stress response and anesthetic potency of unilateral spinal anesthesia for total Hip Replacement in geriatric patients

Recently, some scholars suggested that it is important to keep a stablehemodynamic state and prevent the stress responses in geriatric patients undergoing total hip replacement [THR]. We conducted this randomized prospective study to observe anesthetic potency of unilateral spinal anesthesia and stress response to it in geriatric patients during THR. We compared the effect of unilateral spinal and bilateral spinal on inhibition of stress response through measuring Norepinephrine [NE], epinephrine [E] and cortisol [CORT]. Plasma concentrations of NE, E and CORT were determined in blood samples using ELISA [enzyme-linked immunosorbent assays] at three time points: To [prior to anesthesia] T1 [at the time point of skin closure], T2 [twenty-four hours after the operation]. Sixty patients were randomly divided into two groups: group A [unilateral spinal anesthesia] and group B [conventional bilateral spinal anesthesia]. 7.5tymg of hypobaric bupivacaine were injected into subarachnoid cavity at group A and 12mg hypobaric bupivacaine were given at group B. The onset time of sensory and motor block, loss of pinprick sensation, degree of motor block, regression of sensory and motor blocks and hemodynamic changes were also recorded. These data were used to evaluate anesthetic potency of spinal anesthesia. The results of this experiment show that unilateral spinal anesthesia can provide restriction of sensory and motor block, minimize the incidence of hypotension and prevent the stress responses undergoing THR. It is optimal anesthesia procedure for geriatric patients by rapid subarachnoid injection of small doses of bupivacaine

Analysis of the diagnosis, treatment and prognosis in acute obstruction of proximal and distal colorectal cancers / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The study aimed to review the treatment and prognosis of acute obstruction of colorectal cancers and to compare different treatment strategies of those cancers, and to evaluate the risk factors affecting perioperative complications.</p><p><b>METHODS</b>Clinical data of 184 patients with acute obstruction of colorectal cancer undergone operation were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 184 patients with acute obstruction of colorectal cancer was collected in this study, including 58 patients with proximal and 126 patients of distal colorectal cancers. Perioperative death occurred in 2/58 patients (3.4%) with distal colorectal cancer and 6/126 cases (4.8%) of distal colorectal cancer (P > 0.05). The overall perioperative complications in the two groups were not significantly different (P = 0.794). Among the 58 patients with proximal colorectal cancer, one patient underwent colostomy, but among the 126 patients with distal colorectal cancer, 41 patients underwent colostomy, showing a significant difference between the two groups (P = 0.002). ASA scores (grade 3 - 4), elderly age (≥ 70 years) and colon perforation peritonitis were independent prognostic factors associated with perioperative mortality and morbidity. Patients in the self-expandable metallic stent (SEMS) group had a significantly shorter hospital stay (25.4 ± 8.3) d than that in the emergency surgery group (32.8 ± 16.4) d, (P = 0.039).</p><p><b>CONCLUSIONS</b>Endoscopic stent implantation provides an acceptable modality of palliation for acute proximal large bowel obstruction caused by malignancies. In acute colorectal cancer obstruction, SEMS can provide a minimally invasive management compared with surgical intervention.</p>

Comparison of the diagnosis and treatment of mechanical bowel obstruction due to tumor or other causes / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to review the etiology and pathogenesis of patients who underwent surgery for mechanical bowel obstruction. The treatment and prognosis of bowel obstructions caused by intra-abdominal tumors were compared with those due to other causes.</p><p><b>METHODS</b>The clinical data of 203 patients with mechanical bowel obstruction undergoing operation were analyzed retrospectively. The tumor cases were classified as group I, and all other cases as group II. A range of factors were investigated to estimate the postoperative outcome: gender, age, comorbidities, symptoms and findings of physical and radiological examinations, sites of the obstruction, etiology, therapeutic approach, postoperative complications and mortality.</p><p><b>RESULTS</b>Group I included 73 patients and Group II 130. Large bowel carcinoma and peritoneal adhesions were the most common causes of Group I and II, contributing 58 and 86 of all cases, respectively. There was no significant difference in terms of gender between the two groups, but the rate of elderly (≥ 70 years) patients was significantly higher (53.4%) than that of the < 70 years old patients (35.4%) (P = 0.012). There was a significant difference between the patients with previous surgical operation history in the tumor group (23.3%) and non-tumor group (58.5%) (P < 0.001). In the 73 cases of the tumor group, the obstruction was located in the large bowel in 58 cases (79.5%), small bowel in 12 cases (16.4%), both small and large bowels in 2 cases (2.7%) and gastric cancer invading the splenic flexure of colon in 1 case, while in the non-tumor group, 111 cases (85.4%) of the obstruction was located in the small bowel and 19 cases (14.6%) and in the large bowel (P < 0.001). Sixty-six cases (90.4%) of the tumor-group underwent intestinal segment excision and 21 cases (28.8%) underwent intestinal fistulation in the tumor group, but in the non-tumor group 61 cases (46.9%) underwent intestinal segment excision and 5 cases (3.8%) underwent intestinal fistulation (all P < 0.001). The hospital stay was (18 ± 6) days in the tumor group and (11 ± 3) days in the non-tumor group (P < 0.01). The complication rate (P = 0.104) and mortality rate (P = 0.187) were not significantly different between the two groups.</p><p><b>CONCLUSIONS</b>Tumor mechanical bowel obstruction is more frequently seen in patients in elder age, with colorectal location and without previous operation history. CT scan may provide effective diagnosis and ascertain the presence of the malignant obstruction. Intestinal fistulation is more often needed in patients with tumor intestinal obstruction and endoscopic stenting is a safe option in selected patients with tumor intestinal obstruction.</p>

