支气管动脉栓塞术并发症分析

目的　研究支气管动脉栓塞术并发症及其相关因素。方法　 1 61例患者 ,大咯血 2 6例 ,支气管肺癌 1 35例。行选择性支气管动脉插管造影确认病变血供 ,分别在支气管动脉干或支气管动脉分支超选择插管下行栓塞术或栓塞化疗术 ,栓塞物质为明胶海绵颗粒、PVA和碘油。结果　并发症发生率 6 .2 % ,包括脊髓缺血 (1 .2 2 % )、肋间动脉缺血 (3 .7% )、肺动脉栓塞 (1 .2 % )。脊髓缺血和肋间动脉缺血均发生在支气管动脉主干栓塞者。脊髓缺血见于PVA组和碘油组 ,肺动脉栓塞见于碘油组 ,而肋间动脉缺血在各栓塞物质组均有发生。结论　支气管动脉栓塞术宜谨慎施行 ,使用同轴导管技术超选择性插管值得推荐 ,明胶海绵颗粒是相对安全的栓塞物质     

支气管肺癌栓塞化疗：明胶海绵与碘油

目的比较研究明胶海绵和碘油在支气管肺癌栓塞化疗术中的应用价值.材料和方法135例支气管肺癌,腺癌52例,鳞癌76例,小细胞肺癌7例.选择性支气管动脉插管造影确认肿瘤血供,分别在支气管动脉干或超选择肿瘤血管支内行明胶海绵栓塞化疗术或碘油栓塞化疗术.结果明胶海绵组85例,均在支气管动脉主干栓塞,伴23例共干的肋间动脉同时栓塞.碘油组50例,肿瘤血管支内栓塞41例,9例支气管动脉干栓塞者有3例共干肋间动脉.碘油组的有效率(CR+PR率)显著高于明胶海绵组(76%55.3%,p＜0.05).碘油组并发症包括脊髓缺血症状、肋间动脉缺血症状和肺动脉栓塞症状,发生率也显著高于明胶海绵组(12%2.4%,p＜0.05),后者仅出现肋间动脉缺血症状,上述并发症经治疗后缓解.选择性肿瘤血管内化疗栓塞者无并发症发生.结论碘油栓塞化疗术治疗支气管肺癌的近期疗效优于明胶海绵栓塞化疗术.明胶海绵栓塞化疗术较安全,碘油化疗栓塞术宜在超选择性肿瘤血管插管的基础上谨慎施行.     

超选择性支气管动脉栓塞化疗治疗肺癌

目的　探讨超选择性支气管动脉栓塞化疗治疗肺癌的安全性和疗效。方法　回顾分析32 9例经病理学诊断的肺癌作单纯支气管动脉灌注化疗和超选择性支气管动脉栓塞化疗的资料。(1)单纯支气管动脉灌注化疗组 (2 2 1例 ) :普通导管插至支气管动脉主干或肋间 支气管动脉干造影后 ,经导管注入顺铂 4 0～ 6 0mg或卡铂 2 0 0～ 30 0mg ,联合用丝裂霉素 10～ 2 0mg或鬼臼乙叉甙 10 0～ 2 0 0mg。间隔 2～ 4周再次灌注化疗 ,2 2 1例共行 5 4 9次。 (2 )超选择性支气管动脉栓塞化疗组(10 8例 ) :普通导管插管造影后 ,在路图成像指引下 ,将微导管超选择性插至供瘤动脉近瘤处 ,经微导管注入抗癌药 (同单纯支气管动脉灌注化疗组 )和栓塞剂。栓塞剂选用 0 5～ 1 5mm3 明胶海绵颗粒30～ 5 0颗和 (或 )超液态碘油 3～ 8ml。间隔 6～ 9周再次作栓塞化疗 ,10 8例共行 2 6 6次。结果　 2组均未出现脊髓损伤等严重并发症。 2 2 1例单纯支气管动脉灌注化疗中 ,完全缓解 (CR) 2 8例 ,部分缓解 (PR) 79例 ,稳定 (S) 88例 ,进展 (P) 2 6例 ,有效率 (CR +PR)为 4 8 4 % ,1年生存率为 5 3 8% ,2年生存率为 4 4 8% ;10 8例超选择性支气管动脉栓塞化疗中 ,CR 16例 ,PR 5 3例 ,S 32例 ,P 7例 ,有效率为 6 3 9% ,1年生存率为 77 8% ,2年     

