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Objective To investigate the effects of propofol combined with nalbuphine on diaphragmatic movement monitored by ultrasound in patients undergoing colonoscopy.Methods Forty patients, males 21 and females 19, aged 18-65 years, BMI 18-25 kg/m2, ASA physical status I or II, were recruited and scheduled to undergo elective painless colonoscopy.All patients were randomly divided into two groups (n =20):propofol group (group P) and propofol combined with nalbuphine group (group F).Patients in group F received nalbuphine 0.1 mg/kg intravenously 1 min before propofol administration, and patients in group P received same volume of normal saline.Propofol was infused by TCI and the initial target plasma concentration was set at 2μg/ml in all patients.The target concentration was adjusted gradually until the Ramsay sedation score reached 5.Then colonoscopy was started.During the colonoscopy, the propofol concentration was adjusted according to the Ramsay score.Ultrasound was used to monitor the movement of the right diaphragm of the patients.SpO2, MAP, HR, PETCO2, RR, diaphragmatic movement (DM), diaphragmatic thickness at the end of inspiration (TEI) and diaphragmatic thickness at the end of expiration (TEE) were recorded under calm breathing after entering the room (T0), Ramsay sedation score 5 points after propofol administration (T1), and Ramsay sedation score 2 after endoscopy (T2).The diaphragmatic thickening fraction (DTF) was calculated:DTF= (TEI-TEE) /TEI.Adverse reactions such as bradycardia, hypotension, body movement, and respiratory depression were recorded.Results Compared with T0, MAP, SpO2, HR and RR decreased, and PETCO2 increased at T1 time point in patients of the two groups (P<0.05).Compared with group F, the dose of propofol increased in group P (P<0.05).DM at T1 and T2, DTF at T1 were obviously higher in group F than those in group P (P<0.05).There were two cases had body movement in group P, and one case had bradycardia in group F.There was no case suffered from hypotension, respiratory depression and reflux aspiration in two groups.Conclusion Compared with propofol alone, propofol combined with nalbuphine can attenuate the dysfunction of the diaphragm.
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Objective:To explore the mechanism,clinical features,and prognosis of trigemino-cardiac reflex (TCR) during skull base operations.Methods:A retrospective analysis was performed on 291 patients with skull base disease from Jan.2009 to Oct.2015 in Peking University First Hospital.By reviewing the patients' operative data and anaesthetic electrical record,and we picked out all the patients who suffered from TCR during the operation and analyzed their surgical procedures,clinical features,influence factors,and prognosis.TCR was defined as a drop in mean arterial blood pressure (MABP) and the heart rate (HR) of more than 20％ to the baseline values before the stimulus and coinciding with the manipulation of the trigeminal nerve.Results:In all the 291 patients receiving skull base surgery,9 patients suffering TCR for 19 times during the operation were found.These 9 cases included three acoustice schwannomas,one trigeminal schwannoma,one petroclival meningioma,one epidermoid cyst in cerebellopontine angle,one cavernous sinus cavernous hemangioma,one pituitary adenoma,and one trigeminal neuralgia.The trigger of TCR was related to manipulation,retraction,and stimulation of the trunk or branches of trigeminal nerve.The baseline heart rate was 62-119/min [mean (79.4 ± 14.6) /min] and dropped about 29.0％-66.4％ (mean 44.3％) to 22-60/min [mean (44.2 ±9.6) /min] after TCR.The baseline mean arterial blood pressure was 75-103 mmHg [mean (87.5 ±7.8) mmHg] and dropped about 23.4％-47.2％ (mean 37.3 ％) to 45-67 mmHg [mean (54.9 ± 6.3) mmHg] after TCR.During the 19 times of TCR,heart rate and blood pressure could return to baseline in a short time while stopping manipulation (8 times),using atropine (8 times,dose 0.5-1.0 mg,mean 0.69 mg),using ephedrine hydrochloride (one time,15 mg),using epinephrine (one time,1 mg),and using dopamine (one time,2 mg).TCR also could be triggered again by a second stimulation.There was no relative cardiologic complication or neurological deficit in the postoperative 24 hours.Conclusion:TCR is a short neural reflex with a drop in blood pressure and heart rate coinciding with the manipulation of the trigeminal nerve in skull base surgery.Correct recognition,intensive observation,and essential management of TCR will lead to a good prognosis.
