直接淋巴管造影对胸导管出口梗阻的诊断价值

目的 探讨直接淋巴管造影对胸导管出口梗阻的诊断价值.方法 回顾性分析124例临床表现为淋巴水肿、乳糜胸、乳糜腹、乳糜尿和小肠淋巴管扩张症等患者的直接淋巴管造影资料,并与颈部胸导管手术探查结果进行对照分析直接淋巴管造影对颈段胸导管的显示与胸导管手术探查情况进行对照,2名影像科医师在不知胸导管手术探查结果的情况下,阅读直接淋巴管造影后DSA造影结果,对手术侧颈干、锁骨下干、支气管纵隔干和胸导管末端入血梗阻的数值差异用Kappa值进行一致性分析.结果 124例中,直接淋巴管造影显示淋巴反流:左颈干80例,左锁骨下干75例,左支气管纵隔干30例.胸导管出口入血障碍118例,与颈部胸导管手术探查结果对比分析,符合率分别为89.9％(80/89)、92.6％(75/81)、90.9％ (30/33)和95.2％(118/124).直接淋巴管造影对颈段胸导管的显示与探查情况进行对照,2名影像科医师阅读直接淋巴管造影后DSA造影结果具有高度一致性(K=0.82,P＜0.05).另外,直接淋巴管造影显示腰干以下淋巴管不同程度迂曲、扩张和结构紊乱者114例(91.9％),无异常者仅10例(8.1％);乳糜池以下不同程度反流者92例(74.2％);肠干反流者16例(12.9％);向肾区反流者11例(8.9％);向心包反流者5例(4.0％).伴有阴道淋巴漏7例(5.6％),腹膜后淋巴漏2例(1.6％),胸腔淋巴漏3例(2.4％),气管淋巴漏1例(0.8％).结论 直接淋巴管造影与颈部胸导管手术探查在显示胸导管出口梗阻的各种征象方面具有较高的一致性,直接淋巴管造影可作为胸导管末段手术探查的重要依据.     

直接淋巴管造影后CT淋巴管成像在原发性小肠淋巴管扩张症中的诊断价值

目的 探讨直接淋巴管造影后CT淋巴管成像（CTL）在原发性小肠淋巴管扩张症（PIL）中的诊断价值。方法 回顾性搜集经手术病理和/或小肠内镜证实的PIL患者55例,所有患者均行直接淋巴管造影后腹盆部、胸部及颈部MSCT检查。CTL中肠系膜、肠壁、腹膜后和/或腹腔其他脏器有对比剂异常分布者为阳性组,以上部位均无对比剂异常分布为阴性组,对两组间各指标进行统计学分析,分类变量采用χ²检验,P﹤0.05为差异有统计学意义。CTL统计指标包括：肠腔瘘、腹腔瘘、对侧腰干反流、骶前反流、腰大肌周围反流、胸部对比剂异常分布、颈部对比剂异常分布、小肠肠壁增厚、肠系膜水肿、肠系膜淋巴结增大、浆膜腔积液等。结果 阳性组中肠腔瘘、腹腔瘘、对侧腰干反流、骶前反流、腰大肌周围反流发生率明显高于阴性组（P=0.045、0.045、0.047、0.000、0.002）,而肠系膜水肿、肠系膜淋巴结增大发生率明显低于阴性组（P=0.023、0.007）,差异有统计学意义。结论 CTL中对比剂在肠系膜、肠壁、腹膜后及腹腔脏器的异常分布是PIL的重要表现,提示腹部淋巴管的异常分布、范围及严重程度,为PIL...     

直接淋巴管造影术后CT对继发性小肠淋巴管扩张症的初步探讨

目的 探讨直接淋巴管造影术后CT对继发性小肠淋巴管扩张症的诊断价值.方法 回顾性分析我院自2007年4月至2012年5月共收治的14例继发性小肠淋巴管扩张症患者的直接淋巴管造影术后CT资料,并与手术及胃肠镜或胶囊内镜所见进行对照分析.结果 肠管不同程度扩张14例;肠壁增厚14例;肠腔液体CT值为3～12 HU,平均约7.1 HU;腹腔积液并肠系膜水肿11例;肠系膜结节9例.肠淋巴干返流8例;腹膜后或胸壁淋巴管扩张、增生及返流14例.结论 直接淋巴管造影术后CT可显示继发性小肠淋巴管扩张症其肠道及肠道以外的淋巴管病变范围和程度,并可同时显示其继发病的部位、范围及程度,为临床治疗和预后提供依据.     

