Volume 88  ·   Issue 41  ·  2008

Because of the melamine pollution incident of infant milk powder, people have paid great attention to the problem of melamine and urinary calculi. How to know the pathogenesis of urinary calculi caused by melamine and how to deal with the urinary calculi caused by melamine in time, so as to eliminate the influence on health, is a scientific problem that needs to be answered urgently.

Whether general anesthesia affects children's intellectual development is still inconclusive in pediatric anesthesiology. Animal models suggest that general anesthesia can stimulate a large number of apoptosis of brain neurons during the rapid growth phase of immature mammalian brain, which has aroused intense discussion among anesthesiologists about the safety of anesthesia in human newborns and infants.

As a kind of unpleasant experience and emotional feeling, pain has attracted more and more people's attention. However, the problem of children's pain is still not fully understood, and the understanding of children's pain is only referred to the research of adults. As a basic human right, the treatment and relief of pain should be regardless of age. There are many differences between children's pain management and adults, and it may even be more challenging: children are individuals who develop continuously with age, and the functions of various organs are still in the process of perfection and maturity; Their response to pain and emotions are changing all the time, and pain assessment is relatively difficult; The treatment of pediatric pain has unique characteristics, and it should even be considered to include education to parents and gain their understanding and cooperation.

[Editor's Note] Children's surgery and adult surgery also need anesthesia, but children's anesthesia, especially pediatric anesthesia, has its own particularities, and there are many differences from adults in anatomy, physiology and anesthesia methods, which are related to the safety of pediatric anesthesia and the future growth and development. Therefore, the Anesthesiology Branch of Chinese Medical Association specially established the Children's Anesthesiology Group in 1984, but it was suspended for 13 years for some reason before it was restored, and the first national academic conference after the restoration was successfully held in 2008. Children are the hope of the motherland. As early as half a century ago, Ms. Soong Ching Ling, the honorary chairman of our country, put forward: "We should leave the most precious things to children", which is particularly important in China, a country with a large population that advocates the one-child policy.

：Objective To investigatethe effectiveness of bispectral index(BIS) during intravenous anesthesia with remifentaniland propofol in children. Methods Forty ASAI or Ⅱ pediatric patients undergoing selective surgery were divided into 4 equal groupsaccording to age: Group A (≤3 m), Group B(>3 m -2 y), Group C (2 -6 y), and Group D(6 - 12 y). In all groups, anesthesia was induced with before induction (T1), afterinduction (T2), at intubation (T3), at skin incision (Ta), at stopping of anes the tics(T5), at spontaneous respiration (T6), and at extubation (T7). The time between stoppinganesthetics and spontaneous respiration and the time of extubation were recordedrespectively. Results (1)The BIS values at T2, T3, T4, T5, and T6 were lower compared withthat at T1 in all groups(all P <0.01).(2) There was no significant difference in thespontaneous respiration recovery time among all groups. The extubation time of Group A wasmuch longer than those of Groups B, C, and D (all P < 0.01) . (3) The UMSS scores at T1and T7 in all groups were all lower than those at T3. Conclusion BIS effectively monitorsthe depth of intravenous anesthesia with remifentanil and propofol.

