脊髓血管畸形的血管内栓塞治疗

目的 :探讨血管内栓塞治疗脊髓血管畸形的适应证、疗效、并发症等。方法 :回顾性分析本院收治的资料完全的脊髓血管畸形 3 2例 ,其中行单纯血管内栓塞者 2 4例。以Aminoff Logue量表对患者双下肢及小便功能障碍程度行定量评价。结果 :栓塞后多数病例临床症状明显缓解。平均随访 2 7月 ,单纯栓塞患者双下肢功能障碍评分从治疗前的3 .5± 1.2 (均值±标准差 )降为 2 .5± 1.3 (P <0 .0 5 ) ,小便功能障碍评分从 1.7± 0 .9降至 1.1± 0 .5 (P <0 .0 5 )。 1例单纯栓塞患者治疗后症状复发 ,予再次栓塞。结论 :脊髓血管畸形的治疗方案应取决于病变的解剖部位和血管造影表现。血管内栓塞治疗至少能在短期内改善症状 ,提高患者生命质量     

心肌梗死后不同阶段冠状动脉介入治疗技术难度与即刻疗效观察

目的　观察心肌梗死后不同阶段进行经皮冠状动脉介入治疗 (PCI)的技术难度、即刻造影效果与安全性。方法　 94例心肌梗死患者分成直接、延期及晚期PCI组 ,病例数分别为 38例、2 2例和 34例。术中根据冠状动脉造影评价梗死相关血管特征、PCI技术难度积分、PCI造影成功率及并发症。结果　三组技术难度积分分别为 1.4 7± 1.79、1.82± 1.72和 2 .85± 2 .83(P <0 .0 5 ) ,PCI造影成功率分别为92 .0 %、91.0 %及 76 .5 % (P <0 .0 5 ) ,PCI中严重并发症分别为 5 .3%、0和 5 .9% (P =NS) ,住院期严重并发症分别为 0、9.1%和 0 (P =NS)。结论　心肌梗死后不同阶段进行PCI的技术难度及有效性各不相同 ,晚期PCI总技术难度增加 ,血管开通机会减少     

腹水浓缩回输腹腔治疗顽固性腹水

采用北京军区总医院肝病研究所自行研制的B型腹水治疗仪 ,对 311例顽固性腹水患者进行了 92 1例次的治疗 ,治疗时间为(2 3± 0 9)h/次 ,滤出腹水为 (6 82 0± 2 315 )ml/次 ,治疗后 2 4h尿量由治疗前为(2 5 7 8±2 35 6 )ml增至 (72 5 8± 4 36 9)ml(P <0 0 1) ,总有效率为 6 9 7% (6 4 2 / 92 1) ,副反应发生率为 8 6 % (79/ 92 1)。该治疗措施操作简便、副反应少 ,能迅速减轻患者痛苦 ,提高其生存质量 ,是一有效的对症处理方法。     

支架成形术治疗肾动脉狭窄

目的　分析支架成形术治疗肾动脉狭窄临床疗效。方法　本组肾血管性高血压患者 15例 ,肾动脉狭窄病变血管 15支 (13例 ,89% ) ,闭塞病变血管 2支 (11% )并肾功能衰竭。其中 ,双侧肾动脉受累 2例。狭窄病例中 ,治疗前狭窄程度为 6 0 %～ 90 %。共植入支架 16枚。术后观察患者状况及血管造影随访结果。结果　技术成功率 10 0 % ,未发生严重并发症。随访 6～ 15个月 ,显示临床治愈 4例(2 6 % ) ,改善 9例 (6 0 % ) ,无效 2例 (13% ) ,临床总有效率 86 %。收缩压由术前平均 (2 7.12± 3.0 9)kPa降至术后随访平均 (18.6 2± 3.12 )kPa ,舒张压由术前平均 (17.73± 1.92 )kPa降为术后平均 (11.12± 2 .4 3)kPa(P <0 .0 5 )。术后肾功能保持稳定者 9例 (6 0 % ) ,明显好转者 5例 (33% ) ,继续恶化者 1例 (6 % )。造影复查 1例 (6 .7% ) ,于术后 6个月出现支架内再狭窄 (约狭窄 70 % ) ,经支架内球囊扩张后 ,随访 2次血管造影其再狭窄程度稳定在 2 0 %左右。结论　内支架成形术治疗肾动脉狭窄 ,临床疗效显著 ;闭塞病例支架成形治疗的成功 ,为介入治疗此病的进一步发展开辟了广阔的前景     

