博宁完全缓解乳腺癌多发骨转移性骨痛25个月个案报告

Bone metastasis of mammary tumor is common in clinic and comprehensive treatment concentrated on chemotherapy is suggested. Short term relief such as pain decrease,improvement of symptoms is available but long term relief was unavailable. In the current study, a case with multiple bone metastasis of mammary tumors showed favorable relief including bone pain relief, complete absorption of bone metastasis loci.This patients has survived for 25 months healthfully.Here is the report.     

博宁缓解肺癌骨转移疼痛的近期疗效

Background:23.8% patients with late stage lung cancer accompany bone metastasis, which bring about severe pain and make great influence on patients' living quality.Boning is the representation of domestic second generation Diphosphonate, which take good curative effects on bone pain caused by bone metastasis of malignant tumor.     

Scaphoid metastasis as the first sign of occult gastroesophageal junction cancer:A case report

BACKGROUND Metastatic tumors of the hand are very rare.They are usually late manifestations of massive advanced malignancies.However,a small portion of acrometastases are indications of occult primary cancer.Here,we report an extremely rare case in which a scaphoid bone lesion was the initial manifestation and was found to be a metastasis from gastroesophageal junction(GEJ)cancer.CASE SUMMARY A 57-year-old male patient presented with ongoing left wrist pain and swelling after trauma.He was initially misdiagnosed with infection of the scaphoid bone and treated with antibiotics and anti-inflammatory drugs.Further radiographic investigations showed a scaphoid pathological fracture,indicating a metastatic tumor derived from the GEJ and/or right lung malignancies.Gastroscopy failed to identify the pathology of the mass at the GEJ,which grew in an exophytic pattern.A lung puncture biopsy was not performed because the patient refused the procedure.To relieve his wrist pain and obtain a definite pathology,we resected the scaphoid lesion.Based on the clinical and pathological results,the patient was finally diagnosed with multiple metastases of advanced GEJ adenocarcinoma.He underwent chemotherapy and died 6 mo after his initial presentation.CONCLUSION Despite the rareness of the disease,orthopedic surgeons should consider the possibility of metastasis to the bones of the hand when patients complain of persistent and progressive pain in the hand.     

Effect of internal fixation and other methods alleviating low back pain caused by isthmic spondylolisthesis

AIM:To explore the long-term therapeutic effects of surgical treatment for isthmic spondylolisthesis.METHODS:42 cases of isthmic spondylolisthesis were analyzed retrospectively among which 13 cases underwent simple lumbar interlaminar bone implant and 29 cases underwent transpedicular fixation combined with bone implantation.Assessment was made according to JOA standards before and after treatment.RESULTS:At a 3 years of follow-up assessment,the functional outcome in transpedicular fixation assessed by JOA was excellent and good in 79.3% as compared with the group without fixation in which the excellent and good result was 76.9%.The level of pain and functional disability were similar in the two groups,but fusion rate in the group with transpedicular fixation was higher than that in group without it.CONCLUSION:Surgical treatment for isthmic spondylolisthesis imprves function and relieves pain.     

Argon-helium cryoablation for thoracic vertebrae with metastasis of hepatocellular carcinoma-related hepatitis B: A case report

BACKGROUND Spinal metastasis of hepatocellular carcinoma(HCC) is rare, with an extremely poor prognosis and results in severe pain. Argon-helium cryotherapy is a local ablation method for HCC.CASE SUMMARY A 54-year-old man was diagnosed with HCC related to hepatitis B one year ago and underwent surgical tumor resection and tenofovir antiviral treatment.However, a new lesion developed on the right liver after 1 mo. Transarterial chemoembolization was performed four times. One month ago, the patient developed back pain, and metastasis on the 11 th thoracic vertebra was detected.Argon-helium cryoablation was performed to treat the right occupancy and metastatic lesion, which immediately alleviated the pain and prolonged survival.CONCLUSION The use of argon-helium cryoablation for thoracic vertebrae with metastasis of HCC achieved favorable results.     

Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture

BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.     

