The distance between the medial border of the two articular processes was measured by CT and MRI. At the level of C5-6-7 it was 23-25 mm(24mm on average). If the distance is 24 mm at C5-6 a tuohy needle is inserted 10 mm(24?2-2) lateral to the midline. When the needle touches vertebral lamina, withdraw the needle 2mm and redirect it cephalad at 45-60, Resistance is encountered when the needle touches ligament flavum. When the resistance disappears, the tip of the needle has entered the lateral recess via tuohy needle. This approach was used in 45 patients with satisfactory results. In ten patients the position of the cathter was confirmed with contrast medium by CT and MRI.

Objective To investigate the effects of intrathecal (IT) NaV 1.8 antisense oligonucleotide on the chronic neuropathic pain induced by chronic constrictive injury (CCI) to the sciatic nerve.Methods Twenty-four male SD rats were randomly divided into 4 groups ( n = 6 each): group Ⅰ CCI + NS 5 ?l; group Ⅱ CCI + mismatch oligonucleotide 45 ?g; group ⅢCCI + antisense oligonucleotide 45 ?g and group Ⅳ CCI + antisense oligonucleotide 90 ?g. CCI was produced by placing 4 loose ligatures on the left sciatic nerve at 1 mm interval with 4-0 chromic catgut as described by Bennett. On the 5th day after CCI IT catheter was inserted at the level of lumbar spine and identified by free flow of CSF. On the 8th day after CCI normal saline or mismatch or antisense oligonucleotide was injected IT twice a day for 5 consecutive days. Threshold to noxious thermal and mechanical stimuli was measured before CCI (baseline) and on the 1st, 3rd, 5th, 7th, 9th, 11th and 13th day after CCI. On the 14th day after CCI the lumbar segment of spinal cord was removed for determination of NaV 1.8 sodium channel expression in L4-6 dorsal root ganglion (DRG) by semi-reverse transcriptase-PCR.Results The threshold to von Frey hair stimulation and noxious thermal stimuli on the operated side was significantly lowered after CCI. On the 11th and 13th day after CCI the threshold to mechanical and thermal stimuli were significantly higher in group Ⅲand Ⅳ than in group I and H . Conclusion IT NaV 1. 8 antisense oligonucleotide can reduce the neuropathic pain by down-regulating NaV 1.8 mRNA expression.

Objective To compare the efficacy of tramadol for patient-controlled intravenous versus provicial epidural analgesia (PCIA vs PCEA) and their effects on the T-lymphocyte subsets and natural killer (NK) cells during postoperative period in patients undergoing gynecological operation for tumor. Methods Thirty-nine ASA Ⅰ-Ⅱ patients aged 18-83 yr undergoing elective surgery for ovarian cancer or uterine cancer or myoma were randomly divided into two groups : PCIA group (n = 21) and PCEA group ( n = 18). Premedication consisted of intramuscular atropine 0.5 mg and phenobarbital 0.1 g. Operation was performed under epidural anesthesia. Epidural catheter was inserted at T12 -L1 approximately 3-4 cm into epidural space cephalad. The patients received a test dose of 2% lidocaine 5 ml. The first dose was 2% lidocaine 10-12 ml followed by 0.5% bupivacaine 5 ml every 45-60 min. Tramadol 100 mg was given iv in PCIA group or epidurally in PCEA group 15 min before the end of surgery. 100 ml of PCIA solution contained tramadol 800 mg (16 ml), haloperidol 5 mg (1 ml) and normal saline 83 ml and 100 ml of PCEA solution contained tramadol 400 mg (8 ml), haloperidol 5 mg (1 ml) and NS 91 ml. The PCA pump was set to deliver a background infusion at 2 ml?h-1 and a bolus dose 0.5 ml with lock-out interval of 15 min. Analgesia was assessed using VAS. Venous blood samples were taken for determination of T-lymphocyte subset (CD3+ , CD4+ , CD8+) and NK cell counts by flow cytometry the day before surgery and on 1st and 2nd postoperative day. Results The postoperative analgesia was satisfactory in both groups, and there was no significant difference in VAS scores between the two groups. No vomiting and respiratory depression were observed in both groups. The NK cell counts decreased significantly on the 1 st and 2nd postoperative day as compared with the preoperative value (P

