肝硬化失代偿期患者钠代谢变化特点及其临床意义

目的：为观察失代偿期肝硬化患者钠代谢变化特点．为临床治疗提供帮助。方法：选取失代偿期肝硬化126例检测血电解质，比较有无腹水组、不同肝功能分级组低钠血症发生率，以及低钠血症与肝性脑病，肝肾综合征和死亡率之间的关系。结果：显示失代偿期肝硬化伴腹水时低钠血症发生率较无腹水时高，差异有显著性意义（P〈0．05）；肝功能越差，其低钠血症的发生率越高，差异有显著性意义（P〈0．05）；低钠血症组转正常血钠组肝性脑病，肝肾综合征，死亡的发生率为高，差异有显著意义。结论：失代偿期肝硬化患者低钠血症发生率与有无腹水、肝功能级别，以及肝性脑病、肝肾综合征和死亡率之间均有密切的关系。     

介入治疗联合干细胞移植治疗肝硬化临床分析

目的:探讨和评价介入治疗联合干细胞移植治疗失代偿期肝硬化的近期疗效及其安全性。方法:30例失代偿期肝硬化患者,随机分为3组,每组各10例。A组仅行药物治疗,B组行TIPS治疗,C组行TIPS联合脐带血干细胞移植治疗。术前1周、术后1月及术后3月观察3组患者丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、总胆红素(TBIL)水平变化及并发症情况。结果:手术及干细胞移植顺利,3组患者术前ALT、ALB、TB均无明显差异;A组患者药物治疗前后肝功能无特殊变化;B组患者术后1月、3月时ALT(P<0.01)及术后1月时TB(P<0.05)较术前升高;C组患者术后3月时ALT较术前减低,ALB则较术前明显升高(P<0.01),但ALB(30.78±0.69 g/L)仍低于正常下限(35 g/L)。术后1月时B组ALT及TB均较A组及C组升高(P<0.05);术后3月时C组患者ALT较其他组降低明显(P<0.05),而ALB则较其他组升高(P<0.01)。C组术后并发肝性脑病1例,术后3月肝胆CT检查分流道通畅,未见占位病变。结论:介入治疗联合干细胞移植治疗失代偿期肝硬化安全可靠,近期疗效显著。     

乙型肝炎肝硬化失代偿期临床指标与预后关系研究

目的：观察乙型肝炎肝硬化失代偿期临床指标与预后的关系。方法：回顾性分析乙型肝炎肝硬化失代偿期80例临床资料及6个月、1年和3年累计病死率。结果：住院好转组与住院死亡组TBIL、ALB、INR和Chitd-Pugh评分两组比较，差异非常显著（P〈0．01），ALT、GLB和HBV-DNA水平两组比较，差异不显著（P〉0．05）。本组病例失代偿期肝硬化患者6个月、1年和3年累计病死率分别为12．5％、26．3％及37．5％；并发腹水54例，6个月、1年和3年累计病死率分别为18．5％、35．29／6及48．2％；并发上消化道出血31例，6个月、1年和3年累计病死率分别为6．5％、32．3％及41．9％；并发肝性脑病10例，6个月、1年和3年累计病死率分别为60．O％、90．O％及90．09／5；并发肝肾综合征11例，6个月、1年累计病死率分别为72．7％、100％。结论：乙型肝炎肝硬化失代偿期患者临床病死率高、并发症多，积极防治各种并发症是提高患者生存率的关键。     

肝动脉灌注细胞因子诱导杀伤细胞联合超液化碘油栓塞介入治疗原发性肝癌

目的 探讨肝动脉灌注细胞因子诱导杀伤(CIK)细胞联合超液化碘油(UFL)栓塞介入治疗原发性肝癌(HCC)的临床价值.方法 采用Seldinger's技术,经肝动脉灌注CIK细胞后用UFL栓塞肿瘤供血动脉治疗HCC 38例(研究组),并与同期经皮肝动脉灌注栓塞化疗(TACE)联合经皮瘤体注射无水乙醇(PEI)双介入治疗HCC 62例(双介入组)进行比较.结果 研究组与双介入组治疗前后CD3、4、CD8变化的组间比较有差异(P＜0.05);AFP的下降率,0.5,1和2年生存率,2组间差异有显著性(P＜0.05);2组近期疗效组间比较无差异性(P＞0.95).结论 肝动脉灌注CIK细胞联合UFL栓塞介入治疗HCC,可以延长患者的带瘤生存期.     

微球联合碘油栓塞治疗肝癌的近期疗效分析

目的 评价微球联合碘油栓塞肝细胞癌(HCC)的近期疗效及安全性.方法 87例病理证实的肝细胞癌患者随机分为两组,微球组,采用粒径100～300μm的Embosphere微球联合碘化油栓塞;对照组,采用粒径350～560 μm明胶海绵颗粒联合碘化油栓塞.术后观察生化及影像学变化,分析临床疗效与不良反应.结果 共87例患者行TACE治疗,微球组44例,对照组43例,治疗后微球组疾病获益率与AFP下降较对照组更明显(P＜0.05),肝功能指标与术前比较差异无统计学意义(P＞0.05),6个月的随访期间微球组介入治疗平均次数少于对照组(P＜0.05).两组患者6、12和18个月生存率差异无统计学意义(P＞0.05).结论 微球联合碘化油栓塞HCC安全,较明胶海绵联合碘化油栓塞近期疗效更明显,能减少患者治疗次数,栓塞前应注意肝动脉门静脉瘘的预处理及微导管的超选.     

