Efficacy of ultrasound-guided great auricular nerve block combined with general anesthesia for middle ear microsurgery in adult patients / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided great auricular nerve (GAN)block combined with general anesthesia for middle ear microsurgery in adult patients.Methods Sixty-four adult patients of both sexes,aged 18-60 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective middle ear microsurgery,were assigned into 2 groups (n =32 each) using a random number tabte:GAN block combined with general anesthesia group (group GANB+G) and general anesthesia group (group G).Patients received GAN block with 0.25％ ropivacaine 2 ml using ultrasoundguided in-plane technique before anesthesia induction in group GANB+G.Anesthesia induction and maintenance protocols (IV infusion of propofol and target-controlled infusion of remifentanil) were similar in two groups.Analgesia was performed with sufentanil,flurbiprofen axetil or parecoxib sodium after operation to maintain visual analog scale score ＜4 within 48 h after operation.The infusion duration and consumption of propofol and remifentanil,requirement for postoperative analgesia and occurrence of postoperative nausea and vomiting were recorded.Results Compared with group G,the consumption of remifentanil was significantly reduced,and the requirement for postoperative analgesia and incidence of postoperative nausea and vomiting were decreased in group GANB + G (P ＜ 0.05 or 0.01).Conclusion Ultrasound-guided GAN block combined with general anesthesia provides better analgesic efficacy in the the perioperative period in adult patients undergoing middle ear microsurgery.

Distribution characteristics of the medial branch of the posterior branch of the spinal nerves around the lumbar facet joints and its clinical significance / 局解手术学杂志

Objective To examine the distribution characteristics the medial branch of the posterior branch of the spinal nerves around the lumbar facet joints, so as to explore the localization and targeting of the medial branch of the posterior branch in neurectomy.MethodsFive corpses were dissected, and the anatomical relationships between the medial branches of the posterior branch of the spinal nerves and the facet joints were examined.Measured the distances from the lateral port of the bone fiber tube,the articular process of the facet joint and the superior articular process to the spinous processes.Results The medial branch of the posterior branch of the spinal nerve was close to the root of the articular process and the transverse process,which was not easy to be explored and dissected.Meanwhile, it was easily traced after the medial branch of the posterior branch of the spinal nerve ran through the fibrous tube.Conclusion It may improve the safety and effective when the techniques of medial branch block is performed after the medial branch ran through the fibrous tube.

Neurovascular distribution around the multifidus muscles in the low back and its clinical implications / 局解手术学杂志

Objective To explore the neurovascular distribution around multifidus muscles in the low back and its clinical significance via regional dissection.Methods Five cadavers were dissected in the low back.The anatomical relationships between the longissimus thoracis,iliocostalis and the start-stop,direction and position of multifidus muscles were observed.Branches,distribution and the characteristics of the erector spinae muscle,the lateral branches of spinal nerves and blood vessels were examined.Then measured the distances from the emerging point of the lateral cutaneous branches of spinal nerves to the spinous processes.Results After removed the deep fascia,the longissimus thoracis was found medially and the iliocostalis was found laterally.The muhifidus muscles located deeply to the longissimus and the iliocostalis muscles.The lateral branches of the posterior rami of the spinal nerves and the dorsal branches of lumbar blood vessels run in the multifidus muscle gaps.Conclusion The multifidus muscle gaps contain plenty of neurovascular bundles.Surgery involving the low back often takes the advantage of the gaps between multifidus muscles.Therefore,surgeons should take caution to avoid damaging the lateral branches of the posterior rami of the spinal nerves and the dorsal branches of lumbar vessels during low back surgery.

