肝硬化门静脉高压症双介入治疗的临床应用

目的探讨双介入治疗对肝硬化门静脉高压性上消化道出血、脾功能亢进的临床价值及并发症的预防。方法对11例确诊为肝硬化门静脉高压合并上消化道出血、脾功能亢进的患者,在B超引导下经皮肝门脉穿刺成功后,将导管超选择插入胃冠状静脉,再经股动脉穿刺插管、超选插入脾动脉分支,混合应用无水酒精、明胶海绵、不锈钢弹簧圈,进行双介入栓塞(胃底食管曲张静脉及部分脾脏栓塞)治疗。结果11例患者术后均有不同程度的发热、腹痛、恶心及呕吐等栓塞后综合征,经对症治疗后缓解、症状消失。24 h~1周白细胞、血小板明显升高。12月内上消化道出血控制率达100%。结论双介入治疗门脉高压性上消化道出血、脾功能亢进,疗效确切。     

部分脾动脉栓塞术治疗肝炎肝硬化脾功能亢进

门静脉高压症常继发于肝硬化,主要表现为脾肿大,侧支循环的建立和腹水,同时亦可引起脾功能亢进.众多临床研究证明,部分性脾栓塞是治疗门静脉高压症的一种有效方法.本文总结近年来门脉高压症、脾肿大的发病机制,分析门脉高压与脾脏肿大的血流动力学关系,综述部分脾动脉栓塞治疗肝炎肝硬化脾功能亢进的原理和临床应用现状,并评价其疗效.     

选择性脾动脉栓塞的临床意义

目的：研究和分析对脾动脉不同部位的栓塞治疗不同疾病的临床效果和方法,方法：选择23例患者,肝硬化合并肝癌6例,单纯肝硬化门脉高压食道胃底静脉破裂出血13例,脾功能亢进4例,男19例,女4例,对19例患者采取脾动脉主干栓塞,而后4例患者作部分性脾实质栓塞（即对部分脾段动脉进行栓塞）。结果：13例肝硬化门脉高压食道-胃底静脉曲张破裂出血的患者于脾动脉主干栓塞后,出血立即停止,除1例栓塞1月后再次出血,1例历肾功能衰竭于栓塞术后48h死亡外,其余11例一年内未再次出血;6例肝癌行脾动脉主干栓塞后进行了肝癌的灌注栓塞（TACE）治疗,未发生术后上消化道出血;4例脾亢患者行脾段动脉栓塞后,第3天白细胞及血小板有明显升高,除左上腹疼痛及发热较明显外,无其他并发症,所有栓塞治疗比较安全,结论：通过动脉超选择性插管栓塞术,可以治疗脾亢及门脉高压引起的上消化道大出血,且保留了脾脏功能,所有治疗方法操作简单、安全有效,值得推广运用。     

肝硬化门脉高压继发脾功能亢进的介入治疗

目的　探讨肝硬化门脉高压引起脾功能亢进的介入栓塞治疗效果。方法　采用Seldinger法穿刺股动脉 ,选择或超选择插管进入脾动脉和 /或其分支血管 ,行部分性栓塞共 2 6例 ,术前血小板、白细胞计数均明显低于正常水平。结果　脾动脉栓塞后 3～ 5d血小板、白细胞显著增加 ,1～ 2周升至或超过正常范围。术后 2月血小板、白细胞计数明显高于术前 ,具有极显著性意义 (Ρ <0 .0 1)。 2 6例患者术后均有脾区疼痛 ,2 4例有发热 ,随访时间 1～ 44月 ,平均 15 .7个月 ,除 2例死于肝癌外其他病例均存活 ,2例血小板计数低于正常 ,但高于术前水平。结论　脾动脉部分栓塞属微创手术 ,既能保留脾脏的免疫功能 ,又能有效地缓解脾功能亢进和门脉高压 ,对肝硬化脾功能亢进的患者是一条安全、有效的治疗途径     

部分脾栓塞术对肝硬化门脉高压症患者肝,脾血流的影响

应用彩色多普勒血流显像技术观察11例肝硬化门脉高压症患者行部分脾栓塞术(PSE)后,肝脾血流变化的结果。患者脾动脉、脾静脉和门静脉的内径、血流速度和血流量较术前显著缩小和下降(P<0.05～0.001),门静脉血流量减少的程度与脾动脉血流量的变化呈正相关(r=0.8635).彩色多普勒血流显像检查为判断 PSE 的疗效和栓塞剂的合理用量提供了重要的影像学依据.     

