OBJECTIVETo investigate the risk factors in postoperative cognitive dysfunction (POCD) induced by patient self-controlled intravenous analgesia (PCIA).

METHODSA case-control study included 103 patients with POCD(P group), assessed by Mini-Mental-State test and 103 cognitive normal controls (NP group). The cases and controls were matched for age, gender,history of operation and PCIA volume dose. The relationship between POCD and various factors was analyzed by univariate and multivariate analysis. Spss 11.5 of statistical software was used for data analysis.

RESULTSData from univariate analysis showed that the history of cerebral trauma, education level and VAS score had significant differences between P group and NP group. Multivariate analysis conformed that the history of cerebral trauma, VAS score and education level were significantly related to POCD induced by PCIA and their ORs (95% CI) were 4.261 (1.344-13.508), 2.364 (1.209-4.624), 0.312 (0.170-0.573) respectively.

CONCLUSIONPatient's history of cerebral trauma and low VAS score were independent risk factors of POCD induced by PCIA and high education level seemed to be a protective factor.

Aged ; Analgesia, Patient-Controlled ; adverse effects ; Case-Control Studies ; Cognition Disorders ; etiology ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Risk Factors

OBJECTIVETo study the clinicopathologic features and metastasizing potential of solid pseudopapillary tumor of the pancreas (SPT).

METHODSForty-five cases of SPT were retrieved from the archival file and subdivided into metastasizing group (MG, n = 4), and non-metastasizing group (NMG, n = 41), according to the follow-up clinical information. The histological features were reviewed and immunohistochemical study for vimentin, alpha 1-antitrypsin, alpha 1-antichymotrypsin, CD10, neuron-specific enolase, progesterone receptor, chromogranin A, synaptophysin, AE1/AE3, beta-catenin, p53, cyclin D1, CD34 and Ki-67 was carried out. The results were correlated with follow-up data.

RESULTSThere was no statistically significant difference between MG and NMG, in terms of age and gender of the patients, site, size and capsular status of the tumor. No single morphologic parameter could distinguish MG from NMG. In general, increased mitotic activity, tumor emboli in vessels and necrotic foci were more conspicuous in MG than in NMG. According to a morphologic scoring system, all cases of MG had score ≥ 5, in contrast to < 5 in 95.1% (39 cases) of NMG. Immunohistochemically, there was no statistically significant difference between MG and NMG for beta-catenin, p53, cyclin D1 and CD34 staining. Ki-67 positivity however was significantly higher in MG. Amongst the 37 cases with follow-up information available, the average duration of follow up was 37.4 months. Thirty-three patients were alive and disease-free.Four suffered from liver metastases; and none of them died of the tumor.

CONCLUSIONSMitotic activity, presence of tumor emboli and necrotic foci represent as the useful parameters in predicting metastasizing potential of SPT, especially with application of morphologic scoring system. Immunostaining for Ki-67 can also serve as an additional prognostic indicator.

Adolescent ; Adult ; Carcinoma, Papillary ; metabolism ; pathology ; secondary ; surgery ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Ki-67 Antigen ; metabolism ; Liver Neoplasms ; secondary ; surgery ; Male ; Middle Aged ; Mitosis ; Necrosis ; Pancreas ; pathology ; Pancreatectomy ; methods ; Pancreatic Neoplasms ; metabolism ; pathology ; surgery ; Survival Rate ; Tumor Suppressor Protein p53 ; metabolism ; Young Adult ; beta Catenin ; metabolism

OBJECTIVESTo study the efficacy of proximal embolic protection device in preventing intracranial artery embolization during carotid artery stenting (CAS) and to evaluate its security and maneuverability.

METHODSFrom October 2007 to July 2008, 23 patients with carotid artery stenosis who were suitable for surgical therapy according to the standards of NASCET or ACAS were enrolled in this clinical research. Among them 19 patients (82.6%) were symptomatic, 6 patients (26.1%) with 50%-70% stenosis and 17 cases (73.9%) with > 70% stenosis. All the patients received carotid angioplasty and stenting under the protection of MO. MA system (one kind of proximal embolic protection device). We recorded the cerebral ischemic time during the procedure and observed neurologic events within 30 days.

