食管覆膜金属支架置入术治疗食管癌放疗后食管气管瘘

目的探讨食管覆膜金属支架置入术治疗放疗后食管气管瘘的临床疗效。方法 2008年~2013年本院食管癌放疗后食管气管瘘患者43例,其中21例行食道支架置入术,22例置入十二指肠营养管以营养支持,比较两组患者的生存质量,肺部感染控制有效率及生存期。结果支架组患者共有20例成功置入食管覆膜金属支架,技术成功率95.2%,营养管组患者均一次性置入成功,技术成功率100%。治疗后支架组患者的生活质量和肺部感染控制有效率明显优于营养管组(P0.05),术后随访,支架组患者平均存活3.4个月(1~9个月),营养管组患者平均存活1.7个月(1~5个月),两组患者生存期差异有统计学意义(P0.05)。结论食管覆膜金属支架置入术对于食管癌放疗后的食管气管瘘患者是一种有效的姑息性治疗方法,能明显缓解患者症状,提高患者生活质量,有效控制肺部感染,延长患者生存期。     

直结肠恶性梗阻及肠腔渗漏病变内支架治疗

目的:探讨金属内支架治疗直结肠恶性梗阻及肠腔渗漏的临床意义和效果。方法:47例无手术治疗指征的直、结肠恶性梗阻和9例肠腔渗漏,在X线透视下,经肛门置入镍钦记忆合金网状支架。结果:56例患者,共植入镍钛记忆合金网状支架62枚(6例因再次梗阻二次植入支架)。52例支架一次置入成功,占93%(52/56);4例经二次支架置入成功,占93%(4/56);5例因肿瘤破溃形成肠瘘,4例结肠癌手术吻合口瘘,置入覆膜支架成功封堵瘘口。所有病例支架置入后梗阻症状迅速解除,腹胀逐渐消失,可进半流质饮食,一般情况好转。生存6个月以内30%(17/56),6个月以上70%(39/56),5例已超过13个月,现仍在随访中。结论:直结肠金属内支架置入术,是治疗无手术指征的直结肠恶性梗阻和肠腔渗漏病变,首选有效的姑息性治疗手段,临床效果显著。     

金属内支架治疗直结肠恶性狭窄和梗阻

目的探讨金属内支架治疗直结肠恶性狭窄和梗阻的临床意义和效果。方法47例无手术治疗指征的直、结肠恶性狭窄和梗阻,在X线透视下,经肛门置入镍钛记忆合金网状支架。结果47例患者,共植入镍钛记忆合金网状支架53枚(6例因再次梗阻二次植入支架)。43例支架一次置入成功,占91.5%(43/47),4例经二次支架置入成功,占8.5%(4/47)。2例肿瘤破溃瘘道形成病例,置入覆膜支架成功封堵瘘口。所有病例支架置入后梗阻症状迅速解除,腹胀逐渐消失,可进半流质饮食,一般情况好转。生存6个月以内29.8%(14/47),6个月以上70.2%(33/47),2例已超过13个月,现仍在随访中。结论直结肠金属内支架置入术,是治疗无手术指征的直结肠恶性狭窄和梗阻的首选有效的姑息性治疗手段。     

覆膜食管支架治疗食管癌放疗后并发食管狭窄及食管瘘的临床效果

 目的 评价覆膜食管支架治疗食管癌放疗后并发食管狭窄或食管瘘的临床效果。方法 回顾性分析58例食管癌放疗后并发食管狭窄及食管瘘的患者,所有患者均在X线监视下放置Z形全覆膜食管支架,分析支架置入的疗效及安全性。结果 58例食管支架均放置成功,术后患者进食恢复通畅、瘘口封闭,各种临床症状得到有效迅速缓解,放置成功率及治疗有效率均为100.0%。术后出现胸痛52例(89.7%),恶心呕吐31例(53.4%),轻度消化道出血21例(36.2%),前两项经对症处理后可有效控制,后者自行好转。结论 采用覆膜食管支架治疗食管癌放疗后并发的食管狭窄及食管瘘简便、安全、疗效确切,值得推广。     

可回收食管覆膜支架治疗良性食管瘘的疗效分析

目的分析总结置入可回收食管覆膜支架治疗由于多种原因引起的良性食管瘘的疗效及堵漏失败后的治疗策略。方法收集苏州大学附属第一医院自2006年1月至2011年6月经食管碘水造影确诊的21例良性食管瘘患者,在DSA监视下置入可回收食管覆膜支架,支架在体内放置28～250 d后取出并行食管造影检查评估瘘口封闭情况,对堵漏失败的病例,尝试胃镜下钛夹夹闭、DSA下生物胶堵漏及永久食管覆膜支架堵漏后进行成功补救治疗。结果入组所有病例中,可回收食管覆膜支架均一次性置入,技术成功率100%,术中无严重并发症。14例支架取出术后复查食管造影显示瘘口完全封闭,首次支架治愈率66.7%,未成功患者中5例取出支架复查食管造影见对比剂外溢,提示瘘口未完全封闭,其中2例各放置永久性覆膜食管支架1枚,6个月后食管造影复查成功堵漏。2例在用钛夹夹闭瘘口;1例用生物胶堵漏后未成功。2次支架治疗成功率为76.2%,通过其他微创方式补救治疗后成功率85.7%。所有堵漏成功的患者支架取出后或微创补救堵漏成功后行上消化道造影证实无对比剂外溢。支架相关并发症包括不同程度胸骨后疼痛不适或异物感21例(100%),支架移位3例(14.3%);严重并发症为迟发性支架所致大出血、休克、死亡2例(9.5%)。结论应用可回收食管覆膜支架封堵由多种病变引起的良性食管瘘技术成功率及回收率高,封堵瘘口疗效确切,严重并发症少,对堵漏失败者可尝试永久支架或钛夹夹闭方法治疗。     

