内镜直视联合X线监视置人支架治疗胃十二指肠恶性梗阻47例

目的 探讨金属内支架置入治疗胃十二指肠恶性梗阻的操作技术及疗效。方法 本组47例胃十二指肠恶性梗阻患者均在内镜直视联合X线监视下,置入54枚金属内支架治疗。结果 47例患者支架置入均获得了成功,随访期间患者均能进食流质或普食,呕吐减轻,生活质量提高,未出现严重并发症。结论 内镜直视联合X线监视下金属内支架置入治疗胃十二指肠恶性梗阻,安全有效,操作简便、时间短,患者痛苦小,定位准确,支架一次性置入成功率高、覆盖病变完全,具有临床推广应用价值。     

X线引导下金属支架置入治疗胃十二指肠恶性梗阻32例临床随访研究

目的 探讨X线引导下金属支架置入术治疗胃十二指肠恶性梗阻的临床随访与评价.方法 选取32例胃十二指肠恶性梗阻患者,行X线监视下进入导管导丝,超过狭窄或梗阻段,交换人软头超硬导丝,经超硬导丝置入并释放自膨式金属肠道支架.结果 28例患者成功置入支架,成功率为88％.术中透视造影示支架均定位准确、通畅.27例支架放置后1周内梗阻症状得到缓解或消除,临床有效率为96％.7例术后1个月左右出现梗阻复发,3例予再次放置第2枚支架后缓解.患者术后1个月生存率96％,术后2月生存率61％,术后6个月生存率25％.1例患者目前仍在随访中.结论 X线下金属支架置入治疗胃十二指肠恶性梗阻是一种可行、安全有效的方法.     

胃十二指肠恶性梗阻内支架治疗12例报告

目的 用金属内支架缓解不能手术的胃十二指肠恶性梗阻患者的症状。资料与方法 12例胃十二指肠恶性梗阻患者均有反复恶心呕吐症状，且不能手术治疗。在透视监视下，使用介入放射学方法置入13个自膨胀式金属内支架。结果 12例患者支架置入均成功，随访期间患者均能进食，呕吐减轻，生活质量提高。无严重并发症发生。结论 金属内支架置人是一种简单、有效的治疗方法，对不能手术的胃出口部狭窄和术后吻合口狭窄有很好的缓解作用。     

胆肠双支架对胰头癌的姑息性治疗效果初探

目的探讨胆道内支架和十二指肠金属内支架联合应用治疗胰头癌的价值。方法2003年8月～2005年7月,对4例出现胆道梗阻的胰头癌患者先置入胆道内支架行减黄治疗,当其出现上消化道梗阻症状时,再置入十二指肠金属内支架,观察该治疗方法的疗效。结果4例患者的胆道和十二指肠内支架均一次置放成功。置入胆道内支架后,所有患者的胆红素水平在24h后下降50％左右,1周时均降到正常范围,黄疸消退。当胆道支架堵塞时,行支架置换术或再次置入支架,均成功减黄。置入十二指肠金属内支架后,患者的消化道梗阻症状得到缓解,可进食。当肠道梗阻再发时,再次置入十二指肠内支架。其中1例患者先后共置放3枚十二指肠金属内支架。4例患者均无支架置入术相关并发症发生。死亡2例,其中1例置入支架后生存24个月,1例生存22个月,直至临终均无黄疸及肠梗阻症状;另2例患者仍在随访中,1例置入支架术后16个月,1例9个月,目前均无黄疸及肠梗阻症状。结论胆道内支架联合十二指肠内支架可以明显改善胰头癌患者的生活质量,是一种有效的姑息性治疗方法。     

胃十二指肠良恶性狭窄的内支架治疗

目的探讨金属内支架在治疗不能手术的胃十二指肠交界处良恶性梗阻中的作用、疗效和并发症。方法１１例病人，８例术后吻合口复发狭窄，１例胃幽门良性狭窄，２例恶性狭窄。在透视监视下，使用介入放射学方法置入１１个自膨胀式金属内支架。结果１１例病人支架置入均成功，１０例梗阻症状立即解除，随访期间病人均能进食，疗效满意。本组无严重并发症发生。结论介入放射学置入金属内支架是一个简单、有效的治疗方法，对不能手术的胃出口部狭窄和术后吻合口狭窄有很好的缓解作用。     

