急症动脉栓塞治疗难治性产后出血疗效评价

目的评价急症经导管动脉栓塞术(TAE)治疗难治性产后出血的疗效及安全性。方法临床25例难治性产后出血患者,采用右股动脉Seldinger穿刺技术,选择性插管至双侧髂内动脉或子宫动脉,行DSA明确出血部位后以明胶海绵颗粒栓塞。结果插管成功率100%,手术时间25～60min,平均(42.5±4.6)min,术后止血时间3～15min。术后止血总有效率100%。比较术前术后患者血红蛋白及心率,差异具有显著性(t=29.49,P<0.01;t=16.51,P<0.01)。所有患者宫体按期复旧,转经后月经正常。结论TAE创伤小,疗效快速肯定,术后短期及长期随访无严重并发症,对危及生命的产后出血是一种有效治疗措施。     

超选择性动脉插管栓塞对产科大出血的治疗和预防

目的探讨经导管动脉栓塞术(TAE)治疗和预防产科大出血的疗效及安全性。方法产科大出血或有大出血风险的病例17例(其中已出现大出血病例14例),包括产后或流产术后出血10例,葡萄胎出血4例。3例预防性栓塞,包括胎盘前置2例,宫颈妊娠1例。选择性插管至双侧子宫动脉或髂内动脉,行DSA明确子宫血管情况,以直径1～3mm明胶海绵颗粒及明胶海绵条或聚乙烯醇(PVA)栓塞,部分病例经子宫动脉灌注甲氨喋呤(MTX)。结果插管成功率100%,14例大出血病例栓塞后活动性出血停止,手术成功,1～5d后阴道内完全无流血。3例预防性栓塞患者,栓塞后行引产术,1例发生大出血,2例未发生大出血。结论TAE创伤小,疗效快速肯定,且并发症少,对产科大出血是一种有效的治疗措施,对有大出血风险的病例预防应用可降低大出血或死亡的风险。     

经导管动脉栓塞术在经尿道前列腺电切后出血中的应用

目的评价经导管动脉栓塞术(TAE)在治疗良性前列腺电切后难治性出血中的疗效和预后。方法 2009年2月至2011年12月收治7例良性前列腺增生患者,行经尿道前列腺电切术(TURP)后出现严重血尿,保守治疗无效,行数字减影血管造影(DSA)及TAE栓塞出血靶血管。结果 7例患者DSA造影均发现活动性动脉出血,在TAE栓塞靶血管后出血停止。术后未出现相关并发症,随访3个月,未再有血尿。结论 TAE是治疗TURP术后严重出血的一种安全有效的方法。     

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。     

导管栓塞术治疗消化道大出血的临床应用

目的：探讨导管栓塞术治疗消化道出血的临床价值。方法：回顾分析2002年1月-2005年12月间应用导管栓塞技术治疗的27例消化道出血患者，分别行腹腔动脉、肠系膜上动脉和肠系膜下动脉造影。对可疑部位则行超选择性动脉造影，一旦发现造影剂外溢和原发病灶，则超选择性插管入靶血管内行TAE治疗，栓塞剂为0．2—0．5mm直径大小的明胶海绵颗粒，必要时采用PVA颗粒。对十二指肠出血在胰十二指肠上动脉栓塞后，再行胰十二指肠下动脉造影如仍发现出血则应用同法栓塞。结果：造影见阳性征象者24例，其中21例患者成功完成TAE术，6例仅完成血管造影未行栓塞治疗。17例TAE术后24—72小时内无新鲜出血。止血成功率为80．95％（17／24）。结论：导管栓塞治疗消化道出血是有效而安全的，正确选择栓塞的靶血管和合适的栓塞剂及用量是成功的关键。     

经导管动脉栓塞术治疗纵隔出血4例

目的 探讨经导管动脉栓塞术(TAE)治疗纵隔出血的临床应用价值.方法 收集采用TAE术治疗的4例纵隔出血患者临床资料.术前作胸部CT平扫或增强检查,治疗时先行主动脉造影并探寻出血动脉,用微导管超选择至出血动脉后分别用明胶海绵、聚乙烯醇(PVA)颗粒或两者联合作栓塞,术后胸部CT平扫观察栓塞治疗效果并进行随访.结果 术前CT检查确定4例患者均为纵隔出血.术中经主动脉造影和探寻出血动脉发现,4例患者出血分别源自右侧第5肋间动脉纵隔分支、左侧支气管动脉分支、胸主动脉的食管动脉纵隔分支及左膈下动脉纵隔分支,给予明胶海绵及PVA颗粒后造影见对比剂外溢及动脉瘤征象消失.术后复查胸部CT显示4例患者纵隔血肿范围均缩小,随访6个月时3例未发生再出血,1例术后2个月病死于原发病.结论 TAE术治疗纵隔出血具有创伤小、止血直接迅速、疗效确切等优点,为临床治疗提供了一种新手段.     