Efficacy of ultrasound-guided great auricular nerve block with different concentrations of ropivacaine for postoperative analgesia in patients undergoing tympanic and mastoid surgery / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided great auricular nerve block with different concentrations of ropivacaine for postoperative analgesia in patients undergoing tympanic and mastoid surgery.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-60 yr,with body mass index of 19-25 kg/m2,undergoing elective tympanic and mastoid surgery under general anesthesia,were divided into 3 groups (n=30 each) using a random number table:control group (group C),0.25％ ropivacaine group (group R1) and 0.50％ ropivacaine group (group R2).In R1 and R2 groups,great auricular nerve block was performed under ultrasound guidance before anesthesia induction,0.25％ and 0.50％ ropivacaine 2 ml were injected,respectively,10 min later the block in the area innervated by great auricular nerve was evaluated using the method of acupuncture in comparison with the contralateral area.After successful block was confirmed,the patients were ventilated using the laryngeal mask airway under general anesthesia.Flurbiprofen axetil was given as rescue analgesic,sufentanil was used when the efficacy was not satisfactory,and visual analog scale score was maintained less than or equal to 3 points.The number of patients requiring rescue analgesic was recorded within 48 h after surgery.Results The great auricular nerve was successfully blocked in 60 patients of R1 and R2groups.Compared with group C,the requirement for rescue analgesic was significantly decreased within 48 h after surgery in R1and R2 groups (P＜0.01).There was no significant difference in the requirement for rescue analgesic within 48 h after surgery between group R1 and group R2 (P＞0.05).Conclusion Ultrasoundguided great auricular nerve block with 0.25％ ropivacaine provides better efficacy for postoperative analgesia in the patients undergoing tympanic and mastoid surgery.

Relationship between the distribution of spinal nerve posterior ramus and locations of acupoint in low back / 中国针灸

<p><b>OBJECTIVE</b>To explore the relationship between the distributions of posterior ramus of spinal nerve (PRSN) and locations of acupoint in low back through anatomical observation.</p><p><b>METHODS</b>The regional anatomy was performed at five corpses to observe the distribution of erector spinae muscle and PRSN in areas ofpoints and back-points in low back.</p><p><b>RESULTS</b>The T, L, L, Land LPRSN distributed on both sides of the spine; the medial branches of PRSN travelled between spinalis thoracis muscle and longissimus thoracis muscle, while the lateral branches of PRSN travelled between longissimus thoracis muscle and iliocostalis lumborum muscle.</p><p><b>CONCLUSIONS</b> points and back-points in low back are closely associated with PRSN, particularly T, L, L, Land L.</p>

Clinical value of serum cystatin C in infantile pneumonia / 中国小儿急救医学

Objective To explore the clinical value of the serum cystatin C (Cys C) changes in different periods of the infantile pneumonia.Methods Ninety-two cases of infantile pneumonia (59 mild pneumonia patients and 33 severe pneumonia patients) from November 2012 to March 2013 were collected and 40 cases of healthy infant were enrolled for control group.The levels of serum Cys C,urea and creatinine in acute and recovery period were detected.Results In severe pneumonia patients,the average level of Cys C in acute period [(1.98±0.33) mg/L] is significantly higher than that in control group [(0.85 ±0.24) mg/L] (P ＜0.01),and there was no significant difference between recovery period [(1.12 ± 0.23) mg/L] and control group (P ＞ 0.05),and there was significant difference between acute and recovery period (P ＜0.05).In mild pneumonia patients,there were no significant differences in the level of Cys C between the acute period [(1.10 ±0.22) mg/L] and recovery period [(0.94 ±0.21) mg/L] as well as control group (P ＞ 0.05).The positive rate of Cys C in severe pneumonia patients (51.9％,14/27) was higher than that of urea and creatinine (3.7％,1/27) (P ＜0.01).Conclusion Severe pneumonia could result in renal dysfunction,which is reversible.Cys C can be the clinical reference for early diagnosis and the therapeutic effect in severe pneumonia patients with renal dysfunction.

