急性DVT股静脉取栓治疗32例

目的总结急性期单侧下肢深静脉血栓形成股静脉取栓的治疗效果及应用Aegisy可回收下腔静脉滤器预防肺动脉栓塞的效果。方法选择32例急性期单侧下肢深静脉血栓形成患者,通过放置Aegisy可回收下腔静脉滤器后,行股静脉切开取栓,于术后12～16d取出滤器。术后维持抗凝治疗1年。结果32例患者滤器成功置入,股静脉取栓顺利;术后30例成功取出滤器,取出滤器中有20例捕捉到血栓。全组治疗过程中无肺动脉栓塞发生,肢体肿胀明显缓解;随访1—8个月,彩色多普勒超声检查未见下肢深静脉血栓复发。结论股静脉取栓是治疗急性期下肢深静脉血栓形成的有效手段,术中放置可回收下腔静脉滤器能有效预防肺动脉栓塞发生,滤器的置入和取出安全、可行。     

Günther Tulip可回收式腔静脉滤器在急性下肢深静脉血栓形成介入治疗中的作用

目的 探讨G(u)nther Tulip可同收式腔静脉滤器在下肢深静脉血栓形成介入治疗中的应用效果及操作技术.方法 2007年9月至2008年4月于我院就治的急性下肢深静脉血栓形成患者36例,发病时间1～12 h,发病诱因包括术后及骨折后卧床18例、产后5例、无明显诱因13例;合并肺动脉栓塞12例.症状表现为患肢肿胀(患肢大腿周径比健侧大3～10 cm)、疼痛、皮肤晕青紫色或苍白,皮温升高或正常,合并肺动脉栓塞者表现为呼吸困难、胸痛、咯血等.分别经股静脉或经右颈内静脉置入G(u)nther Tulip可回收式腔静脉滤器后,均行静脉内置管溶栓治疗.术后45～75 d经血管超声及血管造影复查证实下肢静脉及肺动脉内无新鲜或游离血栓后,经右颈内静脉入路行G(u)nther Tulip腔静脉滤器取出术,复查下腔静脉造影.术后给予抗凝、抗炎治疗3～5d.随访4～10个月.结果 共置入G(u)nther Tulip可回收式腔静脉滤器36枚,均一次性释放成功,释放过程平均耗时1.5 min(0.5～5 min),释放过程中滤器弹跳幅度小于2 mm,1例滤器置入时倾斜25°,滤器置入后未出现新发生肺动脉栓塞的临床表现.12例患者于术后45～75d行G(u)nther Tulip腔静脉滤器取出术,均一次性回收成功,同收过程耗时4.4 min(2～15 min),下腔静脉造影复查未见管壁穿孔及破裂征象.其余24例患者未行滤器取出术,随访期间未出现肺动脉栓塞及下腔静脉闭塞的临床表现.结论 G(u)nther Tulip可回收式腔静脉滤器具有释放定位准确、捕获血栓能力较高、可取出时间期限长(溶栓治疗时间窗长)、回收成功率高等优点,在下肢深静脉血栓介入治疗中的临床效果良好,技术操作成功率较高.     

下肢深静脉血栓治疗中下腔静脉滤器的临床应用

目的探讨下腔静脉滤器(IVCF)在下肢深静脉血栓治疗中预防肺栓塞的安全性、有效性。方法31例确诊为下肢深静脉血栓的患者于其他治疗前置入IVCF,共置入滤器31支,其中Simmon Nitinol滤器(SNF)7支,Trap Ease滤器(TEF)18支,可回收式Opt Ease滤器(OEF)6支,滤器均放置于肾静脉开口之下的下腔静脉。滤器放置后对18例下肢深静脉血栓行抗凝溶栓治疗,13例行手术取栓。结果31例IVCF置入全部成功,其中,SNF滤器倾斜3例,倾斜角度均小于15°。术后随访1～38个月,无1例症状性肺栓塞发生,无其他相关并发症。下肢深静脉血栓经治疗后,症状及体征消失或缓解。结论下肢深静脉血栓治疗中,IVCF置入可有效预防肺栓塞的发生,但需精心选择手术适应证、手术指征和合适的滤器。     