肝硬化门静脉高压脾功能亢进的介入治疗临床分析

目的探讨肝硬化门静脉高压引起的脾功能亢进的介入栓塞治疗效果。方法采用Seldinger法穿刺股动脉,选择或超选择插管进入脾动脉及其分支血管,行部分性脾栓塞术32例。术前周围血象血小板、白细胞记数明显低于正常水平。结果脾动脉栓塞术后1~2天白细胞显着升高,血小板在1周后生至或超过正常范围。结论脾动脉部分栓塞术既保留了脾脏的免疫功能,又能有效缓解了门静脉压力和脾功能亢进,对肝硬化脾功能亢进的患者是一种安全、有效的治疗途径。     

双介入法治疗肝硬化并上消化道出血及脾亢的临床意义

目的　探讨经皮经肝行胃冠状静脉、胃短静脉栓塞和部分脾动脉栓塞术 (简称双介入法 ) ,治疗肝硬化合并上消化道出血、脾功能亢进的临床意义。方法　对具有完整临床诊断资料的 18例肝硬化合并急性或反复上消化道出血及脾功能亢进的病人 ,采取双介入法用无水酒精、弹簧钢圈、明胶海绵进行胃冠状静脉、胃短静脉及部分脾动脉栓塞 ,其中栓塞胃冠状静脉 18支、胃短静脉 11支 ,脾实质栓塞 5 0 %～ 70 %左右。结果　 18例双介入法手术均顺利完成 ,除栓塞后均有不同程度的发热和脾区疼痛持续 1周～ 1月左右外 ,无特殊并发症发生。术后随访最长 6年 ,最短 4个月 ,18例病人均无再发消化道出血 ,脾功能亢进症状全部改善。结论　双介入法治疗肝硬化合并上消化道出血、脾功能亢进 ,手术操作简便易行 ,临床效果满意 ,值得推广     

双介入法治疗门脉高压症的数字成像技术

目的：探讨双介入法治疗门脉高压症的数字成像技术。方法：本文20例肝硬化病人，在X线透视和B超联合导向下经皮穿刺门静脉，行门静脉造影和胃冠关静脉造影栓塞。同时经皮股动脉穿刺行腹腔动脉造影，再作脾动脉造影和部分脾脏栓塞。结果：20例手术全部成功，均进行了胃冠状静脉和脾栓塞，复查DSA示栓塞效果满意。结论：运用X线数字成像技术，采用双介入治疗门脉高压症是一种安全有效的治疗方法。     

部分脾栓塞术联合TACE治疗原发性肝癌伴脾功能亢进的研究进展

脾功能亢进是原发性肝癌肝硬化门静脉高压的严重并发症之一,部分脾栓塞术（PSE）在治疗脾功能亢进上具有安全、有效、可重复、微创且能保留脾脏部分免疫功能等优点,已在经导管肝动脉化疗栓塞术（TACE）治疗原发性肝癌伴脾功能亢进中具有举足轻重的作用。本文主要对原发性肝癌发生脾功能亢进的机制、PSE的优势、操作方法及术后常见并发症进行综述。     

原发性肝癌伴脾亢的介入治疗(附31例报告)

目的　探讨肝动脉化疗栓塞联合部分性脾动脉栓塞 (PSE)治疗原发性肝癌合并脾功能亢进的意义及方法。方法　原发性肝癌合并脾亢 3 1例 ,采用经皮穿刺肝动脉化疗栓塞术 (TACE)和PSE治疗 ,治疗前后测定血细胞数量 ,CT观察肝脏肿瘤及脾脏大小改变。结果　PSE术后 2 4h、1周、4周血白细胞和血小板均较栓塞前明显升高 (Ρ <0 .0 1)。 2 8例脾栓塞面积在 40 %～70 % ,2例 80 % ,1例 <40 %。术后 1月CT复查肝脏肿瘤缩小 2 2例 ,占 70 .97% (2 2 / 3 1)。脾脏有所缩小 ,内可见均一低密度梗死区。结论　肝动脉化疗栓塞及部分性脾动脉栓塞是治疗肝癌合并肝硬化脾功能亢进安全、有效的方法     

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.     

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.     

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.     

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）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme