展神经MRI与塑化薄层断面解剖学研究

目的　对展神经进行MRI与塑化切片对照研究 ,获得正常影像和断层解剖资料。方法采用生物塑化技术制作展神经横断面、矢状面和冠状面各 1例的薄层切片 ,同时采用快速小角度激发三维成像 (FLASH 3D)序列完成头颅标本及 6 0例正常人脑干MR扫描 ,对展神经脑池段及Dorello管的形态、走行进行对比观察。结果　展神经及Dorello管的行程、解剖结构能够准确显示 ,塑化切片与MRI有良好的对应关系 ;展神经在桥前池内向前上外侧走行 ,与脑干背侧连线夹角 12 7 2 0°± 8 16°,5 0岁以上年龄组夹角较小 ,与 30岁以下年龄组之间差异有显著性意义 (t=1 80 0 ,P <0 0 5 ) ;展神经与脑正中矢状面的夹角左右分别为 32 6 7°± 9 17°、31 87°± 11 18° ,左右侧差异无显著性意义 (t =1 990 ,P >0 0 5 )。结论　薄层MRI能够准确显示神经脑池段及Dorello管的解剖结构 ,是评价展神经与相关结构的准确的影像学技术     

鼻中隔径路翼管神经切断术

报告了采用Minnis中隔径路翼管神经切断术治疗变态反应性鼻炎93例的疗效。其中对翼管暴露不佳的26例采用了改良Minnis方法。测量蝶嘴-蝶腭孔(15±3mm)、蝶窦-蝶腭孔(10±2mm)间距104例208侧。为手术提供依据。认为鼻中隔径路可同时行双侧手术并提高手术准确性及疗效。经8个月～4年随访观察,总有效率为96.8％,其中痊愈11.8％,显效71％,进步14％。未见有并发症发生。     

旋转法解决硬膜外麻醉导管置入困难11例

连续硬膜外神经阻滞穿刺置管困难并不少见 ,我们用旋转法较好地解决了导管置入困难。1　临床资料1 1　一般情况　 11例中 ,男 8例 ,女 3例。年龄 18～ 6 9岁 ,ＡＳＡⅠ～Ⅱ级。均为连续硬膜外神经阻滞时 ,直入法穿刺成功后发生硬膜外导管置入困难者 ,其中下胸段 8例 ,腰段3例。1 2　方法　常规使用 18号 10ｃｍ勺状硬膜外腔穿刺针穿刺 ,有至少 2项判断硬膜外穿刺成功试验阳性方认为穿刺成功。然后放置硬膜外导管 ,当发生置管困难时 ,将硬膜外导管轻轻拔出 (若遇拔出导管有阻力时放弃 ) ,保持穿入深度不变 ,以每次 90°旋转穿刺针体 36 0° ,…     

经右锁骨下静脉置入中心静脉管的护理

我院于 1997年 7月～ 1999年 12月间对 6 4例晚期癌症患者采用经右锁骨下静脉穿刺置入中心静脉管 ,现将置管所出现的并发症及预防措施总结如下。对象与方法一、对象6 4例患者 ,男性 4 4例 ,女性 2 0例 ,年龄 39～ 87岁 ;置管时间 10～ 6 8ｄ。二、穿刺部位选择及穿刺方法穿刺点定位于右锁骨下方 3ｃｍ ,相当于锁骨下窝处 ,利于导管的固定。穿刺时 ,右上肢平放 ,穿刺针与锁骨及皮肤成 15°～ 30°角紧贴锁骨下方向右胸锁关节方向穿刺 ,穿刺针接上注射器 ,带负压穿刺。穿中时 ,可见血液回流。穿中后调整穿刺针口平面 ,使其指向下方以利导丝进…     

原发性三叉神经痛:三叉神经微观结构与神经脑桥夹角的相关性

【摘要】目的：探讨原发性三叉神经痛患者（PTN）三叉神经的微观结构改变与三叉神经-脑桥夹角之间的相关性。方法：将25例经微血管减压术（MVD）证实存在神经血管压迫（NVC）的单侧PTN患者和25例健康志愿者（对照组）纳入本研究，两组受试者均采用3D-FIESTA及DTI序列行MRI扫描，测量双侧三叉神经脑池段的长度、三叉神经-脑桥夹角、桥小脑角池横截面积以及NVC部位的扩散参数（FA、ADC）值，并分别对神经-脑桥夹角与扩散参数值及二者与视觉模拟评分（VAS）和病程等临床指标进行相关性分析。结果：PTN组患侧神经-脑桥夹角明显小于健侧和对照组［患侧：(39.11±5.76)°，健侧：(49.00±7.59)°，对照组：(45.20±5.76)°；F=15.26，P<0.001］；且当责任血管为小脑上动脉（SCA）时，患侧神经-脑桥夹角显著小于其它责任血管时的夹角［SCA：(36.69±4.90)°，非SCA：(43.42±4.65)°；U=156.5，P=0.002］。与健侧及对照组比较，患侧桥小脑角池的横截面积和脑池段神经长度的差异均无统计学意义（P>0.05），患侧三叉神经的FA值明显减小、ADC值明显增加（P均>0.05）。患侧神经-脑桥夹角与FA值呈正相关（r=0.56，P<0.01），与ADC值呈负相关（r=－0.62，P<0.01）；FA值与VAS评分呈负相关（r=－0.53，P<0.01）。结论：三叉神经与脑桥的夹角可作PTN的临床诊断指标之一，FA值亦可作为一种评估PTN患者临床症状严重程度的指标。     