星状神经节阻滞治疗面部顽固性疼痛1例

1 Case abstract Patient, male,68 years old,got obstinate facial pain 10 years ago after nerve block due to trigeminal neuralgia.Pain resulted in following dysfunction:facial asymmetry,atrophic left facial muscle was 1/2 size of right;Myodynamy decreased,only soft and semiliquid food could be taken and compensation of right muscle was needed;Pselaphesia and thalposis were lost and there was on feeling to water at 40 ℃ .Continuous facial pain led to unstable mood,diet decreasing,bad sleepness,light weight,bad facial impressions and mental disturbance at the end.Once took sedative analgesic drugs such as valium,but effect was unobvious.Diagnosis: left facial pain.According to case history,symptoms,block of left ganglion stellatum was adopted.Dorsal position,head hypsokinesis to expose neck, operator pushed common carotid artery towards external side, and inserted needle at cricoid cartilage level,between trachea and common carotid artery towards C7 transverse process,withdrew needle when feeling substance of bone, if no blood and brain fluid returned, injected 5 ml of 2% lidocaine.After withdrawing,Horner's syndrome and facial burning sensation at the same side often appeared,but complications from celostomea,numb of upper limb to dyspnea weren't found.One time every two days, 5 times as a therapeutic course,the interval was 2 weeks,and 3 therapeutic courses in total.Therapeutic effect was expressed by version analogue scale(VAS):Drew a thick line and divided it into 10 parts,0 indicated no pain,10 indicate severe pain.Patient drew at corresponding position to express his pain degree.Before treatment,VAS score was 7,after 1 therapeutic course decreased to 4,after 2 therapeutic courses,2～ 3,after 3 therapeutic courses it was 0～ 1.With the improvement of disease,atrophy of left facial muscle was also improved and closed to the size of right.pselaphesia and thalposis recovered,masticatory function improved,sleeplessness disappeared,other complications improved much.     

Primary maxillary chondrosarcoma: A case report

BACKGROUND Sarcomas of the head and neck region are rare tumors,constituting less than 1%of malignant neoplasms in this area,of which few cases(20%)originate from bone or cartilage.Chondrosarcoma is a malignant neoplasm that develops in bone,with a predilection for the pelvis,chest wall,and scapula,and is uncommon in the maxilla and jaw.Although this type of lesion has locally aggressive behavior,destroying the affected bone,it can metastasize when it is not diagnosed early and compromise the patient's life.CASE SUMMARY On intraoral examination of a 32-year-old female with a tumor in the middle third of the face,a well-defined rise in volume of approximately 3 cm in diameter was observed.Computed tomography with 3-dimensional reconstruction was performed,and we observed that the osteolytic lesion affected the vestibular cortex as the palatal bone.Hematoxylin and eosin staining revealed an appearance that was similar to mature hyaline cartilage,hypercellularity,nuclear and cellular pleomorphism,and multinucleated cells,with significant vacuolization.CONCLUSION Determination of the clinical and histopathological characteristics of rare neoplasms in the maxillofacial region,such as chondrosarcomas,allows the pathologist and surgeon to make the appropriate therapeutic decisions,optimizing the patient’s prognosis.     

颅骨修补术后局部疼痛分析1例报告

1 GENERAL DATA Case condition:Famle,aged 35 years old,craninal bone repair was performed on May 1998.deficiency of cranial 5 cm× 5 cm,region:tempora and parietal area.Operative time:type of operation is II type repair,repair material was fixed with double size 7 silk,and moulded under local intensified anesthesin.Wound were duched with gentamycin sulfate liquid,drain was laid,removed on next day.Secondary operation:Result of exploration(leading to pain):subcutaneous hydrops.     

