Molecular adsorbent recirculating system in treatment of severe pneumonia complicated with multipie organ dysfunction syndrome / 中华临床感染病杂志

Objective To evaluate the effect of molecular adsorbent recirculating system(MARS)in treatment of severe pneumonia complicated with multiple organ dysfunction syndrome(MODS).MethodsSeventy-five patients who were diagnosed as severe pneumonia complicated with MODS were randomly divided into MARS group,continuous renal replacement therapy(CRRT)group and routine comprehensive therapy group.Flow dynamics,respiration function,liver function and renal function,coagulation function,inflammatory mediators,and Marshall scores were measured and compared before and after the treatment. The survival curves in 60 days were also compared among three groups.Results With MARS therapy,mean heart rates,peak inspiratory airway pressure,serum TBil,plasma D-dimmer levels and Marshall score were decreased;mean artery pressure,PaO2,oxygenation index,urine output,and platelet counts were increased;the levels of proinflammatory(NO,IL-6,IL-8,TNF-α and LBP)and anti-inflammatory(IL-10 and IL-13)mediator were decreased remarkably.The differences of these indicators between MARS group and other two groups were statistically significant(P＜0.05).And after MARS therapy,respiratory rate and Cr level were decreased,while SaO2 and WBC were increased significantly(P＜0.05).The 60 day-survival rate in MARS group was 80%(20/25),36%(9/25)in routine comprehensive therapy,and 52%(13/ 25)in CRRT group(P＜0.05).Conclusion MARS therapy has better effect on severe pneumonia conplicated with MODS than routine comprehensive therapy and CRRT.

Measurement of trace elements in hairs in patients with hyperthyroidism / 中国医师进修杂志

Objective To investigate the changes of trace elements score in hairs in patients with hyperthyroidism and its relationship with thyroid function. Methods The trace elements(Mg,Ca,Cr,Mn,Fe,Cu,Zn,Sr,Mo,Ba)in hairs and serum thyroid hormones(FT_3 and FT_4)were measured in control group (60 cases) and hyperthyroidism group (67 cases). Results The levels of trace elements Zn,Cu,Mg,Cr were significantly lower (P

Video-mediastinoscopy: Report of 128 cases / 中国微创外科杂志

Objective To study the application of video-mediastinoscopy in the preoperative staging of lung cancer and the diagnosis and treatment of mediastinal tumors or malignant pleural effusion.Methods Video-mediastinoscopy was performed in 128 cases under general anesthesia and single lumen endotracheal intubation,including 48 cases of cervical mediastinoscopy,33 cases of parasternal mediastinoscopy,and 47 cases of intercostal mediastinoscopy.Results The diagnosis was clarified under video-mediastinoscopy in 125 cases,including 38 cases of adenocarcinoma,33 cases of metastatic squamous cell carcinoma,9 cases of tuberculosis,8 cases of lymph node inflammation,7 cases of small cell carcinoma,6 cases of squamous cell carcinoma of the thymus,5 cases of non-Hodgkin's lymphoma,4 cases of neuroblastoma,4 cases of thymoma,3 cases of pleural mesothelioma,2 cases of Hodgkin's lymphoma,2 cases of neurilemmoma,1 case of sarcoidosis,1 case of hyperplasia of thymus gland,1 case of carcinoid,and 1 case of primitive neuroectodermal tumor.In 1 case,the mediastinal lymph nodes were diagnosed as reactive hyperplasia by video-mediastinoscopy,and then were confirmed as squamous cell carcinoma by postoperative pathological examination.Two cases were confirmatively diagnosed as having lung cancer in the left inferior lobe by brochoscopy, and video-mediastinoscopy revealed the metastasis to right paratracheal lymph nodes.Complications included 1 case of pneumothorax,1 case of hemorrhage,2 cases of recurrent laryngeal nerve paralysis,and 2 cases of superficial incision infection. Conclusions Video-mediastinoscopy is not only an important examination for preoperative staging of lung cancer and diagnosis of mediastinal diseases,but also a surgical treatment for mediastinal tumors and malignant pleural effusion.