经桡动脉途径和经股动脉途径行冠状动脉介入检查及治疗的前瞻性临床研究

目的　随机比较经股动脉与经桡动脉两种方法行冠状动脉造影和介入治疗 ,评价经桡动脉途径的安全性、可行性。方法　选择 2 0 0 2年 4月～ 2 0 0 3年 11月在心脏中心住院行冠脉检查及治疗的患者为研究对象 ,经桡动脉途径共 76例 ,男 4 0例 ,女 36例 ,平均 (5 7± 11)岁。经股动脉途径共 77例 ,男4 5例 ,女 32例 ,平均 (6 1± 11)岁。结果　桡动脉组与股动脉组冠脉造影的成功率分别为 96 .1% ,10 0 % ,P =0 .10 ,曝光时间 :两组患者冠脉造影和冠脉造影 +左室造影曝光时间分别为 8′34′′± 4′2 0′′ ,6′2 5′′±3′18′′,P =0 .0 9;8′5 3′′± 4′4 6′′,7′32′′± 3′8′′,P =0 .2 3。经桡动脉途径与股动脉途径PTCA STENT术的成功率分别为 98.5 % ,96 .9% ,P =1.0 0 ,曝光时间分别为 :15′32′′± 7′4 0′′、18′19′′± 3′5 1′′,P =0 .39。严重并发症 (死亡和急诊冠脉搭桥 )两组无区别 ,股动脉组局部出血总发生率为 6 .2 % ,发生排尿困难 ,需留置导尿 7例 (9.1% ) ,拔管时迷走反射 2例 (2 .6 % )。桡动脉组有 2例 (2 .6 % )患者出现右侧桡动脉闭塞。其中 1例在 1周时桡动脉搏动恢复。结论　经桡动脉途径介入检查及治疗是一种安全有效的治疗方法     

直接PCI治疗急性心肌梗死出现“无血流”的剖析

目的　探讨直接经皮冠脉介入治疗 (PCI)治疗急性心肌梗死 (AMI)出现“无血流”(no flow ,NF)的发生率和临床意义。方法　 99例连续行直接PCI的AMI患者根据冠脉造影中有无NF现象分为NF组 (18例 )非NF组 (81例 ) ,计算NF的发生率 ,分析两组一般临床特征、blush分级、ST段抬高的变化、磷酸肌酸激酶的峰值 (CPK)、心功能和心血管事件的发生率。结果　NF组 18例患者 ,占所有直接PCI患者的 18.2 % ,既往心梗史、糖尿病、前壁梗死和多支血管病变的发生率方面明显增加 (P <0 .0 5 )。NF组blush分级和ST段抬高下降≥ 5 0 %者显著减少 ,CPK显著增加 [(32 38± 10 0 8)和 (2 4 5 1±112 4 ) ,P <0 .0 5 ],LVEF显著降低 [(0 .38± 0 .11)和 (0 .6 3+0 .10 ) ,P <0 .0 1];NF组总死亡率较非NF组有增加趋势 ,但无显著统计学意义 ;非致死性心衰 (2 1.4 %和 4 .8% ,P <0 .0 5 )和复合终点事件(4 2 .9%和 18.5 % ,P <0 .0 5 )的发生率无论住院期间还是随访 1年均明显增加 ,而两组在不稳定性心绞痛、非致死性再次心肌梗死、缺血性靶血管重建及总的心脏性死亡的发生率方面无显著降低 [(0 .5 8±0 .14 )和 (0 .6 3± 0 .10 ) ,P >0 .0 5 )。结论　直接PCI治疗AMI过程中NF的发生率为 18.2 % ;出现NF者心肌微循环灌注不良 ,梗死     