Analysis of risk factors affecting operative outcome of small bowel obstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the risk factors affecting the early postoperative outcomes in patients with small bowel obstruction.</p><p><b>METHODS</b>Clinical data of 193 patients with small bowel obstruction undergone operation were analyzed retrospectively. A range of factors were investigated to estimate postoperative outcome, including gender, age, comorbidities, etiology of obstruction, presence of strangulated bowel (viable or nonviable), leukocyte count, temperature, and heart rate. Logistic regression analysis was used to study the prognostic value of each significant variable in terms of postoperation.</p><p><b>RESULTS</b>The major causes of small bowel obstruction were adhesion and hernia, contributing 38.9% and 37.8% of all cases, respectively. Strangulation occurred in 42.0% and caused nonviable bowel in 23.3% of obstructing episodes. Elderly (>or=70 years), diabetes, malignant tumors WBC >15x10(9)/L were independent significant factors associated with bowel strangulation. The overall complication rate was 16.1%, the 30-day mortality was 4.1%, and the median postoperative hospital stay was 13 days. Age >or=70 years and bowel resection were significantly associated with postoperative complications in the univariate analysis. Only elderly and malignant obstruction were significantly associated with operative mortality in multivariate logistic regression.</p><p><b>CONCLUSIONS</b>Surgery for small bowel obstruction is still associated with significant mortality and morbidity. Elderly is significantly associated with an increased incidence of strangulation, operative mortality, and complications.</p>

Analysis of 12 children with novel influenza A (H1N1) virus infection / 中华儿科杂志

<p><b>OBJECTIVE</b>Since late March 2009, a novel influenza H1N1 strain emerged in humans in Mexico and the United States. It has rapidly spread to many countries on different continents, prompting unprecedented activation of pandemic preparedness plans. The present study aimed to investigate the characteristics of children with the novel influenza A (H1N1) virus infection.</p><p><b>METHOD</b>Twelve cases with influenza A (H1N1) infection were diagnosed according to the criteria of the Center for Disease Control and Prevention (CDC) of China during 1 May to 15 July 2009 in the Pediatric Hospital of Fudan University were analyzed. Influenza A (H1N1) RNA was detected by RT-PCR in CDC Shanghai China.</p><p><b>RESULT</b>All the 12 children with the novel influenza A (H1N1) virus infection were imported cases, aged from 11 months to 14 years 7 months, 7 of whom were boys, 5 were girls. Five cases contacted closely with influenza A (H1N1) patients; 12 cases had fever and no vomiting or diarrhea; 7 had cough or runny nose or anorexia. One had shortness of breath. Of the 11 cases who could tell about symptoms correctly, 6 had sore throat, 3 had stomachache, and none had muscle pain. Two of the 12 cases had pneumonia, and the disease in 1 of them was fatal and needed intensive care. One case was isolated and treated at home. The 11 cases hospitalized were treated according to the guidance of influenza A (H1N1) diagnosis and treatment issued by the Ministry of Health of China. Ten hospitalized cases were treated with oseltamivir. All the cases recovered completely. The median length of hospital stay was 8.1 days (range, 6 to 16), and the time of negative test results of influenza A (H1N1) RNA from illness onset to collection of samples for viral testing was from 5 to 15 days.</p><p><b>CONCLUSION</b>Symptoms among children with the novel influenza A (H1N1) virus infection were classic and the majority of the cases we treated had a mild clinical course if they were isolated and treated promptly. Antivirals appears to have not had any major adverse effects. More data from different regions and large samples are needed to illuminate the characteristics of children with novel influenza A (H1N1) virus infection.</p>