Objective To evaluate the clinical efficacy and safety of acute hypervolemic hemodilution (AHH) in posterior spinal fusion surgery in children. Methods 36 children with scoliosis ASA Ⅰ～Ⅱ, receive of posterior spinal fusion, were randomly divided into 2 equal groups: AHH group,transfused with hydroxyethyl starch 130/0.4 and sodium chloride(Voluven) 12 ml/kg at the speed of 0.3 ～0.4 ml · kg-1. · min-1(for 30～40 min) through internal jugular vein before operation so as to keep the hemodilution (Hb) status during operation, and control (CNT) group. During operation when the Hb was <80 g/L or the hematocrit was < 25% blood transfusion was conducted to maintain the Hct > 25%.Results There was no significant difference in intra-operative blood loss between these 2 groups. The Hb one day after operation of the AHH group was (89 ± 12) g/L, significantly lower than that immediately after operation [(98 ± 10) g/L, P <0.05]. The Hb one day after operation of the CNT group was (92±22) g/L, significantly lower than that immediately after operation [(94 ± 13) g/L, P <0.05]. However, there were not significant differences in the Hb values between the AHH and CNT groups (all P > 0.05). Both groups received intra-operative transfusion during operation. The amount of transfused red blood cells and fresh frozen plasma of the AHH group were (18±4) ml/kg and (3.5±1.1) ml/kg respectively, both significantly lower than those of the CNT group [(28±11) and (5.8±1.8) ml/kg respectively, both P <0.05]. Conclusion Able to reduce intra-operative blood transfusion and medical expense, AHH can be used safely and effectively in posterior spine fusion in children.

Objective To observe the effectiveness and adverse reactions of fentanyl used by nasal infusion or intravenous injection in post-operative analgesia in pediatric patients. Methods Forty children,underwent selective lower abdomen surgery under intravenous anesthesia. At the end of operation, 36 patients with the scores > 6 according to the Objective Pain Scale (OPS) were randomly divided into 2 groups, Group A (n = 17) undergoing nasal administration of fentanyl 0.5 μg/kg, then intraven ous injectionof 1 ml 0.9% sodium chloride, Group B group (n = 19) undergoing nasal administration of 1 ml 0.9%sodium chloride and then intravenous injection of fentanyl 0.5 μg/kg. Five min later pain scoring was conducted. Those with the OPS score ≥2 received the same protocol once, and then scoring was conducted every 1 min. Another 5 rain later the same protocol was used to those still with the OPS score ≥2 once again. Such a protocol was continued till the OPS score ≤2. Sixty min after the first administration, theprimary scheme was carried out once per hour until 24 h later. Results The time needed to achieve the OPS score ≤2 of Group A was (16±5) min, not significantly different from that of Group B [(14±5)min, P >0.05]. The amount of fentanyl used in Group A was (21±5) μg, signi ficantly higher than that of Group B [(15±7) μg, P < 0.05]. When the OPS score ≤2 was achieved the dizziness rate of Group Bwas 31.58%, and the nausea/vomiting rate of Group B was 21.05% , both significantly higher than those of Group A (11.76% and 31.58% respectively, both P < 0.05), however, there were significant differences in the adverse reaction rates since 12 h after the first administration. There were no significant differences in the OPS score 4 h after the first administration. Conclusion There are not significant differences in thetime needed to achieve the analgesic effect in the pediatric children who undergo lower abdomen surgery.Nasal administration of fentanyl needs a higher dose with a higher comfort and lower adverse reaction rate.

