Orthopaedic postoperative pain not only brings a lot of side effects to patients, but also directly affects early rehabilitation after surgery. Effective preoperative pain management mainly includes three-stage individual pattern analgesia, which refers to preoperative, intraoperative and postoperative analgesia. The purpose is to reduce pain in multiple planes and three-dimension, strengthen the effect of analgesics and reduce dosage and side effect of single drug. This paper summaries new progress on individual-multiple-pattern analgesics, pain assessment method and various therapies.
Analgesia ; methods ; Humans ; Orthopedics ; methods ; Preoperative Period ; Treatment Outcome

Purpose:To study analgesia effect and adverse reaction of diclofenac sodium extended release capsule for cancer pain in senile patients. Methods:20 senile patients with light or moderate cancer pain were selected.The analgesia effect and adverse reaction were observed after diclofenac sodium extended release capsule 100 mg qn po.Results:The treatment of cancer pain with diclofenac sodium extended release capsule in senile patients had obvious analgesia effect without obvious adverse reaction. Conclusions:Diclofenac sodium extended release capsule 100 mg qn po is a safe,effective and simple way to relieve cancer pain in senile patients with light or moderate cancer pain.

Objective　To study the clinical manifestation of small bowel tumors and the prognostic factors. Methods　Retrospective analysis of the clinical data were made on 42 cases of primary small bowel tumors (except periampullary tumors) admitted to our hospital from 1974 to 1999. Results　In this series, there were 6 cases of benign small bowel tumors, 5 of them were leiomyoma and 1 adenoma. Of the 36 cases of malignant 　tumors, there were malignant lyphoma in 17 cases (47.2%), adenocarcinoma in 11 (30.6%),　 leiomyosarcoma in 6(16.7%), carcinoid tumor in 1 (2.8%) and neurofibrosarcoma in 1 (2.8%). There was no characteristic clinical sign in small bowel tumors; endoscopy and barium series were the main diagnostic methods. About 50 per cent of patients with malignancy had metastasis, and only 18 cases (50%) received radical resection. Follow-up were available on 36 cases. The overall 5-year survival rate in the patients with malignant small bowel tumors was 47.3%. Multivariate analysis showed that metastasis and diameter of tumors were the main prognostic factors of the 5-year survival. Conclusions　Early diagnosis and early treatment play the key roles in improving the prognosis of malignant small bowel tumors. Radical resection should be taken if no metastasis is found.

Objective To evaluate the long-term results of partial internal sphincterectomy for the treatment of internal anal sphincter achalasia in childhood. Methods The clinical,radiographic,manometrical and histochemical data of 6 cases were reviewed retrospectively. All patients had received partial internal sphincterectomy and were followed-up for 2 to 8 years. Results All patients presented with severe constipation with or without soiling. No stenosis zone of intestine could be noted in 3 patients by barium enema examination. The rectoanal inhibition reflex on rectal balloon inflation was absent in all patients. The normal acetylcholinesterase activity on rectal biopsies was demonstrated by histochemical staining. Ganglion cells within internal anal sphincter was noted in all cases. On follow-up,all patients regained regular bowel habits and are not on any laxatives. Conclusion The long term results of partial internal sphincterectomy for the treatment of internal anal sphincter achalasia in childhood are satisfactory.

Anatomic hepatic resection not only enables enough tumor-free resection margin,but also guarantee the maximal remnant of normal liver tissue.A 61-year-old male patient with hepatic cancer was admitted to the Affiliated Hospital of Hainan Medical College in February 2012.Multiple space-occupying lesions were found in segment Ⅵ,Ⅶ and Ⅷ by computed tomography (CT).The results of CT volumetry analysis showed that the left hemihepatic volume was lesser than the minimal limit of survival,so anatomic hepatic segmentectomy of Ⅵ,Ⅶ and Ⅷ with preservation of segment Ⅴ was designed to guarantee the maximal remaining of normal liver tissue.Glisson's pedicle transection was used twice to divide the right hemihepatic Glisson's pedicle,segment Ⅵ and Ⅶ Glisson's pedicle,respectivley,then the resection line was determined,and anatomical hepatic segmentectomy of Ⅵ,Ⅶ and Ⅷ was completed.With the procedures adopted,the hepatic ischemia reperfusion injury and hemodynamic instability were maximally reduced during operation.

