肝癌合并动静脉瘘的DSA表现和介入治疗方法初探

目的 探讨肝癌合并动静脉瘘的DSA表现及介入治疗方法.方法 对272例已证实的肝癌患者先行DSA造影,再行肝动脉内化疗栓塞治疗.结果 合并动静脉瘘者有113例(41.5%),其中肝动脉门静脉瘘98例,肝动静脉瘘7例,混合型8例,所有动静脉瘘患者均行了1次或多次肝动脉内化疗(TAI)和/或化疗栓塞治疗(TACE). 结论 DSA影像是肝癌合并动静脉瘘直观可靠的诊断方法.对于轻中度AVS用明胶海绵阻断瘘口血流后TACE安全有效,对重度流量大的AVS,则仅行TAI.     

肝癌合并动门静脉瘘的DSA表现及介入治疗

目的 :探讨肝癌合并动门静脉瘘的 DSA表现及介入治疗方案选择。方法 :对由 AFP、B超、CT诊断的原发性肝癌 95例施行了肝动脉内化疗栓塞治疗 ,治疗前均有 DSA检查。结果 :46例合并动门静脉瘘 (48.4% ) ,其中 1 7例有门脉癌栓。治疗后 AFP均有下降 ,2 7例肿瘤缩小 (58.7% ) ,1 2例肿瘤增大 (2 6.1 % ) ,7例改变不明显 (1 5.2 % )。均未发生严重肝功能损害。结论 :DSA显示动门静脉瘘准确、直观。肝癌合并动门静脉瘘影响疗效 ,但对其仍应积极治疗     

化疗栓塞治疗原发性肝癌合并肝动静脉瘘的临床研究

【摘要】目的：探讨化疗栓塞治疗原发性肝癌合并肝动静脉瘘（HAVS)的临床疗效及影响预后的因素。方法： 67例不能手术切除的原发性肝癌合并HAVS患者行化疗栓塞治疗,观察HAVS栓塞效果及近期、远期疗效。应用Kaplan-Meier法、Log-rank检验进行患者的生存率分析,Cox回归模型进行多因素分析。结果：67例HAVS中肝动脉-门静脉瘘59例,肝动脉-肝静脉瘘8例;轻、中度动静脉瘘53例,重度动静脉瘘14例。HAVS完全栓塞44例(65.7%),轻、中度动静脉瘘的完全栓塞率(73.6%,39/53)高于重度动静脉瘘(35.7%,5/14),差异有统计学意义（χ2=7.04,P=0.008）。67例患者中,完全缓解(CR) 2例,部分缓解(PR) 29例,疾病稳定(SD) 30例,疾病进展(PD) 6例,总有效率为46.7% (31/67）。67例患者1年生存率为49.3%,中位生存期为11.0个月。单因素分析结果显示肿瘤大小(＜8cm/≥8cm）、血管瘤栓(有/无)、术前AFP水平(＜400/≥400ng/mL）、碘油沉积类型(Ⅰ+Ⅱ/Ⅲ)、瘘口栓塞效果(瘘消失/未消失)的生存率差异有统计学意义（P＜0.05）,Cox模型多因素分析显示肿瘤大小、碘油沉积类型是生存率的独立预后因素。结论:化疗栓塞治疗原发性肝癌合并HAVS有效,肿瘤大小、碘油沉积类型是独立的预后因素。     

经肝动脉留置导管持续灌注榄香稀治疗存在肝动静脉或肝动脉门脉瘘的肝癌

目的 探讨榄香稀持续灌注治疗存在肝动静脉或肝动脉门脉瘘的肝癌的疗效.方法 62例存在肝动静脉或肝动脉门脉瘘的肝癌患者给予榄香稀经肝动脉留置导管持续灌注治疗.术后定期复查ALT、AST、T-BIL、WBC、AFP等指标以评价肝功能及肿瘤变化,同时还行肝脏CT或MRI及经肝动脉造影观察肿瘤体积、数目的变化及瘘口封堵情况.结果 35例(56%)患者肝动脉造影显示原有的瘘口基本闭塞,同时AFP的数值亦有所降低;17例(27%)患者肿瘤体积明显缩小(＞50%).12例(19%)患者生存期超过24个月,其余50例(81%)患者生存期为7～15个月.结论 经肝动脉留置导管持续灌注榄香稀治疗存在肝动静脉或肝动脉门脉瘘的肝癌是一种既有效封堵瘘口又最大程度灭活肿瘤的治疗方法.     

肝癌合并肝动脉门静脉瘘导致顽固性上消化道出血的诊断和治疗

目的 研究肝癌合并肝动脉门静脉瘘（HAPVF）时，门静脉压力升高的血液动力学改变，及由此导致的顽固性上消化道出血的诊断和治疗。方法 115例肝癌合并上消化道出血患者行肝动脉造影检查，其中严重HAPVF者用钢圈和（或）无水酒精行瘘口栓塞术。结果 本组84例一般性的上消化道出血者中，15例有轻度的HAPVF；31例顽固性上消化道出血肝癌患者中，26例有严重的HAPVF，差异有统计学意义（X^2=43．01，P〈0．01）。对此26例有严重的HAPVF患者行栓塞术后，DSA示血液分流减轻或消失，其中2例肝动脉主干闭塞。26例治疗后上消化道出血均停止。结论 肝癌出现顽固性上消化道出血时要考虑到可能有严重的HAPVF存在，肝动脉DSA可作出诊断。瘘口栓塞术是治疗此类型出血最有效的方法。     