Objective To investigate the therapeutic effects of alprostadil (Lipo-PGE1) and Ulinastatin on inflammatory response and lung injury after cardiopulmonary bypass (CPB) in pediatric patients with congenital heart diseases. Methods 58 children with congenital heart diseases, including atrial septal defect,ventricular septal defect, and atrioventricular septal defect, scheduled to undergo CPB,aged 4-72 months, were randomly divided into 4 groups: alprostadil Group P (n = 15) receiving alprostadil central vein until the end of operation, Group U (n = 15) receiving ulinastatin 20 000 U/kg divided into several doses to be added into the prime solution, Group PU (n = 14) receiving alprostadil and ulinastatin according to the above protocols, and Group C (control group, n = 14) receiving normal saline of the equal volume. Electrocardiogram (ECG) ,heart rate (HR),pulse oxygen saturation (SpO2), and mean arterial pressure (MAP) were continuously monitored during operation. Duration of mechanical ventilation and staying in ICU were also recorded. Plasma neutrophil (PMN), IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-α and matrix metalloproteinase (MMP-9) levels in the radial arterial blood samples were measured after induction of anesthesia before CPB (T1),30 minutes and (T2),2 hours (T3),6 hours (T4), and 24 hours (T5) after the declamping of aorta. Inhaled oxygen concentration and arterial blood gas analysis were recorded at T1 ,T2 , and T3 for calculation of oxygenation index (OI). Results There were no significant differences in the MAP and HR among these four groups at any time points (all P > 0.05). The umbers of PMN and the levels of IL-6, IL-8, and TNF-α at T2 and T3 of Groups P,U, and PU were all significantly lower than that of Group C (all P < 0.05), with those of Group PU being the lowest. The IL-10 levels at T2 and T3 of Groups U and PU were significantly higher than that of Group C (both P < 0.05), the level of MMP-9 at T2 and T3 of Groups U and PU were significantly lower than that of Group C (all P < 0.05),however, there was not significant difference between Group P and Group C (P >0.05). The Ols at T2 of Groups P, U, and PU were significantly higher than that of Group C (all P < 0.05). The mechanical ventilation time of Groups P, U, and PU were all significantly shorter than that of Group C, and that of Group PU was significantly shorter than that of group C (P < 0.05). Conclusion Decreasing the inflammatory response after CPB, alprostadil and ulinastatin used during CPB effectively reduce the pulmonary injury via inhibition of the neutrophil activation and cytokines release.

Objective To evaluate the clinical feature of nummular headache and the efficiency of treatment in China. Methods The data of 21 NH patients treated from February 2006 to February 2008,were aralyzed. Results They were 9 men, 12 women, aged 37±12 (18-63) years. Headache history ranged from 7 days to 30 years. 13 patients reported head pain confined to a circular area of 0.6 to 5 centimeter, and the other 8 patients had pain in an elliptical area of 1 -2 centimeter × 1.5 -3 centimeter.The symptomatic area was located in the parietal (n = 7), occipital (n = 8), temporal (n = 6), or border regions between temporal and parietal(n = 1). The right side was affected in 10 patients and the left side in the 9 patients, the middle of occipital and parietal areas were affected in 1 patient, respectively. Seven patients had mild pain, 8 patients had moderate pain and 6 patients had severe palm The characteristics of headache included stabbing pain (n = 6), sharp pain (n = 3), pulsating apin (n = 3), grinding pain (n =1) ,exploding pain(n =5), included light -dull apin (n = 3). Three patients were treated by local nerve block with lidocaine plus dexamethasone phosphate/acetate and one of them got some 30 hours of prominent pain relief, no relief was obtained for other two patients. One patient obtained pain remission by acupuncture after amitriptyline, paroxetine had been tried ineffectively. One patient, woman, 38 years old, was treated by carbamazepine (tegretol) and amitriptyline for 3 months and pain relief was obtained gradually and the head pain disappeared finally. 8 patients were treated effectively by amitripline combining indomethacium ,ibuprofen or carbamazepine. One patient was treated effectively by nimodipime. 2 patients were treatedineffectively by amitripline combining indomethacium. 4 patients were not treated. 3 patients were lost to follow-up. Conclusion NH is not very rare and some of NH patients may be treated effectively by acupuncture or amitripline combining indomethacium, ibuprofen or carbamazepine.

Objective To explore the applicable value of ultrasound guidance in percutaneous renal biopsy. Methods 168 patients with kidney diseases underwent ultrasound-guided renal biopsy. Pathological examination was conducted. Predictors of successful rate were assessed by multivariate logistic regression analysis. Results Successful biopsy was achieved in 157 of the 168 patients with a success rate of 93.45%. Satisfying results were obtained from 143 of the 157 samples and normal renal tissues were reported in 14 samples. No serious adverse events were observed in this study. The successful biopsy rate of female patients was 89.16%, significantly lower than that of the male patients (97.65%, P < 0.05). Age,puncture times, thickness of renal cortex, and type of clinical diagnosis were not significantly correlated with the successful rate of biopsy. Conclusion Ultrasound-guided renal biopsy is a kind of safe diagnostic method for kidney disease. The successful rate of renal biopsy in females is lower than that in males.