AIM : To contrastively observe the effects of combinative usage of ipratropium bromide, anti cholinergic inhalant and the small dosage of controlled release theophylline tablets or salbutamol on the patients with COPD. Clinical observation of efficacy of combinative usage of ipratropium bromide and small dosage of theophylline on patients with COPD$$$$ WENG Hai xia, DAI Yuan rong, WU Cheng yun, LIN Jie Department of Respiratory, the Second Affiliated Hospital of Wenzhou Medical College, Wenzhou 325027, Zhejiang, China ABSTRACT AIM : To contrastively observe the effects of combinative usage of ipratropium bromide, anti cholinergic inhalant and the small dosage of controlled release theophylline tablets or salbutamol on the patients with COPD. [WTHZ METHODS : Forty patients with stable COPD were randomly divided into two groups ( n =20 in each): theophylline group or salbutamol group. In theophylline group, each case inhaled 2 puffs of ipratropium bromide ter in die, meanwhile take 0.1 g ophylline capsule orally every 12 hours, measured the maximum and minimum concentration of ophylline. In salbutamol group, each case inhaled 2 puffs of ipratropium bromide and salbutamol ter in die. During 8 weeks trial, the base FEV 1.0 before using medicine and the FEV 1.0 when all the drug were stopped at the end of 1st, 4th, and 8th week was measured, separately. The FEV 1.0 amelioration ratio (△′FEV 1.0 ) compared with base FEV 1.0 was obtained , and another FEV 1.0 amelioration ratio (△FEV 1.0 ) was also detected after bronchodilatation test by salbutamol. Furthermore, PEFR aberration rate was evaluated by measuring peak expiratory flow rate in morning and evening daily. The maximum concentration of ophylline is 8.7 ? 2.1 mg?L -1 , the minimum is 6.1 ? 2.3 mg?L -1 . RESULTS : △FEV 1.0 increased markedly at end of 8th week in theophylline group (P

Objective To study the X-ray features and differential diagnosis of duodenal obstruction in neonates.Methods X-ray data of duodenal obstruction in 52 cases confirmed surgically were analyzed retrospectively.Erect abdominal plain films were done in each case;Upper gastric intestinal investigations(UGI) were performed in 28 cases,and barium or meglumine diatyizoate enemas were done in 36 cases.Results On the plain films,9 cases with single-bubble,29 with double-bubble,6 with tri-tubble,8 with multiple stepladder-like gas-fluid level in the bowel loops were noted.14 cases with completive obstruction and 13 cases with partial obstruction were found in UGI series.Malposition of the jejunum was seen in 8 cases among them.Abnormal location of cecum on barium enema was demonstrated in 30 cases,included 10 cases of microcolon.The etiology of duodenal obstruction included intestinal malrotation 34 cases,duodenal atresia 9 cases,duodenal stenosis 4 cases and anaular pancreas 5 cases.Conclusion Most cases of duodenal obstruction can be diagnosed with plain films combining with clinical materials.Differential diagnosis should be made by UGI series and barium enema.

Objective To explore the relationship between 677C/T polymorphism of methy lenetetrahydrofolate reductase (MTHFR) gene and diabetic macrovascular complications (including cerebral infarction and coronary heart disease) in Shanghai.Methods Among 416 Chinese subjects, 216 were in macrovascular disease group 〔the atherosclerosis (AS) group〕 which included cerebral infarction (CI) subgroup consisting of 111 subjects (50 cases with and 61 without diabetes) and coronary heart disease (CHD) subgroup consisting of 105 subjects (48 with and 57 without diabetes); 100 subjects were in diabetes group without macrovascular disease (DM); and 100 normal subjects in control group (C). Genotypes were determined by PCR/restriction enzyme digestion and the relationship between 677C/T polymorphism and diabetic macrovascular complications was studied by population based association analysis. Results The frequencies of MTHFR TT genotype and T allele were significantly higher in macrovascular disease group. Logistic regression analysis showed that MTHFR gene was a potential contributor to AS. Comparison of genotype frequencies between diabetic and non diabetic subgroups in macrovascular disease group revealed no difference. Significant difference of high density lipoprotein cholesterol and diastolic blood pressure between different genotype subgroups was observed within some macrovascular disease groups after stratification by sex and diabetes. Conclusion MTHFR contributes to the development of macroangiopathy (cerebral infarction and coronary heart disease) whether associated with type 2 diabetes or not in Shanghai district.

BACKGROUND:Many studies reported the relationship of the mechanical properties and water content about bone tissue, which is one of organizations containing the lowest water content on human body. Researches on effect of water on biological tribology behavior of bone tissue have been rarely reported and are the experimental study generally. OBJECTIVE:To explore the influence and the damage mechanism of water on biological tribology behavior of bone tissue, by comparing multiscale numerical model established with the experiment. METHODS:Dehydration of the bone tissue was studied by nanoindentation test and both reciprocating sliding and impact wear tests. A multi-scale finite element model was constructed under a flat-on-ball configuration. RESULTS AND CONCLUSION:The viscoelasticity and the tribological properties of bone tissue significantly decreased as well as the different wear mechanisms under applied loading after drying. The analytical results indicated that there were high stress condition, which incurred the micro-crack initiation and the appearance of peeling and wear, around the Haversian canal, circumferential lamellas and the interstitial tissues. Meso-scale:dehydration weakened the function of absorption and interruption of stress, which facilitated crack extension in pore. Micro-scale:the high stress gradient of structure of canaliculi and lacunae is an important cause of tissue damage.