Leptomeningeal metastasis (LM),with a high omission rate in diagnosis in approximately 5 ％～8 ％ of all patients, is increasingly recognized as a lethality complication. The diagnosis of LM remains challenges,but commonly can be established by CSF cytology or by definitive neuroimaging. Although a combination of focal radiotherapy,intrathecal chemotherapy,and systemic chemotherapy may be necessary to achieve optimal treatment of patients, but prognosis is unacceptable and therapy remains palliative in most patients.

Talus necrosis is difficult to cure in clinical practice and how to treat it remains con-troversy.Microsurgical methods provide a new path for curing the disease and good curative effects have been achieved according to the literature.This article reviewed microsurgical treatments for talus necrosis in recent years and it may provide references for clinical practice.

OBJECTIVE:To find out the regulareity of adverse reactions(ADRs)induced by oral Penicillins(QMSK)and evaluate the safety of QMSK in clinical use.METHODS:Data of ADRs of QMSK,which collected from published articles were retrieved from CHINESE PHARMACEUTICAL ABSTRACT issued between January1995and April2003.According to the given standard,the data were statistically analysed.RESULTS:There were334cases which had24kinds of ADRs of QMSK,of which,121cases were male while213cases were female.There were drug eruption in249cases(74.55%),allergic shock34(10.18%),exfoliative dermatitis9(2.7%)and toxic epidermalnecrolysis7(2.1%),miscellaneous reactions31(8.97%)and5(1.5%)deaths.CONCLUSION:QMSK caused ADRs apparently.QMSK should be used according to penicillins for injections and safe of patients should be ensured in use of QMSK.

The course of functional laboratory science is the bridge between classroom and clinical practice.In functional laboratory science teaching,we should pay attention to features of nursing care,focus on training compassion,clinical awareness,collaboration ability,practical skills for nursing students and combine the reform of functional laboratory science teaching with cultivation of professional quality for nursing students.

Objective:To establish a quantitative method for the determination of lysine hydrochloride in pediatric compound lysine granules. Methods:The quantitative determination was performed on an amino acids analyzer. The cationic resin column(150 mm × 4. 6 mm,7 μm)was used. The mobile phase was citrate buffer solution (pH 3. 45) and citrate buffer solution (pH 10. 85) with gradient elution at a flow rate of 0. 45 ml·min-1 . The detection wavelengths were set at 570 nm and 440 nm. Results:The linear range of lysine hydrochloride was 2. 692-21. 536 μg·ml-1(r=0. 999 5), and the average sample recovery was 98. 85% with RSD of 0. 63% (n=9). Conclusion:The method is sensitive, simple and reproducible. It can be used for the quality control of pediatric compound lysine gran-ules.

Objective:To analyze the osmotic pressure of citicoline sodium injection from different manufacturers to provide experi-mental basis for improving the national standard of the product. Methods:The cryoscopic method was used to detect the osmotic pres-sure of 479 batches of citicoline sodium injection from 45 pharmaceutical factories. Results:The osmotic pressure of citicoline sodium injection was within the range of 359-692 mOsmol · kg-1 , that of citicoline sodium for injection was within the range of 401-1408 mOsmol·kg-1 , and that of citicoline sodium chloride injection was within the range of 278-299 mOsmol·kg-1 . Conclusion:The os-motic pressure of citicoline sodium injection and citicoline sodium for injection from different manufacturers is obviously different. It is necessary to detect osmotic pressure in the quality standard in order to evaluate the quality of preparation process.

