in patients following laparoscopic cholecystectomy. Methods Twenty-five ASA Ⅰ or Ⅱ patients, aged 30-55 yr,weighing 50-70 kg, scheduled for laparoscopic cholecystectomy, were enrolled in this study. Lidocaine 1.5 mg/kg was injected intravenously immediately before anesthesia. Anesthesia was induced with intravenous fentanyl 2 μg/kg, propofol 2 mg/kg and rocuronium 1 mg/kg and maintained with inhalation of isoflurane (end-tidal concentration 1.5%-2.0%) and intermittent iv boluses of rocuronium after tracheal intubation. Lidocaine was infused abdominal intravenously at a rate of 1.5mg·kg-1·h-1 form the end of ofperation to 24 h after operation. The degree of abdominal pain and shoulder pain was assessed with VAS score at 1, 6, 12 and 24 h after operation. The effective analgesia was defined as VAS score of ≤ 3. The adverse reactions were recorded. Results The effective analgesia rate was 100% within 24 h after operation. No adverse reactions occurred. Conclusion Intravenous administration of lidocaine exerts satisfactory analgesia in patients after laparoscopic cholecystectomy.

The author analyzed how toelaborate narrative contents using structured standard with electronical -ly structured medical record information model and the relation of the two .Astructured medical record data entry way was worked outcompatible with standard terminology based on ways of expressing narrative contents using structured standard.It provided a theoretical basis for clinical use .

Objective To raise diagnostic rate of protruded lesion of gastrointestinal mucosa and to judge the precise differentiation to the depth of malignant lesion.Methods 12 cases of gastrointestinal diseases were examined by MPS combined with endoscopic examination.Results To the patients suffering protruded lesion of gastrointestinal mucosa with negative biopsy,the MPS provided a sound basis for diagnosis;To the cases of malignant lesion,findings of MPS with regard to the depth were in total concordance with that of surgical biopsy.Conclusion MPS is significanfly superior to conventional endoscopy with pathological biopsy in the differentation of protruded lesion of gastrointestinal mucosa.But in the case of malignant lesion,only the depth of infiltration of gastrointestinal wall can be correctly assessed by MPS.The value is limited in showing whole Picture for larger focus and in the identification of around lymphnodes and whether or no distal metastases in the near organs.

Objective To evaluate the similarities and differences between four-dimensional radiotherapy (4D-CT ) and active breathing control techniques(ABC) in respiratory management in lung radiotherapy ,and investigate the indications and feasibility of different breathing control techniques for different patients .Methods Twenty-one patients treated with lung radiotherapy received respiratory management .4D-CT technology was used in 11 patients ,while ABC technology was adopted in the rest 10 .The ratios of planning target volume(PGTV) to gross tumor volume(GTV)[(PGTV/GTV)] were calculated .The differences between these two respiratory management technologies were compared in terms of the PGTV ,positioning time ,planning time and treatment time to investigate the indications .Results 4D-CT technology had higher PGTV/GTV ratio ,and shorter positioning time and irradiation time than ABC technology(P<0 .05) ,but there was no significant difference in the planning time(P>0 .05) .In patients with ABC and 4D-CT technology ,objective response rates were 50 .0% ,45 .5% ,respectively ,and the radiation pneumonitis rates were 30 .0% ,27 .3% ,respectively .There was no significant difference in both groups (P>0 .05) .Conclusion In lung tumor radiothera-py ,ABC can reduce irradiation volume ,suitable for patients with good performance status .4D-CT is time-saving and well tolerated , suitable for patients with smaller tumors .

Objective EpCam and Wnt/ β-catenin pathway in colon carcinoma and its clinic-pathological significance of the distribution,studying the relationship between EpCam and Wnt / β-catenin.Methods Retrospective analysis detected by immunohistochemistry 60 cases of colon cancer,20 cases of adjacent atypical hyperplasia,60 normal colon tissue EpCam and Wnt / β-catenin protein expression.Results (1)normal colon tissue,cancer tissue and cancer tissue showed positive expression EpCam clear upward trend,were 23.5％,62.3％,96.5％ ; with normal colonic mucosa to cancer transformation,β-catenin in the membrane expression of the positive rate decreased,while the cytoplasm is followed by increased expression rate in poorly differentiated carcinoma or even nuclear expression,EpCam strong positive expression of Wnt / β-catenin cytoplasmic-positive rate of histological type,depth of invasion,lymph node metastasis; (2)the EpCam with the Wnt / β-catenin expression showed a positive correlation (r =0.653,P ＜0.05) ;(3)high expression EpCam and Wnt / β-catenin in patients with colon significant increase in cancer recurrence rate and 5-year survival rate was significantly reduced.Conclusion EpCam and Wnt / β-catenin pathway in colon cancer positively is correlated,EpCam and Wnt / β-catenin is connected with high expression and tumor invasion,metastasis and prognosis.