碘油化疗栓塞术治疗支气管肺癌的临床研究

目的 研究经支气管动脉碘油化疗栓塞术治疗支气管肺癌的临床应用价值。材料与方法 50例支气管肺癌,腺癌17例,鳞癌30例,小细胞肺癌3例。其中Ⅱa期4例,Ⅱb期17例,Ⅲa期22例,Ⅲb期7例。支气管动脉造影明确该动脉的分支和肿瘤血管,选择性插管肿瘤血管,行局部灌注化疗后,以3－10ml碘油加100mg卡铂的乳剂进行栓塞。结果 （1）栓塞血管：左支气管动脉干5例,其肿瘤分支13例,右支气管动脉干4例,其肿瘤分支21例,左右共干之左支气管动脉肿瘤支3例,左右共干之右支气管动脉肿瘤支4例。（2）近期疗效：CR 1例,PR37例,SD12例,PD 0例,有效率76％。症状缓解率44．4％。（3）并发症：9例在支气管动脉干栓塞治疗者,1例出现一过性脊髓缺血;3例支气管动脉－肋间动脉共干且在支气管动脉干栓塞治疗者,均出现肋间动脉并发症;在支气管动脉肿瘤支栓塞者未出现以上并发症。栓塞过程中出现肺动脉分支碘油沉积者占12％,4％伴有症状。上述并发症对症治疗后均缓解。结论 支气管动脉碘油化疗栓塞术治疗支气管肺癌近期疗效较好,使用同轴导管技术选择性肿瘤血管支插管值得推荐应用。     

支气管肺癌介入治疗的临床研究

目的：探讨经皮支气管动脉灌注化疗和灌注化疗栓塞治疗中晚期肺癌的临床效果。资料与方法：对57例肺癌患者施行了经皮支气管动脉灌注化疗或灌注化疗栓塞术。采用改良式Seldinger技术，行选择性和超选择性支气管动脉插管。经导管注入超液化碘油（3－10ml）和吡柔比星（10mg）的混悬液，然后注入另外2种化疗药物，咳血患者最后用明胶海绵颗粒适量栓塞肿瘤周围小血管，支气管动脉主干保持通畅。结果：40例为富血管型（70．18％），17例（29．82％）为乏血管型。现存15例中，半年生存率100％，1年生存率80．00％。死亡33例，中位生存期14．75个月，半年生存率96．97％，1年生存率73．33％，2年生存率33．81％，3年生存率9．09％。结论：经皮支气管动脉灌注化疗栓塞，三明治方法是治疗中晚期肺癌的最有效方法之一。可以确切延长中位生存期，提高患者生存质量。长期疗效需要大量随机增加病例及长期随访，不断提高肺癌介入治疗的临床效果。     

支气管动脉栓塞术治疗大咯血26例分析

目的：评价支气管动脉栓塞术治疗大咯血的临床疗效。方法：26例大咯血患者，咯血量300～1200ml／24h，平均420ml／24h，其中肺癌12例，支气管扩张6例，肺结核2例，肺棘球蚴病1例，肺血管畸形5例。采用改良Seldinger方法行选择性支气管动脉栓塞治疗。栓塞材料使用明胶海绵颗粒或PVA，血管粗大者加用明胶海绵条。常规行患侧锁骨下动脉、肋间动脉及对侧支气管动脉造影。以了解有无多支供血，发现供血血管则尽量行超选择插管栓塞治疗。肺癌患者根据不同病理类型行常规化疗灌注。结果：18例一次栓塞成功，3例两次栓塞成功，5例肺癌咯血栓塞后出血量明显减少。栓塞术后即时止血率80．77％，近期复发率7．69％，中远期复发率23．08％。结论：支气管动脉栓塞术治疗大咯血即时止血和近期疗效满意，中远期复发与栓塞材料吸收和原发病有关。     