Objective To investigate the efficacy and safety of intrathecal chemotherapy combined with concurrent radiotherapy in patients with leptomeningeal metastases from solid tumors.Methods The clinical and follow-up data of 29 patients with leptomeningeal metastases from malignant solid tumor who had intrathecal chemotherapy combined with concurrent radiotherapy were retrospectively analyzed.The treatment regimen was that 12.5-15.0 mg of methotrexate intrathecal injection once a week for 8 successive weeks combined with whole brain irradiation to a total dose of 40 Gy,20 fractions or with lumbosacral spinal canal irradiation to a total dose of 50 Gy,20-25 fractions.Results Nineteen patients completed the concurrent therapy and 19 patients were dead.There were 9 patients with complete remission of symptoms,11 with obvious improved symptoms,6 with alleviated symptoms,and 3 with no relief.All of the 29 patients,were followed up for 0.4-15.0 months.The median survival was 5 months.The 6-month survival rate was 48％ (11/23),excluding 4 patients with follow-up time less than 6 months and 2 patients noncancer deaths.The main toxicities were myelosuppression,methotrexate-related mucositis,chemical nerve root injuries,chemical meningitis,chronic neurotoxicity,seizures,and radiation-related mucositis.The incidence of severe toxicity was 17％ (5/29).Conclusions Combination of intrathecal methotrexate with concurrent radiotherapy can effectively alleviate the symptoms and improve the life quality of patients.The therapy with low incidence of severe toxicity and good tolerance has the trendency to prolong the median survival.

ObjectiveTo observe the curative effect of Gustilo typeⅢ fracture with soft tissue defect of leg in children.MethodsOf the 15 patients,the area of the soft tissue defect varied from 5 cm × 6 cm to 8 cm × 12 cm.With regard to the location of soft tissue defect,two were situated at the upper third of the leg,eight were middle part of the leg,four were lower portion of the leg and dorsum of foot,one was lower portion of the leg and heel.The fracture was fixed by external fixation device and raw surface was closed by negative pressure drainage in the first stage.The raw surface was eventually covered by the transposition of regional flap or cross leg flap in the second stage.Among them,three patients underwent transposition of saphenous neuro-veno-fasciocutaneous flap, three patients underwent sural neuro-veno-fasciocutaneous flap transposition,one case of medial head of gastrocnemius muscle flap and 7 cases of cross leg flap were performed,while only 1 patient underwent free lateral anterior thigh flap transposition.ResultsOne patient who underwent transposition of saphenous neuro-veno-fasciocutaneous flap present with necrosis of the distal end of the flap 5 days after operation,which was then cured by cross leg saphenous neuro-veno-fasciocutaneous flap.Dark crust in distal end of flap occurred in 1 patient who underwent sural neuro-veno-fasciocutaneous flap,which was cured by changing dressings.Bone fracture of 14 patients were all healed.One patient who was classified as Gustilo Ⅲ c underwent cross leg flap, but bone defect was produced 18 months later.Through 3 months to 2 years follow-up,the texture,colour and shape of flap is good. ConclusionWith regard to Gustilo type Ⅲ fracture combined with soft tissue defect of leg in children,external fixation coupled with flap transposition can cure effectively.