血管内支架置入治疗高危颈动脉狭窄

目的　评价伴对侧颈内动脉闭塞的高危颈内动脉狭窄病人血管内支架治疗的疗效和安全性。方法　 8例不适合颈动脉内膜剥脱的高危颈内动脉狭窄病人接受了血管内支架置入治疗。术前颈内动脉平均狭窄程度为 (85 2± 9 4) % (70 %～ 98% )。术前和术后 2 4h采用NIHSS评分 ,术前和术后 3个月采用改良Rakin评分标准对这些病人进行神经功能评分。术后随访 6～ 1 4个月。结果　术中造影证实 8枚支架均放置成功 ,残余狭窄程度 (5 3± 2 2 ) % (5 %～ 9% ) ,管腔狭窄程度较术前明显改善 (t=4 79,P <0 0 0 1 )。术中没有发生与手术相关的并发症 ,术后 2 4h病人的NIHSS神经功能评分保持在术前水平 [(2 5± 2 4)分 ] ;术后 3个月 ,改良Rakin神经功能评分为 (1 1 3± 0 99)分 ,同术前 (1 2 5± 1 2 8)分比较差异无显著性意义 (T =1 89,P >0 0 5)。术后随访 6～ 1 4个月 ,除 1例偶发一过性脑缺血发作 (TIA)外 ,其他病人未再出现TIA和新的中风。结论　血管内支架置入术是治疗高危颈内动脉狭窄安全、有效的治疗手段     

老年患者冠状动脉旁路移植术围术期处理策略

目的总结65岁以上老年患者行冠状动脉旁路移植术(CABG)的结果,研究围术期处理策略。方法对65岁以上患者行CABG术394例进行总结,其中357例(90·6%)为不稳定型心绞痛,364例(92·4%)合并其他疾病;246例(62·4%)采用非体外循环心脏不停跳下CABG(OPCAB),148例(37·6%)选择常规体外循环下CABG(CCABG)。胸膜外技术游离左乳内动脉(LIMA),保持胸膜腔完整,常规将LIMA与左前降支吻合,其余桥用大隐静脉。术中使用即时超声血流仪测量移植血管血流,保证吻合口通畅。术后加强物理治疗和营养支持,严格控制血糖于6~10mmol/L。结果移植血管数行CCABG患者为3·1±0·6支,行OPCAB患者为2·4±0·8支;379例(96·2%)使用LIMA。全组死亡3例(0·76%),发生并发症9例(2·28%)。术后呼吸机使用时间OPCAB患者为9·7±5·4h,CCABG患者为20·3±15·0h。术后住ICU时间2·7±1·0天,住院时间11·8±5·0天。结论术前充分评估手术风险,选择恰当的手术方案,围术期进行精细处理,老年患者亦可取得良好手术效果。     

连续847例冠状动脉造影术后即刻行选择性肾动脉造影临床总结

目的　评估选择性肾动脉造影在冠状动脉造影患者中的可行性、安全性及其临床意义。方法　 2 0 0 1年 7月至 2 0 0 2年 8月 ,共纳入 84 7例在冠状动脉造影结束即刻行选择性双侧肾动脉造影患者 ,分析肾动脉造影情况、肾动脉狭窄发病率及其相关因素 ,并随机抽取 15 5例患者测定术前术后血清肌酐变化以评估选择性双肾动脉造影的安全性。结果　冠状动脉造影后即刻行选择性双侧肾动脉造影成功率高 (99.6 % ) ;造影前后血清肌酐无明显变化 [术前 :(77± 11) μmol/L ,术后 :(78± 5 ) μmol/L ,P >0 .0 5 ];肾动脉狭窄总体发生率为 19% (16 1/ 84 7) ,明显狭窄 (>5 0 % )占 7.1% (6 0 / 84 7) ,双侧肾动脉明显狭窄发生率为 3.9% (33/ 84 7) ;多因素分析显示肾动脉明显狭窄与年龄 (>70岁 )、高血压、多支冠状动脉病变显著相关。结论　在冠状动脉造影后即刻行选择性双侧肾动脉造影安全、可行 ,对准确发现肾动脉狭窄有重要意义     

心肌桥患者冠状动脉血流储备研究

目的　评估心肌桥对冠状动脉 (冠脉 )血流储备的作用。方法　 2 0 0 0年 9月至 2 0 0 3年 1月 ,13例冠脉造影显示心肌桥患者即刻测定冠脉血流储备 ,与同期 32例冠脉造影正常对照者比较。结果　两组患者一般情况无差异。 13例心肌桥患者临床均有稳定型心绞痛 ;心肌桥均位于左前降支 (中段 11例 ,中远段 2例 ) ,收缩期及舒张期冠脉狭窄分别为 78%± 7%和 15 %± 5 % ,血流储备较对照组显著降低 (2 .0± 0 .3和 3.3± 0 .6 ,P <0 .0 0 1)。结论　心肌桥使冠脉血流储备降低 ,这可能是患者发生心绞痛的原因     

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.     

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.     

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).     

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.