胆管梗阻介入治疗的体会

目的：探讨ＰＴＣＤ及金属内支架对胆管梗阻的治疗作用。材料和方法：利用ＣＴ片作为导向方式，结合透视，２１例胆管梗阻患者作经皮肝穿刺胆管放置外、内外引流（ＰＴＣＤ）。其中８例放置金属内支架，包括胰头癌２例、肝门原发性癌肿２例、左肝管癌１例、胆囊癌１例、肝门淋巴结转移性病变２例。结果：ＰＴＣＤ外、内外引流能使患者血清胆红素下降、临床症状得到控制和改善。在此基础上，胆管内放置金属内支架缓解梗阻效果更为显著     

肝门型胆管癌与胆管炎的关系及其CT与PTC征象

肝门型胆管癌与胆管炎的关系及其ＣＴ与ＰＴＣ征象梁长虹，胡景铃，关月欢，赵廉忠肝门型胆管癌指发生于左、右主肝管或／和肝总管近端１０ｍｍ范围内的胆管细胞癌￣［１］。本病发病原因未定。阻塞性黄疸为其最常见症状。笔者探讨肝门部胆管癌与胆管炎之间关系及其ＣＴ与...     

金属内支架和局部治疗相结合治疗肝门部胆管癌

目的：提高肝门部胆管癌疗效，延长生存时间、改善生存质量。材料与方法：２４例非手术肝门部胆管癌患者先行ＰＴＣＤ减黄术，其中１８例再行局部治疗（胆道内照射或局部化疗）并留置金属内支架１周后拔去引流管，另６例仅行ＰＴＣＤ治疗。结果：２４例行ＰＴＣＤ治疗后，２２例总胆红素下降，未见改变的２例在１个月内死亡。１８例行局部治疗并留置金属内支架的病例，平均生存１０个月，最长２４个月。平均无管（指拔去引流管）生存为５．５个月，最长为１７个月。另６例平均生存２个月，最长为６个月。结论：（１）行局部治疗并留置金属内支架病例的生存时间明显长于单纯ＰＴＣＤ治疗的病例。（２）ＰＴＣＤ后胆红素未见改变或上升者预后不佳。（３）ＰＴＣＤ后的胆道内留置金属内支架与局部治疗相结合是非手术治疗肝门部胆管癌的有效方法。     

经皮肝穿胆道内支架置入术治疗恶性胆管梗阻

目的：探讨经皮肝穿胆道内支架置入术治疗恶性胆管梗阻的疗效及技术要点。方法：３５例恶性胆管梗阻采用经皮肝穿刺肝管胆道内支架置入术，其中胰头癌１３例，肝转移癌５例、肝门淋巴结转移压迫胆管７例、胆管癌１０例。结果：共置入３种４３枚金属内支架，其中８例采用双内支架，技术操作成功率１００％。术前血清总胆红素１７０．００～８６０．０ｕｍｏＩ／Ｌ，术后３１例降至１８．２～５３．６ｕｍｏＩ／Ｌ。半年以上生存率７７．１４％（２７／３５），１年以上生存率４８．５７％（１７／３５）。本组无严重并发症，轻度并发症未作特殊处理。结论：经皮肝穿胆道内支架置入术，是不能手术的恶性胆管梗阻安全、有效的治疗方法。配合动脉插管化疗可显著提高其疗效     

非穿刺探头超声引导经皮肝胆道置管引流的临床应用研究

目的：为探讨非穿刺探头超声引导经皮肝胆道置管引流（ＰＴＣＴ术）临床应用的可行性及临床价值。方法：选择阻塞性黄疸２１例，应用普通探头超声引导行ＰＴＣＤ术。结果：２１例全部一次穿刺成功，其中胆管置管１９例，胆囊内置管２例。全部病例均未出现与ＰＴＣＤ术有关的并发症。结论：非穿刺用超声探头引导ＰＴＣＤ术克服了无专用穿刺探头的限制，定位准确、灵活，并发症少，为阻塞性黄疸患者提供了重要的诊断和治疗措施。     

