Pain is a common symptom among populations with life-limiting illnesses. Like all clinicians, family physicians involved in the care of these patients should acquire the skills and knowledge required to provide good pain control in order for the patients and their caregivers to achieve optimal quality of life. This paper is a review and presentation of the definition, classification, assessment and management of pain at the end of life based on available guidelines and evidence.

Objective To investigate the quality of life (QOL) of patients with frequent premature ventricular contractions (PVCs) and the effects of radiofrequency catheter ablation (RFCA) on them.Methods 120 patients with frequent PVCs,100 cases with frequent APCs and 60 healthy persons were assessed by 36-Health survey questionnaire (SF-36) originally.Three months later,the QOL of 48 cases received RFCA and 72 cases with drug therapy were evaluated again by SF-36.Meanwhile,decrease of PVCs were also calculated between these two groups.Results The scores of physiological function and mental health in patients with PVCs were lower than that of cases with APCs,while the score of bodily pain in patients with PVCs was higher (P value:0.0002-0.0380).In addition,the quality of life in patients with frequent PVCs were worse than healthy control(P value:0.0001-0.0915).Three months later,PVCs in 48 cases with frequent PVCs received RFCA were much fewer than that of 72 cases with drug therapy (t=18.8682,P＜0.01),and the quality of life in the former was much better than the latter (F=15.329-39.274,P＜0.01).Conclusion Frequent PVCs can deteriorate the patients' quality of life.RFCA can control or eliminate PVCs in these patients and markedly improve the quality of life of them.

Forensic Ballistics ; Humans ; Maxillofacial Injuries ; surgery ; Wounds, Gunshot ; surgery

Bone Transplantation ; Humans ; Mandible ; transplantation ; Transplantation, Homologous

Humans ; Maxillofacial Injuries ; diagnosis ; surgery ; Wounds, Gunshot ; diagnosis ; surgery

Objective To compare in vitro fertilization and embryo transfer( IVF-ET ) outcome of gonadotropin-releasing hormone( GnRH ) antagonist protocol and GnRH agonist long protocol in patients with polycystic ovary syndrome ( PCOS)and to provide reference for rational selection of ovulation stimulation protocol for PCOS patients. Methods One hundred and four patients with PCOS who underwent IVF-ET were randomly divided into two groups. In the study group,41 patients were subjected to the GnRH antagonist protocol;In the control group,63 patients were subjected to a long protocol of GnRH agonist. Doses and duration of gonadotropin therapy,the thickness of endometrium and the profile of hormone level on the day of HCG administration,the number of retrieved oocytes,the ratio of fertilization,the ratio of cleavage,the ratio of the good quantity embryos,implantation rate of embryo,pregnancy rate,the cycle cancellation rate and the incidence rate of ovarian hyperstimulation syndrome( OHSS)were recorded. Results The IVF-ET outcome of the two groups was similar with respects to the number of oocytes,the ratio of fertilization,the ratio of cleavage,implantation rate of embryo and the pregnancy rate( P﹥0. 05). Significant differences were found(P﹤0. 05)between the two groups regarding to the doses and duration of gonadotropin therapy,the levels of serum E2 and LH on the day of HCG administration,and the cycle cancellation rate. The incidence rate of OHSS was not significantly different ( 2. 44% vs. 12. 70%) between the two groups. Conclusion The duration of gonadotropins administration,the cycle cancellation rate,incidence of OHSS and the financial burdern are reduced in patients treated with GnRH antagonist. The growth of follicle,the ratio of fertilization,the ratio of cleavage,implantation rate of embryo and the pregnancy rate are not different between the two methods. The GnRH antagonist protocol is optimal for patients with PCOS.