Separate支架在治疗胃十二指肠恶性梗阻中的应用

目的 探讨Separate支架置入术在姑息性治疗不能手术的胃肠道恶性梗阻的可行性和有效性。方法 34例患者采用经口置入Separate支架治疗不能手术的恶性胃十二指肠梗阻。梗阻的原因分别是胃癌11例、胰腺癌12例、转移性肿瘤3例、胆道肿瘤6例和十二指肠癌2例。透视下分别将Separate支架的外层带膜支架和内层裸支架同轴重叠释放在狭窄病变处。结果 技术成功率为97％，未发生严重并发症。33例患者胃肠道梗阻症状缓解或消失，在Separate支架置入后，患者进食能力评分平均从3．8提高到1．2。随访期间未发现支架移位和肿瘤内生性生长等并发症，l例患者由于肿瘤浸润致支架近端梗阻复发，置入第2枚支架。结论 经口途径置入Separate支架姑息性治疗不能手术的胃十二指肠恶性梗阻是可行的和有效的。     

经皮穿肝经口腔双途径联合支架置入治疗胆管和十二指肠恶性梗阻

目的:探讨胆管和十二指肠恶性梗阻双途径联合支架置入介入治疗的方法和效果.方法:23 例胆管和十二指肠恶性梗阻,17例先经皮肝穿刺置入金属支架解除胆管梗阻,出现十二指肠梗阻后,再在X线透视下,经口腔置入记忆合金网状十二指肠内支架.6例因胆管与十二指肠恶性梗阻并存,先置入十二指肠内支架并同时置入胆管支架.测定术前、术后血清总胆红素水平及体重并进行t检验.结果:23例患者双途径联合支架置入成功后,术前、术后血清总胆红素水平及体重比较差异均有显著性意义(P＜0.05).十二指肠支架置入后,消化道梗阻症状迅即解除,当日即能进食,均无严重并发症发生.随访1～20个月进食情况均良好.结论:经皮肝穿经口腔双途径联合支架置入治疗胆管和十二指肠恶性梗阻是首选的有效治疗方法.     

金属内支架治疗直结肠恶性狭窄和梗阻

目的探讨金属内支架治疗直结肠恶性狭窄和梗阻的临床意义和效果。方法47例无手术治疗指征的直、结肠恶性狭窄和梗阻,在X线透视下,经肛门置入镍钛记忆合金网状支架。结果47例患者,共植入镍钛记忆合金网状支架53枚(6例因再次梗阻二次植入支架)。43例支架一次置入成功,占91.5%(43/47),4例经二次支架置入成功,占8.5%(4/47)。2例肿瘤破溃瘘道形成病例,置入覆膜支架成功封堵瘘口。所有病例支架置入后梗阻症状迅速解除,腹胀逐渐消失,可进半流质饮食,一般情况好转。生存6个月以内29.8%(14/47),6个月以上70.2%(33/47),2例已超过13个月,现仍在随访中。结论直结肠金属内支架置入术,是治疗无手术指征的直结肠恶性狭窄和梗阻的首选有效的姑息性治疗手段。     

经口支架置入术治疗胃十二指肠恶性梗阻

目的 探讨经口释放支架治疗胃十二指肠恶性狭窄的治疗方法及临床疗效.方法 12例胃十二指肠恶性梗阻患者,梗阻部位位于胃窦及幽门部4例,胃肠吻合口3例,位于十二指肠降段及以远5例,均在X线引导下采用介入放射学方法,经口腔置入记忆合金支架12枚,并观察术后临床疗效.结果 12例患者均一次性置入支架成功,未出现并发症及不良反应,术后梗阻情况均解除,术后2月,支架均保持通畅,随访结果显示患者死前均未再次出现消化道梗阻症状.结论 金属支架置入术具有操作安全简便、创伤小、恢复快、并发症少等特点,是无法手术治疗的胃十二指肠恶性梗阻有效的治疗方法.     

内支架治疗直结肠癌恶性梗阻的临床分析

目的探讨金属内支架治疗直结肠恶性狭窄和梗阻的临床意义和效果。方法50例确诊直结肠癌晚期无手术治疗指征的恶性狭窄和梗阻患者,在X线透视下,经肛门置入镍钛记忆合金网状支架,术后随访2年,观察直结肠癌晚期患者生活质量有无改善。结果50例患者,共植入镍钛记忆合金网状支架56枚（6例因再次梗阻二次植入支架）。44例支架一次置入成功,占88%（44/50）,6例经二次支架置入成功,占12%（6/50）。2例肿瘤破溃瘘道形成,置入覆膜支架成功封堵瘘口。所有患者支架置入后梗阻症状迅速解除,腹胀逐渐消失,可进半流质饮食,一般情况好转。生存6个月以内28%（14/50）,6个月以上68%（34/50）,2例已超过13个月,占4%（2/50）,现仍在随访中。结论直结肠金属内支架置入术,是治疗无手术指征的直结肠恶性狭窄和梗阻的首选姑息性治疗手段,可以有效地提高患者生存质量。     

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.