Objective To study the methodology of the ear reconstruction using Medpor framework. Methods Using Medpor material as ear framework, 112 cases of ear reconstruction were performed using the expanded skin flap on the mastoid region(method Ⅰ) and the temporal fascia flap adding skin graft ( method Ⅱ) to cover ear framework. Twenty-three cases adopted method Ⅰand 89 cases adopted methodⅡ. Results One hundred and nine cases of the reconstructed ear were successful with a good appearance and 3 cases were failure. The exposure of Medpor framework occurred in 17 cases in this series. Among them the method Ⅰ occurred in 8 cases (34 %) and the method Ⅱ was used in 9 cases (10%). The exposure of Medpor framework in 14 cases were repaired using local skin flap or local fascia flap and skin graft. In 3 cases Medpor framework had to be removed due to the sever exposure. Conclusion It seems that Medpor framework is a good alternative for the ear reconstruction.

Objective To evaluate the efficacy of Coopdech bronchial blocker combined with a strengthened single-lumen tube for airway management in patients undergoing upper mediastinal tumor resection. Methods Twenty-two ASA Ⅱ or Ⅲ patients, aged 24-66 yr, weighing 48-78 kg, scheduled for elective resection of upper mediastinal tumor, were randomly divided into 2 groups (n=11 each):double-lumen tube group(groupⅠ) and Coopdech bronchial blocker combined with a strengthened single-lumen tube group(group Ⅱ).One-lung ventilation was achieved with a double-lumen tube in groupⅠ. The Coopdech bronchial blocker combined with a strengthened single-lumen tube was used for airway management and the Coopdech bronchial blocker was used for lung isolation when one-lung ventilation was required in group Ⅱ. The fiberoptic bronchoscope was used to assist endotracheal tube positioning in both groups. The intubation time, positioning time, the number of patients required for tube displacement, the number of fiberoptic bronchoscopy, increase in airway peak pressure, degree of lung collapse, postoperative sore throat and hoarseness, and the number of patients needing ventilator-assisted ventilation were recorded. Results The intubation time was significantly shorter, the number of patients required for tube displacement was significantly smaller,and the rate of increase in airway peak pressure and incidences ofpostoperative sore throat and hoarseness were significantly lower in group Ⅱ than in group Ⅰ (P＜0.05 or0.01). Conclusion The efficacy of the Coopdech bronchial blocker combined with a strengthened single-lumen tube for airway management is better in patients undergoing upper mediastinal tumor resection than the double-lumen tube.

Objective To investigate the reconstructive effect and method on breast deformation after polyacrylamide hydrogel injection for breast augmentation.Methods Sixty patients underwent B type ultrasonic and MRI examination for confirmation of breast deformation after removal of polyacrylamide hydrogel injection and clear distribution level of the injection material and surrounding tissue infiltration.According to skin elasticity,breast subcutaneous layer,glandular layer and pectoral muscle layer,then placed in the suction apparatus with injection of normal saline and completely sucked out and clear the injection material.Based on the wishes of patients and tissue damage,divided into Ⅰ or Ⅱ prostheses implanted and provided appropriate treatment Results Within 3 months to 3 years visiting,breast shape was good.Prosthesis had no herniation,without infection.Bilateral breasts were symmetry without capsular contracture.Conclusions Reconstruction of breast deformation after polyacrylamide hydrogel injection for breast augmentation can improve breast shape and achieve satisfactory effects.

Objective To report the treatment outcome of nonunion of tibial fractures with local muscle flap transfer and injection of autogenous bone marrow. Methods 15 patients who had suffered from nonunion of tibial fracture 10 to 42 (mean 22) months after the initial injury underwent open reduction, internal fixation with locking intramedullary nail, wound coverage with locally transferred muscle flap and injection of autogenous bone marrow into the fracture site 12 to 15 days after operation. Results The follow-ups revealed bone union in all the cases of this series with a mean healing time of 22 (3 to 11) months. Except for limited necrosis of the skin edge in 2 cases which healed after dressing changes, the wounds healed primarily in all the cases without infection and implant failure. Conclusion Besides stable internal fixation and bone graft, coverage of fracture site with locally transferred muscle flap and injection of autogenous bone marrow can be used to treat nonunion of tibial fractures with satisfactory results.

