Objective To summarize the complications of retroperitoneal laparoscopic nephrectomy.Methods From November 2002 to May 2006,122 patients with renal carcinoma underwent retroperitoneal laparoscopic nephrectomy.Complications occurred in 7 patients,and the morbidity was 5.7%.One case of injury to vena spermatica converted to open surgery,the blood loss was 1000 ml with blood transfusion 800 ml.One postoperation hemorrhage of accessory renal artery which was cut off only by harmonic scalpel,leading to blood pressure decrease to 90/60 mm Hg,and a reoperation was performed and the blood loss was 600 ml with blood transfusion 400 ml.Injury of inferior vena cava by linear cutter stapler in one case,and there was no blood loss.Hemorrhage of renal artery stump after linear cutter stapler in one case and it was controlled by titanium clip.Injury of renal vein occurred in two cases and all were controlled by Hem-o-lok or titanium clip.Injury of tail of pancreas in one case and a drainage tube was placed.Results A patient with vena cava injury was followed for 30 months and no abnormality was noted.A patient with pancreas injury was followed for 1 year and nothing remarkable was noted.The other 5 cases was followed for 20-40 months,and they remained in good health.Conclusion The major complication for retroperitoneal laparoscopic surgery is injury to large blood vessels,the principle of treatment is to elevate the pressure of pneumoperitoneum up to 18-20 mm Hg and clip the blutpunkte or convert to open surgery promptly.A good drainage is necessary for the treatment of injury of pancreas.

Objective To evaluate the curative effects of retroperitoneoscopic nephroureterectomy for the treatment of carcinoma of the renal pelvis. Methods We performed retroperitoneoscopic nephroureterectomy in 22 cases of carcinoma of the renal pelvis between December 2002 and November 2005.Transurethral vesection of the ureteral orifice with bladder cuff was performed and the affected kidney was retroperitoneoscopically dissected en bloc.The dissected kidney and ureter were removed intact through a hypogastric incision.Results The operation was successfully completed in all the 22 cases.The operation time was 2~5 h(mean,4.3 h),the blood loss was 50~600 ml(mean,187 ml),and the postoperative drainage volume,50~200 ml/d(mean,120 ml/d).The drainage tube was removed at 24~48 postoperative hours. The duration of hospitalization ranged 8~13 d(mean,10 d).Pathological findings after operation showed transitional cell carcinoma in all the cases.Followup observations in the 22 cases for 1~24 months(mean,14 months) found no recurrence.Conclusions Retroperitoneoscopic nephroureterectomy in the treatment of carcinoma of the renal pelvis is feasible,effective and micro-invasive.

Objective To evaluate the feasibility of minimally invasive therapy for peripelvic renal cysts by retroperitoneal laparoscopy.Methods Clinical data of 10 cases of peripelvic renal cysts treated by retroperitoneal laparoscopic fenestration in this hospital from October 2003 to March 2005 were retrospectively reviewed.Results All the 10 cases of operation were successfully completed.The operation time ranged 40~60 min(mean,55 min).Follow-up observations in the 10 cases for 3~24 months(mean,12.8 months) showed no recurrence.Conclusions Retroperitoneal laparoscopy is a safe and feasible alternative for the management of peripelvic renal cysts.

OBJECTIVE:To explore quality control of plasma concentration monitoring for sodium valproate and to improve the quality of pharmaceutical monitoring.METHODS:The statistical and continuous analysis of sodium valproate control data from our hospital of 2008 were conducted using fluorescence polarization immunoassay(FPIA).RESULTS:Mean recovery and RSD were 98.37% and 1.94% for low control samples,99.33% and 2.88% for medium control samples,98.17% and 4.10% for high control samples.The RSD of sample was lower than 5% and in line with the requirement for biological sample determination in Chinese Pharmacopoeia.CONCLUSION:FPIA is a comparatively accurate and stable method for plasma concentration monitoring of sodium valproate.

