[Objective]To explore the clinical effect of cervical spondylotic radiculopathy treated with intervertebral foramen block and brachial plexus traction-like technique.[Methods]54 cases of cervical spondylotic radiculopathy were randomly divided into two groups,i.e.control group(cervical traction and brachial plexus traction-like technique) and treatment group(added with intervertebral foramen block).[Results]The cure rate and effective rate were 66.67% and 92.59% in treatment group,and 25.93% and 78.78% in control group,respectively.Clincal efficacy is significantly better in treatment group than that in control one(P

Objective To evaluate the efficacy of continuous lumbar plexus block (CLPB) combined with a bolus dose added at night for postoperative analgesia in patients undergoing hip arthroplasty.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 51-75 yr,weighing 47-77 kg,with body height 150-180 cm,scheduled for hip arthroplasty,were randomized to receive either CLPB (group CLPB) or patient-controlled intravenous analgesia (PCIA) (PCIA group) for postoperative analgesia (n =30 each).Spinal anesthesia was performed at L3,4 interspace.Postoperative analgesia was performed at 30 min before the end of surgery.PCIA solution contained morphine 100 mg in 100 ml of normal saline.The PCA pump was set up with a 2 mg bolus dose and a 5 min lockout interval.CLPB solution contained 0.125 ％ ropivacaine hydrochloride 200 ml.CLPB pump was set up to deliver a 4 ml bolus dose with a 30-min lockout interval and background infusion at 8 ml/h after a loading dose of 0.125％ ropivacaine 30 ml.In addition the patients received 0.25％ ropivacaine 30 ml at 8 o' clock every night after surgery in group CLPB.VAS scores at rest and during activity were recorded at 6,12,18,24,30,36,42 and 48h after operation.The side effect such as nausea and vomiting,pruritus and urinary retention were recorded within 48 h after operation.The patient' s satisfaction was assessed.The maximal hip flexion and abduction ranges of motion were recorded at 12,24,36 and 48 h after operation.The times of sleep interruption resulted from pain during nighttime were also recorded.Results Compared with group PCIA,the VAS scores during activity,severity of nausea and vomiting,pruritus and urinary retention,and times of sleep interruption resulted from pain during nighttime were significantly decreased,and the overall satisfaction score and maximal hip flexion and abduction ranges of motion were increased in group CLPB (P ＜ 0.05).Conclusion CLPB combined with a bolus dose added at night can provide better efficacy for postoperative analgesia in patients undergoing hip arthroplasty than PCIA,with fewer complications.

Objective To investigate the changes in volume and spatial location of target areas and normal tissues before and during intensity?modulated radiotherapy (IMRT) for cervical cancer by quantitative means. Methods Forty patients with cervical cancer who were treated with IMRT were enrolled as subjects. Computed tomography ( CT) was performed before IMRT and during IMRT when a dose of 27 Gy ( 15 fractions) was reached. Clinicians delineated the target areas and organs at risk in the two groups of CT images. The target areas and organs at risk in one group of images were mapped to the other group of CT image by image registration using the Pinnacle treatment planning system. Volume changes in target areas and organs at risk were analyzed, and changes in the spatial location were evaluated by volume difference method and Dice similarity method. Comparison was made by paired t?test. Results There were significant differences in gross target volumes of primary tumor lesions ( GTV?T) and pelvic metastatic lymph nodes (GTV?N) before and during IMRT ( P= 0?? 000; P= 0?? 000). According to the evaluation by volume difference method, the average rate of change in GTV?T was (38.64±19?? 50)% with a range between 3?? 16%and 86?? 49%, while the average rate of change in GTV?N was (42.49± 25?? 68)% with a range between 2?? 79% and 87?? 42%. In the organs at risk, the bladder had the maximum rate of volume change, the average of which was (55.13±33?? 40)% with a range between 3?? 25% and 116?? 01%. According to the evaluation by Dice similarity method, the average Dice similarity coefficient for GTV?T was 0.50± 0?? 18 with a range between 0?? 10 and 0?? 85, while the average Dice similarity coefficient for GTV?N was 0.31±0?? 20 with a range between 0?? 00 and 0?? 71. The rectum had the minimum Dice coefficient in the organs at risk, the average of which was 0.57± 0?? 14 with a range between 0?? 18 and 0?? 76 . Conclusions For patients with cervical cancer to receive IMRT, since there are substantial changes in volume and spatial location of target areas and normal tissues before and during treatment, it is quite necessary to modify the treatment regimen in time in order to provide adequate doses for target areas and avoid overdose for organs at risk.

OBJECTIVETo assess the safety and clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with various stents for treating patients with cirrhosis and esophageal gastric varices bleeding.

METHODSOne hundred and five patients were stratified according to stent type: bare stent group, covered stent-grafts group, combined stents group. Rates of success, shunt insufficiency, rebleeding, patient survival, and major complications were observed. The shunt insufficiency rate, rebleeding rate, and survival rate were calculated by the life tables method, the Kaplan-Meier analytical curve, and the log-rank test; a p-value less than 0.05 was considered statistically significant.

RESULTSThe overall success rate of all TIPS for treating the esophageal gastric varices bleeding was 100%. The overall shunt insufficiency rates at 6-, 12-and 24-months post-TIPS were 8%, 9% and 16%, rebleeding rates were 2%, 6% and 17%, and survival rates were 100%, 97% and 94%. The shunt insufficiency rate was 26% in the bare stent group, 14% in the covered stent-grafis group, and 5% in the combined stents group (x2=1.00, P=0.61). The rebleeding rate was 33% in the bare stent group, 7% in the covered stent-grafts group, and 3%in the combined stents group (x2=1.69, P=0.43). The survival rate was 92% in the bare stent group, 93% in the covered stent-grafts group, and 100% in the combined stents group (x2=1.91, P=0.39). The shunt insufficiency rates were higher in patients with splenectomy than in those without splenectomy (30% vs.14%; x2=4.15, P=0.04). The intraperitoneal hemorrhage rates in the covered stent-grafis group and the combined stents group were significantly lower than that in the bare stent group (0% vs 0% vs 13%; x2=8.88, P=0.01).

CONCLUSIONSTIPS with an 8 mm stent effectively treated and prevented esophageal gastric varices bleeding in patients with cirrhosis. Intraperitoneal hemorrhaging caused by TIPS was significantly decreased in the covered stent-grafts group and combined stents group,which represented an improvement in safety of this treatment. However, the influence of covered stent-grafis and combined stents towards the clinical efficacy of TIPS needs further study.

Esophageal Diseases ; Esophageal and Gastric Varices ; Gastrointestinal Hemorrhage ; Humans ; Kaplan-Meier Estimate ; Liver Cirrhosis ; Portasystemic Shunt, Transjugular Intrahepatic ; Stents ; Survival Rate