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Objective To explone the cause and countemeasuer of complication following laparoscopic cholecystectomy. Methods The cause and management of complications in 1227 casesof laparoscopic cholecystectomy were analyzed retrspectively. Results Related complications were found in 13 cases,including 2 cases of severe complications with bile duct injuryes,2case with bile leakage,5case with hemorrhage and 3 case with enteric perforation, 1 of that patients died for complications. Conclusion Proper selection of patients, identification of local anatomical relationship, to ensure a clear surgical site revealed, flexibly deal with the condition of patients is the key to reducevarious complication.
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@#Objective To sum up the experience of decompressive surgery for the acute massive hemispheric infarction to determine its beneficial effects.MethodsRetrospectively study 6 patients receiving early decompressive craniotomy because of deterioration after infarction.Results 5 patients survived,4 of them recovered to the good level of daily activity (Barthel index ≥60) one year after rehabilitation.One senile patient died of pulmonary infection.ConclusionThe decompressive surgery is an effective method on the survival and functionary recovery for the patients with deteriorating massive cerebral infarction.
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Objective To investigate the value of presurgical functional magnetic resonance imaging(fMRI) in identifying the eloquent brain areas and guiding the resection of cerebral tumors located in these areas.Methods A total of 10 patients(aged 51.3 years on average) with tumors near to the brain functional areas were enrolled in this study,among which 7 had weakness in the limbs,2 had convulsion,and 1 suffered from facial palsy.The preoperative Karnofsky scale of the patients was 82 on average.Before the fMRI,the patients have been confirmed as having tumors involving functional areas.They were treated by total or subtotal resection according to the anatomical relationship between activated areas and the tumor.Injuries to the activated areas should be avoided during the operation.After the treatment,the muscular strength,Karnofsky scales of the patients were tested.Postoperative MRI was carried out in all of the patients,and the results were compared with that before the operation.Results As shown by fMRI,the activated areas were compressed and dislocated by the tumor in 8 of the 10 patients.The minimal distance between the edge of the tumor and the activated spots was 0-26 mm(mean,13.6).Seven of the patients received total resection of the tumor,while the other 3 underwent subtotal resection.After the surgery,the muscular strength was improved in 7 cases;the convulsion disappeared in the 2 patients who had symptom before the treatment;and the one who had facial palsy was improved.One month after the surgery,the mean Karnofsky scale of the patients was 93.Re-examination by MRI performed one week after the operation showed that the tumor was disappeared in 7 patients,and reduced by 95% to 99% in the other three.Conclusions fMRI is valuable in the preoperative evaluation of the brain functional area near to a cerebral tumor.It can be used to guide the tumor resection while preserving the motor areas.
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Meningomyelocele combined with squamous cell carcinoma is rare in literature. In this article,we report the clinical and treatment of a patient with meningomyelocele and squamous cell carcinoma and discuss its mechanism,clinical feature,therapy and prognosis.The patient was a 11-year-old Chinese boy.At the time of his birth he was noted to have a lumbosacral meningomyelocele,which was disrupted and the cerebral spinal fluid flew out when the child was six.The wound surface abrased and exudated repeatedly.Two months before admission,the meningomyelocele was disrupted again and the condition got worse.Inspection showed a meningomyelocele in the lower lumbar region 10 cm in diameter,consisting of a cauliflower-shaped swelling and a central crater containing black slough.The area smelled foul and was constantly draining serosanguineous fluid.Magnetic resonance imaging showed meningomyelocele associa-ted with spinal dysraphism and tethered cord syndrome.After thorough preparation,operation was undertaken.A perpendicular skin incision,which was carried down to the lumbar aponeurosis,allowed the main bulk of the tumour to be undercut and removed.The quick frozen pathological examination confirmed that it was squamous cell carcinoma.The skin and subcutaneous tissue were fruther resected and the vertebral canal explored until frozen section showed the excision edge was clear.Skin closure was achieved by a bi-pedicle advancement flap,some 10 cm wide and the secondary defect was closed with a thigh skin graft.Histological examination showed that the massive outgrowth was a well-differentiated squamous cell carcinoma.The postoperative recovery was uneventful and the wounds healed by primary intention.Although meningomyelocele combined with squamous cell carcinoma is rare in literature,the possibility of can-cerization should be considered when there is a long-term and non-healing ulcer (Marjolin ulcer) with foul smell in a meningomyelocele patient.
