BACKGROUND:Salmon calcitonin or elcatonin has been reported to al eviate acute and severe back pain caused by osteoportic fracture. OBJECTIVE:To evaluate the effects of the combined use of elcatonin and risedronate in the treatment of chronic back pain and the improvement of quality of life in postmenopausal women with osteoporosis. METHODS:Forty-five postmenopausal women with osteoporosis accompanied by chronic back pain persisting for more than 3 months, after excluding women with fresh vertebral fractures within the last 6 months, were randomly assigned to a risedronate group (administration of risedronate alone, n=22) and a combined drug group (combined administration of risedronate and elcatonin, n=23). Pain was evaluated using a visual analogue scale (VAS) and the Roland-Morris questionnaire. Bone mineral density was determined by dual-energy X-ray. Quality of life was assessed using the Medical Outcomes Study 36-Item Short-Form (SF-36) at 6 months after treatment. RESULTS AND CONCLUSION:There were 20 and 19 cases in the risedronate and combined drug groups, respectively included in the final analysis. Significant improvements were found in the combined drug group for VAS and mental health status section scores in the SF-36 at final fol ow-up compared with baseline and 3-month fol ow-up, while no change was found in the risedronate group. Bone mineral density was increased significantly in both groups, while no significant difference was found between groups. These findings suggest that the use of elcatonin in addition to risedronate for more than 3 months may reduce chronic back pain in osteoporosis patients.

Objective Adopt the method of brachial plexus block by a noodle biopsy and pressing the root of interscalene,to discuss the effective of this method on the operation of shower and upper limb.Methods Summarize 182 cases of patients who got the upper limb operation,compared the patients adopting a noodle biopsy and pressing the root of interscalene to block,to the cases which un-pressing the interscalene.Evaluate the anesthesia on sense and movement and record the complicating disease.Results It got a satisfied result from a noodle biopsy and pressing the root of interscalene to block.In this case,all of the sense and movement including shower has disappeared,and has absolutely effect on analgesia.All of the patients avoid to be used herbal supplements and however to complicating symptom.Good rate 97％,compared to 73％ cases of un-pressing.Pressing the interscalene to block is better than un-pressing,on feet nerve,axillary nerves,the median nerve and C4 nerve.Conclusion A noodle biopsy and pressing the root of interscalene to block is a effective and simple method,it needn't special equipment and has a absolutely and extensively block result on the shower and upper limb operation.

Objective To study the clinical features and treatment of the patients with Takayasu's arteritis (TA) with cerebral infarction.Methods Retrospective analysis was done in 14 TA patients with cerebral infarction from 1998 to 2003.Results The patients with TA complicated with cerebral infarction accounted for 10.6%(14/132) of all the hospitalized patients with TA.The time from cerebral infarction to the symptom onset of TA was 1 month to 15 years.In all the cases,there were more than 3 branches stenosis or occlusion of aortic arch and hemiparalysis.Basal ganglion was the most frequently involved infarction area.Corticosteroid and cytotoxic drugs were effective therapy.Conclusion The cases of TA with cerebral infarction have extensive arterial lesions.We must pay attention to it to avoid misdiagnosis.The key point of treatment is to control the primary disease.