标准型主动脉弓分支开口位置的MSCT测量

目的:测量标准型主动脉弓分支的最佳显示角度,旨在为临床工作提供帮助。方法:按照入组标准搜集211例标准型主动脉弓患者的颈部MSCT血管成像资料,将显示两血管最小间距的层面确定为各个分支的最佳观测平面,测量其与矢状面的夹角。结果:头臂干动脉和左颈总动脉最佳观测平面与矢状面之间的夹角最大值为120.7°,最小值为14.6°,平均71.47°±2.16°,无年龄及性别差异;显示左颈总动脉和左锁骨下动脉间距的平面与矢状面之间的夹角最大值为96.6°,最小值为3.6°,平均30.82°±1.62°,无年龄及性别差异。结论:MSCT对主动脉弓的解剖观察可为显示主动脉分支开口提供最佳观测位置。     

主胰管胰头段水平角及开角方向与急性胰腺炎相关性的MRI研究

【摘要】目的：探讨主胰管胰头段水平角及开角方向与急性胰腺炎的相关性。方法：回顾性连续搜集临床及上腹部MRI检查诊断为急性胰腺炎的213例患者的临床资料,按纳入和排除标准入选60例（其中男38例,女22例,平均年龄45岁）为观察组,同期收集43例正常胰腺（男22例,女21例,平均年龄53岁）为对照组。两组均行MRCP,数据上传至工作站行图像处理,在主胰管显示清晰完整的层面上连续三次测量主胰管胰头段及主胰管头尾两端连线与水平线的夹角,记录平均数值及主胰管胰头段水平角方向并行统计学分析。结果：急性胰腺炎组,主胰管胰头段及主胰管头尾两端连线与水平线的夹角分别为25.64°±20.32°和28.07°±11.11°,而正常胰腺组为30.56°±18.56°和28.65°±10.49°（t=1.254/0.253,P=0.213/0.801 ）。60例急性胰腺炎组中,主胰管胰头段开角向上36例,主胰管胰头段与水平线的夹角为32.19°±23.19°, 向下24例,其夹角为16.08°±8.80°;43例正常胰腺组,开角方向上37例,主胰管胰头段与水平线的夹角为32.77°±18.91°, 向下6例,其夹角为16.94°±7.66°。急性胰腺炎组与正常胰腺组,向上或向下开角方向,主胰管胰头段与水平线的夹角差异均无统计学意义（t=0.117/0.219,P=0.907/0.828）,而主胰管胰头段与水平线的开角方向差异具有统计学意义（χ2=8.232,P=0.004）。全部病例中向上开角的角度（32.48°±20.98°）与向下开角的角度（16.26°±8.46°）间差异有统计学意义（t=4.901,P=0.000）。结论：急性胰腺炎与主胰管胰头段水平角大小无关,但与水平角的开角方向密切有关,临床急性胰腺炎多以开角向下方向为主。     

