鼻肠减压管在中晚期恶性肿瘤性小肠梗阻综合治疗中的应用价值

目的 探讨鼻肠减压管在中晚期恶性肿瘤性小肠梗阻治疗中的综合应用价值.方法 18例中晚期恶性肿瘤患者发生小肠梗阻时于DSA透视下插入鼻肠减压管至十二指肠屈氏韧带附近,观察患者鼻肠减压管插入后近期临床表现及导管引流情况,并于导管停止移动后经导管行肠内造影以明确诊断,其中15例患者在腹胀缓解后予口服supportan治疗.结果 18例患者鼻肠减压管均顺利插入预定位置,在术后2 d至1周内肠梗阻症状基本缓解;经导管肠内造影,18例患者均有阳性征象;15例患者口服supportan 2周后营养情况改善.结论 在中晚期恶性肿瘤性小肠梗阻综合治疗中鼻肠减压管插入相对简单,综合治疗效果明显,值得采用.     

X线引导下鼻-肠梗阻导管插入引流治疗不能手术的恶性肠梗阻

目的 评价X线引导下经鼻插入鼻-肠梗阻导管治疗不能手术的恶性肠梗阻的技术可行性和疗效.方法 X线引导下应用传统法(76例)或导丝导管交换法(135例)经鼻插入鼻-肠梗阻导管引流治疗不能手术的恶性肠梗阻患者211例(KPS 20 ～ 60分,中位40分),统计技术成功率、临床有效率、治愈率和不良反应及并发症发生情况;分析...     

经鼻插入型肠梗阻导管治疗粘连性小肠梗阻的临床应用

目的：评估经鼻型肠梗阻导管治疗粘连性小肠梗阻的临床疗效。方法2012年1月—2014年8月221例入院诊断为单纯粘连性小肠梗阻的患者随机行经鼻肠梗阻导管（n=111）、鼻胃管（n=110）减压治疗。观察两组患者腹胀腹痛改善情况、胃肠减压量、肛门排气排便恢复时间、腹部立卧位X线平片示气液平面消失时间,治愈率、有效率及中转手术率等指标。结果所有患者均按要求置管成功。与鼻胃管相比,经鼻插入型肠梗阻导管组患者腹胀腹痛等腹部症状缓解时间、肛门排气排便恢复时间、气液平面消失时间均明显缩短,胃肠减压引流量显著增加。可提高患者治愈率、有效率并降低中转手术率,差异均有统计学意义（P<0.05）。结论经鼻肠梗阻导管置入术治疗粘连性小肠梗阻疗效确切,能够显著改善患者的临床症状,值得在临床中推广应用。     

经鼻型肠梗阻导管在小肠梗阻诊疗中的应用效果分析

目的：探讨经鼻型肠梗阻导管小肠减压与高选择性小肠造影在肠梗阻诊断及治疗中的应用价值。 方法：选取我院2012年2月—2014年10月收治的36例小肠梗阻患者,均在胃镜辅助下先行经鼻型肠梗阻导管置入减压,减压后通过肠梗阻导管进行高选择性小肠造影,动态多角度观察肠管的形态、运动及梗阻局部情况,对小肠梗阻的部位、范围、性质做出影像学诊断,并结合手术及病理结果和治疗效果进行分析。 结果：36例患者全部置管、造影成功。14例经非手术治疗治愈,22例经手术治疗治愈。本组病例术前影像诊断与临床最终诊断符合率为94.4%（34/36）。术前15例影像诊断粘连性肠梗阻,经非手术治疗痊愈13例,2例非手术治疗无效中转手术,非手术治疗梗阻解除率为86.6%（13/15）。8例影像诊断肿瘤性肠梗阻均行手术治疗,7例符合诊断,1例误诊为肠结核。5例影像诊断小肠内疝性肠梗阻均行手术治疗,4例符合诊断,1例误诊为肠粘连。4例影像诊断小肠结石性肠梗阻,其中3例手术治疗,1例经非手术治疗痊愈。4例影像诊断肠套叠性肠梗阻行手术治疗均符合诊断。 结论：经鼻型肠梗阻导管小肠减压能够迅速减轻肠梗阻症状,减少急诊手术,部分患者可经非手术治疗治愈。需要中转手术者,也可对其梗阻部位、程度及梗阻病因等进行初步判明,使手术更具针对性。经鼻型肠梗阻导管造影对小肠梗阻的定性定位诊断有较高的临床应用价值。     