Objective To evaluate the curative effects and complications of synthetic dural substitute (Neuro-Patch) in the surgical treatment of Chiari type I malformation (CMI) complicated with syringomyelia (SM). Methods .Forty patients suffered from CMI with SM were given foramen magnum decompression and duraplasty between June 2002 and June 2004. The duraplasty was performed using either synthetic dural substitute (Neuro-Patch Group, n=20) or autologous fascia lata (Autologous Group, n= 20). Results .Symptoms were improved in 17 patients in both of groups (85.0%) at 6 months postoperatively, and no deterioration of symptoms was seen. Postoperative pyrexia occurred in 12 patients in the Neuro-Patch Group (60.0%) and 9 patients in the Autologous Group (45.0%), without significant differences (?2=0.902,P=0.342). No statistically significant differences were observed between the Neuro-Patch Group and the Autologous Group in the operating time (3.6?0.7 h vs. 3.4?0.4 h; t=1.109,P=0.274), the time to the onset of postoperative pyrexia (7.3?3.4 d vs. 9.4?2.5 d;t=-1.560,P=0.135), the length of duration of postoperative pyrexia (range, 1~19 d vs. 1~8 d, median, 4.5 d vs. 2 d;z=-1.643,P=0.100), the drainage time (1.3?0.5 d vs. 1.2?0.4 d; t=0.230, P=0.820), the drainage volume (range, 15~300 ml vs. 20~250 ml, median, 80 ml vs. 37.5 ml; z=-1.359,P=0.174), the duration of antibiotic administration (15.8?4.8 d vs. 13.7?1.5 d;t=1.260,P=0.223), and the assessment outcomes of curative effects. The length of duration of hormone requirement was longer in the Neuro-Patch Group (12.8?4.1 d) than in the Autologous Group (7.8?3.1 d) (t=3.055, P=0.007). On MRI examinations at 6 postoperative months, no posterior cranial fossa effusion was detected in both of groups. Follow-up checkups for 9 months ~ 2 years in the 40 patients showed delayed infectious granuloma on the wound in 1 patient in the Autologous Group, which was cured by debridement. Conclusions .The Neuro-Patch is a reliable dural substitute for repairing of dural defects in the treatment of CMI associated with syringomyelia.

Objective To discuss the diagnosis and treatment of brain abscesses. Methods A total of 20 patients with brain abscesses from January 1996 to June 2004 were studied.All the patients received a CT scanning,and 8 patients were given an MRI examination(two of them underwent a magnetic resonance spectroscopy).An administration of ceftriaxone in combination with metronidazole was given for 1~9 weeks(mean,3.7 weeks).Surgery was conducted in 8 patients under the guidance of CT scanning or B-ultrasonography,including 3 cases of abscess resection and 5 cases of aspiration and drainage. Results One patient died of ventricle involvement,16 patients were cured without after-effects,and 3 patients were improved but the hemiplegia was left behind.No surgery-related deaths were encountered in the 8 surgical cases.Among 8 patients who complicated with diabetes mellitus,tuberculosis,HIV infection,or kidney transplantation,4 patients were cured;all the remaining 12 patients without co-morbidities were cured.Among 9 patients with lesions closely near the ventricle,5 were cured,while the rest of 11 patients with superficial abscesses were all cured.All the 5 patients with multiple abscesses were cured,and 11 out of 15 patients with solitary lesion were cured. Conclusions Most brain abscesses can be cured by early diagnosis and early drug administration.The magnetic resonance is an important means for early diagnosis,and the stereotactic operation is a favorable surgical treatment.

Objective To investigate the diagnosis and treatment of multiple spinal intradural extramedullary tumors.Methods Totally 15 patients(11 men and 4 women) with multiple spinal intradural extramedullary tumors were enrolled in this study.The patients aged from 16 to 81 years with a mean of(51.0?21.2) years.The mean course of the disease was(11.0?7.6) months(range:2-27 months).In the patients,no skin neurofibroma or coffee spots were detected;brain MR showed no abnormalities.Enhanced MR revealed totally 46 spinal intradural extramedullary tumors,35 of which ≥0.5 cm in diameter,involving the cervical segment in 1 case,the thoracic segment in 5,and lumbar and sacrum segments in 12.All the patients received tumorectomy via the posterior midline approach.If the tumor was less than 1 cm,hemilaminectomy was performed under a microscope;the tumor was removed completely,while crucial nerves supplying the tumor were conserved as much as possible.When it is difficult to separate the nerves,we freed the roots of the nerves at our best ability,so that to carry out anastomosis of the roots after removing the tumor.Antibiotics and hormone therapy were administered after the operation,and the patients were required to wear neck/waist support brace for 2 months,and practice the back and waist muscles at the meantime.Results Among the 15 cases,total resection of the spinal tumors was performed on 12 patients(33 tumors were removed),of which one patient received anastomosis of the nerve roots.In the other three patients,two were diagnosed as having scattered multiple small neurofibroma or Schwannoma(