Objective To investigate the etiological factors, pathogenesis, and treatment of pneumomediastinum not caused by thoracic injury and chest operation. Methods 56 patients with non-thoracotraumatic pneumomediastinum were divided into 3 groups according to etiology: idiopathic pneumomediastinum (n = 37), descending pneumomediastinum (n = 11) and ascending pneumomediastinum (n = 8). All of 56 patients received symptomatic treatment by mediastinotomy andetiological treatment on the basis of different primary affection of mouth, throat, neck, bronchus, colon etc.Results Complete recovery was observed in 45 patients and partial recovery was found in 5 patients. The causes of death in 6 patients were serious pulmonary infection with respiratory failure, descending necrotizing mediastinitis with multi-organ failure and colonic perforation with septicopyemia. Conclusion Most non-thoracotraumatic pneumomediastinum are secondary to the underlying diseases, the mechanisms of its pathogenesis include lung interstitium path (idiopathic), oropharyngeal and cervical interspace path(descending), and extraperitoneal space path (ascending). The treatment should be focused on dealing with primary diseases as well as symptomatic treatment by mediastinotomy.

Objective To explore the efficacy and strategy of transarterial embolization of dural carotid-cavernous fistulas. Methods The clinical data of 19 patients with dural carotid-cavernous fistulas treated by transarterial embolization, including clinical presentations and patterns of angioarchitecture were retrospectively analyzed. Follow-up was conducted for 7 months to 4 years. Results Clinical cure was achieved in 15 cases, significant improvement of symptoms in 3 cases, and failure in 1 case. Complete angiographic obliteration was documented in 12 patients (63%) right after the embolization. Residual shunting was left in 6 patients, and disappeared in 5 cases one month to half a year later by manual compression of the carotid artery. The patient on which transarterial embolization failed received embolization via the bilateral cavernous later, and clinical cure was achieved. Headache and vomiting were the most common symptoms after embolization. There was no permanent procedure-related morbidity. No recurrence was seen during the follow-up. Conclusion Transarterial embolization is a safe, efficient and economical method for part of the cavernous sinus dural arteriovenons fistula patients.

Objective To evaluate the role of androgen and its receptor in the pathogenesis of prolapse of pelvic floor. Methods Specimens of fight cardinal ligament and vaginal wall were collected from 38 patients with prolapse, aged(64±3) (45 -79), all menopausal, and 23 women, aged (50±2) (45 -57), with obstetric or gynecologic diseases other than prolapse (as controls), all undergoing total hysterectomy. The 38 prolapse patients were divided into 2 groups: Group ≥ 60, aged (66±6), and Group < 60, aged(52 ± 5). Western blotting and immunohistochemistry were used to detect the expressionof androgen receptor (AR) in the tissues. Peripheral blood samples were collected from all patients toexamine the levels of serum testosterone and sex hormone binding globulin (SHBG) by chemiluminescentlabeling. Results There were no significant differences in the serum concentrations of testosterone andSHBG between the prolapse and the control groups. The AR positive rates in the cardinal ligament and vaginal wall tissues of the prolapse patients aged ≥60 were (49 ±15)% and (49±10)% respectively,both not significantly different from those of the control group [(43±15)% and (42±3)% respectively,both P>0.05]. Ears, The AR expression rates in the tissues of cardinal ligament and vaginal wall of the prolapse patients were (42±3) % and (43±15) % respectively, both significantly higher than those of the control group [(29±7)% and (29±6) % respectively, both P <0.001]. Western blotting showed that the positive rate of the AR with the relative molecular weight of 45 000 in the cardinal ligament of the prolapse group was 4. 41%, significantly higher than that of the control group (2.1%, P = 0.02),however, the . Positive rate of the AR with the relative molecular weight of 45 000 in the vaginal wall tissue of the prolapse group was 3.34%, not significantly different from that of the control group (2.28%, P =0.2). There were no significant differences in the in the straps of 110 000 and 90 000 detected by C-terminal polyantibedies of AR in the cardinal ligament and vaginal wall tissues between the prolapse patients and the control group (beth P > 0.05). Conclusion The increasing expression of AR in the tissue of vaginal wall and cardinal ligament of the prolapse patients with pelvic floor dysfunction may play an important role in the etiology of pelvic floor dysfunction.