DSA引导的经减压孔快速交换法置入经鼻型肠梗阻导管

【摘要】 目的 研究快速交换法置入经鼻型肠梗阻导管的可行性和优势。方法 29例小肠梗阻患者接受快速交换法置入肠梗阻导管。泥鳅交换导丝到位后,其尾端经肠梗阻导管端孔进入,并经减压侧孔引出,透视下快速交换法置管。临床转归为分为:痊愈、手术、好转、无效。其中,痊愈、好转、手术视为临床有效。以技术成功率和临床有效率评价效果。结果 技术成功率100%。临床转归计有痊愈9例、手术5例、好转13例、无效2例。临床有效率93.1%（27/29）。 结论 DSA引导的经侧孔快速交换法可简捷地置入经鼻型肠梗阻导管,是治疗小肠梗阻的有效方法。     

X线透视下经鼻十二指肠营养管的置入及临床应用

目的探讨X线透视下十二指肠营养管的置入及其临床应用价值。方法从2003年6月3日至2007年8月17日,59例患者在X线透视下行经鼻十二指肠营养管置入,置管成功后营养管末端位于十二指肠空肠连接部。结果59例患者中首次成功放置空肠营养管57例,成功率96.6%,2例患者因明显胃扩张首次置管失败后在充分胃肠减压后置管成功。置管时间为3.9～68.6 min,平均17.8 min。置管中及置管后未发生严重并发症。结论X线透视下经鼻十二指肠营养管置入是一种安全、经济、有效的肠内营养途径,因而具有广泛的临床应用价值。     

X线引导下鼻空肠管置入及临床应用

目的 探讨X线透视下鼻空肠管的置人及其临床应用价值.方法 89例因疾病限制不能经口进食而生命体征相对平稳的危重病患者,鼻空肠管经一侧鼻孔插入,在X线引导下将鼻空肠管插至十二指肠曲氏韧带附近或更远处的小肠.结果 全部病例鼻空肠管均顺利通过幽门插入预定位置,平均置管时间为14.5 min(7～55 min).置管中及置管后未发生严重并发症.经鼻空肠管滴(注)入营养液,促进了患者消化道功能恢复,改善了机体的营养状况,效果满意.结论 X线引导下经鼻鼻空肠管置入是一种安全、经济、有效的肠内给养途径,因而具有广泛的临床应用价值.     

透视下双导丝置管法在食管癌术后吻合口瘘治疗中的应用

目的 探讨透视下双导丝置管法在食管癌术后吻合口瘘患者置管及治疗中的应用价值.方法 12例食管癌手术切除术后出现吻合口瘘的患者,在透视下采用双导丝引导经鼻分别置入十二指肠营养管和胃肠减压管,统计其技术成功率、平均置管时间、并发症以及吻合口愈合情况.结果 所有患者均成功置入十二指肠营养管和胃肠减压管,技术成功率为100%.单个患者置管时间为5～8 min,平均6min.操作及置管使用过程中未出现心律失常、误插、吸人性肺炎、会厌功能紊乱等并发症.10例治愈,愈合时间为17～37 d,平均28 d.2例死亡.结论 透视引导下双导丝置管法操作简单、安全、成功率高,置入十二指肠营养管和胃肠减压管可提高食管癌术后吻合口瘘的治愈率.     

腹膜透析管漂管复位中DSA引导的价值

【摘要】 目的 评价治疗腹膜透析管漂管采用DSA引导的价值。方法 回顾性分析经数字化X线摄影（DR）明确有腹膜透析管漂管的10例患者资料,在DSA引导下,采用多功能导管联合加硬导丝对腹透管漂管进行复位,观察复位成功率及术后并发症,随访期内观察腹膜透析管的通畅性。结果 10例患者均成功复位,手术时间为（30.9±6.1） min,X线透视时间为（7.1±1.7） min。术后仅1例患者发热,抗炎治疗好转,所有患者无腹痛,6个月随访期内所有腹膜透析管均通畅,无移位。结论 采用DSA引导下介入复位治疗腹膜透析管漂管安全、有效、微创,值得临床进一步推广。     

经右颈内静脉球囊飘浮电极导管床旁快速心脏起搏25例

目的　探讨床旁快速起搏的方法。方法　采用Seldinger法穿刺右颈内静脉经鞘管插入顶端球囊飘浮电极导管直至右室起搏。结果　共2 5例在床旁无X线指引下迅速达到有效起搏,插入时间为5 10min(平均8min)。结论　采用Seldinger法穿刺右颈内静脉,沿鞘管送入顶端球囊飘浮电极导管,可在床边不需X线指引,安全快速地进行右心室起搏     

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.