OBJECTIVETo study the effect of different mean arterial pressures (MAP) on arterial to end-tidal CO₂partial pressure difference [(Pa-et)CO₂] and the intrapulmonary shunt (Qs/Qt) in patients undergoing thoracic surgery during one-lung ventilation (OLV).

METHODSForty-two patients undergoing right-sided pulmonary lobectomy were allocated into group A with fluctuation of MAP (at 20 min after OLV) within ± 10% of the baseline (n=22) and group B with lowered MAP by 30% of the baseline (n=20). Arterial and venous blood gas analyses were recorded to calculate [(Pa-et)CO₂] and Qs/Qt at 20 min after induction with two-lung ventilation (T₁), 20 min after OLV (T₂), 30 min after recovery of normal blood pressure (T₃), and 20 min after recovery of two-lung ventilation (T₄).

RESULTSPetCO₂and PaCO₂were well correlated during two-lung ventilation and OLV in group A (P<0.05). In group B, [(Pa-et)CO₂] at T₂was significantly higher than that in group A, but PetCO₂was still correlated with PaCO₂(P<0.05). Qs/Qt increased more obviously in group B than in group A in T₂(P<0.05). Bo obvious correlation was found between the [(Pa-et)CO₂] and Qs/Qt during OLV.

CONCLUSIONPetCO₂reflects the dynamic changes of PaCO₂under normal blood pressure during OLV. In the hypotension period, when [(Pa-et)CO₂] increases and the correlation coefficient between PetCO₂and PaCO₂lowers, PetCO₂may not accurately reflect the changes of PaCO₂and blood gas analysis is warranted.

Arterial Pressure ; Blood Gas Analysis ; Carbon Dioxide ; analysis ; Humans ; Lung ; surgery ; Monitoring, Physiologic ; One-Lung Ventilation ; Oxygen ; analysis ; Thoracic Surgical Procedures

OBJECTIVETo define the ideal time window for intubation after rocuronium administration during target-controlled infusion (TCI) ofpropofol and sulfentanil.

METHODSOne hundred and twenty elective surgical patients (age range 18-55 years) were randomized into 4 groups (n=30) according to the intubation time after administration of the muscle relaxant. Patients with predicted difficult airway were excluded. General anesthesia was induced by TCI of propofol and sulfentanil. A senior anesthesiologist blinded for the randomization performed the intubations at 1, 2, 3, or 4 min after injection of rocuronium, and the vocal card visibility was evaluated upon full exposure of the vocal cord and the intubation conditions assessed according to Cooper's score.

RESULTSThe intubation conditions were excellent or good in all patients, but the vocal cord visibility at 2-4 min differed significantly from that at 1 min after rocuronium administration (P<0.01). Suppression of the neuromuscular function 1 min after rocuronium administration differed significantly from that at other time points (P<0.01).

CONCLUSIONThe condition of vocal cord can be more suitable for intubation at 2-4 min than at 1 min after rocuronium administration as the ideal time window for intubation during TCI of propofol and sulfentanil.

Adolescent ; Adult ; Androstanols ; administration & dosage ; Anesthetics, Intravenous ; administration & dosage ; Humans ; Infusions, Intravenous ; Intubation ; methods ; Middle Aged ; Neuromuscular Nondepolarizing Agents ; administration & dosage ; Propofol ; administration & dosage ; Single-Blind Method ; Sufentanil ; administration & dosage ; Time Factors ; Vocal Cords ; drug effects ; Young Adult

OBJECTIVETo explore the prophylactic effect of acupuncture Neiguan (PC 6) on nausea and vomiting after laparoscopic operation.

METHODSOne hundred patients with laparoscopic gastrointestinal operation were randomly divided into an acupuncture group and a control group, 50 patients in each group. The operation was carried out with the combined infusion and inhalation anesthesia. The patients in the acupuncture group were being punctured at bilateral Neiguan (PC 6) before anesthesia and during the operation. The needles were extracted after operation, and the acupoints were covered with opaque tape. In contrast, the patients in the control group only accepted tape covering without acupuncture. After operation, all patients were given the self-controlled intravenous analgesia, and followed up at 6 h, 12 h, 24 h, 48 h for recording the incidence rate of the nausea, retching and vomiting, then scoring with VAS.