健康成年人骨性半规管和椭圆囊的MSCT显微解剖研究

目的:利用MSCT测量骨性半规管的径线、相互间的角度,椭圆囊的径线及体积,并估算健康成年人前庭器官参考值。方法:对60例健康成人行颞骨MSCT靶扫描及双斜位MPR,以显示各骨性半规管的全程和椭圆囊的全貌,并测量骨性半规管的径线、半规管间夹角以及椭圆囊的长径、短径和体积。用SPSS v16软件进行差异性t检验和参考值估算。结果:①前骨性半规管的内径、高度、跨度的测量值分别为(1.82±0.16)mm、(5.34±0.32)mm、(4.90±0.62)mm;后骨性半规管分别为:(1.57±0.14)mm、(4.89±0.50)mm、(3.06±0.47)mm;外骨性半规管分别为:(2.32±0.31)mm、(2.11±0.46)mm、(3.74±0.44)mm;椭圆囊的长径、短径分别为:(5.01±0.34)mm、(3.51±0.43)mm,体积为(56.7±7.71)mm3。②相应骨性半规管的径线及椭圆囊的体积比较在性别及侧别上差异均无统计学意义(P>0.05);不同半规管间的径线比较差异有统计学意义(P<0.05)。③骨性半规管间夹角测量值:前骨性半规管和后骨性半规管间91.80°±7.18°,前骨性半规管和外骨性半规管间89.71°±4.95°,后骨性半规管和外骨性半规管间91.19°±1.46°。④骨性半规管间夹角比较在性别及侧别上差异均无统计学意义(P>0.05)。结论:①利用MSCT靶扫描结合双斜位MPR可以很好地显示骨性半规管的全程和椭圆囊的全貌。②本组骨性半规管的径线和椭圆囊的测量值处于95%的置信区间内,可以作为正常参考值。③外骨性半规管的内径最大,前骨半规管最小;前骨半规管的高度和跨度最大,外骨半规管最小。骨性半规管间的相互夹角并非严格相互垂直。     

透视引导左锁骨下动脉穿刺的方法学研究

目的　探讨在X线引导下行左锁骨下动脉 (LSCA)穿刺的方法 ,并评价其可行性和安全性。材料与方法　 5 0例患者经股动脉穿刺插管行LSCA造影。观察LSCA分支、走行情况及其与第 1肋外缘交点与毗邻骨性标志的关系。根据观察结果 ,临床上在透视引导下按骨性标志行LSCA穿刺 12 0例。以体表标志引导穿刺LSCA 68例为对照组 ,比较两组穿刺成功率、穿刺次数和并发症。结果　LSCA与第 1肋的交点至第 1肋外缘中点的距离为 0 .0 4± 1.5 6mm ,较恒定在第 1肋外缘的中点及附近。交点处LSCA内径为6.12± 0 .40mm。LSCA通过交点时与横断面的夹角为 3 1.0 2°± 5 .1°。在X线引导下按骨性标志行LSCA穿刺的技术成功率为97.5 % ,对照组为 91.0 %。穿刺次数为 4.7± 2 .3 ,最多达 10次 ,对照组为 8.0± 4.2 ,最多达 2 2次。发现并发症 4例 ,包括气胸 2例 ,局部血肿 2例 ;对照组为 10例 ,包括气胸 5例 ,血胸 1例 ,局部血肿 4例。经统计学检验 ,均有显著性差异 (P <0 .0 5 )。结论　透视下按骨性标志行LSCA穿刺是一安全可行的方法。     

经肝后段下腔静脉建立肝内门腔分流的CT研究

目的　分析肝后段下腔静脉 (RHSIVC)、肝内门静脉的影像学解剖关系 ,为经肝后段下腔静脉途径建立肝内门腔分流 (TRSIIPS)提供形态学依据。资料与方法　分析 2 2 6例肝硬化患者上腹部增强CT图像 ,分别测量肝后段下腔静脉的长度 ,计算周围肝实质包绕RHSIVC的范围 ,以及与距门脉分叉部 1cm的肝内门脉左 (LPV)、右支(RPV)及门脉分叉部 (BPV)同层面的RHSIVC中心至上述部位的距离 ,并计算及比较经肝后段下腔静脉顺行性 (股静脉途径 )、逆行性 (颈静脉途径 )至LPV、RPV、BPV的穿刺深度和角度。数据采用配对t检验。结果　 2 2 6例患者肝后段下腔静脉平均长度为 6 4 .4 6mm± 12 .5 0mm(39～ 130mm)。 5 4 .2 %～ 98.9%RHSIVC管腔被周围肝实质所包绕 ,从肝后段下腔静脉至LPV、RPV、BPV顺行性穿刺的深度及角度分别为 4 3.86mm± 10 .91mm、32 .4 0mm± 9.4 6mm、2 7.96mm±9.0 8mm和 4 2 .88°± 10 .6 9°、4 8.4 9°± 14 .0 2°、5 6 .0 5°± 13.92°;而逆行性穿刺的深度和角度分别为4 4 .18mm± 9.98mm、4 9.4 0mm± 10 .80mm、5 4 .10mm± 10 .338mm和 4 2 .82°± 12 .4 3°、2 9.14°± 10 .15°、2 5 .0 4°± 8.75°。顺行性及逆行性穿刺RPV、BPV的深度及角度有显著性差异 (P <0 .0 5 )。结论　肝后段下     

CT evaluation of pterygoid process pneumatization and the anatomic variations of related neural structures

Objective

This topic is concerned with the clarification of the radiological findings that should be reported as regard the anatomic variations of the neural structures related to the pterygoid process in patients listed for endoscopic sinus surgery.

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）