Risk factors of neurogenic pulmonary edema in the patients with severe hand, foot and mouth disease / 中国小儿急救医学

Objective To understand the risk factors of neurogenic pulmonary edema in the patients with severe hand foot and mouth disease(HFMD). Methods According to neurogenic pulmonary edema or not ,79 patients with severe HFMD were divided into two groups. The difference was analyzed on the clinical symptoms, signs,the outcomes of laboratory and electroencephalogram (EEG) examination between the two groups. Then the risk factors of neurogenic pulmonary edema was analyzed by logistic regression analysis.Results There were significant differences of the EV71 infection rate,high body temperature,myoclonia,limb weakness,the disability of eyeball regulation,tachycardia, hypertension or hypotension, the extension of capillary filling time, leucocytosist, creatine kinase isoenzyme, hyperglycaemia between two groups. However, there were no significant differences of fever, fever time, vomiting, somnolence, convulsion, limb tremor, c-reactive protein and EEG between two groups. Tachycardia, hypertension or hypotension, hyperglycaemia were significant risk factors for neurogenic pulmonary edema by logistic regression analysis. And hyperglycaemia was the most significant prognostic factor(odd ratio 27. 075, P = 0. 000 2). Conclusion Tachycardia, hypertension or hypotension,hyperglycaemia are the significant risk factors for neurogenic pulmonary edema. It is especially important for hyperglycaemia to predict neurogenic pulmonary edema.

Sequential therapy for biliary ascariasis in 19 cases / 中华肝胆外科杂志

Objective To improve the curative effect of non-invasive therapy for biliary ascariasis to shorten the course of treatment and minimize the chance of invasive managements such as surgery and endoscopic therapy. Methods The sequential therapy was conducted as: intravenous injection of vitamin C → oral administration of acid drug → expel the worm in the biliary tract. Results For the 19 cases of biliary ascariasis, 15 responded to the conservative treatment after one course of treatment,2 responded to it after two courses, 1 after 3 courses and 1 did not. Conclusion Sequential therapy is effective, convenient and simple for biliary ascariasis and it can reduce the chance of invasive management.

Applied anatomic study on lamina spiralis below promontory for cochlear implantation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To provide anatomic data for cochlear implantation, and to find the method of locating lamina spiralis (LS) on the surface of promontory.@*METHOD@#Microanatomical study was carried out on 30 sides of human temporal bones by observing and measuring lamina spiralis below promontory, including its location, course and adjacent structures.@*RESULT@#(1) The basal turn of lamina spiralis below promontory can be divided into three segments: the hook segment (1.52 +/- 0.16) mm, the anteroinferior round window segment (3.83 +/- 0.37) mm and the forwarding segment (2.70 +/- 0.36) mm by two hinge points of which one was located at anterior of the junction of superior margin and anterior border of RW, and the other was located at anteroinferior of the round window; (2) The plane of round window anteroinferior segment of LS lay (51.00 +/- 5.97) degrees anteroinferior to horizontal segment of the facial nerve and comparative permanently meet posterior margin of'stapes head. Made posterior margin of stapes head as a fixation point and draw a line on promontory lay (51.00 +/- 45.97) degrees anteroinferior to horizontal segment of the facial nerve. This line can be thought as the projection of anteroinferior round window segment of LS on promontory; (3) The width of scala tympani at cochleostomy site on promontory: width of scala tympani at midpoint of superior margin of round window was (0.36 +/- 0.06) mm; width of scala tympani at midpoint of anterior border of round window was (0.97 +/- 0.14) mm; width of scala tympani at 3 mm point of anteroinferior round window segment was (1.24 +/- 0.21) mm.@*CONCLUSION@#(1) The basal turn lamina spiralis below promontory can be divided into three segments (the hook segment, the anteroinferior round window segment and the forwarding segment) by two hinge points; (2) The projection of anteroinferior round window segment of LS and the features exhibited in its course provide reference for locating the basal turn scala tympani and offer reliable anatomical basis for minimal invasive intervention during cochlear implantation.