Objective To determine relative risk factors for positive surgical margins in extraperitoneal laparoscopic radical prostatectomy(LRP). Methods From February 2004 to September 2007,33 patients(mean age 70 years old)with prostate cancers underwent extraperitoneal LRP.All patients were diagnosed by pathology preoperatively.Gleason score:3+3 14 cases(43%),3+4 11 cases(33%),4+3 6 cases(18%),4+4 2 cases(6%).Clinical stage:T1a-T1b 4 cases(12%),T1c 14 cases(43%),T2a-T2b 5 cases(15%),T2c10 cases(30%).Logistic regression analyses were performed. Results LRP was successfully performed on 31 cases.There were 2 cases converted to open surgery.Nine cases(27%)had PSMs.There were 6 cases(67%)and 4 cases(17%)of clinical stage T2c in PSM and negative surgical margin(NSM)groups respectively(P=0.010).There were 3 cases(33%)and 0(0)with high Gleason score(higher than 7)in PSM and NSM cases(P=0.015).There were 4 cases(44%)and 5 cases(21%)with t-PSA higher than 20dg/ml in PSM and NSM cases respectively(P=0.178).In these 9 cases,there were 4 cases(44%)positive with DRE.However there were 9 in the 24 NSM cases(38%)(P=0.509).Clinical stage T2c was independently positively correlated with PSM(OR=24.69).High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml were positively correlated with PSM. Conclusions Clinical stage is positively correlated with PSM.It is an independent factor.High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml mignt be the risk factors in predicting PSM and should be used together with clinical stage.Positive DRE findings may be also useful to predict PSM.

Objective:To observe influence of preoperative sufentanil delayed preconditioning (SPC) on perioperative cogni‐tive function and myocardial protection effect in patients undergoing on -pump coronary artery bypass grafting (OP‐CABG) .Methods:A total of 60 patients undergoing selective OPCABG were randomly and equally divided into sufentanil group (SPC group) and routine treatment control group (control group) ,blood sample was collected before operation ,1h , 6h ,12h ,24h and 48h after aorta declamping to measure level of cardiac troponin I (cTnT );and all patients received neu‐ropsychological assessment before and 7d after operation .Results:Compared with control group ,there was significant re‐ductions in serum cTnI levels [1h:(23.66 ± 3.15) ng/ml vs .(14.96 ± 2.13) ng/ml] in sufentanil group from 1h after aor‐ta declamping to 48h after CABG ,P<0.05 all .The inotropic agent usage score on 12h ,24h and 48h after entering ICU of sufentanil group was significantly lower than that of control group [12h:(6.4 ± 0.6) scores vs .(8.4 ± 0.6) scores] , P<0.05 all .Incidence rate of postoperative cognitive dysfunction (POCD) in sufentanil group was significantly lower than that of control group (13.3% vs .30.0% ,P=0.041) .Conclusion:Preoperative sufentanil delayed preconditioning posses‐ses myocardial protection effect , and reduce incidence rate of cognitive dysfunction so also possesses certain brain protection in patients undergoing on-pump coronary artery bypass grafting .

Objective To study the clinical characteristics of tracheotomy in patients with critical diseases and obesity aged 80 years and over. Methods A total of 120 patients with critical diseases and obesity undergoing tracheotomy from July 2006 to August 2011 were retrospectively reviewed,and divided into advanced age group(aged 80-99 years,n=60) and control group(aged 60-79 years,n=60).Surgery time,operation preparation,surgery skill and complication after surgery were compared between the two groups. Results A total of 60 patients undergoing tracheotomy were successfully performed by relative surgery skills according to characteristics of critical obesity in advanced age group.There was 1 case (1.7％) and 0 case with trachea cannula exodus,3 cases (5.0％) and 4 cases(6.7％) with cuff leak,4 cases (6.6％) and 3 cases(5.0％) with stoma bleeding,5 cases (8.3％) and 7 cases (11.4％) with subcutaneous emphysema in advanced age and control groups,respectively.Total complication rate was similar between the two groups of patients [13 cases (21.7％) vs.14 cases (23.3％),x2 =1.00,P＞0.05]. Conclusions Individualized procedure of tracheotomy may reduce complication of patients with critical diseases and obesity aged 80 years and over.