Objective To study the anatomic characteristics of the infraorbital ethmoid cells on muhislice CT(MSCT)and explore the relationship between the infraobital ethmoid cells and mueosal swelling of sinuses.Methods Two hundred sixty patients(520 sides) of consecutive axial scans by GE HisDeed VCT and the multiplunar reformation(MPR),virtual endoscopy(VE)reconstruction images by GE AW 4.2 workstation were reviewed retrospectively.The following CT features were assessed:(1)the anatomic characteristics of the infraobital ethmoid ceils,including the frequency of identification,origin,classification.(2)presence of mucosal swelling of sinuses,(3)the maximal transversal diameter of the inflraobital ethmoid cells in ostium of maxillary sinus(perpendicular to the uncinate process),and the diameter of the ostium of maxillary sinus,(4)presence of infraobital ethmoid ceils inflammatory findings and a contact between the mucosal surface of the ostium of maxillary sinus.The results were analyzed by using Chi-square test and logistic regression analysis with the statistical software SPSS 11.5.Results (1) UniLateral infraobital ethmoid cells were f10und in 68 patients(26.1%),and bilateral infraobital ethmoid cells were found in 81 patients(31.2%).Infraobital ethmoid ceHs were found in 230 sides on left Bide (120 sides)and right side(110 sides).(2)Infraobital ethmoid cells originated from the anterior ethmoid cells in 124 sides(53.9%)and from posterior ethmoidal cells in 62 sides(27%),originated from both the anterior ethmoidal cells and the posterior ethmoidal cells in 44 sides(19.1%).(3)The classification of the infraobital ethmoid cells included three types.Infraobital ethmoid cells with different origination differed significantly in theirtypes(x2=193.433,P<0.01).Most ofthe infraobital ethmoid cells originated from tlle anterior ethmoidal cells were type Ⅰ(160 sides),while the type Ⅱ(48 sides)and Ⅲ(45 sides) frequently originated from the posterior ethmoidal ceHs(4)The mueosal swelling of sinuses,were found in 165 sides in presence of infraobtial ethmoid cells and 192 sides in absence of infraobtial ethmoid cells.The presence of infraobtial ethmoid cells had no effect on mucosal swelling(X2=1.824,P>0.05).The maximal transversal diameter of the infraobital ethmoid cells in ostium of maxillary sinus did not differ significantly between the cases with or without mucosal swelling of sinuses(t=0.273,P>0.05).and the diameter of the ostium of maxillary sinus were not significantly related with mucosal swelling of sinuse8 (Wald=2.534,P>0.05).Presence of infraobital ethmoid cells inflammatory findings (Wald=10.817. P<0.01,OR=4.125)and a contact between the mucosal surface of the ostium of maxillary sinus (Wald= 6.640,P<0.01,OR=3.728)were significantly related to mucosal swelling of 8inuses. Conclusions (1)MSCT scan could clearly demonstrate the detailed information of infraobital ethmoid ceIIs.(2)The presence of infraobtial ethmoid cells Was not a risk factor for chronics sinusitis. When we assess inflraobtial ethmoid cells as a possible etiologic factor in chronics sinusitis we should observe presence of infraobital ethmoid cells inflammatory findings and a contact between the mucosal surface of the ostium of maxillary sinud.

Objective To investigate the value of application of magnetic resonance imaging (MRI) in diagnosis and treatment of leptomeningeal metastases from malignant solid tumors.Methods A retrospective analysis was conducted depend on the radiological data of 63 patients who had been diagnosed as leptomeningcal metastasis of malignant solid tumors.Results All patients received brain MRI examination.26 patients underwent cervical or lumbar spine MRI examination.The MRI images showed nodular enhancement in the gyri and sulci,leptomeningeal linear enhancement,dura mater thickening and enhancement,ependymal enhancement,intraventricular metastasis,intraspinal metastatic nodules,communicating hydrocephalus,subdural hydroma and negative imaging.Ncuroimages of ependymal enhancenent,intraventricular metastasis and intraspinal implantation metastasis appeared in 5,7 and 9 patients with small cell carcinoma,respectively,which were higher than that of the other pathological types (P =0.002,P =0.009,P ＜ 0.000 1).Seizure occurred in 7 patients after intrathecal chemotherapy,of which 5 patients had pia mater linear enhancement.Among 33 patients treated with radiotherapy combined with intrathecal chemotherapy,3 patients had poor prognosis,of which 2 patients had negative imaging findings.The conditions of 25 patients were improved obviously after treatment,of which 21 patients showed different imaging remission in MRI re-examination.Conclusions The contrast MRI has an important assistant effect in diagnosis of leptomeningeal metastasis of malignant solid tumors.The MRI findings and clinical features are related with the pathological types.The pia mater linear enhancement indicates a high possibility of seizures after inthathecal chemotherapy,and it suggests that the preventive treatment should be given for such patients.MRI is not applicable to evaluate severity,prognosis and curative effect of the disease.