急诊子宫动脉栓塞治疗产后胎盘植入大出血

目的 探讨急诊子宫动脉栓塞(UAE)治疗产后胎盘植入大出血的方法和疗效.资料与方法 在数字减影机下采用改良式Seldinger技术对7例胎盘植入患者穿刺插管行盆腔动脉造影,明确出血血管后将5 F Cobra导管超选择插入出血侧子宫动脉,立即用明胶海绵颗粒和明胶海绵条栓塞.术后肌注甲氨喋呤并口服米非司酮各一个疗程.结果 7例胎盘植入患者均找到出血位置并一次性栓塞成功,成功率100%.手术时间25～50 min,平均(35.2±5.3)min,术后3～12 min阴道流血停止,平均(5.2±2.4)min,术后患者血压迅速回升至正常,生命体征稳定.术后1天～4周6例排出胎盘组织,平均排出时间15.4天,子宫如期复旧,血绒毛膜促性腺激素(β-HCG)恢复正常,跟踪随访月经正常,自测排卵正常.结论 急诊UAE治疗胎盘植入大出血具有手术时间短、创伤小、疗效肯定和可保留子宫等优点,有较好的临床应用价值.     

经导管动脉栓塞术治疗腹部外科术后迟发性出血

【摘要】 目的 评价经导管动脉栓塞术（TAE）治疗腹部外科术后迟发性出血的临床应用价值。方法 回顾性分析2010年5月至2019年6月采用TAE诊断治疗的腹部外科术后迟发性出血患者23例。术中动脉造影明确出血责任动脉,对动脉主干出血予以弹簧圈栓塞动脉远段和近段,对动脉末梢出血予以明胶海绵颗粒或明胶海绵颗粒联合弹簧圈栓塞。术后随访至患者治愈出院或院内死亡。结果 23例患者中造影表现阳性22例,阴性1例,阳性率为95.7%。阳性患者中动脉假性动脉瘤形成8例,动脉破裂伴对比剂外溢14例。所有阳性患者均接受进一步TAE治疗,术后治愈17例,死亡3例,复发2例,临床有效率为86.4%。术后1例死于肝衰竭,2例死于多脏器衰竭,2例复发患者再次TAE治疗后治愈出院,所有患者均未发生胃肠坏死和胃肠穿孔等栓塞并发症。结论 动脉造影结合TAE诊断腹部外科术后迟发性出血阳性率高,治疗效果确切,可作为首选方法。     

输尿管动脉栓塞在难治性产后出血介入治疗中的价值

目的 探讨输尿管动脉向子宫供血的特点及其在介入栓塞治疗难治性产后出血中的临床应用价值.资料与方法 回顾性分析3例难治性产后出血的盆腔侧支血管数字减影血管造影(DSA)表现及经动脉栓塞(TAE)止血情况.结果 3例患者均有输尿管动脉参与子宫供血,其中2例起源于髂外动脉,1例起源于子宫动脉和髂外动脉,将其栓塞后产后出血得到有效控制.结论 输尿管动脉是参与子宫供血的重要侧支血管;输尿管动脉参与子宫供血是单纯子宫动脉/髂内动脉栓塞后止血效果不佳的重要原因之一.     

肝癌经导管脉灌注栓塞中操作技术对疗效的影响

对50例肝细胞癌(HCC)作105疗次经导管动脉灌注栓塞术(TAI/TAE)。发现16例 TAI/TAE 操作技术不当,包括:肝动脉超选插管不成功6例;首次或第2疗次后之 TAI/TAE 术中经狭窄肝动脉再插管失败6例;其余4例为未发现肿瘤的寄生性膈下动脉供血,因而未对其行 TAI/TAE 治疗,是由于在 TAI/TAE 术中忽略了腹主动脉造影造成。此16例操作技术不当的分析显示:肿瘤缩小程度多小于50%,或无变化,少数病例肿瘤较前增大。16例之肿瘤缩小率与对照组比较有显著性差异(P<0.01)。笔者认为 TAI/TAE 操作技术不当可明显影响 HCC 之 TAI/TAE 疗效。     

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.     

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.     

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）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme     

改进的定位技术在胸部肿瘤穿刺活检中的应用

目的：探索CT-SIM三维定位系统、体模固定技术和PET-CT融合影像导引定位技术在胸部肿瘤经皮穿刺活检中的应用价值。方法：对380例胸部肿瘤患者行改进的CT定位技术下的经皮穿刺活检术。根据肿瘤的大小、深度、毗邻关系、活动度以及患者的心肺功能状态,综合运用CT-SIM系统、体模固定技术和PET-CT融合影像导引技术,为患者进行穿刺前定位。统计穿刺定位时间长度、成功率、确诊率、并发症发生情况,并与210例采用传统铅栅定位下胸部肿瘤穿刺活检的相应资料进行比较。结果：采用改进的CT定位技术的380例患者穿刺定位精确,平均定位时间（9.5 min）较传统方法（16.8 min）缩短7.3 min,活检成功率和确诊率分别是98.7%和95.3%,高于传统定位方法的93.3%和83.3%,两者差异均具有统计学意义（P〈0.05）。穿刺并发症发生率相似,气胸发生率分别为2.8%和2.9%,咯血发生率分别为11%和12.8%。结论：根据患者状态及肿瘤特点,在CT-SIM系统快速精确定位技术的基础上,综合运用体模固定技术和PET-CT融合影像导引技术,能显著缩短经皮穿刺活检的定位时间,提高活检成功率。