事故性局部放射损伤诊断和治疗中值得重视的几个问题

事故性局部放射损伤诊断和治疗中值得重视的几个问题杨志祥，王方薪在放射事故照射条件下，多发生以局部损伤为主的全身不均匀照射．给诊断和治疗带来新的问题和困难。作者根据近几年来治疗的国内几起事故性外照射所致以局部损伤为主，伴有全身放射反应或放射病的经验和体...     

第3讲 局部放射损伤的药物治疗

局部放射损伤的治疗是一个比较复杂、困难的问题 ,尤其是事故性放射损伤 ,虽然损伤面积不大 ,但是多数病例除局部损伤外 ,同时有全身或者内脏损伤 ,有的局部严重放射损伤后出现全身反应。局部严重放射损伤除皮肤溃疡外 ,常累及肌肉、肌腱、神经干、大血管和骨骼 ,形成大而深的复合性溃疡 ,一般传统的治疗方法难以奏效 ,若处理不当 ,可影响功能 ,造成伤残 ,甚至危及生命。因此 ,在治疗过程中 ,应当抓好全身治疗和局部处理两个环节。全身与局部的治疗相辅相成 ,全身状况的改善有利于促进局部损伤创面的愈合 ;局部损伤处理的成败 ,直接影响全身…     

局部放射损伤的临床诊治现状

随着和平利用原子能的不断发展和放射性核素在各个领域的广泛应用,各种辐射事故或医源性照射后引起的局部放射损伤常有发生,特别是在辐射事故条件下,常发生极不均匀外照射,产生以局部损伤为主,或伴有全身过量照射,或伴有全身放射病的临床综合病症,给临床诊断和治疗...     

第7讲 局部放射损伤诊治发展趋势

随着和平利用原子能的不断发展和放射性核素在各个领域的广泛应用 ,各种辐射事故或医源性照射后引起的局部放射损伤将常有发生 ,尤其是在辐射事故条件下 ,常发生极不均匀的外照射 ,产生以局部损伤为主、伴有全身放射病的临床综合征。与此同时 ,随着科学技术的不断发展 ,局部放射损伤的机制研究、诊断技术、治疗措施也将不断提高。1　损伤机制的深入研究有关局部放射损伤机制的研究 ,以往主要认为是射线造成组织细胞的直接损害、微血管的广泛损伤等。创伤愈合是一个十分复杂的过程 ,随着分子生物学和细胞生物学的发展 ,对创伤愈合的认识已经…     

南京“5.7”192Ir源放射事故患者局部组织的改变

目的 观察1例¹⁹²Ir源急性外照射致局部放射性损伤的改变,探讨局部放射损伤的诊治。方法 重点观察该例患者局部病变的临床经过;采用磁共振成像(MRI)评估局部组织损伤;采用双能X射线法检测患者骨密度;应用电化学发光法检测患者血清Ⅰ型胶原羧基端肽(β-CTx)、血清Ⅰ型前胶原氨基末端肽(PINP)和血清睾酮(T)水平。结果 受照后患者局部表现为红斑、肿胀、疼痛、水疱、溃疡、坏死,诊断为Ⅳ度急性放射性皮肤损伤,受照后383 d伤口愈合,但患者右下肢运动障碍。MRI检查显示局部损伤累及皮肤、股骨、多处肌肉及骨髓组织。骨密度检查显示患者骨量减少(-1.5~-1.1),血清β-CTx一过性升高(493.50~1 580.00 pg/ml),血清PINP出现波动(49.30~291.80 ng/ml),且血清睾酮出现波动(5.41~608.80 ng/dl)。结论 大剂量急性外照射可致局部重度放射性皮肤损伤,MRI有助于评估局部放射损伤,骨密度、骨代谢指标联合血清睾酮可用于评估骨损伤。临床医生救治局部放射损伤时应注重全身治疗和局部治疗。     

局部放射损伤的临床特点和治疗

局部放射损伤是一个比较复杂的临床问题,尤其是在辐射事故条件下,常发生以局部损伤为主的全身不均匀外照射,产生以局部损伤为主,或伴有全身放射病的综合病症。因此,了解其临床特点和治疗是我们临床研究的主要课题之一。一、临床特点１初期反应差异大在事故条件下,...     

γ射线外照射对胶原代谢等指标的影响

目的通过观察动物模型局部组织胶原代谢指标、以及全身和局部与胶原代谢相关的生化指标，以阐明γ射线所致放射性皮肤损伤中胶原代谢变化的分子机理。方法采用^60Coγ射线外照射新西兰兔后臀部皮肤制作皮肤放射损伤模型。实验动物分为正常对照、2．0，6．0和12．0Gv4组，14d后处死动物，观察局部组织胶原代谢指标及全身和局部与胶原代谢相关的生化指标。结果(1)γ射线外照射可引起局部组织Ⅲ、Ⅰ型胶原含量下降，伴基质金属蛋白酶活性升高，组织蛋白分解加强：(2)γ射线可引起全血或血浆5-羟色胺、超氧化物歧化酶、脂质过氧化物量的改变，但对它们局部组织含量影响不大。结论γ射线引起的放射性皮肤损伤机理中胶原代谢变化可能起主导作用。     

一例~(192)Ir极不均匀外照射局部极重度放射损伤的临床观察

目的对１例１９２Ｉｒ极不均匀外照射局部极重度放射损伤病人进行临床观察。方法系统观察了病变的临床过程和应用红外线热成像技术测定了损伤部位的温度变化。结果照射后２小时出现肢体麻木、抽搐，最早照后４小时出现红斑、肿胀，５４小时出现水疱，第５天出现坏死和剧痛，最晚出现红斑、肿胀是照射后４１天，４７天出现水疱和糜烂创面。红外线热成像显示：损伤早期温度升高，水疱、坏死区和损伤后期温度降低，温度升高越早，损伤越重，温度改变区域与损伤范围相一致。结论大剂量极不均匀外照射放射损伤的初期反应早，放射病与局部损伤相互加重病情，症状先后不一，轻重不等，致残率高和疼痛剧烈，红外线热成像温度变化可以作为临床诊断的指标之一。     

电子直线加速器外照射后NOS和SOD的变化研究

目的 探讨β射线放射损伤后NOS和SOD的改变情况。方法 采用直线加速器照射制作动物的β损伤模型，同时对NIH3T3细胞进行β外照射，观察NOS、SOD含量的改变。结果 β损伤后NOS在一定剂量范围内上升；SOD则在一定剂量范围内下降。结论 β损伤后能产生自由基，但其作用效应主要在全身，自由基在受照局部皮肤组织中改变的作用不大。     

颅内原发肿瘤三维适形再次放疗的结果

诊断和治疗技术虽在不断改进,但中枢神经系统胶质瘤患者经手术和放射治疗后局部复发率仍较高。一旦复发,化疗和手术等治疗手段均有局限性,而运用近距离放疗和放射外科治疗则要求患者全身状况好、病灶直径≤6cm。本文分析了Michigan大学医学中心在1988年5月～1991年8月20例成人脑肿瘤复发后接受三维适形外照射放疗的生存情况。所有患者均被认为不适于近距离放疗和放射外     

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）