暂时性蘑菇状内支架与经鼻经食管脓腔引流管置入治疗食管-胃吻合口瘘

目的探讨暂时性蘑菇状覆膜内支架与经鼻经食管脓腔引流管置入治疗食管-胃吻合口瘘的疗效。方法对8例食管-胃吻合口瘘患者透视下,经鼻腔和食管向脓腔内置入引流管,负压抽吸脓液,再经食管置入蘑菇状覆膜内支架封堵瘘口。定时经引流管冲洗脓腔,适时复查脓腔造影,及时调整后退引流管的位置,直至引流管完全拔出;在置入术后1个月左右(约在引流管拔出后1周)取出支架。结果8例蘑菇状覆膜内支架和引流管置入技术操作全部成功,放置位置合适。经鼻经食管脓腔引流14～21d,脓腔消失,引流管完全拔出。置入术后1个月内以介入技术顺利取出支架,复查造影瘘口均愈合,脓腔消失。结论暂时性蘑菇状覆膜内支架与经鼻腔经食管脓腔引流管置入治疗食管-胃吻合口瘘,操作简单安全、无严重并发症、花费低、创伤小,是一项值得推广的新技术。     

覆膜食管支架置入治疗食管恶性狭窄的临床应用

目的评价覆膜食管支架置入术治疗食管恶性狭窄的临床效果并探讨手术并发症的相关因素和对策。方法102例食管恶性狭窄患者在X线监视下经口置入覆膜食管支架。支架使用国产和进口2种类别、规格多样。92例于支架置入前(后)完成了放射治疗。随访。结果手术成功率100%,共置入覆膜食管支架110枚。术后患者临床症状消失或显著好转。并发症包括:胸骨后疼痛36例(35.3%),再狭窄7例(6.9%),食管返流6例(5.9%),支架移位6例(5.9%),食管出血4例(3.9%),支架端瘘1例(1%),支架腔嵌塞1例(1%)及支架脱落并部分丝线断裂1例(1%)。中位生存期10.6个月。结论覆膜食管支架置入治疗食管恶性狭窄是一种非常有效且简便易行的方法,但并不十分安全。     

内支架治疗直结肠癌恶性梗阻的临床分析

目的探讨金属内支架治疗直结肠恶性狭窄和梗阻的临床意义和效果。方法50例确诊直结肠癌晚期无手术治疗指征的恶性狭窄和梗阻患者,在X线透视下,经肛门置入镍钛记忆合金网状支架,术后随访2年,观察直结肠癌晚期患者生活质量有无改善。结果50例患者,共植入镍钛记忆合金网状支架56枚（6例因再次梗阻二次植入支架）。44例支架一次置入成功,占88%（44/50）,6例经二次支架置入成功,占12%（6/50）。2例肿瘤破溃瘘道形成,置入覆膜支架成功封堵瘘口。所有患者支架置入后梗阻症状迅速解除,腹胀逐渐消失,可进半流质饮食,一般情况好转。生存6个月以内28%（14/50）,6个月以上68%（34/50）,2例已超过13个月,占4%（2/50）,现仍在随访中。结论直结肠金属内支架置入术,是治疗无手术指征的直结肠恶性狭窄和梗阻的首选姑息性治疗手段,可以有效地提高患者生存质量。     

经皮肝穿胆管内金属支架置入联合伽玛刀立体定向放射治疗肝门部胆管癌

目的探讨经皮肝穿胆管内金属支架置入联合伽玛刀立体定向放射治疗肝门部胆管癌的疗效及安全性。方法 2005年10月—2007年1月对不愿意手术或不能手术治疗的21例肝门部胆管癌患者,给予经皮肝穿胆管内金属支架置入联合伽玛刀立体定向放射治疗。肿瘤边缘剂量4～8Gy/次,隔日1次,总剂量为40～60 Gy,10～20 d完成。结果患者行经皮肝穿胆管内支架置入术后,血总胆红素及直接胆红素水平均有显著下降。治疗后1~3月复查,1例出现再梗阻,其余血胆红素水平基本上接近正常。肿瘤病灶CR 2例,PR 14例,PD 1例,SD 3例,总有效率(CR+PR)为80%。胆道支架植入术中及术后,出现血压下降4例,放疗不良反应以消化道反应多见,均为I~II度。患者中位生存期为14.5月,1、2年生存率分别为47.6%、14.2%。结论经皮肝穿胆管内支架置入术联合伽玛刀立体定向放射治疗是肝门部胆管癌的一种有效方法,并发症及不良反应少。     

覆膜内支架治疗食管癌放疗后狭窄及食管气管瘘临床分析

目的评价覆膜食管内支架治疗食管癌放疗后狭窄及食管气管瘘的临床效果。方法本组89例食管癌放疗后狭窄及食管气管瘘的患者,其中并发食管气管瘘28例。食管内覆膜支架置入均在数字减影血管造影机(DSA)监视下进行。结果 89例患者均成功置入覆膜内支架,27例中上段食管气管瘘完全被封闭,进水呛咳症状消失。18例术后再狭窄,再次置入支架。结论食管覆膜内支架治疗食管癌放疗后狭窄及食管气管瘘安全有效,能提高患者生活质量,延长生存期。     

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.     

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).     

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.     

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.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.