下腔静脉滤器在下肢深静脉血栓治疗中的意义

目的评价置入下腔静脉滤器预防下肢深静脉血栓脱落引起肺栓塞的价值及实行导管溶栓的方法.方法34例下肢深静脉血栓患者分别经右侧股静脉(26例)或右颈静脉(8例)置入波士顿公司的Greenfield滤器或巴德公司Simon's滤器.下腔静脉滤器置人后,将溶栓导管经右股静脉插人到左髂总静脉,经右颈内静脉插入到左髂总静脉进行溶栓.药物尿激酶100～150万u.结果下腔静脉滤器置入全部成功.溶栓经右侧股静脉26例,成功12例,成功率为47%;经颈静脉8例均成功.结论置人下腔静脉滤器防肺栓塞是操作简单、安全有效的方法.经颈静脉溶栓,成功率高,效果好,值得推广.     

自制可回收下腔静脉滤器预防急性肺栓塞的实验研究

目的 探讨一种新型可回收下腔静脉滤器预防急性肺栓塞的有效性、安全性.方法 12只犬制备成髂股深静脉血栓模型,分为滤器组(实验组)与无滤器组(对照组),每组6只.滤器组在深静脉血栓脱落前于对侧股静脉置入下腔静脉滤器,其后使血栓脱落;对照组直接使血栓脱落即形成肺动脉栓塞.通过血栓脱落前后的肺动脉造影、肺动脉测压以及动脉血氧饱和度测定评价滤器的血栓捕获性能.结果 滤器组均成功捕获脱落的深静脉血栓,无一例发生肺动脉栓塞,8 h后滤器均能成功回收;而对照组在推注血栓后均发生了肺动脉栓塞.结论 自制可回收下腔静脉滤器能有效预防下肢深静脉急性血栓脱落引起的肺动脉栓塞,其置入和回收简便.     

经颈股静脉双向入路取出植入40天后的永久滤器一例

下腔静脉滤器常被用于下肢深静脉血栓患者以预防肺栓塞。我科接收1例下肢深静脉血栓患者滤器置入术后继发下腔静脉血栓。溶栓成功后,为避免滤器长期置入而引起的并发症,采取经颈股静脉双向入路成功取出植入40 d后的永久滤器(Cordis TrapEase)1枚,现报道如下。     

可回收下腔静脉滤器取出术相关并发症探讨

目的探讨可回收下腔静脉滤器取出技巧及出现的相关并发症。方法收集2008年5月—2015年3月接受彩超检查发现下肢深静脉血栓形成并置入可回收滤器的72例病人,对其中的35例溶栓效果良好且无发生肺栓塞风险的病人行下腔静脉滤器取出术。结果 35例病人中下腔静脉滤器成功取出33例,取出率94%,其中有3例病人取出滤器后发现滤器内捕获血栓,2例滤器取出过程中及术后造影发现下腔静脉穿孔,1例发生顽固性心律失常,经积极对症处理后未发现症状性肺栓塞及猝死等严重情况。另外2例取出失败后转为永久留置。结论规范、熟练地操作下腔静脉滤器取出术既可以避免下腔静脉滤器长期留置的远期并发症,同时也减少下腔静脉滤器取出术操作中并发症的发生。     