Objective To develop a polymerase chain reaction restriction fragment length polymorphism (PCR RFLP) method using designed primers for determining the genotype of humen platelet antigens (HPA)5 system. Methods HPA 5 system of 25 healthy blood donors were genotyped using PCR RFLP method. The results obtained by PCR RFLP were compared with those determined by allele specific oligonucleotid hybridization (PCR ASO). Results The results of HPA 5 system obtained by PCR RFLP in 25 health donors were as follows: 24 of aa, 1 of ab and 0 of bb. All were in good agreement with those determined by PCR ASO. Conclusions Because PCR RFLP method is plain, fast and reliable for HPA 5 system genotyping, it is suitable for the diagnosis and therapy of neonatal alloimmune thrombocytopenia, posttransfusion purpura, platelet transfusion refractoriness and so on..

Objective To study the signal transduction pathway of norepinephrine (NE)-induced expressions of oncogenes c-fos and c-myc in the rat heart. Methods mRNA levels of c-fos and c-myc in the left ventricle of the Langendorff-perfused rat heart was quantitated by reverse transcription and polymerase chain reaction (RT-PCR). Results NE increased the expressions of c-fos and c-myc while the effects of NE on the expressions of c-fos and c-myc were blocked by ? 1-adrenergic blocker prazosin (5?10 -6 mol/L) completely. Neomycin (5 mmol/L) and ruthenium red (10 ?mol/L) decreased the NE-induced c-fos and c-myc mRNA levels. Conclusion NE can induce the expressions of oncogenes c-fos and c-myc in the ventricle mediated by ? 1-adrenergic receptor. The signal transduction pathway of NE-induced c-fos and c-myc expressions may be associated with inositol phosphates-Ca 2+ system and diacylglycerol-protein kinase C system.

Objective To study the classification, management and outcome of the fracture of ulna coronoid process. Methods Retrospective analysis was carried out in 31 patients with fracture of ulna coronoid process. There were 19 males and 12 females with an average age of 29.8 years old (range, 18-52 years old). The fractures of ulna coronoid process were classified into 4 major groups based on the condition of the injury of ulna coronoid process, the anterior bundle of the ulnar collateral ligaments(UCL) and the elbow stability. The fracture of coronoid process within half of the height was defined as type Ⅰ. The half of coronoid process fracture with the injury of UCL was defined as type Ⅱ. The base of coronoid process fracture with the dislocation of elbow joint was defined as type Ⅲ, sometimes with the injury of UCL. The severe comminute fracture of coronoid process with elbow instability was defined as type Ⅳ. There were 11 cases in typeⅠ, 9 typeⅡ, 6 type Ⅲ and 5 type Ⅳ in our group. According to the type of injury we choose correlative treatment. Results The follow-up was 18-72 months(average 28.6 months). All the patients got fracture union, and without inflammation, neural injuries and elbow instability. 1 type Ⅲ and 2 type Ⅳ had traumatic osteoarthritis, and 2 type Ⅲ and 2 type Ⅳ occurred heterotopic ossification. There was a statistical significance when the motion range of two-side joints was compared in type Ⅳ. Conclusion We choose conservative treatment in the fracture of typeⅠ. But if the piece of bone affected motion of elbow joint, we can choose operative treatment, and elbow stability is not affected. The fracture of type Ⅱ and type Ⅲ with elbow instability should be reduced internal fixation and the ligament must be repaired or reconstructed. In cases of type Ⅳ, bone reconstruction is necessary to recover of elbow stability. Proper post-operative rehabilitation can decrease the rate of traumatic osteoarthritis.

OBJECTIVE:To introduce the Fair PharmaCare program of BC Canada for the reference of the reform of China's medical insurance system.METHODS:The running procedure of Fair PharmaCare program of BC Canada was introduced in detail and its characteristics were analyzed.RESULTS & CONCLUSIONS:Fair PharmaCare program covers all BC residents and protects them against economic difficulties in pharmacare.The program serves as a reference for the reform of China's medical insurance system.