ABSTRACT
<p><b>OBJECTIVE</b>To explore the clinical characteristic, therapeutic efficacy and prognosis of patients with hepatitis-associated aplasitc anemia (HAAA).</p><p><b>METHODS</b>the clinical data and labrotatory examination results of 30 cases of HAAA were analyzed retrospectively, the 6-month response ratio and overall survival (OS) were assessed.</p><p><b>RESULTS</b>HAAA most commonly occured in males, with the occurence rate of males and females was 4:1, the median onset age was 16 (4-43) years old, HAAA oriented focus on sever aplastic anemia (SAA)(4 cases,13%) and very sever aplastic anemia (VSAA)(22 cases,73%). Aplastic anemia (AA) could be seen on occurence of hepatitis (accompanied aplastic anemia) (7 cases,23%), or after the onset of hepatits (delayed aplastic anemia) (23 cases,77%), but more often occured in the latter. Statistical analysis showed that when compared with the patients of delayed aplastic anemia, patients accompanied aplastic anemia possesses lower levels of glutamic-pyruvic transaminase(ALT), aspertate aminotransferase (AST) and total bilirubin (TBIL)(P=0.042,0.012,0.001), and possessed a more obvious lymphoid cell disorder when AA occured, with more lower peripheral blood CD19B cells proportion (P=0.046) and more obvious imbalance of CD4/CD8ratio, but the difference was no statistical significant (P=0538). Factors affecting the 6-month respose were the severity of AA (P=0.044), the peak level of bilirubin of hepatitis (P=0.006) and the propotion of mature monocyte in bone marrow (P=0.034). The long-term follow-up showed that the 2-year OS of HAAA was 64.3±9.2%, the 6-month curative efficacy significantly affect the prognosis (P<0.001).</p><p><b>CONCLUSION</b>HAAA more often occur in young male, HAAA is mainly SAA and VSAA and mostly non-A-C hepatitis associated aplastic anemia, patients usually have a high incidence of early infection. Patients acompanied with aplastic anemia possess more obvious immunological derangement; the treatment efficacy for HAAA is poor, patients who haven't obtained 6-month response indicate a sinister prognosis, allogeneic hematopoietic stem cell transplantion is a better choice for these patients.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To investigate whether the separating brachial plexus block combined with preoperative analgesia by patient controlled analgesia (PCA) can be applied in tendon repair and postoperative active or passive functional exercise.</p><p><b>METHODS</b>Two hundred and ten cases with tendon injury were randomly divided into 3 groups and all of the patients were administered Bupivacaine (0.25%), Papaverine (0.0625 mg/ml), and Dexamethasone (0.25 mg/ml) in separating brachial plexus block through axillary approach. Group A was control group, and preoperative analgesia was not applied. Preoperative analgesia was applied in group B and C. Tramadol and Ondansetron were administered in group B, Midazolam was administered besides Tramadol and Ondansetron in group C. The injection volume in the PCIA pump was increased to 100 ml by mixing physiologic saline. The pump was started after separating brachial plexus block in velocity of 2 ml/h, and its maintenance time was 48 h. The effect of separating brachial plexus block at 1, 2, 3, 6 and 12 h after finishing brachial plexus block was compared. The VAS, Ramesay assessment scoring were recorded at 0, 12, 24 and 48 h after starting pump.</p><p><b>RESULTS</b>In each group, the effect of motor block became greater in the ascending order from 1, 2 to 3 h after finishing brachial plexus block, and less in the descending order from 3, 6 to 12 h after finishing brachial plexus block. Only at 6 and 12 h after finishing brachial plexus block, the effect of motor block of group B and group C was significantly less than that of group A (P < 0.05, < 0.01), the effect of motor block of group C was less than that of group B (P > 0.05). The effect of sensory block in the patients of all 3 groups was satisfactory. The VAS, Ramesay assessment scoring, effect of analgesia and sedation at 24 and 48 h after starting pump became greater in the ascending order from group A to group C, in which group B and group C were significantly greater than group A (P < 0.01).</p><p><b>CONCLUSIONS</b>The separating brachial plexus block combined with preoperative analgesia by 2 kinds of PCIA dispensation can be both applied in tendon repair, but the separating effect of brachial plexus block of group B was superior to the group C.</p>