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Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.
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With the increasing of doctor-patient conflicts,the communication between them gradually becomes a critical element in medical service activities.How to improve the doctor-patient communication is an important content in resident communication skill training.Oncology is a developing discipline with fast development and high risk and residents in oncology department need more communications with patients in the era which individualized treatment is emphasized.Systematization and institutionalization of the training system of doctor-patient communication is beneficial to popularizing doctor-patient communication experiences,protecting the rights and interests of them and ensuring the smooth process of medical treatment.
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Objective To evaluate the short-term outcome of side-to-side staple cervical esophagogastrostomy after esophagectomy. Methods The clinical data of 105 patients with esophageal cancer who were admitted to the Daping Hospital from January 2006 to March 2009 were retrospectively analyzed. Of the 105 patients, 97 received side-to-side stapled cervical esophagogastrostomy and eight received traditional hand-sewn end-to-end cervical esophagogastrostomy. Nine patients were selected from the 97 patients who received side-to-side stapled cervical esophagogastrostomy to conduct matched pair analysis. The efficacy of the two methods was analyzed using the t test. Results No postoperative death was observed. The mean operation time of side-to-side staple cervical esophagogastrostomy was (21 ± 3 )minutes (range, 15-30 minutes). Postoperative complications were observed in 16 patients, including pulmonary complications in seven patients, vocal cord paralysis in four patients, anastomotic leakage in three patients and anastomotic stricture in two patients. The mean anastomotic diameter of patients who received side-to-side staple cervical esophagogastrostomy was ( 3. 01 ± 0. 17 ) cm, which was significantly longer than ( 1.69 ± 0. 26) cm of patients who received traditional hand-sewn end-to-end cervical esophagogastrostomy (t =2. 093, P ＜0.05 ). Dysphagia occurred in two patients who received side-to-side stapled cervical esophagogastrostomy and in four patients who received traditional hand-sewn end-to-end cervical esophagogastrostomy.Conclusions Side-to-side stapled cervical esophagogastrostomy is simple, safe and effective for patients with esophageal cancer after esophagectomy. This technique could decrease the incidence of postoperative dysphagia and improve the pharyngo-esophageal motor function.
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Numerical taxonomic studies were carried out in order to elucidate the taxonomic relationship among 17 species belonging to Paris. Eighteen characters including 10 morphological, 4 pollen morphological, 2 cytotalonomical and 2 habitat characters were used for the analysis. On basis of UPGMA clustering analysis, two subgenus and seven groups were recognized. The classification of the two subgenus was different from the opinion of subgenus Daiswa and subgenus Paris by Li Heng. The classification of sect. Dunnianae, sect. Axiparis and sect. Paris was correspondence with the classification of Li Heng. But sect. Fargesianae, sect. Marmoratae and sect. Thibeticae which were established based on the especially characters by Li Heng were put into cluster 2, cluster 3 and cluster 4.
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Magnoliopsida , Classification , PhylogenyABSTRACT
Objective To review the outeonle of intrathoracic esophageal reconstruction using circular stapler after esophageal or cardiac cancer resection.Methods From June 1996 to April 2007,744 patients underwent tumor removal and intrathoracie esophageal reconstruction in Daping Hospital.Of all patients,658 suffered from thoracic esophageal cancer and the other 86 from cardiac cancer.The operative modalities consisted of gastroesophageal anastomosis at the top of tim thoracic cavity or above the aortic arch in 402 patients,gastroesophageal anastomosis below the aortic arch in 317,and total gastrectomy in 25(esophageal replacement with colon in 21 patients and esophagojejunostomy in 4).Results Anastomotie bleeding oecurred in 5 patients intraoperatively.One patient died of acute respiratory distress syndrome,1 of septic shock and 1 of hepatic failure postoperatively.Psychiatric disorder was observed in 5 patients,respiratory complications in 34,anastomotie fistula in 4,and anastomotic stricture in 20.Three weeks after the operation,the esophageal manometric examination in 25 patients showed that intraesophageal,anastomotie and intragastric pressures were(-0.2±2.0),(1 1.2±4.4)and(2.4±1.5)mm Hg(1 mm Hg=0.133 kPa),respectively.Twenty-four hour pH monitoring demonstrated that 13 patients had abnormal DeMeester score(＞14.72),3 of thenl developed reflux symptoms and got relieved after receiving acid suppression therapy for 1.0-2.2 months.The 13 patients with abnormal DeMeester score were followed up for 3-38 months,and the pH value of the esophagus was back to normal in 2 patients,and it almost remained the same in 9 patients.Two patients died of tumor reculTenee of metastasis.Conclusions Intratlmracic esophageal reconstruction with circular stapler is safe,reliable and able to reduce the postoperative complications such as anastomotic fistula.