RESULTSAt 6 h, 12 h, 24 h, 48 h after operation, in the acupuncture group, the incidence rates of the nausea were 12.0%, 6.0%, 6.0% and 2.0%, and the incidence rates of the retching were 0, 0, 2.0% and 2.0%, respectively; in the control group, the incidence rates of the nausea were 28.0%, 20.0%, 12.0% and 2.0%, and the incidence rates of the retching were 2.0%, 6.0%, 2.0% and 0, respectively. At 6 h, 12 h after operation, the incidence rates of the nausea and retching in the acupuncture group were lower than those of the control group (P < 0.05, P < 0.001). The vomiting was not happened in both groups. There was no difference between the two groups according to the scoring with VAS.

CONCLUSIONAcupuncturing at Neiguan (PC 6) can reduce the incidence rates of the patients' nausea and retching after laparoscopic operation, especially in 24 h.

Acupuncture Therapy ; Adult ; Aged ; Analgesics ; adverse effects ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Nausea ; prevention & control ; therapy ; Postoperative Complications ; therapy ; Vomiting ; prevention & control ; therapy

OBJECTIVETo investigate the effects and prognosis of surgical treatment in primary gastrointestinal stromal tumors (GIST).

METHODSThe clinicopathological data of 73 patients with primary GIST underwent operation from April 1997 to December 2007 was retrospectively analyzed, and the prognosis was evaluated too.

RESULTSAmong the 73 cases, 68 cases received complete tumor resection, among which 12 cases underwent laparoscopic operation; while palliative resection and biopsy only were carried out in the other 5 cases. There was significant difference in survival rate between the two groups (P = 0.000). The 1-, 3-, 5-year survival rates of the 66 cases had been followed up was 91.0%, 78.2% and 74.1%, respectively. The malignancy risk grades of GIST was related to the survival rates on statistical analysis (P = 0.002). Significant differences were found in the survival rates between the patients with very low grade, low grade and high grade malignancy tumors (P = 0.012, 0.002).

CONCLUSIONSComplete tumor resection should be emphasized in primary GIST, and more attention should be paid to the initial surgical treatment. Extended surgical resection is required for tumors of higher malignancy risk. The indications of laparoscopic surgery in GIST should be selected with caution for tumor complete resection.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Analysis

OBJECTIVETo investigate the changes of EEG approximate entropy (ApEn) in rats during focal cerebral infarction.

METHODSTwenty-four Sprague-Dawley (SD) rats were randomly divided into infarction group (n=12) with middle cerebral artery occlusion and sham-operated group (n=12). The EEG data (ApEn) was recorded in the bilateral areas (C3, C4) of the rats with focal cerebral infarction before the infarction and immediately and at 5, 15, 30, and 60 min after the infarction. The same measurement was carried out in the sham-operated group.

RESULTSIn the sham-operated group, ApEn in C3 and C4 showed no obvious differences at the time points (P>0.05), but in the infarction group, ApEn in C3 and C4 increased significantly after the infarction. ApEn in the ischemic area (C4) was significantly lower than that in the non-ischemic area (C3) (P<0.05). The bilateral ApEn decreased with the passage of time. ApEn in the ischemic area (C4) was significantly lowered at 30 min after the infarction in comparison with that before infarction (P<0.05). In the sham-operated group, ApEn showed no significant difference between C3 and C4. ApEn was comparable between the two groups before the operation.

CONCLUSIONApEn can help monitor the occurrence of focal cerebral infarction of rats, and may be used to assess the extent of cerebral ischemia after infarction.

Animals ; Cerebral Infarction ; physiopathology ; Electroencephalography ; Entropy ; Male ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the clinicopathological characteristics, surgical treatment and prognosis of gastrointestinal stromal tumors(GIST).

METHODSThe clinicopathological data of 84 patients with GIST undergone resection between April 1997 and June 2008 were analyzed retrospectively, and the prognosis was evaluated.

RESULTSOut of 84 cases, 42 tumors located in stomach, 24 in small intestine, 18 in other sites. Tumor sizes ranged from 0.5 to 25 cm(average 5.6 cm). Positive rate of CD117 expression determined by immunohistochemical methods was 96.4%. Seventy-nine cases underwent complete tumor resection, while 5 cases received palliative resection or biopsy. Seventy-eight patients were followed up and their 1-, 3-, 5-year survival rates were 92.0%, 79.2%, 72.0% respectively. The Fletcher's classification of malignancy risk groups for GIST was related to the survival rates(P=0.001). The differences of survival rate among very low risk group, low risk group and high-risk group were significant(P=0.003, P=0.000).

CONCLUSIONSComplete tumor resection in the initial operation of GIST should be emphasized. The Fletcher's classification of malignancy risk groups for GIST is related to the survival rate. Extended surgical resection is required for GIST of higher malignancy risk.

Adult ; Aged ; Aged, 80 and over ; Female ; Gastrointestinal Stromal Tumors ; mortality ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate

OBJECTIVETo investigate whether RhoA/Rho-kinase contributes to the occurrence of chronic post-thoracotomy pain (CPSP) by up regulation of glutaminase 1 (GLS1) expression in the spinal dorsal cord.

METHODSTwenty five male Sprague Dawley (SD) rats were divided into control group (n=5) and model group (n=20). The rats in the model group were randomized into two sub groups (n=10) for observation on day 10 and day 21 after thoracotomy, and each group was further divided into CPSP and non CPSP groups according to the behavioral test results. All the rats were sacrificed after behavioral test for examination of GLS1 and RhoA expressions in the spinal cord using Western blotting and RT PCR. We also compared the effect of the Rho kinase inhibitor fasudil and saline, both injected intraperitoneally daily at 10 mg/kg for 7 consecutive days following thoracotomy, on CPSP and GLS1 expression in 30 male SD rats on day 21 after thoracotomy.

RESULTSCompared with the control group, the rats with CPSP showed significantly increased expressions of GLS1 and RhoA mRNA in the spinal cord on both day 10 and day 21 following thoracotomy (P<0.01), but the rats without CPSP did not show obvious changes in GLS1 and RhoA expressions. In fasudil treated rats, the mechanical pain threshold was obviously increased and the expressions of GLS1 and RhoA were significantly reduced as compared with those in saline treated rats (P<0.01).

CONCLUSIONRhoA plays an important role in the occurence of CPSP by up-regulating the expression of GLS1 in the spinal dorsal cord of rats.

OBJECTIVETo establish an modified rabbit model of the acute lung injury induced by cardiopulmonary bypass (CPB) with ascending aorta and right atrium catheterization and detect the changes in serum tumor necrosis factor-α (TNF-α) level after modeling.

METHODSTen healthy adult male New Zealand rabbits were randomly selected to establish CPB models. The model establishment was deemed successful if the rabbits survived for over 4 h with stable heart beat after termination of CPB. The vital signs of the rabbits were recorded after anesthesia (T), before CPB (T), at 15 after blocking the ascending aorta and pulmonary artery (T), immediately after re-opening of the ascending aorta and pulmonary artery (T), and at 1 (T) and 4 (T) after CPB. Arterial blood gas (ABG) was monitored at T, Tand Tand the serum levels of TNF-α were also detected with ELISA.

RESULTSNine rabbit models of CPB with acute lung injury were successfully established. During the operation, the MAP was maintained at a level above 55 mmHg, HCT significantly decreased from (30.18∓2.88)% at Tto (17.73∓1.95)% at T(P<0.05), and plasma lactate level increased significantly from 3.65∓1.13 mmol/L at Tto 9.36∓1.28 mmol/L at T(P<0.05). The oxygenation index (PaO/FiO) at Twas significantly lower than that at T(281.64∓55.76 vs 468.36∓56.28 mmHg, P<0.05). The serum levels of TNF-α were significantly increased (P<0.05) and obvious lung interstitial edema and inflammatory cell infiltration occurred after CPB establishment.

CONCLUSIONThe modified rabbit model of CPB with acute lung injury is stable and reliable and can be used for studying acute lung injury induced by CPB.

Multiple primary malignant neoplasms (MPMNs) are rarely reported and it is important to give early diagnosis and proper therapy for these patients. Here reported a case of 62-year-old man with concomitant three early stage cancer lesions in upper gastrointestinal tract, all of which were detected by endoscopy. The first one was an IIc-type lesion at angular part of stomach under endoscopy, which was histologically confirmed to be a mucosal well-differentiated adenocarcinoma. The patient underwent a standard radical gastrectomy for the lesion after the failure of endoscopic treatment. The other two neoplasms were observed during follow-up and were indicated as early stage lesions by synthesizing information from endoscopy, endoscopic ultrasonography, computed tomography and biopsy. One displayed as a hyperemic patch (3 cm×4 cm in size) located at the part of esophagus 27 cm away from the incisor teeth and was proved to be moderately differentiated squamous cancer by histopathological examination. The other was an IIc-type lesion (3.0 cm×3.5 cm in size) located at the part of esophagus 36 cm away from the incisor teeth, and the biopsy result showed a poorly differentiated squamous carcinoma. Both the two lesions were treated with radical radiation because the patient refused surgery management. No recurrence of former lesions or occurrence of novel lesions were observed during post-treatment follow-up, suggesting radical radiation might be effective for this patient.
Gastrointestinal Neoplasms ; diagnosis ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary ; diagnosis ; Upper Gastrointestinal Tract ; pathology

OBJECTIVETo investigate the manifestation and diagnostic value of multislice spiral CT (MSCT) and MRI imaging in detection of tumor recurrence after liver transplantation for hepatocellular carcinoma (HCC).

METHODSThe clinical data of 161 consecutive HCC patients who underwent orthotopic liver transplantation were retrospectively reviewed. Twenty-nine HCC patients were classified by pTNM according to the "Pittsburgh criteria". MSCT and MRI findings of tumor recurrence after liver transplantation were evaluated retrospectively in 29 stage II-IVb HCC patients. The recurrence site and relapse interval between liver transplantation and recurrence were analyzed.

RESULTSLung tumor recurrence were found in 21 cases, presented as cotton-like lesions in a diameter of 2 - 3 cm, with a clear margin and homogeneous density. Pleural tumor recurrence was detected in 4 cases. Liver tumor recurrence were found in 9 cases, which can be divided into four subtypes: multinodular in 4 cases, diffuse lesion in 2 cases, huge mass in 2 cases, and uninodular in 1 case. Two cases showed tumor thrombus in the inferior vena cava and portal vein. Lymph node tumor recurrence was found in 9 cases, presented as multiple nodules at hepatic hilum, lesser peritoneal sac, posterior mediastinum, retroperitoneum, or around pancreatic head, and accompanied with merging and necrosis in one case. Bone tumor recurrence were found as osteolytic destruction in 4 cases, and accompanied with adjacent soft-tissue mass in 2 cases. The recurrence sites of the 29 cases were as following: lung (21 cases, 72.4%), liver (9 cases, 31.0%), lymph nodes (9 cases, 31.0%), bone (4 cases, 13.8%) and other sites (3 cases, 10.3%). Lung tumor recurrence was found in all the 10 stage IVb patients with tumor recurrence after liver transplantation, significantly more frequent than that in stage IVa patients (P = 0.023). After liver transplantation, all 25 patients with stage III approximately IVb HCC developed recurrence within one year, but in the 4 cases with stage II HCC at one year later (P = 0.009).

CONCLUSIONThe results of our study show that in hepatocellular carcinoma patients after liver transplantation, the lung and pleura are the most frequent site of recurrence, followed by liver, lymph node and bone as the second and third sites. The Stage IVb hepatocellular carcinoma should be regarded as a contradiction for liver transplantation due to rapid recurrence. Tumor recurrence occurs later in stage II HCC than in stage III approximately IVb patients. MSCT and MRI are of significant importance in diagnosis and formulating operation plan in HCC patients with recurrence after liver transplantation.

Adult ; Carcinoma, Hepatocellular ; diagnosis ; diagnostic imaging ; secondary ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; surgery ; Liver Transplantation ; Lung Neoplasms ; diagnosis ; diagnostic imaging ; secondary ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; diagnosis ; diagnostic imaging ; Neoplastic Cells, Circulating ; Pleural Neoplasms ; diagnosis ; diagnostic imaging ; secondary ; Retrospective Studies ; Tomography, Spiral Computed ; methods