联合应用直接淋巴管造影后MSCT与99Tcm-DX淋巴显像诊断原发性小肠淋巴管扩张症的价值

目的 探讨联合直接淋巴管造影（DLG）后多层螺旋CT（MSCT）CT淋巴管成像（CTL）与⁹⁹Tc^m-DX淋巴显像两种检查方法在诊断原发性小肠淋巴管扩张症（PIL）中的应用价值。方法 回顾性分析经手术病理和/或小肠内镜确诊为PIL的52例患者资料,所有患者均行⁹⁹Tc^m-DX淋巴显像及CTL两种检查。根据⁹⁹Tc^m-DX淋巴显像结果将PIL分为三型：1型：肠道动态显影型;2型：肠道延迟显影型;3型：肠道未显影型。并分别记录每组的CTL影像学表现,CTL评价指标包括肠系膜、肠壁、腹膜后、腹腔脏器对比剂异常分布、肠腔瘘、腹腔瘘、骶前反流、对侧腰干反流等。将各组的CTL评价指标进行统计学分析,P﹤0.05为差异有统计学意义。结果 52例PIL患者⁹⁹Tc^m-DX淋巴显像表现为1型12例,2型17例,3型23例。CTL影像评价指标中,肠系膜、肠壁对比剂异常分布、腹膜后对比剂异常分布、腹腔脏器对比剂异常分布、肠腔瘘、腹腔瘘...     

联合应用CT淋巴管成像与99mTc-DX淋巴显像在原发性乳糜性心包积液中的诊断价值

目的 探讨^99mTc-DX淋巴显像和CT淋巴管成像(CTL)联合应用在原发性乳糜性心包积液中的诊断价值。方法 回顾性分析经临床确诊的48例原发性乳糜性心包积液患者,所有患者均行^99mTc-DX淋巴显像和CTL。根据^99mTc-DX淋巴显像表现进行分型：Ⅰ型为异常浓聚型,表现为左颈静脉角处异常放射性浓聚,Ⅱ型为异位引流型,表现为右颈静脉角区对比剂持续性浓聚,伴或不伴有左颈静脉角放射性浓聚,Ⅲ型为未显影或一过性显影型,表现为左颈静脉角未显影或在检查过程中一过性显影。CTL的评价指标包括：(1)颈部、锁骨下区、胸导管末端、右淋巴导管末端及腋窝对比剂异常分布及反流;(2)胸部对比剂异常分布,包括胸深部(前纵隔、主肺动脉窗、气管及支气管周、隆突下、后纵隔、肺门、支气管血管束周围、心包等)对比剂异常分布,胸浅部(肋间、胸膜、横膈上)对比剂异常分布;(3)胸导管扩张是指胸导管最宽径>3 mm为扩张;(4)横膈下、同侧髂组、腰干对比剂异常分布,对侧髂组、对侧腰干反流,腹膜后对比剂异常分布。并将各组CTL表现进行统计学分析,P<...     

淋巴管肌瘤病的影像表现

目的：探讨淋巴管肌瘤病(LAM)的影像学诊断价值。方法 回顾性分析15例经临床和病理证实的LAM胸部X线平片、HRCT,腹部CT和直接淋巴管造影(DLG)及DLG后胸腹部CT扫描等影像资料。结果 15例中,X线胸片上未见异常1例,双肺纹理增多3例,弥漫性小蜂窝状影或网格状影11例,气胸2例,胸腔积液14例。胸部常规CT和HRCT扫描显示15例均具有典型LAM表现,均可见两肺散在囊状影或广泛密布的囊状影。按Avila等肺部疾病程度分级标准：Ⅰ级3例;Ⅱ级5例;Ⅲ级7例。腹部CT显示14例在腹膜后、盆腔可见囊性淋巴管瘤9例,淋巴管肌瘤13例,二者共同存在7例,并发肝脏脂肪瘤和血管平滑肌脂肪瘤、肾脏小错构瘤及子宫肌瘤各1例。DLG检查,除1例淋巴管梗阻部位在腰3水平外,其余14例均可见胸导管不同程度的狭窄、梗阻及颈干和（或）锁骨下干和（或）支气管纵隔干淋巴管反流。DLG术后CT,除3例未显示胸导管出口梗阻外,其余12例显示胸导管出口梗阻情况与DLG基本一致。结论 HRCT对肺淋巴管肌瘤(PLAM)的诊断具有特征性价值,CT可发现腹部LAM,DLG和DLG后MSCT对因LAM引起的胸导管或淋巴管干梗阻部位的显示具有价值,可为手术治疗提供一定的帮助。     