Objective To investigate the clinical indication and effect of instant reconstruction of breast after removal of polyacrylamide hydrogel injection for breast augmentation.Methods Patients had breast ultrasound,MRI check before operation,to define the distribution and level of the injections and tissue infiltration.Depending on tissue degree,capsule integrity and breast degeneration situation,three different methods were chosen,including implantation of silicone gel underneath the breast,pectoralis major or dual-plane.Results 56 patients' incision healed well.Follow-up for 6 months to 3 years showed that breast shapes were good without scars,prosthetic herniapsular,capsular contracture and other complications.Conclusions Instant reconstruction of the breast after removal of polyacrylamide hydrogel injection can improve breast shape and get satisfied effects.

OBJECTIVE: To report the current situation of dialysis and transplantation in Foshan City. METHODS: A total of 18 hospitals performed dialysis filled the registration forms, which comprised situations of hospital, staff establishment, blood purification developing, blood purification equipments, hemodialysis patients, peritoneal dialysis patients, and acute renal failure patients. The registration time was form the beginning to ending of 2007, and the information was statistical analyzed.RESULTS: Totally 18 hospitals in Foshan district performed hemodialysis and 6 of them offered peritoneal dialysis simultaneously. There were 155 hemodialysis machines, 6 CRRT machines, and 15 dialyser reuse devices. Totally 1 718 patients received dialysis in 2007 year, including 93.60% hemodialysis patients and 6.40% peritoneal dialysis patients. Until the end of 2007, 1011 patients were received dialysis treatment, including 90.60% hemodialysis and 9.40% peritoneal dialysis. Glomerulonephritis (47.1%) was still the first primary disease of dialysis, then diabetic nephropathy (28%), third arteriosclerosis nephropathy (9.7%), fourth obstructive nephropathy (3.2%). Totally 743 hemodialysis patients stopped treating for reasons of death, improvement or recovery, changed to peritoneal dialysis, kidney transplantation, transfer, economics and lost follow-up, accounted for 20.3%, 20.1%, 7.2%, 4.1%, 21.5%, 20.2% and 6.6%, respectively. Cerebrovascular disease, cardiovascular disease, infection, dystrophy, synthetic factors and other were the main reasons for death, which accounted for 16.6%, 28%, 17.2%, 3.2%, 18.4% and 16.6%. A total of 16 patients stopped peritoneal dialysis for death (68.7%), improvement or recovery (18.7%), changed to hemodialysis (7.1%), or lost follow-up (6.3%). The causes of death were cerebrovascular disease (21.4%), cardiovascular disease (7.1%), infection (28.6%) and others (42.9%).CONCLUSION: There are 18 hospitals can perform dialysis treatment in Foshan district. Glomerulonephritis, diabetic nephropathy, arteriosclerosis nephropathy and obstructive nephropathy are the first four primary diseases of dialysis. Cerebrovascular disease and infection are the main causes of death.

Objective The study was designed to compare the ultrasound-guided technique for the cannulation of subclavian vein with the traditional technique using anatomic landmarks.Methods One hundred and twenty ASA Ⅱ or Ⅲ patients undergoing cannulation of subclavian vein before gastrp-intestinal tumor resection were randomly divided into 2 groups (n=60 each) according to the technique used for cannulation:ultrasound-guided group (group US) and anatomic landmark group (group AL).The puncture time,successful puncture and complications were recorded.Resulls The success rate was 100% in group US;while the cannulation failed in one patient in group AL.The rate of successful puncture at 1st attempt was 100% in group US but ouly 90% in group AL.The cannulation time was significantly shorter in group US than in group AL.The incidence of accidental puncture of subclavian artery,hematoma and pneumothorax was significantly higher in group AL than in group US.Conclusion The ultrasound-guided catheterization of the subclavian vein is superior to the landmark technique.

