血管内栓塞术治疗37例假性动脉瘤

目的 探讨血管内栓塞术治疗内脏和外周假性动脉瘤的应用价值.方法 回顾性分析37例假性动脉瘤的血管内栓塞治疗前后的临床资料,3 ～ 36个月随访期内观察栓塞疗效及术后并发症等.结果 37例患者DSA造影发现41枚假性动脉瘤,其中来源于内脏动脉26例,臀上、臀下动脉5例,颈外动脉分支4例,肢体动脉2例.36例患者成功栓塞40枚假瘤,其中明胶海绵栓塞7枚,PVA颗粒栓塞9枚,弹簧圈栓塞11枚,弹簧圈辅以明胶海绵或PVA栓塞13枚.随访期内36例患者中34例出血停止,假瘤完全闭塞,有2枚假瘤复发,术后无严重并发症发生.结论 血管内栓塞术治疗假性动脉瘤安全、有效,假性动脉瘤的性质和栓塞材料的选择在一定程度上会影响疗效.     

医源性胆道出血的血管造影表现和介入治疗

目的评价医源性胆道出血中血管造影诊断及介入栓塞治疗的价值。方法回顾性分析医源性胆道出血患者21例。经皮选择性肠系膜上动脉、腹腔动脉和肝总动脉造影,明确出血的部位后,进行选择性或超选择性插管及栓塞治疗。结果 21例患者血管造影均证实有出血病变。血管造影表现为假性动脉瘤者17例(81.0%),对比剂外溢者4例(19.0%)。栓塞材料采用PVA颗粒栓塞者2例,单纯弹簧圈8例,明胶海绵颗粒+弹簧圈11例。1次栓塞止血成功率为85.7%(18/21),3例患者栓塞后再次大出血而行第2次栓塞成功。术后随访5～28个月,患者均未再发胆道出血。所有患者介入栓塞术后均未出现异位栓塞、肝功能衰竭、栓塞所致感染等严重并发症。结论经皮选择性血管造影和介入栓塞术微创、安全、可靠且疗效确切,是诊断和治疗医源性胆道出血的首选方法。     

选择性动脉栓塞术在医源性出血中的应用

目的：探讨选择性动脉栓塞术在治疗医源性出血中的临床应用价值。方法回顾性分析32例医源性出血患者资料,首先经皮选择性动脉造影,明确出血部位及特点,然后超选择性介入栓塞止血,栓塞材料选择明胶海绵、线段、弹簧圈及 PVA 颗粒等。结果32例患者中26例血管造影发现活动性出血征象,主要表现为对比剂外溢,伴有假性动脉瘤6例,伴有动静脉瘘1例,均成功施行介入栓塞止血,仅1例术后8 d 再次出血行二次栓塞治疗。本组病例术后随访1月,25例患者未出现严重并发症,1例多脏器功能衰竭死亡。6例血管造影阴性患者,3例失血性休克死亡,3例经内科治疗出血停止。结论选择性动脉栓塞术在医源性出血治疗中是一种安全、有效的措施。     

超选择微弹簧圈栓塞治疗PCNL后肾出血体会

目的探讨经皮肾镜取石术（PCNL）后严重肾出血超选择微弹簧圈栓塞术的止血效果。方法采用GEInnva3100IQ数字平板血管造影机、美国COOK微导管和COOK 0.018in微弹簧圈及明胶海绵颗粒,对9例因PCNL后肾脏出血患者进行超选择肾脏肾段动脉内释放微弹簧圈栓塞术;对合并动静脉瘘者加用明胶海绵颗粒栓塞。结果经超选择微导管肾脏肾段动脉微弹簧圈栓塞术,9例肾出血患者得到有效控制,肾功能受到保护。结论把握时机、选择合适栓塞材料,采用经微导管联合微弹簧圈栓塞术可作为PCNL后严重肾出血的首选治疗方法。     

选择性动脉插管栓塞治疗子宫大出血的价值

目的 评价选择性动脉插管栓塞治疗子宫大出血的临床应用价值.资料与方法 对64例子宫大出血患者均行双侧髂总动脉数字减影血管造影(DSA)检查,明确出血部位后选择或超选择插管,栓塞子宫动脉或髂内动脉前干,栓塞剂采用明胶海绵、聚乙烯醇(PVA)微粒、弹簧钢圈.结果 64例患者行DSA检查时,盆腔区均可见对比剂外溢和聚集,其中36例采用明胶海绵颗粒栓塞子宫动脉或髂内动脉前干后31例止血一次成功,其中5例7～10天再发大出血,行第二次介入栓塞治疗后3例止血成功,仅2例止血效果不佳而行子宫切除术;20例采用PVA微粒和明胶海绵颗粒栓塞以及3例合并有动静脉瘘和2例合并有假性动脉瘤者采用明胶海绵条加弹簧钢圈后止血一次成功;3例采用PVA微粒和明胶海绵颗粒仅栓塞一侧子宫动脉或髂内动脉前干后3～7天再发出血,行第二次介人栓塞对侧子宫动脉或髂内动脉前干止血成功.介入术后随访2～6个月无复发,均有正常月经来潮,无严重并发症发生.结论 动脉栓塞治疗子宫大出血安全、止血迅速、微创,绝大多数能避免手术切除子宫.     