RESULTSAll the procedures were performed successfully, the mean carotid artery blocking time was (5.3 +/- 1.2) min. No death or stroke occurred during perioperative period. Two cases of patients developed transient loss of consciousness combined with contralateral limb convulsion, while the common carotid artery was occluded by balloon. Two cases of patients developed bradycardia, sustained 6 hours and 1 week. Plaque debris in the withdrawal blood from carotid artery were found in 9 cases. At 30-day follow-up after CAS, TIA occurred in 1 case, new contralateral stroke occurred in 1 case, the incidence of 30-day stroke and death rate was 4.3%.

CONCLUSIONThe application of proximal embolic protection device in CAS procedure for preventing neurologic complications is safe and effective, especially for severe stenosis and unstable plaque in carotid artery stenting.

Aged ; Aged, 80 and over ; Angioplasty, Balloon ; instrumentation ; methods ; Carotid Stenosis ; surgery ; Embolic Protection Devices ; Female ; Follow-Up Studies ; Humans ; Intracranial Embolism ; etiology ; prevention & control ; Male ; Postoperative Complications ; prevention & control ; Stents ; Treatment Outcome

Objective To explore the correlation between periodic limb movement index (PLMI) and the apnea-hypopnea index (AHI), apnea index (AI), hypopnea index (HI) and lowest oxygen saturation (LSaO_2) in sixty-four children with sleep-disordered breathing(SDB).Methods Between March 2008 and May 2009, sixty-four children suspected of OSAHS underwent overnight polysomnogram monitoring in our medicine sleep center.OSAHS was diagnosed according to the general criterion.Sixty-four children were divided into two groups.Thirty children were diagnosed as OSAHS and 34 children were diagnosed as primary snoring (PS, 32 children) or upper airway resistance syndrome (UARS, 2 children).The difference of PLMI and periodic limb movement index during sleep associated with arousals (PLMl-arousal) were compared between the two groups.Besides this, the correlation between PLMI, periodic limb movement index during sleep associated with arousals and AHI, AI, HI and LSaO_2 were also analyzed in all SDB children.Furthermore, all SDB children were divided into two groups according to PLMI (< 5 events/h vs ≥5 events/h).AHI, AI, HI, LSaO_2 and sleep structure were compared between the two groups.Results ①The difference of PLMI and PLMI-arousal between the children with OSAHS and children with other SDB types(PS and UARS) were not significant (z value, - 1.279, - 1.490; P value, 0.201,0.136, respectively).② The increased sleep stage I was significant as being compared between the two groups (<5 events/h vs ≥5 events/h, t = -2.16, P <0.05).However, other sleep stages and sleep efficiency were not significantly different (P value, all > 0.05).③ The difference of HI, AI, AHI, arousals index (ArI) and LSaO_2 were not significant between the two groups(<5 events/h vs ≥5 events/h, P value, all > 0.05).④ PLMI and PLMI-arousal were not correlated with AHI, HI, AI, AHI and LSaO_2 (Spearman rank correlation analysis).Conclusions PLMS may be independent of SDB and PLMS had a little influce on sleep structure.