Objective To compare the effects of different medications of fentanyl during anesthesia induction on fentanyl-induced cough.Methods Four hundred and twenty ASA Ⅰ or Ⅱ patients aged 18-60 yr undergoing selective operations under general anesthesia,were randomly divided into 4 groups ( n =105 each):group Ⅰ (control group) received successive intravenous injection of midazolam 0.05 mg/kg,fentanyl 2 μg/kg,propofol 2 mg/kg,and rocuronium 1 mg/kg,group Ⅱ (pre-injection group) received successive intravenous injection of midazolam0.05 mg/kg,fentanyl 0.5 μg/kg,propofol 2 mg/kg,rocuronium 1 mg/kg,and fentanyl 1.5 μg/kg,group Ⅲ (dilution group) received successive intravenous injection of midazolam 0.05 mg/kg,fentanyl 2 μg/kg (20 μg/ml),propofol 2 mg/kg,and rocuronium 1 mg/kg,and group Ⅳ (last injection group) received successive intravenous injection of midazolam 0.05 mg/kg,propofol 2 mg/kg,rocuronium 1 mg/kg,and fentanyl 2 μg/kg.Fentanyl concentration was 50 μg/ml in each group except group Ⅲ.Endotracheal intubation was performed 2 min after anesthesia induction.The incidence and severity of fentanyl-induced cough before intubation were recorded and the incidence of propofol-induced pain was recorded.Invasive arterial blood pressure (ABP) and heart rate (HR) were observed before induction (T1 ),immediately after induction (T2 ),at time of coughing (T3 ),and at time of endotracheal intubation (T4).Results ABP and HR had no significant differences at T1,T2,T3,and T4between the four groups (P ＞ 0.05).The incidence of propofol-induced pain had no significant differences between the four groups (P ＞ 0.05).The incidences of cough was 7.6％ in group Ⅱ,9.5％ in group Ⅲ,and 1.9％ in group Ⅳ,which were significantly lower than 35.2％ in group Ⅰ ( P ＜ 0.01).The incidence of cough in group Ⅳ was significantly lower than that in groups [ and Ⅲ (P ＜ 0.05).In the four groups,ABP and HR were significantly higher at T3 than that at T1 and T2 ( P ＜ 0.01 ).Conclusion Different medications of fentanyl including last injection,pre-injection,and dilution of fentanyl can significantly reduce the incidence of fentanyl-induced cough during anesthesia induction,and injection has the best effect.

Objective To investigate the effect of lung protective ventilation regimen on regional cerebral oxygen saturation(rSO2)during one-lung ventilation(OLV)in elderly patients undergoing radical esophagus cancer resection.Methods Forty ASA Ⅰ-Ⅲ patients,aged 65-76 yr,weighing 45-75 kg,undergoing radical esophagus cancer reseclion,were randomly divided into 2 groups(n =20 each):conventional ventilation group(group CV)and prolective ventilation regimen group(group PV).Anesthesia was induced with midaaolam 0.05 mg/kg,sufentanil 0.4 μg/kg,rocuronium 1 mg/kg and propofol 1.5 mg/kg and maintained with 2％ sevoflurane and intermittenl iv boluses of rocuronium 0.5 mg/kg.Double lumen tube was inserted.Correct positioning was verified by fiberoptic broncboscopy.The patients were mechanically ventilated.In group CV,PEEP was set at 0,Vt was set at 10 ml/kg,and I:E was set at 1:2 during two-lung ventilation(TLV)and OLV.In group PV,PEEP was set at 5 cm H2O,Vt was set at 6 ml/kg,and I:E was set at 1:2 during TLV and OLV.PETCO2 was maintained at 35-40 mn Hg in both groups.Arterial blood samples were taken before induction of anesthesia,at 10 min of TLV and at 30 min of OLV for blood gas analysis.Qs/Qt was calculated and rSO2 was recorded at the same time.Low rSO2 (rSO2 score ＞ 3000％)was recorded during OLV.Results Compared with group CV,PaO2 and rSO2 were significantly increased,and Qs/Qt was significantly decreased at 30 min of OLV,and the incidence of low rSO2 was significanfly decreased in group PV(P ＜ 0.05).Conclusion Lung protective ventilation regimen can improve oxygenation,decrease intrapulmonary shunt,and reduce the occurrence of low rSO2 during OLV in elderly patients undergoing radical esophagus cancer resection.

Objective To identify the clinical and pathological features of blastic plasmacytoid dendritic cell neoplasm (BPDC). Methods The characteristics of BPDC hematodermic neoplasm were discussed with a report of two new cases and review the literatures. Results Both patients presented with skin nodules and the tumors were CD+4 and CD+56. Lineage specific markers for B- and T-cell were negative and the tumors did not express myeloperoxidase. Systemic chemotherapy resulted in complete remission, but the disease relapsed quickly and were unresponsive to further chemotherapy. The patients died 26 months and 11 months respectively after diagnosis. Conclasion BPDC hematodermic neoplasm is a rare subtype of lymphoma with distinct clinicopathologic and immunophenotypic features. The disease often has a fulminant course with a poor prognosis. More recent studies suggest that there is a derivation from a plasmacytoid dendritic cell precursor.