The new approaches were designed to have anti-inflammatory analgetics act concentratively on the surrounding of pathological nerve roots or to inject collagenase directly to the protruding lumbar intervertebral disc for more simple and effective treatment of the low back pain. Method: The approaches to epidural lateral recess via incisura margo lateralis of lamina arcus vertebrae or margo medialis of joint processus artieularis were supposed and applied in clinic after study of anatomy and analysis of lumbar vertebra X-ray and CT photographes. The safety and feasibility of the approaches were evaluated according to the test of block region, measurement of therapeutic effect and monitoring of CT during the whole procedures in some cases. Result: A total of 170 cases via the incisura margo lateralis of lamina areus vertebrae were tested, 168 cases turned out to be successful and 2 cases failing. Another 15 cases via margo medialis of joint proeessus articularis, all punctures were successful. Conclusion: The approaches can lead to epidural lateral recess precisely to obtain a better treatment. When the technique is applied to discolysis, no X-ray machine will be needed and therefore no injury of X-ray occurs to both doctors and patients.

Objective To evaluate the analgesic effect and safety of subarachnoid chromaffin cell allograft for terminal cancer pain Methods Ten patients with intractable cancer pain despite traditional treatments were randomly divided into two groups In test group(n=4), 2ml of the suspension chromaffin cells cultured in vitro for 3 days was injected into the subarachnoid space through lumber puncture The same amount of cell free culture solution was injected intrathecally in control group(n=6) Opioids were administered continuously after transplantation The intensity of pain was assessed by VAS, the dose of opioids taken was recored,and the catecholamine and enkephalin concentrations in cerebrospinal fluid and immune function were measured before and after transplantation Results The VAS scores declined markedly in both groups after transplantation (P

Objective To compare the effects of epidural administration of different combinations of lidocaine, corticosteroids (dexamethasone, prednisolone) and vitamins(B 1,B 6,B 12 ) on epidural space adhesion and nerve root inflammation in rabbits Methods Forty eight adult Japannese white rabbits of either sex weighing (2 38?0 31)kg were anesthetized with intramuscular ketamine 15 mg?kg -1 and midazolam 0 2 0 3 mg?kg -1 A catheter was inserted into epidural space at L 2 when the ligamentum flavum was exposed by surgery and advanced caudally for 2 3cm Correct placement of the catheter in epidural space was confirmed by injecting 0 5% lidocaine 0 2 ml through the cathter when the animal was awake 24h after epidural cathter placement 0 2ml?kg -1 of normal saline containing talcum power 1mg?ml -1 was injected into epidural space 3 days later the animal were randomly divided into 8 groups: group Ⅰ received no treatment, group Ⅱ epidural normal saline 0 2ml?kg -1 , group Ⅲ epidural 0 5% lidocaine 0 2ml?kg -1 , group Ⅳ epidural compound lidocaine solution 1 (lidocaine 100mg +dexamethasone 10 mg in 20 ml normal saline) 0 2ml?kg -1 , group V epidural compound lidocaine solution 2 (lidocaine 100mg+prednisolone 50 mg in 20 ml normal saline)0 2 ml?kg -1 , group Ⅳ epidural compound lidocaine solution 3 (lidocaine 100mg+dexamethasone 10 mg+vitamin B 1 200mg in 20 ml normal saline) 0 2 ml/kg, group Ⅵ epidural compound lidocaine solution 4 ( lidocaine 100mg+dexamethasone 10 mg+vitamin B 6 200mg in 20 ml normal saline) 0 2 ml/kg, and group Ⅷ epidural compound lidocaine solution 5 (lidocaine 100mg+dexamethasone 10 mg+vitamin B 12 200mg in 20 ml normal saline) 0 2 ml/kg One week later animals were killed by intravenous injection of air Spinal column below L 1 was removed Epidural space and nerve root adhesion was checked first with naked eye then examined under microscope Epidural space adhesion was divided into 4 grades according to Rydell Results 1 Macroscopic examination of epidural space for adhesion: there was no significant different between group Ⅰ and group Ⅱ,Ⅲ, also between group Ⅱ,Ⅲ and group Ⅳ,Ⅴ,Ⅵ,Ⅶ,Ⅷ; there was significant different between group Ⅰ and groupⅣ,Ⅴ,Ⅵ,Ⅵ,Ⅷ (P

