辅助性介入栓塞术在青少年鼻咽纤维血管瘤治疗中的应用

目的 探讨辅助性供血动脉栓塞术在鼻咽纤维血管瘤综合治疗中的应用价值.方法 回顾性分析2000年2月至2005年6月以来经手术及病理证实的鼻咽纤维血管瘤患者17例,其中13例于外科手术前1～4 d行DSA检查及选择性颈外动脉供血支栓塞,4例因鼻腔大出血常规止血无效行急症栓塞治疗后根据病情择期手术,观察造影表现、止血效果及外科手术情况.结果 血管造影可清晰显示肿瘤病变范围及供血情况,16例表现为颈外动脉分支颌内动脉为主供血,1例为颈内动脉和颈外动脉双重供血,供血动脉多少与肿瘤分期有关.鼻腔大出血者表现为末梢血管增多紊乱及点片状对比剂外溢,栓塞治疗后出血停止.栓塞术无明显并发症,外科手术中出血量280～1 600 ml,平均(460±255.5)ml,肿瘤完整切除.结论 鼻咽纤维血管瘤行DSA检查及选择性供血动脉栓塞能进一步明确肿瘤特征,有效治疗急性鼻腔大出血,减少外科术中出血并提高肿瘤切除率.     

鼻咽部纤维血管瘤血管造影及术前超选择栓塞治疗

目的探讨鼻咽部纤维血管瘤术前超选择栓塞的临床价值方法14例经CT和MRI诊断并为手术病理证实的鼻咽部纤维血管瘤患者,术前全部行双侧颈内外动脉及椎动脉血管造影肿瘤颈外系统供血动脉术前使用100～300μm明胶海绵颗粒或聚乙烯醇(PVA)颗粒超选择性栓塞治疗,栓塞后1～3d行手术切除结果14例患者,颌内动脉分支供血9例,颌内动脉和咽升动脉分支供血4例,颌内动脉、咽升动脉和颈内动脉分支供血1例所有患者颈外动脉供血分支微导管超选择性栓塞均获得成功栓塞后,8例肿瘤染色完全消失,6例肿瘤染色大部分消失手术全切率92.8%(13/14),手术平均出血约420m,l手术时间平均150min所有患者栓塞后均未发生严重并发症结论使用微导管术前血管内超选择栓塞鼻咽部纤维血管瘤,是一种安全有效的辅助治疗方法     

鼻咽血管纤维瘤术前供血动脉栓塞的临床应用

目的探讨鼻咽血管纤维瘤术前供血动脉栓塞的临床应用价值。方法7例患者,确诊为鼻咽血管纤维瘤。为控制术中出血,采用Seldinger技术,行供血动脉造影及栓塞治疗。栓塞剂为明胶海绵、PVA颗粒。另选7例为术前未行供血动脉栓塞直接手术切除的鼻咽血管纤维瘤患者作为对照组,对术中出血、输血量作比较。结果7例行供血动脉栓塞患者术中出血量及输血量明显减少,两者比较差异有显著性;手术见瘤周水肿明显,易于剥离。结论鼻咽血管纤维瘤术前供血动脉栓塞术对于减少术中出血具有明显疗效。     

局部穿刺栓塞进展期青少年鼻咽纤维血管瘤

目的 探讨局部直接穿刺栓塞在青少年鼻咽纤维血管瘤(JNA)术前辅助性栓塞治疗中的临床应用价值.方法 29例JNA患者均行颈动脉造影明确肿瘤供血动脉.然后经皮直接穿刺到肿瘤内,注射组织胶栓塞瘤腔.结果 29例患者造影显示由颈内、颈外动脉双重供血.经局部直接穿刺栓塞后造影显示肿瘤血管染色明显减少,供血动脉远端未见明显显示.所有患者在栓塞后1周内行手术切除,术中出血明显减少,出血量150～500 ml,平均350ml.结论 直接穿刺肿瘤栓塞(DPTE)技术安全,能有效栓塞瘤腔,明显减少术中出血.     

鼻咽血管纤维瘤术前双重介入栓塞的临床价值

目的探讨双重介入栓塞对治疗鼻咽血管纤维瘤的临床价值。方法7例鼻咽血管纤维瘤患者,术前均行DSA造影检查,其中6例病灶主要由上颌动脉及颈内动脉分支供血,均行双重介入栓塞治疗即局部穿刺瘤体内直接栓塞 供瘤动脉栓塞;另1例仅上颌动脉供血,故仅行供瘤动脉栓塞。结果所有病灶在栓塞后造影检查中均明显缩小。结论双重介入栓塞治疗可作为鼻咽血管纤维瘤术前必备的辅助治疗措施。     

