CT导向下经皮肺活检的穿刺方法的改进和临床应用

目的：评价ＣＴ导向下经皮肺活检的穿刺方法，以提高临床诊断率，减少并发症。材料和方法：回顾分析６０例资料完整的病例，提出了保留麻醉针头导向法，用不同的活检穿刺针进行了细胞学和组织学取材。结果：一次穿刺成功率１００％，检出肺率３９例，肺结核８例，肺炎性病变７例，穿刺活检正确率９０％，结论：保留麻醉针头导向法减少穿刺方向调整次数，提高了一次穿刺成功率，具有定位准、安全、可靠、诊断准确等优点。     

18G套管血管穿刺针导引20G活检枪经皮穿刺活检的临床应用(附45例报告)

目的 :评价 18G套管血管穿刺针引导 2 0G活检枪经皮穿刺活检的临床应用效果。方法 :45例患者均为占位性病变 ,其中肺 18例、肝 16例、甲状腺 2例、纵隔 3例、颈深部软组织 2例、胸膜 3例、腹腔 1例 ,均在CT导向下以 18G套管血管穿刺针先行穿刺病灶 ,后以 2 0G弹射式活检枪取活检和 (或 )涂片。结果 :共行活检手术 47次 ,穿刺成功率 10 0 % ;取材成功率 93 .3 % ( 4 2 / 45 ) ,活检诊断率 95 .2 % ( 4 0 / 42 ) ;肝组取材率、成功率、诊断正确率 10 0 % ;肺组取材率、成功率 88.9%( 16/ 18) ,诊断符合率 87.5 % ( 14 / 16)。并发症 :气胸 3例 ,咯血 1例 ,总发生率 8.9% ( 4 / 45 )。结论 :18G套管血管穿刺针引导 2 0G活检枪经皮穿刺活检能够提高共轴法穿刺取材成功率 ,降低并发症 ,缩短手术时间 ,是一种安全、高效、简便的共轴穿刺方法。     

CT导向经皮肺部病变穿刺活检的临床效果

目的探讨CT导向经皮肺穿刺活检的临床应用和体会。方法 66例经CT导向做肺穿刺活检的患者,肺内肿块为62例,胸膜病变2例,肋骨及胸腺病变各1例,采用切割针和抽吸针。结果经一次穿刺成功诊断59例。穿刺后病理怀疑肺鳞状细胞癌,结果为肺脓肿1例;第一次穿刺假阴性6例,其中有2例再次穿刺成功诊断为肺腺癌和鳞状细胞癌。本组穿刺活检总的成功率为92.4%。结论 CT导向经皮肺穿刺活检是一项安全有效的诊断方法,CT的准确定位和良好的穿刺技术及病理科的配合和熟练的技术操作是提高活检成功率的重要因素。     

多层螺旋CT在经皮穿刺肺组织活检中的应用价值

目的探讨多层螺旋CT(MSCT)引导下经皮穿刺肺组织活检的技术方法,并评价MSCT在经皮穿刺肺组织活检中的应用价值。资料与方法对42例患者的42个肺部病灶进行MSCT引导下经皮穿刺肺活检。结果42个病灶均成功穿刺(成功率为100%)。肺外周小病灶的一次穿刺成功率为88.2%(15/17),肺门部病灶的一次穿刺成功率为86.7%(13/15)。病理检出40例,诊断成功率和活检准确率均为95.2%。术后并发肺出血2例,发生率为4.8%;气胸2例,发生率为4.8%。结论MSCT引导不仅能提高经皮穿刺肺外周部小病灶和肺门部病灶的技术成功率、诊断成功率和活检准确性,而且能减少并发症的发生。     

CT引导甲状腺穿刺活检术的应用

目的 探讨CT导向甲状腺穿刺活检在介入治疗甲状腺功能亢进(甲亢)基础研究中的应用.方法 对15例甲状腺动脉行PVA(直径150 μm)微粒及平阳霉素栓塞治疗的Graves病(GD)患者于术前、术后共行52次甲状腺穿刺活检,穿刺术前按甲状腺肿大程度进行分组:(1)甲状腺Ⅱ°以上肿大患者19例次,行触摸法穿刺活检术.(2)甲状腺不肿大或Ⅱ°以下肿大患者33例次,按时间先后依次进行触摸下和CT引导下穿刺活检,触摸下穿刺取材9例次后,因触摸穿刺成功率较低而改行CT引导下穿刺取材.结果 ①甲状腺Ⅱ°以上肿大患者19例次行触摸法穿刺活检术17例次成功,成功率89.5%.②甲状腺不肿大或Ⅱ°以下肿大组中触摸法穿刺活检术成功5/9例次,CT引导穿刺活检术成功22/24例次(91.7%)两者比较,差异有统计学意义(P＜0.05).③全部病例未出现穿刺并发症.结论 CT导引甲状腺穿刺活检术,是介入治疗GD术后为基础研究提供标本的一种准确、安全、成功率高的穿刺方法.     