Objective To evaluate the efficacy of interventional management in treatment of severe complications after percutaneous transhepatic cholangiography and percutaneous implantation of biliary stents. Methods Percutaneous biliary drainage and implantation of biliary stents for malignant biliaryobstruction under fluoroscopic guidance was performed in 113 patients. Thirteen of them developed severe complications: drainage catheter slipping and locating between liver and abdominal in 4 cases, bowl obstruction due to lower implantation or slipping of stent into the duodenum in 4 cases, and plenty of bloody drainage in 5 cases. Results For the 4 cases of drainage catheter slipping, under guidance of CT scan (2cases)or DSA fluoroscopy (2 cases), 21G needle was used to puncture the drainage catheter left in biliary tract in order to fix the catheter so as to avoid its continuous slipping. Then curved catheter located betweenthe abdominal wall and liver could be pulled straight and then advanced into the biliary tract again with the help of a guide wire. For the complication of bowl obstruction in 4 cases, stent was captured and pulled out through oral cavity and then a new stent was implanted back with the help of endoscopy in 3 eases. One patient refused to accept re-implantation of stent and had to undergo nasobiliary drainage. Complication of bloody drainage was successfully overcome by embolizing the bleeding blood vessel or implanting covered stent in the site of fistula caused by puncture in 5 cases. Conclusion Active attitude and methods should be adopted to cope with severe complications after percutaneous transhepatic biliary drainage and percutaneous implantation of biliary stents for better prognosis.

Objective To investigate the electrophysiological evidence of inhibitory control deficit in panic disorder patients using a visual simple Go/Nogo task. Methods Sixteen patients with panic disorder and 13 healthy volunteers received a visual simple Go/Nogo task. The stimuli were single or double English letters and appeared with equal probability. The subjects were instructed to press a button as quickly as possible when the double letter was presented (I. E. , GO), but make no response to the single letter (I. E. ,Nogo). 32 channel EEG data were recorded. Result All subjects displayed a distinct Go/Nogo effect in the N2 component (PD group: F1,30= 8.00, P = 0.008 ; NC group: F1,24 = 4.60, P = 0.042) and P3 component (PD group:F1,30 = 7.85,P =0.009; NC group:F1,24 = 13.57,P =0.000) at frontocentral sites, but the amplitudes of Nogo-N2 and Nogo-P3 were significantly reduced in panic disorder patients as compared to the healthy subjects (Fz: F = 9.135, P = 0.005 ; F = 8.511, P = 0.006, respectively). There was no significant differences between the latencies of Nogo-N2 and Nogo-P3. Conclusion Panic disorder may consist inhibitory control deficit which may assist in of fering new objective evidence to understand the etiology of panic disorder.