地五养肝胶囊辅助治疗乙肝肝硬化失代偿期患者的疗效观察

目的 观察地五养肝胶囊辅助治疗乙肝肝硬化失代偿期的临床疗效.方法 69例乙肝肝硬化患者随机分为常规治疗组(36例)和联合治疗组(33例),其中常规治疗组选用常规内科西药治疗.联合治疗组在常规治疗的基础上给予"地五养肝胶囊"治疗,疗程为12周.比较两组患者治疗前后临床症状、血生化指标变化情况.结果 两组患者治疗后临床主症较治疗前均有明显改善(P<0.05),且联合治疗组改善明显优于常规治疗组(P<0.05);两组治疗后血清PAB、ALB、CHE水平明显升高(P<0.05),而TBIL明显下降(P<0.05),且联合治疗组较常规治疗组比较升高或降低更为显著(P<0.05).结论 地五养肝胶囊可明显改善乙肝肝硬化失代偿期患者的临床症状及实验室指标.     

肝癌患者化疗栓塞后肝功能严重失代偿的相关因素分析

目的：探讨肝癌患者动脉灌注化疗栓塞(TACE)后肝功能严重失代偿的相关因素。方法回顾性分析接受 TACE治疗的109例患者,单因素分析性别、年龄、外科切除史、肝硬化史、肿瘤大体分型、TACE 次数、动门静脉瘘、门脉癌栓、Child-Pugh 分级、血清总胆红素、白蛋白、天门冬氨酸氨基转移酶、吲哚菁绿15 min 滞留率和术中碘油用量与术后发生严重肝功能失代偿的相关性,并将有统计学意义(P <0.05)的结果引入 Logistic 回归模型分析。结果肝硬化、Child-Pugh 分级、门脉癌栓、白蛋白和吲哚菁绿15 min 滞留率与术后发生严重的肝功能失代偿相关,多项 Logistic 回归分析显示：肝硬化、门脉癌栓和吲哚菁绿15 min 滞留率是导致术后发生严重肝功能失代偿的危险因素。结论导致 TACE 后发生肝功能严重失代偿的危险因素有肝硬化、门脉癌栓和吲哚菁绿15 min 滞留率,需要在术前评估中引起警惕。     

原发性肝癌双介入治疗疗效的临床研究

目的 评价双介入方法治疗原发性肝癌的临床应用价值.方法 选择2001年3月至2003年2月在我院进行介入治疗的原发性肝癌患者68例,其中,单纯性肝动脉化疗栓塞36例(TACE组),行肝动脉化疗栓塞(TACE)和经皮肝穿注射无水乙醇(PEI)双介入治疗32例(双介入组).全部病例定期做CT复查和AFP测定,观察肿瘤的客观疗效.结果 TACE组肿瘤客观有效率(CR PR)36.1%,AFP下降幅度56.1%,2 a生存率44.4%;双介入组客观有效率65.7%,AFP下降幅度78.6%,2 a生存率62.5%,两组间有显著差异(P＜0.05).结论 双介入方法治疗原发性肝癌疗效肯定,优于单纯应用TACE.     

中晚期肝癌肝移植术前介入治疗的临床价值

目的 探讨中晚期肝癌(HCC)肝移植术前介入治疗对预防肝移植后肝癌复发及提高患者生存率的临床价值.方法 回顾分析2004年1月至2005年11月我院接受肝移植的40例中晚期HCC患者的临床资料,其中加例(介入组)术前辅以介入治疗,另外20例作为同期对照组(未介入组),比较两组的累计生存率和无瘤生存率,并观察介入治疗的安全性及不良反应.结果 经统计学分析,介入组和未介入组1、2年无瘤生存率分别为70%、55%和45%、30%,两组累计无瘤生存率比较差异有统计学意义(P＜0.05);介入组1、2年生存率(80%、60%)亦高于未介入组(55%、35%),两组术后累计生存率比较差异有统计学意义(P＜0.05).介入组患者均未出现与介入治疗相关的肝、肾毒性或影响移植手术的血管性病变.结论 移植前辅以介入治疗可显著提高中晚期HCC术后生存率.     

TACE联合索拉非尼治疗BCLC-C期肝细胞癌20例疗效分析

目的 评价TACE联合索拉非尼治疗BCLC-C期HCC的疗效,为临床选择合理的治疗方案提供依据.方法 回顾性分析2008年8月-2014年1月有完整资料的BCLC-C期HCC病例76例,按照不同治疗方法分为3组,其中A组单纯TACE组29例,B组TACE联合索拉非尼组20例,C组支持治疗组27例.观察指标主要为:中位总生存时间(MOS),中位肿瘤进展时间(MTTP),疾病控制率(DCR),3、9和15个月生存率.结果 3组的MOS分别是9.2,12.6和3.1个月(P＜ 0.01); MTTP分别为3.2,5.6和1.5个月(P＜0.01);1～2个月内的DCR分别是82.8％,85.0％和14.8％(P＜ 0.01);3个月生存率分别为100％,100％和51.9％(P＜ 0.01);9个月生存率分别为51.7％,85％和0(P＜ 0.01);15个月生存率分别为10.3％,40％和0(P＜ 0.01).但是A组与B组的DCR、3个月生存率相比较,差异无统计学意义(P＞0.05).结论 对于BCLC-C期HCC,TACE联合索拉非尼疗效最优;对于无法联合治疗的患者,单纯TACE优于支持治疗.     

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 role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

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.