鼻内窥镜下微波切除鼻咽血管纤维瘤2例的教训

鼻内窥镜在手术中的应用越来越广泛.作为鼻内窥镜手术的扩展应用,鼻内窥镜下切除鼻咽血管纤维瘤的尝试是极其危险的.现就我科试行的2例手术介绍如下. 例1,男,28岁,右侧鼻塞3个月.检查:鼻咽部增强CT扫描,考虑为"右侧鼻咽血管纤维瘤".收缩鼻甲后见右鼻腔后段有一暗红色新生物,后鼻孔镜检查亦见右鼻咽部有一光滑、淡红色新生物.在局麻下行鼻内窥镜下微波鼻咽血管纤维瘤切除术:鼻腔表麻并收缩鼻甲后在肿瘤根部浸润麻醉,而后用微波在根部凝固并切除之,由口腔取出,用气囊导尿管囊内注水行后鼻孔填塞,压迫止血.术中出血约2 000 ml,输全血800 ml.术后因严重贫血而再输全血1 000 ml.肿瘤病检为:血管纤维瘤.术后5 d取出气囊及鼻腔填塞纱条,术后6 d出院.9个月后鼻内窥镜复查,鼻咽部未见肿瘤复发.     

改良半面中部掀翻式径路治疗鼻咽血管纤维瘤20例

鼻咽血管纤维瘤传统的鼻侧切开径路和经腭径路 ,术野暴露不充分 ,手术操作困难 ,且术后外观较差。1 993～ 1 999年 ,我们对半面中部掀翻式径路进行了改良 ,治疗鼻咽血管纤维瘤 2 0例 ,效果满意。1　临床资料1 1　一般情况　 2 0例均为男性 ;年龄 1 4～ 4 8岁 ,平均 2 0 8岁。本组均有鼻阻伴反复鼻出血 ,病史 3个月～ 3年。查体可见鼻腔和鼻咽部红色肿物。术前ＣＴ扫描Ｚａｎａｒｅｔ分期[1] :Ⅰ期 1 8例 ,Ⅱ期 2例 ,均经手术证实。1 2　手术方法　全麻后 ,沿健侧切牙至患侧第 1磨牙唇龈粘膜移行部切开粘膜 ,直达骨膜 ,骨膜下分离拉起患侧…     

鼻咽部血管纤维瘤术前动脉栓塞的临床应用价值

目的 评价超选择性颈外动脉栓塞术在鼻咽部血管纤维瘤经鼻内镜切除术前的临床应用价值.方法 对20例鼻咽部血管纤维瘤患者经鼻内镜切除术前1 ～ 3 d行超选择性颈外动脉分支,供血动脉栓塞术,回顾性分析术中出血、手术时间及并发症等情况.结果 20例患者均成功接受超选择性颈外动脉栓塞术,1 ～ 3 d后行经鼻内镜切除术,平均术中出血155 ml,平均手术时间为75 min,栓塞术后6例发生轻度并发症,经对症治疗后消失.切除术后无严重并发症发生,术后平均住院时间为3.5 d.结论 超选择性颈外动脉栓塞术可明显减少鼻咽部血管纤维瘤术中出血和术后并发症,有效缩短手术时间,联合经鼻内镜切除术是鼻咽部血管纤维瘤微创、有效的治疗手段.     

经导管动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用

目的：探讨经导管动脉栓塞术在鼻咽血管纤维瘤除术前的临床应用价值。方法：12例鼻咽血管纤维瘤,经股动脉行超选择插管造影,采用聚乙烯醇颗粒和／或明胶海绵颗粒栓塞肿瘤供血动脉,全部患于栓塞后3～7d手术切除肿瘤。结果：12例均见到明显的肿瘤染色,供血动脉丰富。颌上动脉栓塞12例,同时栓塞咽升动脉8例。所有病例均取得良好效果。结论：本组资料表明超选择插管造影诊断、栓塞、治疗及栓塞颗粒大小是技术成功的主要条件。经导管动脉栓塞术在鼻咽血管纤维瘤除术前的应用是安全有效的。     

