2种材料支气管动脉栓塞治疗大咯血的临床分析

目的　探讨 2种栓塞材料聚乙烯醇(PVA)颗粒和明胶海绵颗粒支气管动脉内栓塞治疗急性大咯血的临床疗效。方法　62例(男 40例,女 22例)临床表现为急性大咯血患者,先行选择性支气管动脉插管造影,再做超选择支气管动脉插管,A组 (32例 )注入PVA颗粒栓塞末梢支气管动脉,再用明胶海绵颗粒栓塞近端支气管动脉。B组 (30例 )单纯用明胶海绵栓塞。结果　A组即刻止血 28例(87. 5% ), 72h内咯血停止 4例 (12. 5% ),有效率 100%;B组即刻止血 25例 ( 83. 3% ), 72h内咯血停止 5例(16. 7% )。2组近期疗效无差别(P>0. 05)。随访 1年,A组复发 2例(6% ),B组复发 9例(30% ),复发率差异显著(P<0. 01)。2组均未见严重不良反应。结论　PVA及明胶颗粒支气管动脉栓塞治疗大咯血安全、有效,前者不易复发,值得临床推广应用。     

大咯血的介入治疗及复发的影响因素分析

目的评价大咯血不同血供方式、栓塞方法的疗效及复发因素分析。方法120例大咯血患者行支气管动脉及临近体循环动脉造影,超选择性插管栓塞出血动脉。按供血方式分为单支动脉供血(35例)和多支动脉供血(85例)2组;按栓塞方法分为单纯明胶海绵栓塞(59例)、单纯PVA颗粒栓塞(20例)、PVA颗粒加明胶海绵栓塞(41例)3组,分别行χ2检验,评价各组的疗效。根据治疗效果分为复发(35例)与未复发(85例)为2组,对供血方式和不同栓塞方法进行分析,建立Logistic和Cox回归模型,评价各因素对复发的影响程度。结果120例患者行介入栓塞治疗后咯血均完全停止,技术成功率为100%。随访1～7年,35例复发,总有效率为70.8%。其中单支动脉供血4例复发,复发率11.4%;多支动脉供血31例复发,复发率36.5%。单纯明胶海绵组26例复发,复发率为44.1%;单纯PVA颗粒组3例复发,复发率为15.0%;PVA颗粒加明胶海绵组6例复发,复发率为14.6%。复发率差异有统计学意义(P<0.05)。单纯明胶海绵栓塞后复发时间最短(P<0.05);单纯PVA颗粒栓塞及PVA颗粒加明胶海绵栓塞复发时间较长,但两组之间差异无统计学意义(P>0.05)。结论单纯明胶海绵栓塞和多支动脉供血更容易导致介入栓塞治疗后复发且时间较短;单纯PVA、PVA加明胶海绵栓塞后疗效较好且复发间隔时间较长。     

不同栓塞剂治疗大咯血的对比研究

目的:观察不同栓塞剂对复发率的影响,探讨并比较不同栓塞剂在支气管动脉栓塞治疗大咯血中的疗效.方法:129例经选择性或超选择性支气管动脉栓塞治疗的大咯血患者,单纯明胶海绵栓塞63例,PVA颗粒联合明胶海绵栓塞组37例,KMG微球联合明胶海绵栓塞组38例.随访16个月,复发病例经再次栓塞.结果:即刻止血率99.2%,复发31例.GS组复发21例,含PvA组复发3例,含KMG组复发5例;1年中总复发率为24.0%;3组复发率差异有显著性意义.结论:合理的选用栓塞物质可有效的降低咯血患者的复发率,PVA颗粒及KMG微球在支气管动脉栓塞治疗大咯血中安全、高效,能有效的减免复发率,值得临床推荐.     

肋间支气管动脉栓塞治疗大咯血的疗效分析

目的 探讨明胶海绵(GS)颗粒和聚乙烯醇(PVA)颗粒用于肋间支气管动脉内栓塞治疗急性大咯血的临床疗效.方法 52例急性大咯血患者,先行选择性支气管动脉造影, 利用同轴导管技术,用3F SP微导管超选择插管至出血支气管动脉分支,A组(24例)用GS颗粒栓塞;B组(28例) 用PVA颗粒栓塞.结果 A组24例患者,栓塞后即刻止血16例(66.67%),72 h内完全停止咯血7例(29.17%),栓塞止血有效率为95.83%;B组28例患者栓塞后即刻止血24例(85.71%),72 h内完全停止咯血1例(14.29%),栓塞止血有效率为100%.A、B 2组有效率无显著性差异(P﹥0.05).随访1年,A组复发6例(25%),B组复发1例(3.57%),复发率有显著性差异(P﹤0.05).结论 肋间支气管动脉栓塞术是治疗大咯血有效方法,应用PVA颗粒为栓塞剂,安全有效,不易复发,临床疗效显著.     

