用改良翼点、颅颧或颅眶颧入路显微手术切除大型及巨大型蝶骨嵴内侧脑膜瘤

目的 :研究探讨改良翼点、颅颧或颅眶颧入路显微手术切除大型及巨大型蝶骨嵴内侧脑膜瘤的技术要求及效果。方法 :本组男 7例 ,女 13例 ,临床症状和体征为典型的蝶骨嵴内侧脑膜瘤表现 ,行CT或MR检查确诊。肿瘤体积为 5cm× 4cm× 4cm～ 11cm× 9cm× 7cm。采用改良翼点入路 11例 ,颅颧或颅眶颧入路 9例。行肿瘤全切 12例 (6 0 % ) ,次全切除 5例 (2 5 % ) ,大部切除 3例 (15 % )。结果 :本组无死亡。术后 14例恢复良好 ,保持术前状态 3例。随访 6月～ 5年 ,有 4例肿瘤复发。结论 :根据肿瘤大小及生物学特征 ,采用这三种入路能够较好地处理这类病变     

经前颅窝底入路切除眶内及眶颅沟通病变

经前颅窝底入路切除眶内及眶颅沟通病变穆苍山，赵宗尧，金鹤基，亢文，王宪武，韩力强总结８例眶内及眶颅沟通病变，包括脑膜瘤３例、神经纤维瘤２例、肝转移癌１例、瘤样纤维组织增生１例、视网膜母细胞瘤１例。术中均采用经硬膜外，前颅窝底人路切除病变，术后无井发症...     

CT和MRI在颅底沟通性肿瘤中的诊断价值

目的探讨颅底沟通性肿瘤的CT和MRI表现特征与诊断依据。方法回顾性分析经手术病理证实的颅底沟通性肿瘤42例,术前行MR横轴位、矢状位、冠状位扫描和/或CT扫描。结果 42例中按肿瘤沟通部位分类:颅眶沟通性肿瘤17例,颅鼻沟通性肿瘤18例,颅鼻眶沟通性肿瘤7例;按肿瘤原发部位分类:来源于鼻眶部肿瘤26例,来源于颅内肿瘤9例,来源于颅底的骨性、膜性及神经性结构的肿瘤7例。38例行手术切除,其中34例CT及MRI所见病灶范围与术中所见一致;另4例因肿瘤广泛累及鼻腔鼻窦、眼眶及颅内,只行活检未做手术切除。结论 CT和MRI能较准确地显示颅底沟通性肿瘤的沟通路径及病变特征,有助于提高颅底沟通性肿瘤的诊断水平,为手术治疗提供重要的依据。     

显微外科手术治疗颅咽管瘤46例分析

目的探讨颅咽管瘤显微手术切除的方法和效果。方法采用显微外科手术治疗颅咽管瘤46例。术前对临床表现、影像检查进行分析,经额下或翼点入路进行手术。结果全切除18例,次全切除28例,无手术死亡。术后临床症状和体征均有不同程度的恢复。结论采用显微手术治疗颅咽管瘤,可以提高肿瘤本身和肿瘤壁的全切除率,达到保护视力,改善内分泌功能,减少各种并发症的目的。首次手术应尽量全切。     

颅后窝实质性血管母细胞瘤手术前血管内栓塞治疗

目的:探讨术前血管内栓塞治疗对血管母细胞瘤手术切除的价值.材料和方法:16例经CT、MRI及DSA检查诊断为血管母细胞瘤患者(9例病变位于小脑半球,3例位于小脑蚓部,2例位于延髓,1例位于第四脑室,1例位于左侧CP角)手术切除前均在局麻下经微导管行供血动脉PVA颗粒栓塞.栓塞后1周内行手术切除肿瘤并病理检查.19例相似部位的未行术前栓塞而直接手术的颅后窝实质性血管母细胞瘤作为对照组,两者作回顾性对比分析.结果:微导管均到达供血动脉,注入适量250～350μmPVA颗粒后,9例肿瘤血管和肿瘤染色完全消失;7例肿瘤血管和肿瘤染色大部消失.16例栓塞后均顺利实施肿瘤手术全切除,与对照组相比,术中出血和输血量明显减少,手术时间缩短,手术视野清晰,肿瘤界限清楚,容易切除,且不易误伤邻近正常结构,9例完全栓塞者表现尤为显著.结论:术前栓塞对血管母细胞瘤手术切除可使手术时间缩短,术中出血明显减少,肿瘤切除更为容易,邻近正常结构不易损伤,手术并发症及死亡率降低.     