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Objective To explore the risk factors and indications for perioperative tracheostomy in patients with myasthenia gravis. Methods A total of 174 patients with myasthenia gravis undergoing thymectomy were reviewed retrospectively between April 1980 and August 1999. Perioperative tracheostomy was performed on 44(25.3%) cases. Myasthenic or cholinergic crisis happened in 38 cases (21.8%). The relationship of the crisis incidence and Osserman classification, state of illness, present of thymoma, preoperative pulmoary function and the dose of anticholinergic agents given preoperatively were analyzed. At the same time the indications of perioperative tracheostomy were discussed. Results The highest incidence of myasthenic or cholinergic crisis and perioperative tracheostomy were found in cases with long history of the disease, high dose of anticholinergic agents administration, Osserman classification over stageⅡb, with infiltrated thymoma, and preoperative pulmoary function impairment. Conclusion Perioperative tracheostomy and artificial ventilation are most important approaches when myasthenic or cholinergic crisis after thymectomy appeared. But the indications for postoperative prophylactic tracheostomy and artificial ventilation must be strictly selected.
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Objective To explore the effect of video-assi sted thoracic surgery (VATS) on common diseases of chest. Methods Video-assisted thoracoscopic surgery was performed on 131 patients with ches t diseases from April 1994 to December 2000 in which 109 cases were spontane ous pneumothorax and hemothorax, 10 pulmonary tuberculoma, 5 pulmonary carcinoma , 3 esophageal carcinoma, 2 localized benign mesothelioma, 1 pulmonary hamartoma and 1 myasthenia gravis. Results There was no operative death in all cases. Four patients with spontaneous pneumothorax complicated persist ent air leak(more than 7 d) and 1 patient with hemopneumothorax formed hemoth orax after the operation, which was stopped by the second VATS. The others recov ered well without any postoperative complications. Conclusion VATS is characterized by safety and mild tissue injury in the operation, and les s pain, fewer complications, rapid recovery and short duration of hospitalizatio n after the operation.
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Objective To study the effect of epidermal growt h factor receptor(EGFR) on the development and progress of thymoma. Me thods Expression of EGFR was detected by immunohistochemical stain in t he tissues of 11 cases of normal thymus and 29 cases of thymoma. Result s The positive expression of EGFR was 75.9%(22/29) in thymomas and 18.2%(2/11) in normal thymus. The difference was significant(P<0.01). The positive rate of EGFR was higher in invasive thymomas than in non-invasive ones (P<0.01). T he positive rate of EGFR increased with Masaoka stage with a significant increm ent in Ⅲ-Ⅳ stage compared with I stage (P<0.01). EGFR was strongly expre ssed in 5 cases of invasive thymomas, in which recurrence or metastasis occurred in 3 during the follow-up period after operation. But there was no statistical correlation with whether complicated with myasthenia gravis (MG) and histolog ical type. Conclusion EGFR might be related to the tumori genesis and development of thymoma. There is high risk of recurrence and metast asis in case of EGFR over-expression and radiotherapy, chemotherapy and follow up should be enhanced.