Objective To investigate the expressions and clinical pathological significance of EpCAM and the β-catenin pathway in colon cancer,and the correlation between EpCAM andβ-catenin.Methods Immunohistochemistry was used to detecte the expressions of EpCAM and β-catenin proteins in colon cancer tissues and corresponding adjacent tissues of 70 cases of colon cancer patients,the clinical and pathological features of colon cancer and their relationship were retrospective analyzed.Results ①EpCAM and β-catenin protein expressions in colon cancer tissue was 52 cases (74.3％) and 55 (78.6％) positive respectively; EpCAM and β-catenin proteins in cancer adjacent tissues in 13 cases( 15.7％ ) and 9 cases ( 12.9％ ) were positive,the differences were statistically significant.②the EpCAM expression is positively correlated with the β-catenin expression ( r =0.616,P ＜ 0.01 ).③The expressions of EpCAM and β-catenin correlated with the tumor differentiation,invasion depth,lymph node metastasis and TNM staging related ( P ＜ 0.05).Conclusion EpCAM and β-catenin pathways in colon cancer positively correlate,and closely correlate with colon cancer.The expression level of EpCAM and β-catenin can be used as a reference for the colon disease course and healing.

Objective To discuss the influence of the progress and result in gastic cancer operation through application of neo-adjuvant chemotherapy in multi-disciplinary team (MDT).Methods Clinical data of the patients treated in MDT model 45 cases and non-MDT model(78 cases) were respectively analyzed,and the index about pathologic change,histologic transform and operative result between the two groups were compared.Results In the index of pathologic change,the incidence of abdominal adherence and ascites and pyloric obstruction in MDT model group were obviously less than non-MDT model group( P ＜0.05 ).In the index of histologic transform,texture of mesentery in MDT model group was more fragile than non-MDT model group( P ＜0.05).In the index of operative results,the operative duration and intra-operative bleeding in MDT model group were less than non-MDT model group (P ＜0.05).Conclusion Neo-adjuvant chemotherapy has certain influence in gastric caneer operation,but the successful operations were performed by standard and correct procedures.Therefore,optimizing combined therapy in MDT model and constructing preoperative evaluation system with neo-adjuvant chemotherapy.

Objective To investigate the effect of different reference transducer positions measurement on intra-abdominal pressure (IAP) in ICU patients. Methods 31 cases of patients in ICU in need of measuring IAP were studied from January 2015 to July 2015 in this study. In each patient, transvesical and the direct methods were both used to measure IAP. Three sets of IAP measurements were obtained in the supine position, using the different reference levels and kept as IAPpubis, IAPmidax, IAPphlebostatic. The results were compared using Spearman rank correlation,paired t test and Bland–Altman statistics. Results When symphysis pubis was uesd, the result of direct method was (9.82±4.01) mmHg, the result of indirect method was (8.77 ± 4.48)mmHg (P<0.05), the correction between two methods was 0.967, P<0.05. When midaxillary level was uesd to measure, the result of direct method was (11.74 ± 4.71) mmHg, the result of indirect method was (11.65 ± 4.63)mmHg, the correction between two methods was 0.972, P=0.10. When phlebostatic was uesd, the result of direct method was (10.98 ± 4.65) mmHg, the result of indirect method was (10.38 ± 4.75)mmHg, the correction between two methods was 0.970, P<0.05. The calculated bias between IAPmidax and IAPpubis was 2.9 mmHg, 95%agreement of limits was (-0.8-6.5) mmHg, and the maximum difference value was 11 mmHg. The calculated bias between IAPmidax and IAPphlebostatic was1.3 mmHg, 95%agreement of limits was-1.4-4.0 mmHg, and the maximum difference value was 4.2 mmHg. Conclusion In supine position, the value obtained via the bladder can reflect the true IAP, and the symphysis pubis or phlebostatic axis reference lines are not interchangeable with the midaxillary level.

Objective To investigate the diagnosis and treatment of the blunt pancreatic injury.Methods The clinical data of 21 blunt pancreatic trauma patients admitted to our hospital in the past 5 years were analyzed retrospectively.Results 3 of 21 patients were simple blunt pancreatic injury, while the other 18 patients were complicated with other abdominal organs injuries.According to the grading criteria, the number of Ⅰ , Ⅱ, Ⅲ, Ⅳ, Ⅴ grade injury were 4, 7, 5, 3 and 2 cases, respectively, and only 9 patients were diagnosed by CT before operation, and the diagnosis was confirmed during the operation in 11 patients, and 1 was miediagnosed in the first operation.Single drainage or debridement and drainage were performed in 8 cases and distal pancreatectomy with and without spleen were performed in 5 and 3 cases, respectively, and 3patients received pancreaticojejunostomy, 1 received Whipple operation, the other 1 case underwent duodenorrhahy and diverticulation.The mortality rate was 9.5% (2/21), and the complications of pancreatic pseudocyst and fistula developed in 2 (9.5%, 2/21 ) and 5 (23.8%, 5/21 ) cases respectively, and they were cured by drainage, while the other 12 were cured completely.Conclusions The preoperative misdiagnosis rate of pancreatic trauma is high;CT scan should be used to confirm the diagnosis.Careful pancreatic exploration is mandatory and simple and effective surgical procedures with effective drainage is important for treatment success.