甲状腺功能亢进的介入治疗

目的　探讨动脉内栓塞治疗甲状腺功能亢进的临床应用。方法　经股动脉穿刺应用Seldinger技术引入导管鞘 ,作甲状腺上动脉及下动脉的超选择性插管 ,使用PVA、明胶海绵颗粒、弹簧圈栓塞上述血管。结果　 11例甲状腺动脉栓塞均获成功 ,栓塞后甲状腺功能逐渐恢复到正常水平 ,临床治愈。结论　动脉内栓塞治疗甲状腺功能亢进 ,是疗效良好、简单安全的一种方法     

介入性栓塞治疗甲状腺机能亢进症

目的 :探索甲状腺动脉栓塞治疗甲状腺机能亢进 (简称甲亢 )的临床效果。材料和方法 :对 19例甲亢患者经甲状腺动脉超选择性插管 ,采用PVA ,硬脑膜微粒及钢圈栓塞治疗。结果 :甲状腺动脉超选择性插管、全部栓塞成功 ,13例甲亢症状缓解及T3、T4降至正常 ,所有的病例甲状腺体积有不同程度缩小 ,无严重并发症发生。结论 :甲状腺动脉栓塞治疗甲亢是安全、有效的方法。     

甲状腺动脉栓塞术治疗甲状腺功能亢进的疗效分析

目的 :探讨甲状腺动脉介入栓塞治疗甲亢的方法及临床疗效。方法 :选择 3例临床确诊甲亢患者 ,经DSA下用PVA微粒行双侧甲状腺上动脉及一侧下动脉栓塞。结果 :3例增粗的甲状腺动脉已被基本栓塞 ,腺体染色消失。栓塞后临床随访 1～ 4个月 ,术前T34.0～ 10 .4nmol/L ,平均 6 .8± 3.14SD ,T4 193.7～ 4 0 2nmol/L ,平均 2 6 5 .6 3± 10 8.15SD ,术后T3降至 3.5～ 9.3nmol/L ,平均 5 .11± 2 .89SD ,T4降至 182 .0～ 339.3nmol/L ,平均 2 2 8.87± 81.11SD。甲状腺B超 ,甲状腺肿大小术前 2 .5～ 5 .9cm ,术后缩小至 1.5～ 4 .3cm。临床症状逐渐缓解 ,未闻及明显颈部血管杂音。术后不良反应 ,栓塞综合征经对症处理后症状消失。结论 :介入治疗甲亢是一种安全有效替代内、外科治疗的新方法。     

选择性甲状腺动脉栓塞术治疗甲状腺机能亢进

目的　探讨动脉栓塞治疗甲状腺机能亢进的临床应用。方法　 16例经临床确诊甲状腺机能亢进患者 ,选择性行双侧甲状腺上动脉造影 ,并应用无水乙醇、明胶海绵 /PVA颗粒进行动脉栓塞。结果　 16例行甲状动脉造影及栓塞治疗技术成功率 10 0 % ,栓塞后甲状腺不同程度缩小 ,症状明显缓解或消失 ;甲状腺机能恢复正常或接近正常水平 15例 (93 .8% ) ,无严重并发症。结论　选择性甲状腺上动脉栓塞治疗甲状腺机能亢进安全、有效 ,有较大临床应用价值     

甲状腺功能亢进时甲状腺的血供分析

目的　研究甲状腺功能亢进 (甲亢 )时各支甲状腺动脉的粗细及其供应甲状腺组织的多少 ,为甲亢的动脉栓塞治疗提供相关的理论依据。方法　对 5 5例甲亢患者行甲状腺动脉造影 ,测量各支甲状腺动脉的直径及其供应的甲状腺组织所占单侧甲状腺的比例 ,供应比例 >6 0 %时定义为主要供血 ,占 4 0 %～ 6 0 %时为上下动脉供血相当。结果　右侧甲状腺上动脉内径 2 .2～ 6 .0mm ,平均 (3.8±0 .90 )mm ,1例缺如 ;右侧甲状腺下动脉内径 1.7～ 5 .6mm ,平均 (3.5± 1.3)mm ,2例缺如。左侧甲状腺上动脉内径 2 .4～ 6 .0mm ,平均 (3.7± 0 .9)mm ,1例缺如 ;左甲状腺下动脉内径 1.0～ 5 .2mm ,平均 (2 .9± 1.0 )mm ,3例缺如。左右侧甲状腺最下动脉各有 1例显示。双侧甲状腺上动脉相比 ,其粗细相差不明显 (t=0 .2 74 1,P >0 .0 5 ) ,双下动脉相比 ,右侧较左侧粗 (t=2 .3917,P <0 .0 2 ) ;右上下动脉相比 ,相差不明显 (t=0 .95 5 6 ,P >0 .0 5 ) ,左上下动脉相比 ,上动脉明显较下动脉粗 (t =3.7796 ,P <0 .0 1)。右侧甲状腺由右上动脉供血为主者占 5 6 .4 % (31/ 5 5 ) ,上、下动脉供血相当者占 4 0 % (2 2 / 5 5 ) ,右下动脉为主者 3.6 % (2 / 5 5 ) ,后两者合计占 4 3.6 % ;左侧甲状腺由左上动脉供血为主者占 4 9.1% (2     

致命性大咯血的支气管动脉栓塞治疗

目的:探讨支气管动脉栓塞术治疗致命性大咯血的价值。方法:34例致命性大咯血患者用明胶海绵颗粒行支气管动脉栓塞。按治疗方式分为2组,支气管动脉逐级间歇性完全栓塞20例(A组),单纯支气管动脉栓塞者14例(B组)。结果:总有效率为82.4%(28/34),总复发率为29.4%(10/34)。A组较B组疗效好、复发率低(P<0.05)。主要的并发症为自限性短暂的胸痛和发烧。结论:支气管动脉栓塞术是致命性大咯血的一种安全、微创、高效的治疗方法。     

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.     

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.