Objective To investigate the clinical characteristics of invasive bum wound infection with sepsis in patients with major burns and to summarize the successful expenences in the treatment of such patients. Methods Eight patients with major bums, complicated by invesive bum wound infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock. The plasma concentrations of IL-6,IL-8,TNFα and lypopolysaccharibe (LPS) were assayed before and after surgical intervention, as well as when the patient' s vital signs became stable. Results The patients' conditions usually deterieorated abruptly when extensive invasive bum wound infection emerged. While multi-microbial infection was usually found, Pseudomonas aeruginosa was the predominant bactena isolated from the subeschar tissue. The plasma concentrations of IL-6, IL-8, TNFα and LPS before surgical intervention wore significantly higher than those after surgical intervention (P＜0.05).The lowest levels of the inflammatory mediators were abserved when the patients'conditions became stable,and the values were significantly lower than those before surgical intervention ( P＜0.001). Conclusion Since the main cause of burn wound sepsis is the presence of a large area of infected bum wound, they should be excised and covered as early as possible. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn sepsis. Athough favorable results should be attributed to compmhessive treatment, we believe that early, aggressive and thorough surgical excision of infected burn wounds, followed by sound and complete coverage of the area, play a crucial role.

OBJECTIVETo explore the treatment of breast sclerosis caused by capsular contracture after augmentation mammaplasty, and preventive measures after the treatment to avoid the recurrence.

METHODSWith the incision through periareola, a part of the fibrous capsule and fibrillate tissue which is between the base of the capsula and the wall of the capsula were resected in the shape of wedge. At the same time, the wall of the capsular cavity was incised in radiant shape to relax it. After operation, the early and effective massage should be fully used.

RESULTS17 case of 26 case were given follow-up over half a year, the results were satisfactory.

CONCLUSIONSAfter capsular contracture was relaxed and a part of the fibrous capsula between the base and the wall of the capsular cavity was resected in the shape of wedge, the prosthesis can be moved smoothly in the suitable cavity without any obstruction. In addition to the early and effective massage after operation, the methods might reach the ideal results.

Adult ; Breast ; surgery ; Contracture ; surgery ; Female ; Humans ; Mammaplasty ; adverse effects ; Postoperative Complications ; surgery

OBJECTIVETo assess the feasibility and safety of thoracoscopic bulla resection under laryngeal mask anesthesia with low tidal volume high-frequency lung ventilation.

METHODSSixty patients with pulmonary bulla were randomized into two groups (n=30) to undergo video-assisted thoracoscopic surgery (VATS) for bulla resection with laryngeal mask anesthesia and high-frequency low tidal volume lung ventilation general anesthesia and or with intubation anesthesia and one-lung ventilation through double-lumen endotracheal intubation.

RESULTSNo significant differences were found in anesthesia time, surgery time, intraoperative lowest SpO2, intraoperative highest PetCO2, operative field, anesthetic effects, or blood loss between the two groups. The post-operative WBC and NEU% showed significantly smaller increments in the mask anesthesia group than in the intubation group, and the postoperative awake time, initial eating time, ambulation time, in-hospital stay, and drainage time were significantly shortened in the former group with also lower incidences of gastrointestinal reactions, throat discomfort and hoarseness.

CONCLUSIONThoracoscopic bulla resection under laryngeal mask anesthesia with low tidal volume high-frequency lung ventilation is safe and feasible and results in better patient satisfaction and shorter in-hospital stay than procedures performed under intubation anesthesia with one-lung ventilation.

Adolescent ; Adult ; Aged ; Anesthesia, General ; methods ; Blister ; Child ; Female ; High-Frequency Ventilation ; Humans ; Intubation, Intratracheal ; Laryngeal Masks ; Lung Diseases ; surgery ; Male ; Middle Aged ; One-Lung Ventilation ; Thoracic Surgery, Video-Assisted ; Young Adult

Objective:To investigate the effect and safety of the hi-channel in one-stage of minimally invasive pereutaneous nephrolithotomy (mPCNL) in management of complicated renal calculi, compared with single chan-nel in two-stage of mPCNL. Methods: 57 patients underwent mPCNL in treatment of complicated renal calculi were retrospectively reviewed. 31 eases in group A underwent bi-channel in one-stage of mPCNL;26 eases in group B underwent single channel in two-stage of mPCNL. Results= The mean bleeding in the group A was 146. 4 m1(75-262.5 ml), compared with the group B 154.3 ml(75-300 ml), there was no statistically difference between the two groups (P>0.05). The mean operation time in the group A was 88. 4 rain(65-136 min), compared with the group B 123.1 min(70-180 min), there was statistically difference between them(P<0.05). Compared of the clearance rate of stone in the group A 83.9 % (26/31) and B 57.8% (15/26), there was statistically difference be-tween them (P<0.05). Conclusions:According the treatment of complicated renal calculi, the bi-ehannel in one-stage of mPCNL has shorter operation time, higher clearanee rate of stone, compared with single channel in two-stage of mPCNL. The patients need less expenses and shorter time staying in hospital. It is an ideal method.