经翼点眶内入路显微手术切除球后肿瘤临床分析

目的探讨经翼点眶内入路显微手术切除球后肿瘤的方法和疗效。方法对4例球后肿瘤患者在全麻下经翼点眶内入路手术治疗,观察手术疗效,并根据病理指导治疗。结果4例均肿瘤全切,其中转移瘤1例,神经鞘瘤1例,脑膜瘤1例,眶内脓肿1例。视力2例恢复正常,1例好转,1例未恢复。结论经翼点眶内入路是切除球后肿瘤的有效入路。     

颈静脉球瘤的DSA表现及术前栓塞治疗

目的：分析颈静脉球瘤的ＤＳＡ表现，评价栓塞治疗的作用。材料和方法：患者５例（男性３例，女性２例）。采用Ｓｅｌｄｉｎｇｅｒ技术，行超选择性动脉插管并造影；栓塞剂采用明胶海绵颗粒和／或真丝线段，分次缓慢注入栓塞材料，栓塞过程中监测肿瘤血管及供血动脉闭塞情况。结果：５例颈静脉球瘤。ＤＳＡ动脉期表现为颈静脉孔、乳突区或后颅凹大片血管团块影，其间血管婉蜒迂曲，颈外动脉之咽升动脉、耳后动脉、枕动脉为主要供血动脉，颈内动脉脑膜垂体干、椎动脉之脑膜支、小脑后、前动脉可参与供血。实质期肿瘤呈湖状、巢状染色。静脉期２例肿瘤较大者见粗大的引流静脉丛向下引流至颈内静脉。栓塞后肿瘤的供血动脉大多被栓塞，肿瘤染色明显减少或消失。栓塞术后７天内行手术，肿瘤完全或大部分切除。结论：ＤＳＡ是显示颈静脉球瘤供血动脉的最佳方法，根据ＤＳＡ表现，可以准确确定肿瘤的位置和侵犯范围。术前栓塞为手术切除提供了良好条件。     

中枢神经系统血管母细胞瘤术前栓塞

目的 探讨术前栓塞对中枢神经系统血管母细胞瘤手术切除的作用。方法 11例经CT、MRI及DSA检查诊断为中枢神经系统血管母细胞瘤患者，8例病变位于小脑，1例位于延髓，2例位于脊髓胸段内。手术切除前均在局麻下经微导管行供血动脉PVA颗粒栓塞。栓塞后均行手术切除肿瘤。结果 微导管均到达供血动脉，注入适量直径为250～350μmPVA颗粒后，6例完全栓塞，肿瘤血管和肿瘤染色完全消失；5例大部栓塞，肿瘤血管和肿瘤染色仅存小部分。11例栓塞后均顺利实施肿瘤手术切除。与既往未栓塞的病例相比较，行术前栓塞的病例手术时肿瘤界限清楚，术中出血减少，手术视野清晰，不易误伤邻近正常结构，容易分块切除，手术时间缩短，6例完全栓塞者表现尤为显著。11例手术均未出现并发症。结论 术前栓塞对血管母细胞瘤手术切除可使肿瘤切除更为容易，临近正常结构不易损伤，手术时间缩短，术中出血明显减少，手术并发症及病死率降低。     

术前超选择性栓塞高血运脑膜瘤的临床意义

目的　探讨术前超选择性血管内栓塞对高血运脑膜瘤的疗效和临床意义。方法　在术前3～ 9d ,对 98例高血运脑膜瘤行DSA检查和微导管超选择栓塞肿瘤供血动脉 ,栓塞材料包括PVA颗粒、明胶海绵和真丝线段等。栓塞后行手术切除肿瘤。结果　高血运脑膜瘤主要由脑膜中动脉、咽升动脉、枕动脉、颌内动脉及副脑膜动脉供血。栓塞后 ,4 2例肿瘤染色在影像学上完全消失 ,5 6例肿瘤染色大部分或部分消失。绝大部分患者均在栓塞后的 3～ 9d进行了开颅手术切除肿瘤。全切除肿瘤 6 4例 ,术中平均出血 95 0ml;次全切除 34例 ,术中平均出血 15 0 0ml。结论　最佳手术时机是栓塞后 7～ 9d。高血运脑膜瘤的术前栓塞能明显减少术中出血 ,提高手术安全性及全切率 ,是一种安全、有效的微创方法。     

眼眶-中颅窝沟通性脑膜瘤手术颅底重建

目的 探讨经眶上裂沟通眼眶-中颅窝的脑膜瘤手术的颅底重建的方法.方法 总结我院自2007-01至2012-05采用眶-翼点入路显微手术治疗72例通过眶上裂沟通眼眶-中颅窝底的脑膜瘤患者的临床资料,对该类肿瘤颅底重建的方法进行分析.结果 颅底硬脑膜及骨缺损修补效果满意,肿瘤全切率为90.3％.术后无脑脊液漏、局部脑膨出、脑膜炎等并发症的发生;皮下积液12例.结论 对于该类颅眶沟通性脑膜瘤行眶-翼点入路显微手术是较好的手术方式,颅底重建是手术成功的关键之一.     

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.