Objective To analyse the clinical features of children with obstructive sleep apneahypopnea syndrome(OSAHS),accompanying with risk factors.Methods The clinic data of 19 patients treated in the Department of Otorhinolaryngology of Guangzhou Children's Hospital between January 2005 to January 2008 were investigated retrospectively.Among them,5 were＜2 years old,6 with craniofacial deformity:small mandible and(or)mandibular retrusion(5 cases),transverse facial cleft(1 case),Down's syndrome(2 cases),cerebral palsy(2 cases),chronic bronchitis(3 cases)and mucopolysaccharidoses(1 case).Nineteen patients with symptoms of snoring, mouth breathing,were diagnosised as OSAHS by polysemnography(PSG)and treated by tonsillectomy and(or)adenoidectomy in hospital.All patients were closely followed-up.Results Fourteen patients underwent PSG 6 months to 1 year after operation,11 patients recovered,the median [percentiles 25;percentiles 75]apnea-hypopnea index(AHI)decreased from the pre-operative 22.5[16.5;24.3]times/h to 2.0[1.5;4.3]times/h,and the lowest oxygen saturation(LSaO2)before operation was 0.63,and was higher than 0.92 after operation,1 case accompanying with chronic bronchitis,the pulmonary hypertension was improved after operation.One case with Down's syndrome wag not significantly impmved,preoperative AHI and LSaO2 was 22.4 times/h and 0.67,and after operation was 14.2 and 0.84;2 cases accepted adenoidectomy only,snoring,mouth breathing reappeared 3 mornths after operation.pre-operative PSG results showed AHI 24.6 times/h and 26.6 times/h,LSaO2 was 0.69 and 0.73,after operation the AHI was 10.6 times/h and 8.5 times/h,LSaO2 was 0.90 and 0.88,the symptoms disappeared after adenotonsillectomy.Five cases did not have PSG because they lived far away in the other cities,their pre-operative PSG showed AHI 16.4 to 26.2 times/h,LSaO2 was 0.65 to 0.76.One year after operation,these patients were followed-up by telephone,4 children were significantly improved,1 case with mandibular symptoms showed no improvement.Conclusions For OSAHS children accompanying with risk factors,if they have adenoid and tonsil hypertrophy,adenotonsillectomy is the major treatment.Because of the existence of risk factors,perioperative risk increased,even the failure of operation.so these patients must be comprehensively assessed before operation.Satisfied results Can be achieved by close observation after operation and management of complications as soon as possible.

Objective To analyze the similarities and differences of the clinical manifestations between the children with upper airway resistance syndrome (UARS) and obstructive sleep apnea-hypopnea syndrome (OSAHS), and to explore the clinical features and characteristics of sleep respiratory parameters. Methods Using the double-blind method, all children were diagnosed as UARS or OSAHS through the polysomnography test and the results of all children were analyzed by a sleep technician and an otolaryngologist. Another ENT doctor recorded their clinical and physical examination in detail. Results Polysomnography showed that the apnea-hypopnea index (AHI) and the lowest oxygen in 253 children with OSAHS were 3.60 [ 2. 00 ;7. 55 ] times/h and 0. 90 [ 0. 85 ;0. 91 ], and were 0. 90 [ 0. 50; 1.10 ] times/h and 0. 95 [ 0. 92 ;0. 96 ] in 102 children with UARS, the difference of the two groups by rank test was statistically significant. The proportion of UARS and OSAHS was more common during preschool period than during school-age period. The chief complaint in two groups was sleep snoring, and the main symptoms were sleep restless, attention deficit/hyperactivity and breath with mouth open. The incidence rate of above symptoms were as follows, 94. 1% ,72. 5% ,62. 7% and 37. 3% in children with UARS, 92. 9% ,78. 7% ,57. 7% and 45. 5% in children with OSAHS. The difference was not significant by chi-square test (P >0. 05). Tonsil and adenoid hypertrophy were also observed in the two groups, the difference was not significant ( x2 = 0. 27, P =0. 87). However, the children with OSAHS were more apt to have the sleep apnea than with UARS, the difference was statistically significant (x2 =34.07,P<0.001). Conclusions The clinical manifestations of two groups are similar, the difference between UARS and OSAHS can not be determined by the patient's clinical performance. Sleep apnea can be more easily observed in children with OSAHS than that in UARS, the final diagnosis is based on polysomnography.

OBJECTIVETo explore the level of serum uric acid (UA) in children with obstructive sleep apnea/hypopnea syndrome (OSAHS).