BACKGROUND: Xenograft cortical bone is an easy and inexpensive bone graft material, which has good biocompatibility and bio-mechanical properties. As a bone graft, it can function as biological framework for new bone growth and bio-supporting. Moreover, it can also be processed into internal fixation devices.OBJECTIVE: To review the biological properties, preparation methods and clinical applications of heterogeneous cortical bone for fracture fixation.METHODS: A computer-based online search of Pubmed database (1990-01/2009-05) and CNKI (1990-01/2009-05) was performed for related articles with key words of "Xenograft cortical bone, Bone graft, Fixation" in English and Chinese.RESULTS AND CONCLUSION: A total of 128 articles were collected. Xenograft cortical bone has a good biological performance, in particular, a certain degree of bio-mechanical properties. It is not only able to complete bone filling, bone induction, but also function as internal fixator following processing. However, the traditional preparation process reduces their bio-mechanical properties. Heterogeneous cortical bone can be widely used in intra-articular fractures and cancellous bone fracture fixation, and can be self-absorbed, avoiding the second operation. However, its instability limits its initial mechanical properties of fractures at other sites.

Objective:Study the effect about cone beam CT(CBCT) image guidance sytem to improve the positioning accuracy and reducing the set-up uncertainty in precise radiotherapy. Methods:Use CBCT system to scan head and neck tumors patients (30 cases) and chest tumor patients (40 cases), including head and neck tumor patients were scaned 90 times, chest tumor patients were scaned 113 times. Setup deviation statistics about anterior and posterior, head and feet, left and right direction. Results:The patients with head and neck cancer, the maximum error of anterior-posterior is 6mm, Three directions errors which greater than 3mm all less than 10%. Patients with chest tumor position error are in the head and foot direction, greater than 5 mm up to 21.51%. Before and after the direction of the error did not exceed 5mm. The left and right direction greater than 5 mm up to 4.53%. Conclusion:It greatly enhances the precision of radiotherapy, improved the curative effect of radiotherapy by using CBCT online image guidance system for the patient position correction. Compared with EPID, patients scaned with CBCT absorb smaller cumulative dose, the image resolution is higher, image matching is more accurate. But compared with the ordinary helical CT,the resolution and scanning range also need to improve.

Objective To study CT findings, diagnosis and differential diagnosis for prostate cancer. Methods 28 cases with prostate cancer confirmed by surgery and pathology, of them 4 cases were recurrence after operation. Results In 24 cases confirmed by surgery 21 (87.5%) were diagnosed by CT. Their CT appearances were : (1) Focus: in non enhanced scanning the prostate was enlarged unevenly in 18 cases. The density of the mass was slightly lower than the normal prostate in 17 cases, and equal to normal in 11 cases. Patchy calcification was seen in 2 cases moderate. In enhanced scanning, 22 cases showed nodular enhancement but slightly less than normal, 6 cases were equal to normal. (2) Metastastic lesions: 8 cases had local thickened bladder wall, 4 cases had enlarged seminal vesicle with unneven density, 2 cases with thickened anterior wall of rectum.And pelvis mass, enlarged lymph nodes, bony destruction of pelvis and pulmonary metastasses 1 case for each respectively. Conclusion (1) It is emphasized enhanced CT study should be a routine examination in the diagnosis of prostate cancer by CT; (2)CT can define the extent of the lesion and metastases thereby helpful to predict the prognosis and evaluate the effect of treatment.

A 65-year-old lady with End-Stage Renal Failure (ESRF) receiving Continuous Ambulatory Peritoneal Dialysis (CAPD) was admitted acutely for altered mental status and neurological symptoms. She presented to the Emergency Department with bilateral upper limb weakness and clumsiness, bilateral lower limb weakness for 1 day’s duration. In addition, her family members reported altered behaviour for the previous 1 day. On examination, the patient had slurred speech, weakness in all limbs and brisk reflexes throughout. Significantly, she had been diagnosed with herpes zoster 2 days earlier by a family physician, for which she was started on oral acyclovir. Our patient was diagnosed as having acyclovir toxicity and commenced on urgent haemodialysis. Her symptoms resolved completely after 2 days. Our case details the uncommon but potentially fatal complication of acyclovir toxicity in patients with renal impairment, reinforces the importance of dose reduction in these patients and demonstrates haemodialysis as a good form of treatment for acyclovir toxicity. Family physicians should be familiar with dose adjustments for common medications prescribed to ESRF patients in the outpatient setting as the burden of chronic kidney disease increases in Singapore.