Objective To investigate the technique and effectiveness of CT-guided collagenase injection into prominence of herniated lumbar disc and the surface of prominence in the treatment of lumbar disc herniation. Methods One hundred and fifty-five patients with lumbar disc herniation diagnosed by clinic and CT received CT-guided collagenase injection, with the approaches via intervertebral foramen in L3-4 and L4-5, and the approaches via margo medialis of joint processus articularis in L5-S1. Results Injection was done successfully in all patients (100%), the clinical rate of excellent and good results were 94.2%. The herniation disappeared or significantly reduced as demonstrated by CT scan in 32 of 34 patients (94.1%), the rate of excellent and good results were 100%. No changes existed in 2 cases. There were 2 cases of disc inflammation in our group. Conclusions CT-guided collagenase injection into the prominence of herniated lumbar disc and its surface is a safe and efficient method in the treatment of herniated lumbar disc.

Finite element analysis can analyze the stress and strain change of object with complex shape,structure,constitution and load condition,and is widely applied to spinal biomechanical studies due to its controllability,reproducibility and versatility in mechanics tests.The article briefly introduced several finite element analysis software,summarized the mechanical characteristics of vertebral body,intervertebral disc,accessories and the ligament and muscle around the spine,and summarized research achievements of finite element analysis in lumbar fusion,concerning the biomechanics of Cage,its influence on lumbar fusion and related surgery choice,dynamic fusion,artificial intervertebral disc and the biomechanical variation of different fusion style after spinal tumor vertebrectomy.Finite element analysis can help understand the spine biomechanics and provide biomechanical reference for lumbar fusion choice.

Objective To analyze the results of inhaled allergens detection in children with allergic rhinitis(AR)in Changzhou ar-ea and the distribution situation of allergens in different age groups.Methods The levels of serum allergen specific IgE antibodies in 473 children cases(aged 1-12 years)of allergic rhinitis(AR)were detected by the Allergy Screen allergen screen system.The children cases were divided into the infants group(0-3 years old),preschool children(4-6 years old)and school age children(7 -12 years old)according to age.The allergen positive rates and the change tendency were compared among different age groups.Re-sults Among 473 children cases of allergic rhinitis,340 cases(71.9%)were positive.The top three allergens were house dust mite (55.6%),mixed fungi(25.8%)and house dust(18.8%).The positive rate of allergen showed the upward trend with the age in-crease.The distribution of house dust mite(χ2 =21.061,P =0.000),house dust (χ2 =15.111,P =0.000)and the cat and dog dan-der(χ2 = 7.597,P = 0.022 )was statistically significant among the three groups.Single allergen positive rate was the highest (38.5%)and the secand was double allergens(23.7%).The top three positive in single allergens was consistent with sort of total allergen positive rate.The most common double allergen was the combination of house dust mites and house dust.The multiple al-lergen positive rate had statistical significance in the distribution among groups(χ2 =13.399,P =0.001).Conclusion The inhaled allergens of AR children in Changzhou area are dominated by house dust mite,mixed fungi and house dust.The positive rate shows the increasing trend with age increase.The allergen constituents are different in different age groups.The positive single allergen is most common,followed by positive double allergens.

Objective To compare the effects of early and long term treatment with captopril on clinical outcome between elder patients (65 75 years old) and younger patients (0 05), 25 patients in elder treatment group and 52 patients in elder control group (9 29% vs 24 41%, relative risk = 0 37, 95% CI 0 29 0 48, P 0 05), and both the elder and younger patients had better survival (all P