Objective To observe the effects of a newly developed technique to transform the dish-like bone defect into contained bone defect and adopt the cancellous bone obtained from bone cut to make parvule impacted bone graft to repair the bone defect of tibial plateau in total knee arthroplasty (TKA) for osteoarthritis (OA) patients with severe varus or valgns. Methods 54 OA patients (74 knees) with severevarus or valgus (> 25°) received TKA. The average depth of the bone defect at the tibia/plateau measured in the operation was 18.23 mm and the average thickness of the bone cut was 9.97 mm. The average depth of the dish-like bone defect left after bone cutting was g. 78 mm and the defect occupied averagely 31.5% of the total section area. The sclerotic bone layer was removed to the depth of the cancellous bone by saw blade or reamer, which made the defect to be contained. Small holes were drilled in the contained bone defect.Fragments 5-8 mm in diameter were made from the cancellous bone osteomized from the femur and tibia were impacted into the bone defect. The defect was finally covered by a bone slice to make a fiat tibial section allowing the tibia prosthesis to be firmly seated on it by routine technique. Follow-up was conducted for 32.2 months on average. Results The tibial deformity was repaired effectively and reliable support for the prosthesis at the tibia side was provided. Subsequent X ray films showed that no bone defect was seen under the prosthesis and the position of the prosthesis was fine. No autograft resorption and complete radiolucency between the graft and the tibial host bone appeared during the follow-up. The average KSS score raised from 45. 6 preoperatively up to 94.5 postoperatively. Conclusion In comparison with other techniques, the impacted autografting technique more effectively reconstructs the bone defects of tibial plateau in TKA. The cancellous bone obtained from the bony end can be used fully, thus over-cutting can beavoided and the mechanical characteristics of the knee joint would not be disturbed.

International Alliance Against Epilepsy and Bureau of Epilepsy (ILAE & IBE 2005) on a new definition of epilepsy "Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure."

congenital scoliosis (CS) is a three-dimensional deformity of the spine caused by axial bone development disorder [1]. It has been proved that a transitional tissue in embryonic period-"somite" determines axial bone formation, and its development abnormality can lead to vertebral deformities, including vertebral body formation disorders (hemivertebrae, wedge vertebra and butterfly vertebra) and dissegmentation [2].

The 35th Annual Meeting of the Cervical Spine Research Society (CSRS) was held in San Francisco from November 29 to December 1, 2007. The author wrote the summary of this annual meeting to introduce the characteristics of CSRS and its related academic activities to our counterparts in China, and to disseminate the latest progress in clinical diagnosis, treatment and basic Research in the field of Cervical Spine surgery.

"Academic journals are an important link in the whole process of modern science and technology, and their protagonists are academic papers. To promote the development of scientific journals, the primary task is to promote the development and maturity of academic papers. The quality of academic papers is higher, and the quality of academic journals is higher." Professor Feng Changgen, Secretary of the Secretariat of China Association for Science and Technology, expressed the above views in his report entitled "Development and Innovation of Scientific Journals" at the 4th National Forum on the Development of Scientific Journals held on October 16th.

A 22-year-old male was admitted to the surgical intensive care unit of Peking University People's Hospital on August 21, 2007 mainly because of "mediastinum occupying space for more than 2 months, choking and coughing after drinking water for more than 10 hours, and adding reed for 2 hours".

The degeneration and necrosis of adipose tissue caused by inflammatory lesions of subcutaneous adipose tissue is called panniculitis, and the more common panniculitis in clinic is nodular panniculitis, also known as Weber-Christian disease (WCD), which is an autoimmune disease with adipose tissue as the target organ. It is characterized by recurrent inflammatory nodules or plaques of subcutaneous adipose, accompanied by fever and other systemic symptoms, in addition to cytophagic histiocytic panniculitis (CHP) and eosinophilic panniculitis.

Patients with AIDS may be complicated with pulmonary tuberculosis or infected with tuberculosis in the course of treatment. However, anti-tuberculosis treatment based on rifampicin can reduce the plasma concentrations of nevirapine and efavirenz, so the antiviral effect of the latter is not clear<A study evaluating the efficacy and tolerability of a combination of rifampicin-based anti-tuberculosis therapy and nevirapine or efavirenz-based antiviral therapy was published in the Journal of the American Medical Association (JAMA, 2008, 300:530-539).

A 68-year-old female was admitted to hospital for headache accompanied by vomiting for 10 days. There was no special past history, personal history and family history. Physical examination showed no positive signs, and there was no enlargement of superficial lymph nodes in the whole body. CT showed isodensity space-occupying lesions in the right frontal lobe, with patchy low density lesions in it, which was not related to the skull, and mildly enhanced.