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Congenital bilateral perisylvian syndrome(CBPS) is rare in literature,especially in China.In this article,we report the clinical and treatment of a patient with CBPS and discuss its mechanism,clinical features and therapy.This patient was a 28-year-old man.His main clinical features were pseudobulbar palsy,cognitive deficits and intractable epilepsy.MRI shows bilateral thickening of the cortex around the sylvian fissures which were deeper than normal and polymicrogyria.The electroencephalogram demonstrated slow spike in right temporal lobe and left frontal lobe.Rhythmal 4 Hz ? waves exist in left frontal and parietal lobe.As the epilepsy was poorly controlled by antiepileptic,section of the corpus callosum was carried out.After callosotomy,there was pronounced seizure reduction and intelligence development improvement.CBPS is characterized by pseudobulbar palsy,cognitive deficits,and bilateral perisylvian abnormalities in imaging studies.If intractable epilepsy is combined,callosotomy may be effective.
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In this paper,through the questionnaire analysis of teachers' teaching quality,the author got to know the students were contented with the teaching quality and there were some problems in the classroom teaching. Moreover,the author offered a few advises to improve the teaching level and teaching quality.
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Objective To summarize and evaluate the experience and near-term outcomes of microsurgical treatment of myelomeningocele in the lumbar and sacral region in children.Methods Clinical data of 35 cases of myelomeningocele from October 2005 to November 2006 were analyzed retrospectively.The spinal cord and the cauda equine nerves were dissected microsurgically from the surrounding tissues.The duraplasty was performed and the thecal sac was reconstructed.The tight filums were released simultaneously in 8 cases and a ventriculoperitoneal shunt was placed in 10 children with severe hydrocephalus. Results The microsurgical repair was implemented and the spinal cord was released successfully in all the 35 cases.Among 10 cases of vesicorectal dysfunction,there were 3 cases of improvement of rectal sphincter functions after operation.Out of 9 cases of equinovarus,the tension of varus was decreased in 4 cases and no obvious functional improvement was observed in the rest of 5 cases.Leakage of cerebrospinal fluid from the incision occurred in 2 cases,and in the remaining cases the incision healed by first intention.The 10 cases of severe hydrocephalus were cured with ventriculoperitoneal shunting,including a delayed shunt insertion in 9 cases and a single-stage insertion in 1 case,in which a postoperative infection was encountered and a re-operation of ventriculoperitoneal shunting was given. Conclusions For children with myelomeningocele,a surgical treatment should be given as early as possible.A delayed shunt insertion 1~2 weeks after myelomeningocele repair is safe and effective.The duraplasty and optimized closure of the subcutaneous tissue are important for preventing cerebrospinal fluid leakage.
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Objective To compare the efficacy of carotid endarterectomy(CEA)and carotid artery stenting(CAS)for the treatment of high-risk atherosclerotic carotid artery stenosis.Methods We retrospectively studied the surgical outcomes of 58 patients with high-risk atherosclerotic carotid artery stenosis.Among the cases,32 received CEA and 26 underwent CAS.All of the patients were followed up with carotid ultrasonography,CTA or DSA in 30 days,6 months,and 1 year after the procedures,their neurological function was assessed meanwhile.Cumulative incidence of death,stroke,or myocardial infarction within 30 days after the surgical intervention and death or ipsilateral stroke events between 30 days and 1 year were set as the primary endpoint of the study.And the secondary endpoints were the CEA or CAS-correlated complications or severe restenosis within 1 year after the treatment.The outcomes of the two groups were compared.Results The primary endpoint occurred in 3 patients in the CEA group(9.4%)and 4 in the CAS group(15.4%)(?2=0.086,P= 0.769).And the secondary endpoint was found in 4 of the CEA group(12.5%)and 4 of the CAS group(15.4%)respectively(?2=0.000,P=1.000).Conclusions For the patients with high-risk carotid artery stenosis and coexisting conditions,CEA is as safe and effective as CAS.