超声导向穿刺活检对Duchenne型肌营养不良症的诊断价值

目的:探讨超声导向穿刺活检对Duchenne型肌营养不良症(DMD)的诊断价值。方法:回顾性分析14例DMD患者,在高频率超声导向下用Bard活检枪和18G切割活检针进行经皮穿刺活检。结果:穿刺活检成功率及诊断准确率为100%,且无并发症发生。结论:超声导向穿刺活检技术微创、安全,直接获取病变组织,诊断准确率高,为临床诊断DMD提供了一种有效方法。     

CT定位仪在CT引导经皮肺部肿块穿刺活检的对照研究

目的 探讨CT穿刺角度定位仪(CT定位仪)在CT引导经皮肺部肿块穿刺活检(percutaneous puncture biopsy,PPB)的应用价值.方法 根据电脑数字表随机分配原则对126例肺部肿块患者进行分组,研究组使用CT定位仪,对照组不使用该仪器,两者均进行CT引导下PPB检查,比较两组一次穿刺成功率,穿刺诊断的正确率,穿刺次数和并发症发生率.结果 研究组借助CT定位仪独有导向针的指向作用,大大提高了一次穿刺的成功率,两组一次穿刺的成功率分别为95%和82%(P=0.023),在肿块直径≤2 cm患者尤其明显(P=0.026);提高了穿刺诊断的正确率:两组分别是95.2%和84.1%(P=0.04);两组气胸发生率分别为4.8%和15.8%,两组间差异有统计学意义(P=0.040 4).结论 使用CT定位仪行经皮肺肿块穿刺活检术,尤其在病灶小且远离胸壁时,可以准确把握穿刺方向,提高穿刺的准确度,减少手术盲目性及危险性,从而提高穿刺成功率,减少气胸发生.同时,CT定位仪具有使用简便,适用于各种螺旋与非螺旋CT机等优点,具有良好的临床应用前景.     

超声导向穿刺活检在浅表神经源性肿瘤的诊断价值

目的:探讨超声导向穿刺活检在浅表神经源性肿瘤的诊断价值。方法:回顾性分析手术病理证实的浅表神经源性肿瘤17例,在高频超声导向下用Bard活检枪和18 G切割活检针进行经皮穿刺活检。结果:穿刺活检成功率100%,取材满意度95.7%,组织学阳性率及诊断准确率为100%;无并发症发生。结论:超声导向穿刺活检技术微创、安全、准确率高,为临床医生制定手术方案、选择手术方式提供明确的组织学依据。     

CT导向下经皮喉咽部穿刺活检的临床应用

目的:探讨CT导向下经皮喉咽穿刺活检的方法并评价其临床应用价值。方法:采用SiemensSomatom HiQ S型和GELightSpeedQX/I型螺旋CT扫描仪及Angiomed自动活检枪行CT导向下经皮喉咽穿刺活检8例。结果:8例均1次穿刺到位,并均得到定性诊断,无1例发生并发症。结论:CT导向下经皮喉咽穿刺活检自动活检枪成功率和诊断准确率高,并发症少,作为内镜补充检查,值得临床推广应用。     

CT定位导向下软组织活检术的临床应用

目的探讨在CT导引下半自动活检枪经皮软组织活检术对病变的诊断价值及临床应用,提高CT导向经皮穿刺活检技术的水平。方法采用ToshibaXvision螺旋CT机和SiemensEmotion6型多层螺旋CT扫描仪及半自动活检枪(16G～22G),对100例胸、腹部占位性病变患者行CT导向经皮穿刺活检术。病灶直径1.5cm～11.7cm。结果99例患者穿刺成功,穿刺成功率为99%,其中,93例取得满意的细胞和组织学材料。本组患者均未发生与操作相关的严重并发症。结论CT导向经皮半自动活检枪穿刺活捡成功率和确诊率高,创伤小,并发症少,是胸、腹部占位性病变诊断及鉴别诊断的一种操作简便、安全可靠的检查方法。     

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.     

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.     

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）