左髂静脉受压综合征并发下肢深静脉血栓形成的综合介入治疗

目的 探讨介入治疗髂髂静脉受压综合征并发左下肢深静脉血栓形成的临床价值.方法 对28例左髂静脉受压综合征并发左下肢深静脉血栓形成患者采用经颈静脉插管溶栓、左髂静脉球囊扩张及支架治疗,部分血栓已蔓延至下腔静脉的患者在溶栓前行下腔静脉滤器置入.结果 28例患者均在术前彩色多普勒超声检查及术中造影检查明确诊断;5例行可回收性下腔静脉滤器置入,所有患者均经颈静脉置入溶栓导管于髂股静脉进行溶栓治疗,髂股静脉血栓溶解率100%,溶栓后均予以球囊扩张左髂总静脉,其中6例置入髂静脉支架.术后肢体肿胀症状明显减轻或消失,随访3～12个月临床效果满意.结论 采用滤器置入、经颈静脉溶栓、髂静脉球囊扩张及支架治疗左髂静脉受压综合征并发左下肢深静脉血栓形成是一种安全、微创、有效的治疗手段,具有较好的效果,值得临床推广.     

滤器置入联合手术取栓治疗产后下肢DVT的临床分析

目的 总结产后急性期单侧下肢深静脉血栓形成(DVT)腔静脉滤器联合手术取栓治疗的疗效及应用.方法 回顾性分析59例产后单侧下肢急性期DVT行腔静脉滤器联合手术取栓治疗的患者临床资料.结果 56例成功行腔静脉滤器置入及手术切开取栓,3例因髂静脉近端血栓闭塞严重无法开通,股静脉切口远端成功行手术取栓,术后拔除腔静脉滤器.本组有效率为100%,治愈率为88.1%,无死亡及新发肺动脉栓塞病例.随访3~36个月,1例髂静脉狭窄病例于球囊扩张3个月后复发,再次手术置入髂静脉支架后患肢肿胀明显减轻.结论 腔静脉滤器置入联合手术取栓治疗急性期产后单侧下肢DVT安全可行、疗效确切.     

下腔静脉滤器在下肢深静脉血栓治疗中的意义

目的评价置入下腔静脉滤器预防下肢深静脉血栓脱落引起肺栓塞的价值及实行导管溶栓的方法.方法34例下肢深静脉血栓患者分别经右侧股静脉(26例)或右颈静脉(8例)置入波士顿公司的Greenfield滤器或巴德公司Simon's滤器.下腔静脉滤器置人后,将溶栓导管经右股静脉插人到左髂总静脉,经右颈内静脉插入到左髂总静脉进行溶栓.药物尿激酶100～150万u.结果下腔静脉滤器置入全部成功.溶栓经右侧股静脉26例,成功12例,成功率为47%;经颈静脉8例均成功.结论置人下腔静脉滤器防肺栓塞是操作简单、安全有效的方法.经颈静脉溶栓,成功率高,效果好,值得推广.     

产后下肢深静脉血栓的急诊介入治疗

目的 探讨产后下肢深静脉血栓(DVT)急诊介入治疗疗效.资料与方法 对17例发病48 h～20天的 DVT患者进行颈静脉下腔静脉可回收滤器置入,同时股静脉内置入直头多侧孔导管,术后双向溶栓并抗凝治疗.结果 所有病例均成功置入滤器,血栓溶解,下肢水肿消失,治愈出院,未出现肺栓塞.结论 产后DVT患者置入可回收滤器,术后双向溶栓并抗凝治疗,能提高DVT的深静脉早期复通率和有效预防发生肺栓塞.     

经皮血栓碎吸介入治疗髂-股深静脉血栓的临床疗效

目的 探讨经皮血栓碎吸治疗髂-股深静脉血栓形成(DVT)的临床疗效.方法 回顾分析本院2005年4月至2009年1月236例急性髂-股DVT患者的临床资料.经健侧股静脉入路置入下腔静脉滤器,患侧股静脉插入14 F鞘管经皮碎吸髂-股段深静脉血栓.112例合并髂静脉狭窄或闭塞患者,行经皮血管成形术(PTA)和支架置入术;术后辅以溶栓抗凝治疗.结果 出院时健、患肢膝上、下15 cm处周径差降为(1.34±0.57) cm和(0.93±0.42) cm,与入院比较差异有统计学意义(t=19.37和23.99,P=0.00);随访16 ～48个月,中位随访35个月,随访率97.88％.术后36个月,水肿、色素沉着、溃疡等后遗症发生率分别为12.99％ (30/231)、8.23％(19/231)、0％;静脉通畅率98.27％;随访疗效优92.21％.支架置入术后12、24、36个月通畅率均为100％.结论 经皮血栓碎吸治疗髂-股DVT疗效显著,并发症少,住院周期短,能够明显降低后遗症的发生率.     

超声引导下置管溶栓治疗下肢深静脉血栓

目的 探讨超声引导下经皮置管溶栓治疗下肢深静脉血栓形成(DVT)的临床应用价值.方法 自2009年9月至2011年9月共收治下肢DVT患者34例,均采用下腔静脉滤器置入后,患肢在超声引导下经皮置管,持续导管内给予溶栓药物尿激酶50 万u/d和肝素5 000 u/d,交替使用.其中2例患者合并下腔静脉血栓,采用经颈静脉途径释放下腔静脉滤器;2例患者采用大隐静脉置管;其余均采用经皮腘静脉置管.结果 所有患者均置管成功,放置溶栓导管5 ～ 7 d.27例患者术后下肢肿胀基本消失,活动能力明显改善.5例患者活动后仍有较明显乏力和沉重感.1例患者术后3个月复发,再次置管后好转.1例患者术后6个月复发合并健侧下肢DVT,采用外周血管溶栓治疗.所有患者均采用DSA了解溶栓情况,26例患者髂股静脉术后连续性通畅,8例患者阶段性通畅.结论 超声引导下经皮置管溶栓治疗具有创伤小、定位准确、药物剂量个人化以及溶栓率高等优点,是治疗DVT的有效方法.     

下肢深静脉血栓介入治疗发生肝素诱发血小板减少伴血栓形成综合征一例

临床资料患者女,70岁。因右下肢胀痛1周,渐进性加重活动受限3 d入院。查体:右侧下肢肿胀明显,肌张力较对侧高,皮色加深,右侧深静脉走形区压痛。彩色多普勒超声检查示:右侧下肢深静脉血栓形成(DVT)急性期。治疗方案:①右髂股静脉导管溶栓;②下腔静脉内置入可回收滤器预防肺动     

介入性综合治疗下肢深静脉血栓的临床应用

目的 评价介入性综合治疗下肢深静脉血栓(DVT)的疗效.方法 回顾性分析经介入性溶栓治疗33例下肢DVT患者,其中10例患者仅行下腔静脉滤器植入术,术后溶栓抗凝治疗.23例患者行下腔静脉滤器植入术和同期患侧股髂静脉开通术.结果 随访33例患者均未出现大出血和致死性肺动脉栓塞等严重并发症,23例患者下肢DVT完全溶解,10例部分溶解.结论 介入性综合治疗下肢DVT是一种安全可行、疗效好的方法.     

下肢深静脉血栓介入综合治疗临床效果分析

目的 探讨经颈内静脉置管溶栓联合可回收下腔静脉滤器(IVCF)置入术治疗急性下肢深静脉血栓形成(ALEDVT)的临床疗效.方法 选取57例ALEDVT患者作为研究对象,所有患者均在DSA引导下经颈内静脉行IVCF置入和下肢深静脉置管溶栓术.间隔1～3天复查造影,根据复查结果调整溶栓导管位置.溶栓治疗后撤除溶栓导管并行I...     

双股静脉入路治疗髂-股静脉血栓的临床研究

目的　探讨应用双股静脉入路技术 ,治疗髂 -股静脉血栓 (I -FVT)的有效性。方法　下肢深静脉顺行造影证实为I -FVT患者 18例。经健侧股静脉置入下腔静脉滤器 ,然后经健侧股静脉置管于患侧髂静脉入下腔静脉处造影。导丝导管无法进入患侧髂 -股静脉者 ,行患侧股静脉穿刺插管 ,顺行开通股 -髂静脉至下腔静脉内。随后再经健侧插管至患侧开通段内 ,并继续开通下方的闭塞段。对开通段用球囊导管顺次扩张、拖拉 ;对闭塞段中较松软的血栓应用血栓消融器 (ATD)或溶栓导管 (OASIS)进行消融或抽吸术 ;术后保留导管 1～ 6d ,持续行接触性溶栓与抗凝治疗 ,撤管后继续行严格抗凝、溶栓治疗。结果　 18例经双股静脉入路治疗者 ,15例取得明显的疗效 ,表现为患肢肿胀迅速消退 ,疼痛消失 ,肢体松软 ,活动恢复正常 ;另外 2例开通后 ,患肢肿胀减轻 ,好转出院 ;1例未能开通 ,经同侧足背静脉静滴抗凝、溶栓药物 ,症状好转出院。全部病例均未发生肺梗死。术后随访 3～ 39个月 ,平均 16.4个月 ,无症状性复发。结论　双股静脉入路治疗I -FVT ,是一种较为简便、安全、有效的方法     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.