鼻内镜围手术期微波理疗疗效观察

目前鼻窦炎、鼻息肉在功能性鼻内窥镜鼻窦手术治疗的同时要注重综合治疗，包括术前用药，正确合理的手术方式，手术后维持3-6个月术腔清理、鼻腔冲洗．全身和局部的合理药物治疗。其中围手术期治疗对临床疗效有重要作用，功能性鼻内窥镜鼻窦手术围手术期配合微波治疗可以减轻炎症和水肿．防止粘连和鼻息肉再生。本研究观察患者应用功能性鼻内窥镜鼻窦手术配合围手术期微波治疗的效果。     

鼻咽血管纤维瘤术前超选择性颌内动脉栓塞3例报道

鼻咽血管纤维瘤为临床多发病患，需手术治疗，因术中出血量多，肿瘤不易彻底切除，常使手术难以取得满意效果，我们报道3例术前经超选择性颌内动脉栓塞，为治疗鼻咽血管纤维瘤提供了一种新的途径。     

鼻内窥镜下手术治疗鼻咽血管纤维瘤12例疗效观察

目的 探讨鼻内窥镜下JNA的手术治疗方法。方法 在鼻内窥镜下切除中鼻甲后端，以圈套器摘除JNA。结果 12例患者术后内窥镜复查鼻腔粘膜恢复良好；随访1-3年，无手术并发症，术后无复发。结论 鼻内窥镜下行JNA手术切除安全可行，具有损伤小，术野充分，出血量相对较小等优点。     

选择性血管栓塞在鼻咽血管纤维瘤术前的应用

随着血管放射学技术的发展,据认为,血管检塞后手术切除是治疗头颈部血管瘤或血管畸形的有效方法。我科与神经外科及放射科合作,对2例鼻咽血管纤维瘤行血管栓塞后手术切除,效果明显,兹报告如下。     

血管运动性鼻炎合并鼻结构异常手术治疗的初步分析

目的 评估内镜下鼻内结构正常化手术对血管运动性鼻炎合并鼻结构异常的治疗效果.方法 对确诊为血管运动性鼻炎合并鼻结构异常的76例患者行常规鼻内镜检查及鼻窦CT扫描,根据患者的手术意愿将其分为微波组及手术组,微波组(41例)接受对双侧下鼻甲及鼻丘黏膜微波处理,手术组(35例)接受内镜下鼻内结构正常化手术.两组分别于术后3、6、12个月时进行随访.结果 微波组术后3、6、12个月时有效率分别为90.2%、46.3%、4.9%,而手术组分别为97.1%、97.1%、88.6%,两组3个月时的疗效无显著差异(P0.05),6、12个月时疗效差异显著(P<0.05).微波组鼻干、鼻腔粘连发生率分别为70.7%、56.1%,手术组鼻腔粘连发生率为22.9%.结论 对常规治疗效果不理想且合并鼻结构异常的血管运动性鼻炎患者,施行内镜下鼻内结构正常化手术可取得较好效果.     

颈外动脉栓塞术联合鼻内镜切除富血供鼻咽部血管纤维瘤

目的评价颈外动脉栓塞术联合鼻内镜切除术治疗富血供鼻咽部血管纤维瘤的临床疗效,并与单纯鼻内镜切除术进行对比分析。资料与方法搜集本院收治的富血供鼻咽部血管纤维瘤患者33例,其中采用颈外动脉栓塞术联合鼻内镜切除术治疗20例(A组),单纯鼻内镜切除术治疗13例(B组),回顾性分析两组病例切除术中失血量、手术时间、术后住院时间等差异,对术后1年复发情况进行随访。结果 A组切除术中失血量为(154.5±84.3)ml,手术时间为(75.0±30.9)min,术后住院时间为(3.5±1.3)天,动脉栓塞术后6例发生轻度并发症,经对症治疗后消失,随访1年有1例复发;B组切除术中失血量为(623.1±142.3)ml,手术时间为(100.8±62.2)min,术后住院时间为(5.7±2.1)天,随访1年有1例复发。结论颈外动脉栓塞术联合鼻内镜切除术是治疗富血供鼻咽部血管纤维瘤微创、安全、有效的方法,与单纯鼻内镜切除术相比,具有术中失血量少、手术时间短、术后恢复快的优势。     

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.