The preliminary experience of intercostal video-mediastinoscopy in clinical application / 中华胸心血管外科杂志

Objective: To determine the value of intercostal video mediastinoscopy (VMS) in clinical application. Methods: The clinical data of 126 patients treated with intercostal VMS were summarized retrospectively. Of them, 8 patients with suspected malignant pleural effusion underwent intercostal VMS pleural biopsy and talc poudrage pleurodesis, 118 patients with palmar hyperhidrosis underwent bilateral intercostal VMS sympathectomy. Results: Definitive pathologic diagnosis has been made through VMS pleural biopsy in pleural effusion group, and the efficiency of talc pleurodesis was 100%(8/8). In 118 patients with palmar hyperhidrosis, the symptom of hands sweating disappeared completely after operation. Both hands became dry with an increasing skin temperature of 1 5℃～3 0℃ immediately after operation. No recurrence was recorded during the follow up. No mortality and morbidity were reported in this group. Conclusion: Comparing with VATS, intercostal VMS is easier to operate and less invasive. It is an effective and alternative procedure in the treatment of malignant pleural effusion and palmar hyperhidrosis.

A clinical study on composite transplantation of meshed split-thickness autograft and heterologous dermal matrix / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of the composite transplantation of 1:3 meshed split-thickness autograft and acellular heterologous (porcine) dermal matrix.</p><p><b>METHODS</b>9 inpatients with full thickness skin burn or hypertrophic scar were selected in this study. After the eschar or scar was excised, the wound was covered with acellular heterologous dermal matrix. Then the meshed (1:3) split-thickness autologous skin sheet was grafted on the dermal matrix. Before dressing up, the radiated pigskin was placed on the composite transplants.</p><p><b>RESULTS</b>The composite transplantation was successfully used in 9 cases. The meshed split-thickness autograft was expanded 3 times and covered the dermal matrix tightly. The clinical results of the composite transplantation were similar to that of intermediate split thickness skin graft or full thickness skin graft.</p><p><b>CONCLUSION</b>The composite transplantation of meshed (1:3) split-thickness autograft and acellular heterologous (porcine) dermal matrix allowed the expansion of the autologous skin sheet to 3 times. The clinical results were similar to that of intermediate split thickness skin graft or full thickness skin graft.</p>

Thoracic sympathectomy under video mediastinoscopy for palmar hyperhidrosis: Report of 55 cases / 中国微创外科杂志

Objective To explore the feasibility of thoracic sympathectomy under video mediastinoscopy (VM) for palmar hyperhidrosis. Methods Operations on 55 patients with palmar hyperhidrosis were performed under general anesthesia with double lumen endotracheal tube placement. The patients were maintained in the 30?～45? semi-sitting position, with abduction of both arms to 90?. The VM entered the thoracic cavity via the third intercostal space on the anterior axillary line. The T 2～T 4 sympathetic ganglions were resected by electrocautery. Results Hyperhidrosis disappeared postoperatively in all the cases. The temperature of patients' both hands increased by 1.5～3 ℃,with their both hands becoming dry and warm. The operation time was 20～40 min (mean, 30 min) and the hospital stay was 3～7 d (mean, 4 d). No severe complications occurred. Mild subcutaneous emphysema along with pneumothorax was found in 3 cases and compensatory hyperhidrosis in the trunk happened in 5 cases. Conclusions Thoracic sympathectomy under VM is less invasive and simpler than that under video-assisted thoracoscopic surgery (VATS) in the treatment of palmar hyperhidrosis, being a feasible alternative.

Treatment of lumbar spondylolisthesis with decompressive laminetomy, bone grafting and solid SOCON instrumentation / 中华骨科杂志

Objective To observe the early clinical outcome of the lumbar spondylolisthesis treated with decompressive laminetomy, intertransverse process arthrodesis with bone grafting, interbody fusion cage and solid transpedicle SOCON instrumentation. Methods From December 1997 to December 1999, 38 cases of lumbar spondylolisthesis were treated with decompression for spine canal stenosis. And intertransverse process arthrodesis was done by means of bone chip grafting obtained from the iliac crest, or the interbody fusion cage and the SOCON system. According to Meyerding classfication of lumbar spondylolisthesis, 32 cases were classified as degree 1, 6 cases as degree 2. The levels of lumbar spondylolisthesis was between L 4 and L5 in 29 patients and between L 5 and S 1 in 9 cases. Results The patients were followed up from 14 to 26 months with an average of 18.2 months. The results showed that the pre operative clinical symptoms disappeared completely in 31 of 38 patients. Pain relief was seen in 81.6%. 32 cases with degree 1 and 4 of 6 cases with degree 2 obtained the complete reduction of the slide intervertebral body. Anatomical reduction rate was 94.7%. The other 2 cases of the degree 2 patients obtained 90% of reduction. No infection or neurologic complication occurred in this series. Conclusion Treatment of lumbar spondylolisthesis with SOCON system has satisfactory reduction rate and excellent clinical results.