选择性鼻咽纤维血管瘤供血动脉术前栓塞的应用

目的 探讨选择性鼻咽纤维血管瘤供血动脉术前栓塞的应用价值。方法 对15例鼻咽纤维血管瘤行数字减影血管造影(DsA)检查和栓塞治疗。供血动脉主要为颈外动脉的颌内动脉和(或)咽升动脉，栓塞材料用明胶海绵。结果15例在选择性颈外动脉栓塞后行手术治疗，13例术中出血量明显减少，2例由颈外动脉，颈内动脉系统同时供血，仅选择性颈外动脉栓塞，术中出血量较多。栓塞后2～5d手术最为理想。结论鼻咽纤维血管瘤供血动脉术前栓塞是临床有效的治疗方法之一。     

晚期鼻咽纤维血管瘤切除术前介入栓塞的临床应用

目的 探讨晚期鼻咽纤维血管瘤（juvenile nasopharyngeal angiofibroma,JNA）术前介入栓塞的临床应用价值。方法 回顾性分析2020年11月至2021年9月复旦大学附属眼耳鼻喉科医院收治的13例晚期鼻咽纤维血管瘤患者的临床资料。所有患者均在肿瘤切除术前行介入栓塞术。分析所有患者的肿瘤供血动脉、介入栓塞并发症、切除术中出血量、肿瘤切除率等情况。结果 所有患者无明显介入栓塞并发症,栓塞当日行肿瘤切除,术后复查肿瘤均得到完全或大部分切除,术中出血量为100～2000 mL,平均877 m L。所有患者术后病理结果均证实为纤维血管瘤或血管纤维瘤。结论 晚期鼻咽纤维血管瘤术前介入栓塞可以减少肿瘤切除术中出血量,提高肿瘤切除率,是一种行之有效的方法。     

鼻咽部纤维血管瘤的血管造影表现及手术前栓塞

目的：了解鼻咽部纤维血管瘤的血供情况及术前栓塞对术中出血、手术全切率和术后疗效的影响。材料与方法：对１６ 例鼻咽部纤维血管瘤患者进行数字减影血管造影,并经５Ｆ 造影导管用直径２５０ ～１０００μｍＩｖａｌｏｎ 栓塞肿瘤供血动脉。结果：鼻咽部纤维血管瘤主要由同侧的颌内动脉供血,同侧颈内动脉参与供血的占６／１６ ,对侧颈外动脉参与供血的占５／１６ 。供血动脉栓塞后肿瘤染色大部分消失,术中出血明显减少。结论：鼻咽纤维血管瘤的术前栓塞有助于减少术中出血,增加手术安全性,提高手术全切率和术后疗效。     

鼻咽纤维血管瘤术前上颌动脉栓塞的临床价值

目的　探讨鼻咽纤维血管瘤术前栓塞的价值。方法　回顾性分析 13例病理证实的鼻咽纤维血管瘤患者 ,采用 4 .1F或 5FHead Hunter导管行双侧颈动脉造影 ,了解瘤体供血情况后 ,依据供血动脉的粗细 ,选择不同大小的钢圈行纤维血管瘤供血动脉术前栓塞治疗 ,术中以出血量的多少来判断瘤体栓塞效果。结果　钢圈术前栓塞后 ,13例患者均无明显并发症 ,栓塞距手术时间 1～ 4d ,平均 2d行外科手术治疗 ,术中平均出血量为 (5 84 .6± 379.4 )ml(2 5 0～ 15 0 0ml) ,瘤体均完整切除。结论　鼻咽纤维血管瘤术前钢圈栓塞 ,能有效降低术中出血量 ,提高全切率 ,减少并发症。     

局部穿刺栓塞治疗头颈部高血流病变

目的 总结局部穿刺栓塞治疗头颈部高血流病变的经验。方法 11例头颈部高血流病变(8例颌骨中心性血管瘤，3例鼻咽纤维血管瘤)进行了局部穿刺栓塞治疗。数字减影颈动脉造影在Philips V3000下完成。颌骨中心性血管瘤采用的栓塞材料为附纤毛的螺形圈，鼻咽纤维血管瘤采用的栓塞材料为组织胶(N-butyl-2-cyanoacrylate，NBCA)。穿刺针为14G和长7号注射针。结果 颌骨中心性血管瘤急性出血的患者经局部穿刺栓塞圈栓塞，有效控制了出血。随访9～24个月后，未发现有口腔内渗血或出血，随访X线平片可见螺形圈周围成骨。3例鼻咽纤维血管瘤局部穿刺栓塞后行手术治疗，手术中未行输血，完整摘除肿瘤。结论 局部穿刺栓塞治疗头颈部高血流病变是1种有效、安全的治疗方法。     

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.     

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.     

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).     

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.