HRCT和CT淋巴管成像在淋巴管平滑肌瘤病中的诊断价值

目的 探讨HRCT和CT淋巴管成像在淋巴管平滑肌瘤病中的诊断价值。方法 回顾性搜集56例确诊为淋巴管平滑肌瘤病患者的临床和影像资料,所有患者均行胸部HRCT平扫,其中45例于直接淋巴管造影(DLG)后行胸腹盆部CT扫描(CTL),分析胸部病变的HRCT及胸腹盆部CTL影像表现,并采用分类变量资料中的构成比进行统计描述。结果 56例患者的胸部HRCT表现为双肺弥漫大小不等的薄壁含气囊肿56例,肺内磨玻璃密度影16例,肺内结节8例,肺不张32例,支气管血管束增粗12例,小叶间隔增厚25例,心包积液6例,纵隔淋巴结增大9例,胸腔积液45例,气胸12例。45例患者CTL均显示不同部位的碘油异常沉积：胸导管末端24例,右淋巴导管7例,肺内7例,肺门7例,纵隔20例,心包1例,胸腔7例,肋间17例,腋窝6例,横膈周围32例,脊柱旁27例,腹盆腔45例,双髂41例,双侧腹股沟36例,会阴部3例。此外,3例伴有肝脏血管平滑肌脂肪瘤,8例伴有肾脏血管平滑肌脂肪瘤,3例伴有小肠壁弥漫增厚,31例伴有腹盆腔积液。结论 HRCT和CTL能够显示淋巴管平滑肌瘤病的一些特征性表现,同时伴有不同部位的淋巴管异常,为...     

系统性红斑狼疮合并淋巴管受累的CT淋巴管成像影像表现

目的 探讨系统性红斑狼疮合并淋巴管受累的CT淋巴管成像影像表现。方法 回顾性搜集15例确诊为系统性红斑狼疮合并淋巴管受累患者的临床和影像资料，所有患者均于直接淋巴管造影术(DLG)后行常规胸腹盆部CT扫描，同时重建CT淋巴管成像(CTL)图像，分析CTL及常规胸腹盆部影像表现，并采用分类变量资料中的构成比进行统计描述。结果 15例患者CTL均显示不同部位的碘油异常沉积：胸导管末端10例，右淋巴导管5例，肺内3例，肺门3例，纵隔11例，胸腔8例，肋间1例，腋窝2例，腹盆腔15例，左髂6例，右髂10例，腹股沟15例，臀部2例，肠壁外1例，肝门1例。15例患者常规胸腹盆部CT表现为肺内磨玻璃密度影10例，斑片状实变影2例，肺内结节6例，肺不张11例，支气管扩张1例，蛙卵征4例，小叶间隔增厚6例，心包积液4例，纵隔脂肪间隙浑浊5例，胸腔积液12例，胸壁皮下水肿4例，叶间裂积液6例，叶间裂增厚13例。此外，2例伴有小肠壁弥漫增厚，5例伴有肠系膜肿胀，11例伴有腹盆腔积液，8例伴有腹壁皮下水肿。结论 CTL不仅能够直接显示受累淋巴管的异常，而且能够显示常规CT胸腹盆部异常表现，为本病的诊断和治疗提...     

淋巴管肌瘤病合并乳糜性胸、腹腔积液的影像学表现与手术对照

目的 探讨淋巴管肌瘤病(LAM)合并乳糜性胸、腹腔积液的影像学表现.方法 回顾性分析20例合并乳糜性胸、腹腔积液的LAM患者的直接淋巴管造影(DLG)及CT资料,其中15例行胸导管探查,18例行手术治疗.结果 20例LAM均合并不同程度的乳糜性胸腔积液,其中8例合并乳糜性腹腔积液.DLG显示20例LAM腹膜后及髂淋巴管均不同程度扩张,并5例向对侧返流.DLG直观显示14例胸导管出口受阻,其中13例行胸导管探查证实梗阻存在,并行胸导管梗阻解除术,1例胸、腹腔积液完全消失,12例减少或趋于稳定.6例胸导管部分于DLG未见明确显示,其中2例为胸导管结扎术后,1例行髂外淋巴管静脉吻合术后腹腔积液好转;其余4例中2例行胸导管探查证实出口受阻,行胸导管出口梗阻解除术后胸、腹腔积液减少;另2例未行胸导管探查,行髂外或下肢淋巴管静脉吻合术后腹腔积液减少.结论 DLG及CT成像可为LAM合并乳糜性胸、腹腔积液的诊断及治疗提供重要信息.     

MSCT直接淋巴管造影在弥漫性淋巴管瘤病中的诊断价值

目的 探讨MSCT直接淋巴管造影(DLG)在弥漫性淋巴管瘤病中的诊断价值.方法 回顾性分析9例弥漫性淋巴管瘤病的影像学资料,5例行DLG及造影后胸、腹、盆部CT检查,余4例行CT检查.9例中3例行MRI检查.结果 9例中,8例累及脾,5例累及腋窝,5例累及颈部,5例累及腹腔及腹膜后,4例累及髂部及腹股沟,3例累及纵隔,3例累及腹壁,2例累及肺,1例累及肝,1例累及颅内硬膜下,CT表现为囊状低密度影,MRI表现为囊状长T1、长T2信号.8例累及骨,CT上表现为边界清楚的类圆形低密度影,MRI上表现为长T1、长T2信号.5例行DLG、造影后CT及胸导管探查示胸导管出口受阻,腹膜后淋巴管扩张迂曲.9例中有4例合并乳糜返流,1例合并锁骨上乳糜囊肿.结论 弥漫性淋巴管瘤病影像学表现具有特异性,MSCT DLG可明确显示淋巴管的异常,可为其病因诊断及合并乳糜返流性疾病的治疗提供直接信息.     

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.