Phwarmaclogiic therapy in management of cancer—related pain

Background:According to small scale of investigation,world health organization(WHO)infers thwat moderate and serious pain is observed in about 1/3 of patients receiving active anti-cancer therapy and 60% in late stage.Cancer-related pain is a threat to patients‘ living quality and confidence,so rehabilition becomes an important part in treatment of cancer.Objective:To observe effect of pharmaologic therapy in management of cancer-related pain.Unit:Affiliated First Hospital of Dalizn Medical University.Subjects:230 cases of cancer diagnosed by pathological and physiochemical examination and complicated with cancer-reated pain were investigated,including 138 males,92 females aged 8-90(mean:67) years old.Somatic pain,81 cases,visceral pain,133 cases,neural pain,16 cases.All cases were the first time to receive ladders pharmacological therapy.NRS method was adopted and degrees of pain were expressed by nubbers(0-10) with 0 expressing painless,10 expressing sever pain.Grading of pain:0:no pain;1-3:minor pain;4-6:moderate(sleep was affected);7-10;severe pain(unable to sleep).Intervention:Different ladders of therapy were taken according to different pain graded.First ladder:suitable to minor and part of moderate grade of pain,non-opium drugs,Fenbid was used.Second ladder:suitable to moderate pain and minor opium was adopted codein/Ap-237.In treatment courses,if pain didn‘t alleviated completely,dosage was added or ladder was in creased.Third ladder:suitable to severe pain or cases not effective by second ladder ,,major opium was used,morphine or fentanyl, dosage of former,60-300mg/d,dosage of later,2.5-5.0mg/72h,dosage was modified according to 30%-50% of former dosage,until obvious effect was achieved.Strict drug-taking time was obeyed.When using fentanyl,if effect wasn‘t satisfying at 2th,3th day,morphine was supplied,dosage of fentanyl was modified by 24h total amount of morphine.Administration way:oral,anal were first choices and muscle injection of morphine was used when ecessary.Result:Alleviatin condition:Minor:before therapy,40 cases,after therapy,2 cases,alleviation rate.95.0%;Moderate before therapy,92 cases ,after therapy,26 cases,alleviation rate,71.7;Severe:before therapy,98 cases,after therapy,19 cases,alleviation rate,80.6% Conclusion:Ladders pharmacologic therapy was and effective method in treatment of cancer-related pain.     

The characteristics of interpretation of results of analysis of protein amount in urine of pregnant women

The adequacy of implementation of present proteinuria diagnostic thresholds under examination of pregnant women was examined. The analysis was applied to all urine samples of pregnant women from December 2009 to March 20010. The amount of protein in urine was concurrently evaluated by turbidimetric analysis with sulfosalicylic acid, colorimetric analysis with pyrogallol red, "dry chemistry" technology (the diagnostic strips). It is established that the mentioned techniques of analysis of protein in urine provide independent results. The results of colorimetric analysis are characterized by better precision and adequacy. However, in case of pregnant women the diagnostic threshold of protein concentration should be shifted from 0.120 to 0.150 g/l.     

超声评价放疗对颈动脉溃疡斑块形成的影响

目的 探讨超声在评价放疗对颈动脉溃疡斑块形成的影响的价值。方法 回顾性收集经病理学证实为头颈部肿瘤、放疗前后的颈动脉超声资料以及其他基线资料完整的患者93例,比较放疗前后放疗侧颈动脉和非放疗侧颈动脉粥样硬化斑块和溃疡斑块的总数量、平均内膜-中膜厚度、最大斑块面积、最大溃疡斑块的面积、最大溃疡口的面积。结果 放疗前后颈动脉超声检查的平均间隔时间为（6.1±1.9）年;放疗前放疗侧斑块总数量、平均内膜-中膜厚度、最大斑块面积、溃疡斑块的总数量、最大溃疡斑块的面积、最大溃疡口的面积与非放疗侧比较差异均无统计学意义（P均>0.05）;放疗后放疗侧斑块总数量、平均内膜-中膜厚度、最大斑块面积、溃疡斑块的总数量、最大溃疡斑块的面积、最大溃疡口的面积均较非放疗侧加重,差异有统计学意义（P均<0.05）。结论 放疗可导致头颈部肿瘤患者颈动脉粥样硬化斑块的形成和进展,且斑块具有易损性特点。     

《中国内镜杂志》主编雷光华教授简介

雷光华男,1970年12月生,骨科学博士,一级主任医师,二级教授,博士生/后导师。国家"万人计划"领军人才,教育部"长江学者"特聘教授,科技部"中青年科技创新领军人才",国家卫生计生突出贡献中青年专家,享受国务院政府特殊津贴专家,国家临床重点专科骨科和运动医学学科带头人,全国青年岗位能手,湖南省"芙蓉学者"特聘教授,湖南省科技领军人才和骨科学科领军人才,湖南省普通高校学科带头人,湖南省首届"优秀科技工作者",中南大学"湘雅名医"。     

超声诊断主动脉窦瘤

本文报告31例主动脉窦瘤患者,全部用二维超声(2DE)和多普勒超声检查。其中手术治疗24例,超声符合22例,符合率为92％。误诊2例,误诊率为8％。故超声实际诊断主动脉窦瘤29例中右冠窦瘤18例(62％),无冠窦瘤7例(24％),二叶瓣型主动脉窦瘤4例(14％)。窦瘤破入/膨入右室和右房内的例数分别为16例和13例。本病主要的合并症为主动脉瓣关闭不全和室缺。通过分析我们认为二维加多普勒超声是诊断主动脉窦瘤最有价值的无创技术。