In the treatment of hiccup in the elders by acupuncture plus ear-point embedding method, main acupoints Neiguan (PC 6), Zusanli (ST 36) and Tiantu (CV 22) were treated. Qihai (CV 6) and Taixi (KI 3) were added for those with weak constitution due to old age and severe illness, Zanzhu (BL 2) added for those with cerebrovascular disease, and Zhigou (TE 6) added for those with digestive disease and constipation, and Hegu (LI 4) added for those with respiratory disease. Ear-point embedding method on Diaphragm(MA), Stomach(MA), Ershenmen(MA-TF 1), Subcortes(MA-AT1) and Kidney(MA) were conducted. Results showed cure in 45 cases, improvement in 10 cases and the effective rate was 100%.

Purpose: To observe the curative effects of different treatments on genual osteoarthritis.Methods: The 148 cases were randomly divided into 4 groups: acupuncture group; Chinese herbs plus spectrograp irradiation group; comprehensive treatments group and western medicine group. Results:The total effective rate in these groups were 78.9%, 72.7%, 92.3% and 78.9% respectively, and there was not a significant difference among the groups (P＞0.05). The marked effective rate in comprehensive treatments group was higher than that in other three groups (P＜0.05). Conclusion: Acupuncture and Chinese herbs plus sepectrograp irradiation had certain effect on gonitis. Comprehensive therapies could coordinate the actions of acupuncture, and Chinese herbs plus spectrograp irradiation, and raise the curative effect.

A 24-year-old man presented with a 6-year history of pustules,atrophic scars,and alopecia of the scalp.Dermatological examinations showed generalized alopecia and atrophic scarring of the scalp.A few hairs remained at the vertex region with keratotic papules,pustules,or black sears around the hair follicles.There were also residual hairs at the forehead,temples,and occipital region near the hairline.Clusters of hairs were noted in the occipital region,and keratotic papules were observed around the hair follicles.Erythema,scales,and follicular keratotic papules were found in the superciliary arch.The eyebrows and axillary hairs partially shed and were sparse.Follicular keratotic papules were also found on both cheeks,axillae,chest,abdomen,back and limbs.Stomatological examinations revealed a large space between the upper and lower anterior teeth,anteverted upper anterior teeth,congenital absence of (+1) tooth,deep overbite and deep overjet of anterior teeth.He had a fissured tongue which lacked filiform papillae.Pathological examinations of the skin lesionsshowedathickenedspinouslayer andmassiveinfiltrationsof plasmacytes, neutrophils, and multinucleated giant cells around hair follicles.A diagnosis of folliculitis spinulosa decalvans was made based on the clinical manifestations and histopathological findings.

Objective To investigate the change in NF-κB activity in astrocytes in spinal dorsal horn in a rat model of neuropathic pain and the underlying mechanism. Methods Sixteen male SD rats aged 2-3 months weighing 220-280 g were randomly divided into 2 groups ( n = 8 each) : sham operation group (group S) and CCI group. Neuropathic pain was induced by chronic constrictive injury (CCI) . Right sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1 mm intervals with 4-0 chromic catgut. In group S the right sciatic nerve was exposed but not ligated. The paw withdrawal threshold (PWT) to von Frey filament stimulation and paw withdrawal latency (PWL) to radiant heat stimulation were measured at 1 d before (baseline) and 7 d after operation. The animals were then killed and the lumbar segment of the spinal cord (L_(4-6)) was removed. The expression of NF-κB in the astrocytes in spinal dorsal horn was determined by immuno-histochemistry. Results PWT and PWL to mechanical and thermal stimuli were significantly decreased after operation as compared with the baseline before operation in group CCI. The number of NF-κBp65 immunoreaction positive cells in the spinal dorsal horn on the operated side was significantly larger in group CCI than in group S. Conclusion NF-κB signal transduction pathway in the astrocytes in the spinal dorsal hom may be involved in neuropathic pain.