OBJECTIVE: To explore the application value of postmortem multi-slice spiral computed tomography (MSCT) in cases of fall from height through observing and analyzing the injury features of the fall and reconstructing the process of the fall based on the the above procedure. METHODS: One real fatal case due to fall from height was fully examined using MSCT and three-dimensional reconstruction technique. Analyzing the manner and cause of death through combination of MSCT and systemic autopsy was also implemented. The differences between autopsy and MSCT in getting information of injuries were compared. RESULTS: Fractures involving multiple body regions and liver rupture were found through MSCT and three-dimensional reconstruction. The autopsy got the same results with imageological examination. The case of death was deduced to be fall leading to systemic polytrauma. CONCLUSION Application of MSCT can be used as the complimentary for traditional autopsy in the analysis of injury manner of fall from height.
Autopsy ; Death ; Forensic Pathology ; Fractures, Bone ; Humans ; Multiple Trauma ; Tomography, Spiral Computed

BACKGROUND:Repeated hyperbaric oxygenation (HBO) preconditioning induces tolerance against ischemia in spinal cord. The confirmation of this phenomenon paves a new way in clinic to prevent and treat complications of spinal ischemia following thoracoepigastric aorta surgery. Probing into its mechanism of is chemic tolerance has provided basis for clinical application.OBJECTIVE: To investigate the changes of mitochondrial structure and ATPase activity during spinal cord ischemic tolerance induced by repeated HBO preconditioning in rabbits.DESIGN: Randomized and controlled trial.SETTING: Department of Anesthesiology, Xijing Hospital of Fourth Military Medical University of Chinese PLA.MATERIALS: The experiment was conducted in the hyperbaric oxygen chamber of the Department of Air Medicine; Experimental Animal Center of the Department of Anesthesiology, Xijing Hospital of Fourth Military Medical University of Chinese PLA, between March and June 2004. Totally 50 male New Zealand rabbits were selected.METHODS: Fifty male New Zealand rabbits were randomly divided into two groups: simple ischemia control group and HBO group with 25 rabbits in each group: 0.25 Mpa, 100% O2, one hour per day for 5 days. Spinal ischemia model was prepared 24 hours after the last preconditioning.Spinal cord ischemia (20 minutes)/reperfusion model was prepared by blocking the infrsrenal aorta. The motor function of hind-limbs was scored at 6 hours, 24 hours and 48 hours after reperfusion. The mitochondrial ATPase activity was measured and compared between two groups before ischemia, at 6 hours, 24 hours and 48 hours after reperfusion.MAIN OUTCOME MEASURES: ① The score of motor nerve function of the hind-limbs; ② The activity of mitochondrial ATPase; ③ Pathological evaluation.RESULTS: Totally 50 rabbits were involved for result analysis, and finally 25 rats in each group entered statistical analysis with no loss in the midway. ① The score of motor nerve function of the hind-limbs in HBO group at 6 hours, 24 hours and 48 hours after HBO preconditioning was significantly higher than that in control group (P ＜ 0.01). ② The activity of mitochondrial ATPase: the mitochondrial Na+, K+-ATPase activity and Ca2+, Mg2+-ATPase activity at each time point of the animals in the two groups after is chemia were significantly decreased; Na+, K+-ATPase activity in HBO preconditioning group at 6 hours, 24 hours and 48 hours of ischemia was significantly higher than that in control group (P ＜ 0.01); Ca2+, Mg2+-ATPase activity at 6 hours and 24 hours after ischemia was significantly higher than that in control group (P ＜ 0.01). ③ Pathological evaluation: The structure of mitochondria in control group was seriously damaged while it was found almost normal in spinal cord in HBO group animals at 48 hours after reperfusion.CONCLUSION: The mechanism of ischemic tolerance induced by hyperbaric oxygenation pretreatment may partly be related to the attenuation of mitochondria ATPase activity decrease after ischemia, thereby protecting the function of mitochondria.

Phytochemical investigation on the EtOH extract from the aerial part of Callicarpa kwangtungensis led to the isolation and characterization of 10 caffeoyl phenylethanoid glycosides, 2'-acetylacteoside (1), tubuloside E (2), acteoside (3), tubuloside B (4), isoacteoside (5), alyssonoside (6), 2'-acetylforsythoside B (7), brandioside (8), forsythoside B (9), and poliumoside (10). Compound 4 was isolated from the plants of Verbenaceae,and 6 was obtained from the Callicarpa genus, for the first time, while compounds 1, 2, 5 and 7 were firstly reported from the plant.
Caffeic Acids ; chemistry ; isolation & purification ; Catechols ; chemistry ; isolation & purification ; Chromatography, High Pressure Liquid ; Ethanol ; chemistry ; Glucosides ; chemistry ; isolation & purification ; Glycosides ; chemistry ; isolation & purification ; Phenols ; chemistry ; isolation & purification ; Verbenaceae ; chemistry