Objective To assess the value of implanting remedial or prophylactic cardioverter defibrillator in patients with Brugada syndrome for protecting from malignant ventricular arrhythmias and to estimate the initial outcomes in one-month follow-up. Methods Implantable cardioverter defibrillators (ICDs) were implanted in 21 consecutive patients (9 symptomatic and 12 asymptomatic) with Brugada syndrome using standard procedure under general anesthesia. Patients presented the typical ECG changes of Brugada syndrome with or without sodium channel blockers but without structural heart disease in all the cases. Electrophysiological examinations were performed in all patients. Eight asymptomatic patients had spontaneous or induced malignant ventricular arrhythmias and 4 asymptomatic patients had single positive family history. Results Sixteen single chamber ICDs (VVI) and 5 double chamber ICDs (DDD or DDDR) were implanted. The DDD- or DDDR-ICDs were applied for patients with sinus node dysfunction and/or atrioventricular conduction disturbances. Battery/lead status measurements of ICDs were good and met with standards of implantation during the procedure. No complications occurred after ICD implantation and also no changes of various electrophysiological parameters during re-hospitalization in one-month follow-up. There were no events' record of anti-tachycardia pacing or cardiovertion or defibrillation for ventricular arrhythmias in the memory of treatment by ICDs. Conclusions ICDs were implanted successfully with safety in patients with Brugada syndrome showing good function for the initial outcomes in one-month follow-up.

Objective To assess the factors affecting survival of malignant pheochromocytoma/malignant paraganglioma.Methods The clinical data of 85 malignant pheochromocytoma/malignant paraganglioma patients were analyzed retrospectively.All the patients were followed up,the duration from 2 months to 283 months,the median time was 48 months.The overall survivals of 5 years and 10 years were calculated.The possible affecting factors,such as gender,age,tumor function,metastatic sites,metastatic fields,incipience or recurrence,the time to recur,were analyzed.Survival differences between groups were compared with the log rank test.Multivariate analysis was performed by using Cox regression analysis to detect variables independently associated with survival.All P values were 2 tailed with P ＜ 0.05 considered statistically significant.All statistical analysis was done by SPSS 17.0 software package.Results The overall median survival time was 62 months,5-year survival rate was 44.7％,10-year survival rate was 11.8％.Gender (P =0.649),age (P =0.228),incipience or recurrence (P =0.217) had no significant effect on the survival time.Significance was found in tumor function (P =0.034),metastatic sites,metastatic fields (P =0.009),the time to recur (P =0.003).The median survival time of patients with nonfunctioning tumor and functioning tumor was 90 months and 37 months.The median survival time of patients with multiple system metastases and single system metastasis was 37 months and 117 months.For the patients with single system invaded,there were 15 cases (26.8％) of bone metastasis,10 cases (17.9％) of lymph node metastasis,8 (14.3％) of liver metastasis,7 (12.5％) of lung metastasis,6 (10.7％) of renal metastasis,6 (10.7％) of intestine metastasis and 4 (7.1％) of brain metastasis.The median survival time was 110,77,28,14,26,8 and 19 months.The median survival time of patients with lung,liver,intestine metastasis were shorter than the other patients (P ＜ 0.05).Fifty-five patients were found recurrence after operation,recurrent time was from 4 to 65 months,and the median time was 22 months.The survival time of patients with recurrence within 2 years was shorter than patients above 2 years (P =0.003).Conclusions The prognosis of malignant pheochromocytoma/malignant paraganglioma is poor.Gender,age,incipience or recurrence could not affect the overall survival time.The survival time has relationship with the function of tumor,metastatic field,metastatic sites and time to recurrence.The patients with nonfunctioning tumor have longer survival time than those with functioning tumors.The survival time of patients with single system invaded is longer than ones with multiple systems invaded.The common metastatic sites are bone,lymph node,liver,lung,kidney,intestine and brain.Patients with intestine metastasis have worst prognosis.The patients with only bone and lymph node metastasis have best prognosis.Patients with recurrence above 2 years have a better prognosis than those within 2 years.