Randomized controlled multi-center trial for treatment of varicella in pediatric patients with hydrochloride valacyclovir / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of hydrochloride valacyclovir in treatment of varicella in pediatric patients between April 2006 and March 2007.</p><p><b>METHODS</b>A randomized controlled multi-center clinical trial was conducted in 5 pediatric centers, i.e., Children's Hospital of Fudan University, Children's Hospital of Zhejiang University, Children's Hospital of Nanjing Medical University, Pediatric Department of Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology and Children's Hospital, Chongqing University of Medical Sciences. Patients who were clinically diagnosed as varicella without any complications and were beyond 3 years of age were enrolled into the study from the out-patient clinics. The subjects were divided into two groups randomly, one was treated with hydrochloride valacyclovir, the other with ribavirin. There were 128 cases in the group treated with hydrochloride valacyclovir and 132 cases in control group treated with ribavirin. The treatment duration of two groups was five days. The clinical efficacy and safety were evaluated after the first day and the fourth day of the treatment and within three days after the end of the treatment. The clinical efficacy was assessed by efficacy index.</p><p><b>RESULTS</b>(1) The efficacy index on the fourth day of the therapy (0.80 +/- 0.24) in the valacyclovir group was significantly higher than that of ribavirin control group (0.59 +/- 0.37) (t = 5.42, P < 0.01). The efficacy index at the end of the treatment (0.86 +/- 0.14) in the hydrochloride valacyclovir group was also significantly higher than that (0.70 +/- 0.30) of the ribavirin control group (t = 5.43, P < 0.01). (2) In the valacyclovir and ribavirin groups, the effective rates on the fourth day of the therapy were 94.53% and 72.7% respectively (chi2) = 22.38, P < 0.01). The effective rates at the end of the therapy were 99.2% and 88.6%, respectively (chi(2) = 12.60, P < 0.01). The rates of cure of the two groups were 33.6% and 25.0% (chi2) = 2.32, P > 0.05). (3) No severe adverse drug reactions were observed in any of the two groups.</p><p><b>CONCLUSIONS</b>The hydrochloride valacyclovir was safe, reliable and convenient in treatment of uncomplicated varicella in children.</p>

Management of pediatric patients who underwent liver transplantation / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the outcome of pediatric patients who underwent liver transplantation between Oct. 2002 and May 2005 in the Pediatric Hospital.</p><p><b>METHODS</b>Eight cases aged from 4 to 67 months who underwent liver transplantation were analyzed retrospectively. Four of the patients were boys and 4 girls, whose body weight at the time of liver transplantation was 6-19 kg. The underlying diseases were biliary atresia, congenital cholestasis, drug-induced cholestatic cirrhosis and cryptogenic cirrhosis. These patients had been followed up for blood routine examinations, liver and renal function, serum electrolytes and blood concentration of tacrolimus for 16 to 43 months after liver transplantation. Results of serological studies for viral etiology, liver biopsy, growth and mental development were also recorded.</p><p><b>RESULTS</b>One-year survival rate was 75.0% with the longest survival time being 43 months after transplantation. One patient died from renal failure due to postoperative bleeding 24 hours after the surgery and another case died of variceal hemorrhage 8 months after transplantation. Posttransplantation complications included acute cellular rejection, viral infection and hypoalbuminemia. Viral infections included cytomegalovirus infection in 3 cases, Epstein-Barr virus infection in 1 and hepatitis B virus infection in 1. Surgical complications of portal vein thrombosis and stenosis of inferior vena cava and hepatic vein occurred in 2 cases respectively. Side effects of tacrolimus including hypertension, renal damage, liver damage and diarrhea were observed. Significant growth-retardation was not often seen. A self-reported high quality of life was common.</p><p><b>CONCLUSIONS</b>Close follow-up and management of patients after liver transplantation may significantly increase the survival rate and improve quality of life in children with end-stage liver diseases.</p>

Effect of integral syndrome differentiation acupuncture on the tear film stability in the patient of xerophthalmia / 中国针灸

<p><b>OBJECTIVE</b>To probe into a treatment method for increasing clinical therapeutic effect on xerophthalmia.</p><p><b>METHODS</b>Forty-five cases were randomly divided into acupuncture group 1, acupuncture group 2 and control group. The acupuncture group 1 were treated with acupuncture based on syndrome types, and the acupuncture group 2 with acupuncture at local acupoints, and the control group with dripping of artificial tears. Local symptoms of eyes, S1T, BUT and FL were observed before and after treatment.</p><p><b>RESULTS</b>S1T and BUT increased after treatment in the two groups (P < 0.01, P < 0.05), but did not significantly change in the control group (P > 0.05). There were significant differences in change of FL as the control group compared with the acupuncture group 1 and 2. The total effective rate was 86.7%, 66.7% and 33.3% in the acupuncture group 1, 2 and the control group, respectively.</p><p><b>CONCLUSION</b>The integral syndrome differentiation acupuncture can improve secretion of tear, increase stability of tear film, improve local symptoms of eyes with a therapeutic effect better than acupuncture at local acupoints and artificial tears.</p>