多层螺旋CT在肝细胞肝癌肝动脉化疗栓塞中的表现及介入治疗中的意义

目的探讨多层螺旋CT(MSCT)在肝细胞癌(HCC)肝动脉化疗栓塞中的表现特点及其介入治疗中的指导意义。方法45例肝癌患者行肝动脉化疗栓塞前同期分别行MSCT和DSA2种检查。MSCT应用三维容积再现(VRT)、最大密度投影(MIP)或多平面重组(MPR)技术观察腹腔动脉的解剖及走行分支,比较CT与DSA对病灶、合并症的显示情况及肿瘤的血供情况等。结果45例患者,MSCT发现病灶167个、门静脉癌栓11例、动脉静瘘12例;DSA发现病灶172个、门静脉癌栓8例,动静脉瘘15例。MSCT与DSA比较,DSA对肿瘤的数目显示率略高于MSCT,但差异无统计学意义。MSCT能够显示腹腔动脉及其主要分支的三维结构,优于DSA,观察与腹主动脉夹角较DSA更方便;MSCT发现肝动脉起源变异4例,与DSA完全符合。结论MSCT对肝细胞肝癌肝动脉化疗栓塞有重要指导意义。     

肝癌合并门静脉癌栓的金属内支架、TACE、PVC三联治疗

目的 探讨经皮穿肝门静脉内支架置入术和经皮穿刺门静脉化疗术(PVC)及经皮穿刺肝动脉化疗栓塞术(TACE)三种方法 联合治疗肝癌合并门静脉癌栓的疗效. 资料与方法 动脉造影观察肝肿瘤血供和门静脉癌栓情况;经皮穿刺门静脉,在癌栓部位置入支架;再从门静脉和肝动脉内灌注化疗和抗肿瘤血管生长药物以及栓塞剂. 结果 本组12例中晚期患者,支架通畅时间2～22 月,中位通畅期5月.治疗后3个月、6个月、12个月、12个月以上生存率分别为91.7%(11/12)、83.3%(10/12)、50%(6/12)、25%(3/12). 结论 肝癌合并门静脉癌栓应用经皮穿肝门静脉内支架置入术、PVC术、TACE术是一种有效的联合治疗方法 .     

肝癌介入术中动静脉瘘的评判与处理

目的 分析肝癌动静脉瘘(AVS)的DSA表现,寻找与其相适应的瘘口封堵方法,改善合并AVS 肝癌的治疗效果.方法 通过对637例患者中发现的183例AVS进行影像学分析,对轻度AVS患者在碘油栓塞后进行供血动脉栓塞,对中、重度患者先行瘘口处理,保证药物在肿瘤组织中的有效灌注与碘油在瘤组织中的良好沉积.结果 89例轻度AVS碘油栓塞后都能成功地进行肿瘤供血动脉的栓塞,94例中、重度患者中68.1%(64例)封堵后碘油得到良好或较好沉积,14.8%(13例)栓塞不完全,进行单纯化疗药物灌注,11.7%(11例)过度栓塞导致碘油沉积不满意,6.4%(6例)痿口过大或瘘口过于弥漫未能封堵.未发生严重并发症.结论 绝大多数肝癌伴AVS患者都能得到有效的瘘口封堵,改善了肝癌合并AVS的疗效,对瘘口的栓塞处理是安全、可靠的.     

肝癌合并动静脉/门脉分流的DSA分型与栓塞治疗

目的:探讨并总结肝癌合并动静脉/门脉分流的DSA分型及介入栓塞封堵治疗方法。方法:32例肝癌合并动静脉/门脉分流经DSA检查分型和介入栓塞治疗,根据分流速度将其动静脉分流分为3型:①快速型;②慢速型;③中速型,选择相应的栓塞材料进行栓塞封堵治疗。结果:快速型6例,慢速型16例,中速型10例。23例(72%)一次封堵成功,4例(13%)二次封堵瘘口消失,3例(9%)因分流口较大,同时伴有门静脉癌栓,未行封堵术,2例(5%)因分流口较多且分散,只进行了部分分流口封堵及栓塞化疗。32例中20例DSA同时显示合并门静脉癌栓,超声仅检出16例。结论:中晚期肝癌患者栓塞术前DSA检查可准确显示动静脉/门脉分流和癌栓情况,采用分流速度分型法简便、实用并对栓塞治疗有良好指导作用。     

肝癌合并动-静脉瘘的CT征象与肝动脉造影对照分析

目的　研究肝癌合并动—静脉瘘 (AVF)在CT增强扫描中的表现及对其诊断价值。方法　 50例肝癌合并AVF患者均先行螺旋CT平扫及增强扫描 ,后经肝动脉造影证实。对比分析CT征象和肝动脉造影所见。结果　 1 7例动—门静脉瘘 (中央型 ) ;1 0例动—门静脉小分支瘘 (周围型 ) ;3例动—肝静脉瘘 ;5例合并上述三种表现 ;2例合并动—门静脉瘘及动—肝静脉瘘 ;另 1 3例无特征性。CT显示AVF征象 37例 ,敏感性 74%。提示AVF诊断 2 6例 (52 % )。结论　门静脉和 /或下腔静脉提前显影 ,尤其相应肝叶、段或亚段性显著强化视为AVF的诊断依据。并对其局限性进行了讨论     

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.