Objective To improve the diagnosis and treatment of von H ippel-Lindau (VHL) disease.Methods The clinic data of one kindred with VHL disease type Ⅱ B was reviewed including clinical manifestation,imaging,pathology and therapy.A 40-year-old male complained of the left upper extremity numbness for 6 months,and a variety of visceral tumors were found 3 months ago.Contrast-enhanced MR imaging showed multiple brain tumors.CT showed left kidney tumor,pancreatic tumor,pars-aortic tumor and left adrenal tumor.Fundoscopy showed multiple retinal hemangioblastoma.PET-CT discovered abdominal multiple tumors.And pedigree analysis was to determine the family medical history,and 6 members got genetic screening.Results In the kindred with VHL disease type Ⅱ B,9 members (30％) out of 40members in 4 generations got the disease.Six members got genetic screening,and the result showed 5 (5/6) members had mutation.Three (3/5) members with 3 sites genetic mutation showed clinical manifestation,1 (1/5) members with 3 sites genetic mutation without clinical manifestation found brain tumors by MRI,and 1 ( 1/5 ) member with 1 site genetic mutation did not find disease by comprehensive checkup.The main mutation located at exon 1 in chromosome 3p25 of VHL gene.All mutation was hetcrozygous mutation.The 295,337 and 337 nucleotide thymine of the VHL gene were substituted by cytosine,cytosine and adenine,which made the 98th,112th and 112th tyrosine substituted by histidine and asparagines.One member with 1 site mutation had 98th tyrosine substituted by cytosine.The first operation was to remove brain tumor,and the second operation was to remove adrenal tumor,para-aortic tumor and renal tumor.Pathology of the brain tumors showed hemangioblastoma,and the retroperitoneal tumors were clear cell carcinoma,paraganglioma and pheochromocytoma.Followed up for 6 months after operation,no relapse occurred.Conclusions VHL disease is a relatively rare autosomal dominant disorder.Comprehensive management of patients should also include genetic counseling and screening for other manifestations of the disease process.Genetic testing might be helpful in early detection of asymptomatic VHL patients.Members having gene mutation should be followed up strictly.Surgical management of VHL disease should be decided on the base of comprehensive assess.Multiple lesions could be cut off in one operation.For patients with pheochromocytoma,pheochromocytoma shuld be handled first.

Objective　To compare the effects of early and long-term treatment with captopril on clinical outcome between elder patients (65-75 years old) and younger patients (＜ 64 years old) suffering from acute myocardial infarction (AMI). 　Methods　In a randomized trial, 822 patients with a first AMI were treated with captopril at initial dosage of 6.25 mg and adjusted to 25 mg t.i.d according to blood pressure (209 younger patients, 269 elder patients) and conventional treatment (131 younger patients, 213 elder patients). Survival rate of the four groups was calculated with Kaplan-Meier method. 　Results　The survival of treatment group was correlated significantly with age during hospitalization (P=0.0002). Eight patients in younger treatment group and 10 patients in younger control group (3.83% vs 7.63%, P＞0.05), 25 patients in elder treatment group and 52 patients in elder control group (9.29% vs 24.41%, relative risk = 0.37, 95% CI 0.29-0.48, P＜0.0001) were died. During follow-up period, the survival was however not related to the age (P＞0.05), and both the elder and younger patients had better survival (all P＜0.01 ) and lower cardiac events (all P＜0.01) during captopril treatment. 　Conclusions　 Captopril exerts less effect on the younger patients but more effect on the elder patients during hospitalization after AMI. Long-term captopril had no difference between the youngers and the elders in prognosis.

Objective CT-guided collagenase injection through posterolateral path into the interior and superficial prominence of the herniated lumbar disc in the treatment of L4-5 lumbar disk herniation.Methods The approach of posterolateral path to the prominence through intervertebral foramen and epidural space of L4-5 was established according to the analysis of anatomical features and vertebral medical images. The accuracy and safety of the approach were evaluated by CT scanning after epidural injection with air. CT-guided injection was operated in 66 cases of prolapse of L4-5 intervertebral disc confirmed by CT. Results Technical success was 100%. Followed up for 3 months to 3 years, 62 cases (93%) were markedly suecessfud with the effective rate of 93%. Twenty-three had CT re-examination three months later showed the prominences becoming smaller or disappeared in 22 patients having a resolved rate of 95%.Conclusions CT-guided injection of collagenase is one of the effective methods for the treatment of prolapse of L4-5 intervertebral disc.