Objective To study the characteristics of pulmonary impact injury under closure and open states of glottis. Methods One hundred and eight rabbits were randomly divided into two groups (54 each group). Open state of glottis group(open group): impact injuries with opened glottis; closure state of glottis group (closed group): impact injuries with closed glottis. Parameters were set up with various combinations of driven pressures and compress percentage and the model of rabbit blunt chest trauma were established. Pathological changes were examined and abbreviated injury scale (AIS), water containing and mortality were recorded. Results Two and four rabbits died in open group and closed group respectively under the condition of 30% for compress percentage and 8 250 mmHg for driven pressures. In most cases, AIS values of closed group were significantly higher than that of open group (Plt;0.05). AIS values were positively related to driven pressures and compress percentage (r=0.9313, 0.7847; Plt;0.01, 0.01). Quantities of contained water in lung of closed group were significantly higher than that of open group(t=2.28,Plt;0.01). Conclusion The severity of injury, the increased mortality and earlier occurrence of traumatic acute lung injury were the characteristics of pulmonary impact injury under the closure states of glottis.
Objective To summarize experiences of surgical treatment and long-term results of myasthenia gravis (MG). Methods Two hundred thirty-six patients underwent thymectomy for MG in our department from Jan.1978 to Dec. 2002. The perioperative management, relative factors of postoperative crisis and long-term results were analysed. Results In 236 patients postoperative crisis took place in 44 cases accounted for 18.6%. The occurrence of postoperative crisis was related to preoperative management, modified Osserman clinical classification and combination with thymoma. Three cases died in the postoperative periods. Among them, one died of acute respiratory distress syndrome induced by aspiration and the other died of crisis. The effective rate in 1, 3, 5 years was 84.6%, 91.0% and 89.0% respectively. Conclusions Thymectomy for MG is safe and effective. Delayed extubation could decrease the needs of tracheotomy in patients with high risk factors for postoperative crisis. The partial sternotomy approach is less traumatic but the long-term effects of surgery are identical to those reported by the most authors.
Abstract: Due to complicated procedures and severe trauma, esophagectomy still remains an operation with high mortality and morbidity. With the advancement of anesthetic and surgical technique, as well as perioperative management, the mortality and morbidity after esophagectomy decreased significantly in recent years. The optimal perioperative management, normalized and individualized treatment was of importance in preventing postoperative complications and decreasing mortality after esophagectomy. This review summarizes the current state of perioperative management for esophagectomy.