Aegisy可回收腔静脉滤器的临床应用与观察

目的探讨hegisy可回收腔静脉滤器预防肺动脉栓塞的临床应用价值。方法对32例急性或亚急性下肢深静脉血栓形成（deep vein thrombosis,DVT）和（或）肺动脉栓塞（pulmonary embolism,PrO的患者经健侧股静脉置入滤器,经用药物或手术治疗,观察有无肺动脉栓塞症状及有无肺动脉栓塞症状加重情况,滤器有无形态及位置变化。结果下腔静脉滤器置入全部成功,下肢深静脉血栓形成患者治疗后效果良好,无症状性肺动脉栓塞发生,置入滤器平均（14．0±2．0）天,取出可回收滤器捕捉血栓24例,占75％。结论可回收下腔静脉滤器预防肺动脉栓塞的疗效确切,具有较高的临床应用价值。     

国产ZQL型可回收式腔静脉滤器的初步临床应用与观察

目的　探讨自行开发的可回收式腔静脉滤器 (国产ZQL型可回收式腔静脉滤器 ,以下简称滤器 )预防肺动脉栓塞的临床应用价值。方法　对 2 4例下肢深静脉血栓形成 (deepveinthrombosis,DVT)和 (或 )肺动脉栓塞 (pulmonaryembolism ,PE)的患者经右侧颈内静脉或经健侧股静脉置入滤器 ,并同时行肺动脉造影。术后第 3和第 7天摄腹部平片。术后 3、6、12、18个月摄腹部平片及行下腔静脉、肺动脉造影。如果在 2周内下肢深静脉血栓完全清除 ,则取出滤器 ,取出前摄腹部平片及行下腔静脉、肺动脉造影 ;如果在 2周内下肢深静脉血栓未能完全清除则将滤器长期留置于下腔静脉内。如果随访期间出现病情变化 ,则需随时复查。所有影像资料经 2位主任医师采用盲法进行评价。结果　 2 4例患者的下腔静脉滤器均成功置入预定部位 ,其中肾静脉水平以下 2 3例 ,肾静脉水平以上1例 ,2例患者置于肾静脉水平以下的滤器分别于术后第 7天和第 9天顺利取出。中位随访期为 6个月。未发生滤器展开不良、滤器移位 (>10mm)、滤器倾斜 (>10°)、滤器断裂或滤器穿透静脉壁造成血肿等。除 1例腔静脉滤器捕获栓子外 ,未发生滤器血栓形成 ,无下腔静脉闭塞发生 ,随访期内全部患者未再发生肺动脉栓塞。结论　国产滤器置入操作简便、定位准确、稳定性     

导管抽吸联合滤器保护治疗下腔静脉滤器血栓形成初步探讨

【摘要】 目的 评估导管抽吸联合滤器保护治疗下腔静脉滤器血栓形成（IVCFT）的安全性和有效性。 方法 回顾性分析2017年6月至2019年11月东南大学附属中大医院收治的12例IVCFT患者临床资料。下肢静脉超声和肺动脉CTA明确下肢深静脉血栓形成（DVT）和肺栓塞（PE）。健侧股静脉入路行下腔静脉滤器置入、导管抽吸清除血栓,并逐一取出原滤器和保护滤器。术后予以抗凝治疗,观察患者症状、体征缓解情况,记录手术技术成功率、临床成功率、下腔静脉通畅情况、血栓清除情况及PE等并发症。结果 12例下肢DVT伴PE患者均成功置入下腔静脉滤器保护,抗凝治疗后患肢水肿缓解10例,未缓解2例,健侧下肢肿胀3例。下腔静脉造影显示血栓形成在滤器下方6例,滤器内12例,滤器上方2例,无一例滤器内、上方、下方均有血栓。12例患者均成功完成导管抽吸,清除较多陈旧血栓;12枚原滤器和12枚保护滤器成功取出,取出成功率100%。术后造影显示下腔静脉通畅,下腔静脉残余附壁血栓7例。术中患者均无肺部症状和体征,术后2 d出现症状性PE 1例,临床成功率91.7%。 结论 导管抽吸取栓联合滤器保护治疗IVCFT安全有效,有助于提高IVCFT患者滤器取出率和取出安全性。     

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.