金属内支架治疗恶性梗阻性黄疸的临床研究：附33例分析

目的：总结胆管金属内支架放置术的临床经验和疗效分析。材料与方法：恶性梗阻性黄疸患者３３例，男２３例，女１０例。胆管癌１６例，胰头癌２例，原发性肝癌２例，肝转移瘤３例，肝门淋巴结转移瘤压迫胆管１０例。本组共采用金属内支架行内引流３３例，共使用６种３８枚金属内支架。１２例支架放置术后加局部放射治疗和化学治疗（简称放、化疗）。结果：３３例采用经皮经肝穿刺置入胆管支架均获得成功，其中２９例一次性植入支架，４例先行胆汁引流术（ＰＴＢＤ）后再放置金属内支架；９例因胆管梗阻复杂，金属支架置入后仍保留引流导管，其中３例在置管１５～２００天后拔除引流管。２８例（８４．８５％）黄疸消退满意。本组中位生存期７个月，支架植入后加局部放、化疗组中位生存期１０个月。结论：胆管内金属支架治疗恶性梗阻性黄疸，可用于不能手术治疗的高位胆管梗阻，支架植入后加局部放、化疗可望提高远期疗效。     

恶性梗阻性黄疸的介入治疗临床价值

目的：经皮经肝穿刺放置引流管、内涵管或金属内支架作胆汁外引流、内外引流或内引流，可缓解黄疸，改善由于梗阻性黄疸引起的各种症状。提高患者的生存质量，为下一步治疗创造条件。方法：恶性梗阻性黄疸常由于胆管癌、胰头癌、原发性肝癌、肝脏转移瘤、肝门淋巴结转移等压迫和侵及胆管所致，外科手术切除率低。主要技术包括PTCD、胆管内外引流、胆管内涵管及内支架置入术。结论：可作为手术前辅助治疗，主要行经皮肝穿刺胆管引流术（PTCD）或姑息性内外引流治疗以解除黄疸。     

超声与透视引导下PTCD治疗恶性阻塞性黄疸的比较研究

经皮经肝胆道置管引流术(PTCD)在重症阻塞性黄疸胆管减压方面的重要意义已被临床广泛证实[1],对晚期无法手术的恶性阻塞性黄疸患者能明显改善症状,延长生命[2],我们对PTCD治疗的引导方式就超声与透视做了比较研究,现报告如下。1材料与方法本组28例,男20例,女8例,年龄48~69岁,平均年龄59·4岁。胰头癌10例,胆管癌8例,壶腹部癌9例,肝门肝癌1例。临床有不同程度的乏力、纳差、厌食、全身黄染、大便灰白等症状,2例有全身奇痒,8例大便呈陶土色。治疗前总胆红素(Tbil)110~687μmol/l,直接胆红素78·4~321μmol/l。12例病人在超声引导下行PTC…     

肝门部胆管癌多枚金属内支架置入治疗的应用分析

目的探讨应用金属内支架治疗复杂型肝门部胆管癌，特别是侵犯肝内胆管的肝门部胆管癌的介入治疗方法。方法肝门部胆管癌45例，其中Bismuth Ⅱ型12例、Ⅲa型17例、Ⅲb型10例、Ⅳ型6例。45例均先行经皮经肝胆管引流术后实施胆管内支架置入术，分别以T、Y、X型或其组合方式留置2或3枚内支架。结果45例患者内支架96枚全部置人成功，治疗后胆红素[（312±249）μmol／L]与治疗前[（51±42）μmol／L]相比明显下降（t=4．21，P〈0．01），支架置人后30d内病死率为2．2％（1／45）。平均支架开通时间181．5d（26～473d），平均生存时间215．3d（26～516d）。结论对于复杂型肝门部胆管癌，胆管内支架治疗是一种有效改善患者生存质量的方法。特别对病变侵犯肝内胆管的病例，应选择不同的穿刺路径及支架留置方法，尽可能解决更多肝段的胆管引流。     

肝外胆管恶性梗阻PTC诊断（附15例报告）

肝外胆管恶性梗阻ＰＴＣ诊断（附１５例报告）上海市杨浦区中心医院放射科茅士戈本文报告１５例临床资料完整，肝外胆管恶性梗阻ＰＴＣ诊断。１一般资料共１５例，男１０例，女５例；年龄４７～７６岁，平均６３．３岁。均有无痛性或上腹隐痛伴进行性黄疸。血清胆红素最低...     

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.