同轴导管超选择支气管动脉碘油化疗栓塞治疗肺癌的初步研究

目的：探讨经微导管行超选择性支气管动脉碘油化疗栓塞治疗肺癌的可行性，观察碘油在癌灶内的沉积情况及临床疗效。资料与方法：用同轴导管技术将微导管超选择插至17例肺癌患者（男1例，女4例，年龄41－78岁，平均59．5岁）的支气管动脉深部，插管成功者采用碘油化疗栓塞治疗，并于术后1天、1周、4周行CT复查，观察碘油在瘤体内的沉积情况。插管未成功者仅行灌注化疗。结果：超选择插管成功13例（76．5％），术后1天碘油沉积0级1例，Ⅰ级3例，Ⅱ级7例，Ⅲ级2例。碘油在肺癌组织内沉积多可持续4周以上。治疗后4周有8例肿瘤缩小50％以上，4例缩小25％－50％，1例大小无明显变化。均未出现与栓塞有关的并发症。结论：采用微导管同轴导管系统行超选择性支气管动脉碘油化疗栓塞治疗肺癌是一种安全有效的治疗方法，在临床上具有可行性。CT能清楚显示碘油在瘤体内的沉积情况。     

支气管动脉栓塞-灌注法治疗反复咯血的临床研究

目的 研究明胶海绵颗粒栓塞支气管动脉分支加红霉素溶液灌注支气管动脉主干治疗反复咯血的临床价值。材料与方法 ３５例内科治疗无效的咯血患者分为Ａ、Ｂ两组。Ａ组行靶动脉单纯明胶海绵颗粒栓塞术,Ｂ组针对支气管动脉及肋间动脉行栓塞－灌注法治疗,针对胸廓内动脉行单纯明胶海绵颗粒栓塞术。Ａ、Ｂ两组均随访６个月以上。结果 Ａ组治愈率为３５．７％,Ｂ组治愈率为７０％,两者统计学上有显著差异;Ａ组有效率为７１％,Ｂ组     

支气管动脉栓塞术治疗肺咯血疗效分析

目的分析支气管动脉栓塞术治疗肺咯血的临床价值。方法对87例咯血患者(支气管扩张46例、肺结核18例、肺癌15例、支气管动静脉畸形2例、原因不明咯血6例)行选择性支气管动脉或肋间动脉栓塞治疗。其中支气管动脉栓塞78例,肋间动脉栓塞6例,支气管动脉与肋间动脉一同栓塞3例。2例使用同轴微导管行超选择栓塞,使用明胶海绵微粒栓塞85例,使用明胶海绵微粒与聚乙烯醇颗粒联合栓塞2例。全部病例随访12～18个月。结果栓塞后即刻止血58例,咯血量明显减少19例。于栓塞后1周、2周、1个月分别有5例、3例、2例复发。10例复发患者再次行栓塞治疗后未再出现咯血。有效率为89%(77/87)。全部病例无并发症发生。结论支气管动脉栓塞术是治疗肺咯血的一种安全、有效、微创的有效方法。     

原发性肝癌自发性破裂出血的介入治疗

目的探讨介入治疗原发性肝癌自发性破裂的疗效。方法对3例原发性肝癌自发性破裂患者,采用肝动脉化疗栓塞术进行治疗,先行化疗灌注,再用明胶海绵颗粒及明胶海绵条进行栓塞。结果3例肝右叶巨块型肝癌破裂均一次性栓塞成功,其中1例加用超液化碘油已带瘤生存20个月。结论肝动脉化疗栓塞术急诊止血效果显著,可达到止血和治疗肿瘤的双重效果。     

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.