损伤性肾出血的介入治疗

目的探讨介入超选择性肾动脉造影及栓塞治疗经保守治疗无效的肾损伤出血的临床价值方法2006年5月至2011年12月收治76例肾脏损伤出血患者,采用肾动脉造影.明确肾动脉损伤的部位及程度,采用明胶海绵或弹簧圈对出血动脉行超选择性栓塞治疗。结果 76例患者经超选择插管明胶海绵颗粒或金属弹簧圈栓塞后均能有效止血,栓塞后造影显示出血动脉中断闭塞,肾动脉出血征象消失术后1～3 d肉眼血尿消失。随访未再次发生出1血情况.未见继发性肾功能损害发生。结论对保守治疗无效的肾损伤出血患者,介入性超选择肾动脉栓塞治疗疗效确切,发全有效,能最大限度的降低肾功能损害。     

大咯血的介入治疗及复发的影响因素分析

目的评价大咯血不同血供方式、栓塞方法的疗效及复发因素分析。方法120例大咯血患者行支气管动脉及临近体循环动脉造影,超选择性插管栓塞出血动脉。按供血方式分为单支动脉供血(35例)和多支动脉供血(85例)2组;按栓塞方法分为单纯明胶海绵栓塞(59例)、单纯PVA颗粒栓塞(20例)、PVA颗粒加明胶海绵栓塞(41例)3组,分别行χ2检验,评价各组的疗效。根据治疗效果分为复发(35例)与未复发(85例)为2组,对供血方式和不同栓塞方法进行分析,建立Logistic和Cox回归模型,评价各因素对复发的影响程度。结果120例患者行介入栓塞治疗后咯血均完全停止,技术成功率为100%。随访1～7年,35例复发,总有效率为70.8%。其中单支动脉供血4例复发,复发率11.4%;多支动脉供血31例复发,复发率36.5%。单纯明胶海绵组26例复发,复发率为44.1%;单纯PVA颗粒组3例复发,复发率为15.0%;PVA颗粒加明胶海绵组6例复发,复发率为14.6%。复发率差异有统计学意义(P<0.05)。单纯明胶海绵栓塞后复发时间最短(P<0.05);单纯PVA颗粒栓塞及PVA颗粒加明胶海绵栓塞复发时间较长,但两组之间差异无统计学意义(P>0.05)。结论单纯明胶海绵栓塞和多支动脉供血更容易导致介入栓塞治疗后复发且时间较短;单纯PVA、PVA加明胶海绵栓塞后疗效较好且复发间隔时间较长。     

超选择性动脉栓塞术治疗医源性肾出血的临床疗效

目的评价超选择性动脉栓塞术治疗医源性肾出血的临床效果。方法 22例医源性严重血尿患者,均经选择性肾动脉数字减影血管造影(DSA)及超选择性肾动脉栓塞(TAE),其中17例用弹簧圈加明胶海绵栓塞,另5例单用明胶海绵栓塞。结果 DSA清晰地显示了全部患者病侧肾的对比剂外溢,其中4例合并动静脉瘘,主要累及肾中下极动脉分支。22例中的20例(90.9%)是一次TAE获得成功,其余2例起先均是单用明胶海绵栓塞,栓塞后,1例持续有血尿,另1例3 d后再次出现血尿,随后,二次用弹簧圈加明胶海绵栓塞遂使血尿完全消失。平均随访6个月,所有患者均无血尿复发。结论超选择性TAE对于保守治疗无效的医源性肾出血提供了一种安全且有效的治疗方法。     

经导管血管内栓塞治疗肝动脉假性动脉瘤的疗效观察

目的 评价血管内栓塞治疗肝动脉假性动脉瘤(HAPA)的疗效和对肝功能的影响.资料与方法 8例HAPA患者行选择性腹腔动脉造影明确动脉瘤的部位后,再超选择至载瘤动脉进行血管内栓塞治疗.栓塞术后随访3～60个月,观察临床和肝功能情况.结果 8例血管造影均明确诊断.其中肝外型4例,肝内型4例;7例用弹簧圈或微弹簧圈栓塞,1例单纯明胶海绵颗粒栓塞.栓塞术后造影复查8例HAPA均消失.动脉瘤破裂出血患者出血均停止.阻塞性黄疸的患者术后1周黄疸消褪.1例单纯明胶海绵颗粒栓塞者术后3天出血复发;7例钢圈栓塞者无出血和HAPA复发,影像学复查4例HAPA消失,3例HAPA缩小、机化.肝功能检查,2例转氨酶一过性轻度升高[谷-草转氨酶(AST)达286 U/L,谷-丙转氨酶(ALT)达103 U/L)],2例栓塞前肝功能异常栓塞后1周恢复正常;余4例肝功能无异常改变.结论 弹簧圈血管内栓塞治疗HAPA疗效好、并发症少.选择性肝动脉弹簧圈栓塞,对肝功能无明显影响.     

隐源性咯血患者的DSA表现及介入栓塞治疗策略

目的探讨隐源性咯血患者的DSA表现及介入栓塞治疗策略。方法回顾性分析2013年1月~2015年12月入住我院隐源性咯血患者的DSA表现及介入栓塞治疗策略,术后观察止血效果并随访疗效。结果 36例患者的DSA主要表现为责任动脉迂曲、增粗、紊乱、对比剂外溢等。根据DSA表现选择合适的介入栓塞治疗策略,所有患者行介入栓塞治疗后咯血即刻停止。随访11~36个月,咯血复发5例,单纯明胶海绵栓塞(方法 1),单纯栓塞微球栓塞(方法 2),栓塞微球、明胶海绵或加用弹簧圈混合栓塞(方法 3)3组在疗效上,差异具有统计学意义,方法 2和3的疗效均优于方法 1。结论隐源性咯血患者的DSA主要表现为支气管动脉异常,使用永久性栓塞剂行介入栓塞治疗后,复发率低,疗效显著。     

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）