METHODBetween Sep. 2008 and Mar. 2010, 138 children with OSAHS were enrolled in study group. Sixty-five children with accessory auricle or ptosis of upper lid were enrolled into the control group. Furthermore, according to apnea/hypopnea index (AHI) or obstructive apnea index (OAI) the study group was further divided into three subgroups (mild, moderate and severe group). At last, the study group and control group were divided into two groups according to the body mass index (BMI), separately. The fasting serum UA level was compared among the different groups. Then the correlation between the serum UA level and AHI, BMI, oxygen desaturation index, least arterial oxygen saturation (LSaO(2)) and the percentage of total sleep time with arterial oxygen saturation < 0.92 was also analyzed in OSAHS children with or without overweight and obesity respectively.

RESULTThe difference of serum UA level between the study group and control group (z = -0.443), and the difference among the three groups (χ(2) = 1.241) was not significant(P > 0.05). The serum UA level in overweight and obese children [study group, 273.0 (238.3 - 357.3); control group, 298.0 (253.0 - 336.0)] was significantly higher than that in children with normal BMI [study group, 246.5(215.8 - 300.0); control group, 266.0 (224.0 - 303.3)] (z = -2.084, -2.214, P < 0.05). That serum UA level did not correlate with the above index of OSAHS was observed in children with or without overweight and obesity in study group (P > 0.05).

CONCLUSIONFindings of higher serum UA level were not observed in children with OSAHS. There was no correlation between serum UA level and the above indices of OSAHS. The serum UA level in overweight and obese children was significantly higher than that in children with normal BMI.

Case-Control Studies ; Child ; Child, Preschool ; Humans ; Sleep Apnea, Obstructive ; blood ; Uric Acid ; blood

Objective To explore the diagnostic value of pulse transit time(PTT) in children with sleep disordered breathing(SDB).Methods Forty eight randomly selected snorers(2-13 years)with SDB were examined by PSG and PTT in the same time. Data obtained were analyzed by different technicians respectively. Statistics and analysis of the data were performed. Results Apnea hypopnea index (AHI),obstructive apnea index(OAI), the lowest oxygen and micro-arousal index were obtained by PSG and PTT.The results was described as M [25 percentile; 75 percentile]:4.9[1.3; 10.1], 4.6 [1.5; 11.8]; 1.2[0.7;4.9], 1.3[0.6;5.0]; 0.93[0.85;0.95], 0.93[0.84;0.95]; 14.5[12.6;16.4], 26.0[17.4;30.6]. The difference of AHI, OAI, and the lowest oxygen were not significant (P＞0.05), while the PTT arousal index detection rate was higher than PSG(Z=-5.19, P＜0.01). There was no significant difference in the diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) and determination of degree of patient's condition (P＞0.05). PTT could identify upper airway resistance syndrome in children without OASHS. Conclusions Both methods can be used to diagnose SDB. However, PTT is easy to useand suitable for the diagnosis of SDB in children, especially for UARS.

Objective To explore the reasons of multiple operations in children with airway foreign body through analyzing the clinical data of children who received two or more operations. Methods From 2003 to 2009, all children with airway foreign body who received two or more operations in hospital were enrolled. The clinical manifestations, image before and after operation and intraoperative conditions were retrospectively analyzed, in order to find the reasons of multiple operations. Results All children fully recovered, no serious complications or death. The reasons of two or more operations were multiple: 21 cases (42.8%) were related to the factor of apparatus, 20(40.8%) cases were related to the quality,surrounding conditions and location of the foreign body and experience and surgical skills of operator,4(8. 2% ) cases were due to incarceration of foreign body , another 4(8. 2% ) cases were due to unstable intraoperative oxygen saturation. Conclusions Both subjective and objective factors ( quality, surrounding conditions or location of foreign body, et al) were related to multiple operations. To reduce the chance of multiple operations, careful preoperative assessment and preparation are necessary.